We aimed to capture the breadth of health outcomes that have been associated with the presence of Urinary Incontinence (UI) and systematically assess the quality, strength, and credibility of these associations through an umbrella review and integrated meta-analyses.
We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p-values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV).
From 3172 articles returned in search of the literature, 9 systematic reviews were included with a total of 41 outcomes. Overall, 37 out of the 41 outcomes reported nominally significant summary results (p < 0.05), with 22 associations surviving the application of a more stringent p-value (p < 10-6). UI was associated with worse scores than controls in female sexual function (Class II), while it was also associated with a higher prevalence of depression (odds ratio [OR] = 1.815; 95% confidence interval [CI]: 1.551-2.124), and anxiety (OR = 1.498; 95% CI: 1.273-1.762) (Class IV). UI was associated with poorer quality of life (QoL), higher rate of mortality (hazard ratio = 2.392; 95% CI: 2.053-2.787) an increase in falls, frailty, pressure ulcers, diabetes, arthritis, and fecal incontinence (Class IV).
UI is associated with female sexual dysfunction, with highly suggestive evidence. However, the evidence of other adverse outcomes including depression, anxiety, poorer QoL, higher mortality, falls, pressure ulcers, diabetes, arthritis, fecal incontinence, and frailty is only weak. A multidimensional approach should be taken in managing UI in the clinical setting.
Aging clinical and experimental research. 2023 Jan 13 [Epub ahead of print]
Pinar Soysal, Nicola Veronese, Simona Ippoliti, Damiano Pizzol, Anne Marie Carrie, Simina Stefanescu, Guillermo F López-Sánchez, Yvonne Barnett, Laurie Butler, Ai Koyanagi, Louis Jacob, Ramy Abou Ghaydya, David Sheyn, Adonis K Hijaz, Jose M Oliva-Lozano, Jose M Muyor, Mike Trott, Andreas Kronbichler, Igor Grabovac, Mark A Tully, Lin Yang, Jimin Hwang, Jong Yeob Kim, Seoyeon Park, Junmin Song, Jae Il Shin, Petre-Cristian Ilie, Lee Smith, European Society of Geriatric Medicine Special Interest Group in Systematic Reviews, Meta-Analyses
Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan Street), Fatih, 34093, Istanbul, Turkey., Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy., Urology Department, Hull University Teaching Hospitals NHS Trust, Hull, UK., Italian Agency for Development Cooperation, 33 Street, Amarat, 79371, Khartoum, Sudan., The Queen Elizabeth Hospital Foundation Trust, King's Lynn, UK., Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain., Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK., Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, 08830, Barcelona, Spain., Department of Urology, University Hospitals Cleveland Medical Center, 11000 Euclid Avenue, Cleveland, OH, USA., Health Research Centre, University of Almeria, Almeria, Spain., Centre for Public Health, Queen's University Belfast, Belfast, UK., Department of Internal Medicine IV, Medical University Innsbruck, Innsbruck, Austria., Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090, Vienna, Austria., School of Medicine, Ulster University, Londonderry, BT48 7JL, UK., Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Canada., Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Yonsei University College of Medicine, Seoul, Republic of Korea., Keimyung University School of Medicine, Daegu, Republic of Korea., Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea. .