title: Future Directions of Research and Care for Urinary Incontinence: Findings from the National Institute of Diabetes and Digestive and Kidney Diseases Summit on Urinary Incontinence Clinical Research in Women.
abstract: Female urinary incontinence is prevalent, costly and morbid. Participants in a NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) sponsored summit reviewed findings from NIH (National Institutes of Health) funded clinical research on urinary incontinence in women and discussed the future of urinary incontinence research.
  
  
  
  The NIDDK convened the Summit on Urinary Incontinence Clinical Research in Women on March 14, 2014. Participants representing a broad range of clinical expertise reviewed completed NIH sponsored urinary incontinence related studies, including results from community based epidemiological studies such as the BACH (Boston Area Community Health) Survey and from randomized clinical trials such as PRIDE (Program to Reduce Incontinence by Diet and Exercise), and studies conducted by the Pelvic Floor Disorders Network and the Urinary Incontinence Treatment Network.
  
  
  
  BACH Survey results improved our understanding of precursors, incidence, prevalence and natural history of urinary incontinence in a diverse group of women. The Pelvic Floor Disorders Network study found that anticholinergic medications and onabotulinumtoxinA are efficacious for treating urge urinary incontinence, and Burch colposuspension and retropubic mid urethral polypropylene slings are efficacious for decreasing stress urinary incontinence following pelvic organ prolapse surgery in women with potential stress urinary incontinence. The Urinary Incontinence Treatment Network study found that fascial slings were better than colposuspension, and that retropubic and transobturator mid urethral polypropylene slings were equivalent for stress urinary incontinence. In patients with stress urinary incontinence a preoperative urodynamic study was noninferior to basic office examinations for surgical outcome. The addition of behavioral intervention did not allow female patients to discontinue antimuscarinics for urge urinary incontinence. PRIDE showed that modest weight reductions significantly decreased urinary incontinence.
  
  
  
  Strategies for future research on urinary incontinence should include a focus on early disease, risk factor identification, better phenotyping, incorporation of new technologies, patient centered research and prevention.
authors.affiliation: Department of Urology, Yale School of Medicine, New Haven, Connecticut. Electronic address: toby.chai@yale.edu.
authors.forename: Toby C
authors.initials: TC
authors.lastname: Chai
authors.affiliation: Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, New York.
authors.forename: Tirsit S
authors.initials: TS
authors.lastname: Asfaw
authors.affiliation: Department of Obstetrics and Gynecology, University of Utah Health Care, Salt Lake City, Utah.
authors.forename: Jan E
authors.initials: JE
authors.lastname: Baker
authors.affiliation: Division of Geriatric Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Becky
authors.initials: B
authors.lastname: Clarkson
authors.affiliation: Howard University Hospital, Washington, D.C.
authors.forename: Pamela
authors.initials: P
authors.lastname: Coleman
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, St. Louis University School of Medicine, St. Louis, Missouri.
authors.forename: Susan
authors.initials: S
authors.lastname: Hoffstetter
authors.affiliation: Center for Faith-Based and Neighborhood Partnerships, U.S. Department of Health and Human Services, Washington, D.C.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Konkel
authors.affiliation: Women's Health Foundation, Chicago, Illinois.
authors.forename: Missy
authors.initials: M
authors.lastname: Lavender
authors.affiliation: Drexel Center for Women's Health, Drexel University College of Medicine, Philadelphia, Pennsylvania.
authors.forename: Shailaja
authors.initials: S
authors.lastname: Nair
authors.affiliation: Division of Kidney, Urologic and Hematologic Disease, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
authors.forename: Jenna
authors.initials: J
authors.lastname: Norton
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Science, University of California, San Francisco, San Francisco, California.
authors.forename: Leslee
authors.initials: L
authors.lastname: Subak
authors.affiliation: Division of Urogynecology, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Anthony
authors.initials: A
authors.lastname: Visco
authors.affiliation: Division of Kidney, Urologic and Hematologic Disease, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Star
authors.affiliation: Division of Kidney, Urologic and Hematologic Disease, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.
authors.forename: Tamara
authors.initials: T
authors.lastname: Bavendam
mesh_terms: D035843:Biomedical Research / Q000639:trends*; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003226:Congresses as Topic; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D054586:National Institute of Diabetes and Digestive and Kidney Diseases (U.S.); D056887:Pelvic Organ Prolapse / Q000150:complications / Q000601:surgery; D015995:Prevalence; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D014563:Urodynamics / Q000502:physiology*; D013520:Urologic Surgical Procedures / Q000379:methods; D015431:Weight Loss
chemical_list: D018680:Cholinergic Antagonists; D019274:Botulinum Toxins, Type A
keywords: comparative effectiveness research; epidemiology; therapeutics; urinary incontinence; women