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Epidemiology and Consequences of Female Urinary Incontinence in the Middle-East

بسم الله الرحمن الرحيم. Epidemiology and Consequences of Female Urinary Incontinence in the Middle-East. ICS 2008 , Educational Course No . 9, Cairo, Egypt, October 21, 2008. Ahmed Al-Badr, MBBS, FRCS(C), FACOG Chairman, Urogynecology & Pelvic Reconstructive Surgery

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Epidemiology and Consequences of Female Urinary Incontinence in the Middle-East

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  1. بسم الله الرحمن الرحيم Epidemiology and Consequences of Female Urinary Incontinence in the Middle-East ICS 2008, Educational Course No. 9, Cairo, Egypt, October 21, 2008 Ahmed Al-Badr, MBBS, FRCS(C), FACOG Chairman, Urogynecology & Pelvic Reconstructive Surgery Deputy Medical Director, Women’s Specialized Hospital King Fahad Medical City, Riyadh

  2. Outline: • Definitions • Scope of the problem • Worldwide prevalence • Prevalence in the region • Conclusion

  3. Urinary Incontinence (UI): Definition (ICS): The complaint of any involuntary leakage of urine Abrams et al. Neurourol Urodyn, 2002, 21(2) p167-78

  4. UI: Definitions Stress Incontinence: • Is the complaint of involuntary leakage of urine with exertion, effort, sneezing, or coughing • Abrams et al. Neurourol Urodyn, 2002, 21(2) p167-78

  5. UI: Definitions Urge Incontinence: • Is the complaint of involuntary leakage accompanied by or immediately preceded by urgency • Abrams et al. Neurourol Urodyn, 2002, 21(2) p167-78

  6. UI: Definitions Mixed Urinary Incontinence: • Is the complaint of involuntary leakage associated with urgency and also with exertion, effort, sneezing, or coughing • Abrams et al. Neurourol Urodyn, 2002, 21(2) p167-78

  7. UI: Scope of the problem W.H.O. recognizes incontinence as an international health concern Clinical practice guidelines, 1996. US Department of Health and human Services

  8. UI: Scope of the problem Impact on lifestyle ¹ • Avoidance of activities • Depression, isolation, embarrassment… • Impact on marital/sexual relationships • Increased dependence on caregivers • Discomfort and skin irritation • Interference with prayers (Salat) and purity (Tahara) ², 3 • Clinical practice guidelines, 1996. US Department of Health and human Services • Risk et al. Int Urogynecol J 1999;10:160-5 3. Saleh 2005

  9. Prevalence of UI worldwide

  10. Minassian et al 2003

  11. Types of UI Minassian et al 2003

  12. Minassian et al 2003

  13. Prevalence of UI in the Middle-East

  14. UI: Prevalence in UAE • 400 women, PHC & community • Prevalence: 20.3% • 31% sought medical advice: • Embarrassment (38%) • Low expectations from medical care (38%) • UI is normal with age (23%) Risk et al. Int Urogynecol J 1999;10:160-5

  15. UI: Prevalence in Qatar • 1000 women age > 45 years, PHC & comm. • Prevalence: 20.6% • 64%: inability to pray • 47%: interference with marital relationship • 72%: ashamed of themselves and have guilt • 5%: stopped all work • 41%: did not seek help (embarrassment) Saleh et al, Maturitas. 2005

  16. UI: Prevalence in KSA • Prevalence: 35% • Types: • SUI: 57% • UUI: 12% • MUI: 31% Al-Amari et al. 14th SUC 2001

  17. UI: Prevalence in KSA • 379 women, age >15, PHC Jeddah • Mean age 35 (range: 15 - 71) • Prevalence: 41.4% • Types: • SUI: 36.4% • UUI: 27.4% • MUI: 22.2% Brasha et al. 2008, unpublished

  18. UI: Prevalence in KSA • Impact on QoL: • 34% unable to perform prayers • 29% limitations of social activities • 18% affected their sexual life Brasha et al. 2008, unpublished

  19. UI: Prevalence in KSA 18% sought medical advice: • 74 % didn’t think it is a significant problem • 9 % didn’t think treatment was available • 19 % embarrassed to discuss with doctor • 4 % did not want to consult a male doctor • 9 % thought it was natural with aging Brasha et al. 2008, unpublished

  20. UI: Prevalence in Jordan • 182 women, age: 50 - 65 yrs, south Jordan (Karak, Taffileh, Aqaba) • Prevalence: 30% • Types: • Stress UI: 23.1% • Urge UI: 26.4% • Mixed UI:18.1% Shakhatreh, Saudi Med J, 2005

  21. UI: Prevalence in Egypt • 1,652 women, age: > 20 • Community (Assiut) • Prevalence: 54.8% • Urge 15% • Stress 14.8% • Mixed 25% El-Azab et al. Neurourol and Urodynam (2007) 788-26:783

  22. UI: Prevalence in Egypt Impact on QoL: • low self-esteem, feeling unclean (65%) • inability to pray (90%) • difficulty in performing physical activities such as housework (33%) • limitations of social activities (30%) • leakage during sexual intercourse (18%) El-Azab et al. Neurourol and Urodynam (2007) 788-26:783

  23. UI: Prevalence in Egypt 4% sought medical advice: • Embarrassment (60%) • Low expectations from medical care (44%) • Assuming UI is normal with aging (38%) El-Azab et al. Neurourol and Urodynam (2007) 788-26:783

  24. UI: Conclusion • UI is prevalent in the Middle-East • UI has a significant impact on QoL • UI is underreported and undertreated • Need to educate health-care workers and the public

  25. Thank you! Q & A

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