Health-related quality of life and economic impact of urinary incontinence due to detrusor overactivity associated with a neurologic condition: a systematic review

Abstract

BackgroundPatients with neurologic diseases often have neurogenic detrusor overactivity (NDO), which can result in a loss of voluntary bladder control and uncontrollable urinary incontinence (UI).The impact of UI due to NDO on patients’ lives has not been well studied. The objective of this review was to assess the health-related quality of life (HRQoL) and economic burden in patients with urgency UI due to NDO in select countries in North America, the European Union, Asia, and Australia.MethodsSystematic literature searches and reviews of articles published in English (January 2000 to February 2011) were conducted using MEDLINE®, EMBASE®, and the Cochrane Library. Studies assessing the impact of UI on HRQoL of patients with an underlying neurologic condition of interest (i.e., multiple sclerosis, spinal cord injury, Parkinson’s disease, stroke, or spina bifida) were included. Economic studies in urgency UI also were included.ResultsOf 876 citations generated in the initial search, a total of 27 articles were deemed relevant: 16 articles presented HRQoL data and 11 articles presented information on the economic burden of UI. Humanistic studies used a range of HRQoL instruments to measure HRQoL burden, and the economic studies included different cost components to quantify the economic burden, making meaningful comparisons challenging. Despite this heterogeneity, the literature suggests that HRQoL in patients with UI due to NDO is worse than patients with UI in general or those with the same underlying neurologic condition without UI. In addition, urgency UI also results in substantial economic costs.ConclusionsIncontinent patients with underlying neurologic conditions have impaired HRQoL as well as substantial economic burden attributable to UI due to NDO. There is a need for urgency UI treatments that improve HRQoL of these patients and alleviate the economic burden of this condition.

Autonomic dysfunction in multiple sclerosis

“…Incontinence often leads to social embarrassment and can have a severe impact on quality of life. The economic burden it produces is not to be depreciated [31].…”

Non-motor Factors Associated with the Attainment of Community Ambulation after Stroke

“…In this sample, 97.5% of individuals with urinary incontinence did not acquire the ability to ambulate in the community. 32,33 According to Kwakkel and colleagues, 34 control of the trunk in the first week post-stroke, was an independent variable for predicting comfortable ambulation at 6 months. Hama and colleagues 35 conducted a study with 452 patients, aiming to verify the association of trunk control, depressive symptoms, and functional outcomes.…”

Improving Outcomes in Patients With Refractory Idiopathic and Neurogenic Detrusor Overactivity: Management Strategies

“…13 UI has also been associated with an increased risk of falls and fractures in older adults 14 and in persons in nursing homes, 15 leading to higher rates of institutionalization among frail older persons. 16 The impact of NDO or OAB on health-related quality of life is significant, [17][18][19][20] and NDO with UI causes a significantly greater effect on health-related quality of life than NDO without incontinence. 19 UI and OAB are associated with depression, 21 loss of self-respect or dignity, decreased productivity in the workplace, interference with sleep 22 and sexual activity, 23 and a restriction of social activities because of fear of UI or because of the need for frequent voids.…”

“…20 As seen in appendix 1, a wide range of neurologic conditions have been associated with NDO. 31 Supraspinal neurologic diseases (eg, Parkinson disease, cerebral palsy) occur above the pontine micturition center and generally cause NDO with synergistic voiding (eg, no detrusor-sphincter dyssynergia).…”