Treating and Managing Urinary Incontinence: Evolving and Potential Multicomponent Medical and Lifestyle Interventions

Abstract

Incontinence is defined by either ICS 2002 or IUGA/ICS 2010 as the involuntary loss of urine and includes urgency urinary incontinence (UUI), stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). It has a high worldwide prevalence with an associated impact on quality of life. Despite existing management options for the management of urinary incontinence, patients continue to be troubled by symptoms or side effects of existing treatment. There is therefore a requirement for ongoing research into treatment options for the management of UUI and SUI, that are more effective and tolerable to patients. Advances in treatment of UUI include a more selective beta 3 agonist, Vibegron, which has less impact on cardiac function than Mirabegron. Hormonal treatment, including Ospemifene and Prasterone, may improve GSM and in turn symptoms of UUI. There are advances in the types of neuromodulators available, including those that are rechargeable at home and are MRI safe. Laser has shown promising initial results. There is developing interest in the microbiome, and how this may impact future treatment modalities. Advances in treatment of SUI include the use of mobile health applications to support delivery of pelvic floor muscle training. Litoxetine, a selective serotonin reuptake inhibitor, has shown promising results at phase III trials. Functional magnetic stimulation is being developed to improve contractility of pelvic floor muscles. We also discuss interventions that improve tissue elasticity and regeneration, such as platelet rich plasma, autologous stem cell transplantation, laser therapy and radiofrequency treatment, which show short term benefits.

Regenerative Medicine in Urogynecology: Where We Are and Where We Want to Be

“…Platelet-rich plasma obtained by centrifugation of autologous blood 33 has been used in orthopedics, plastic surgery, ophthalmology, cardiac surgery, and urology 34 . The key proregenerative factors in PRP include platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), transforming growth factor-beta (TGF-β), fibroblast growth factor (FGF), and insulin-like growth factor (IGF) 35 .…”

“…Lasers have been used in gynecology for decades with the first applications for treatment of cervical lesions. More recently, erbium:YAG lasers and CO 2 lasers have been deployed for LUT dysfunction, GSM, and vaginal aesthetics 33 . The proposed mechanism of action is that the laser causes thermal changes that lead to activation of the inflammatory healing cascade, ultimately resulting in restoration and remodeling of the tissue as evidenced by increased collagen synthesis 44,45 …”