A clinical audit of female urinary incontinence at a urogynaecology clinic of a tertiary hospital in Durban, South Afric

Abstract

RESEARCHBackground. Urinary incontinence (UI) is a common condition with an increasing prevalence worldwide. Although it is not a lifethreatening condition, it can be very disabling. Objective. To describe the clinical profiles, risk factors, diagnosis, treatment and clinical outcomes of women with different subtypes of UI who attended a tertiary hospital in Durban, South Africa. Methods. A retrospective chart review was performed. A structured data form was used to obtain the relevant information. Results. Seven hundred and fifty-eight of 945 charts with a diagnosis of UI were analysed. Stress urinary incontinence (SUI) was the most common subtype of UI (30%). The mean (standard deviation (SD)) age was 50.9 (15.2) years; mean (SD) parity 2.8 (1.4) and mean (SD) body mass index 29.2 (5.3) kg/m 2 . Indians (n=366, 48.3%) were the predominant racial group; black Africans constituted 32.7% (n=248). Mid-urethral tape was the preferred surgical treatment for SUI (n=134, 62.0%). Urge UI was treated mainly with pharmaceutical agents (n=138, 74.2%) with physiotherapy as adjunctive therapy. Urogenital fistulas were repaired via laparotomy (n=42, 53.9%) and vaginally (n=25, 32%). Mid-urethral tapes and Burch colposuspension had success rates of 97% and 83.3%, respectively. Both laparotomy and vaginal fistula repairs had success rates of 95%. Conclusions. Stress UI was the most common subtype of UI observed in this study. Patients were predominantly Indians and overweight or obese. The majority of patients with urogenital fistulas were black Africans. Surgical outcomes at our centre were in keeping with those in international reports.

Prevalence and risk factors of urinary incontinence among women in Africa: a systematic review and meta-analysis

“…The prevalence reported among women with gynaecological issues were similar across studies; 20.2% (95% CI 16-24) [28], 24.0% (95% CI 20-28) [26], 30% (95% CI 27-33) [27] and 39% (95% CI 34-44) [29]. Women with gynaecological issues reported the highest prevalence of UI, while the lowest prevalence was reported among healthy community women.…”

“…Ten of the 14 studies reported on the risk factors of UI as multiparity, later gestational periods, mode of delivery (including having episiotomy and having an instrumental vaginal delivery (IVD)), pregnancy related constipation, having an underlying respiratory condition during pregnancy, undergoing urethral closure stula repair, having a higher body mass index (BMI) or being overweight, experiencing prolonged labour, engaging in heavy lifting during pregnancy, increasing age of woman, and longer second stage of labour [8, 12,13,[26][27][28][30][31][32][33]. One study reported that women who often experienced constipation were 12 times more likely to have UI, whereas women who sometimes experience constipation were 7 times more likely to have a UI [12].…”

“…Two studies [27,31] reported that women with increasing weight (overweight or obesity) have increased risk of developing UI. The risk of an overweight pregnant woman developing UI is signi cant at an adjusted odd ratio (AOR) of 1.39 (95% CI 1.16-1.73), while obese pregnant women's risk was 1.65 (AOR 1.59-3.44) [31].…”