Abstract
Objective
To provide a conceptual framework to guide investigations into burdens of noncancerous
genitourinary conditions (NCGUCs), which are extensive and poorly understood.
Methods
The National Institute of Diabetes and Digestive and Kidney Diseases convened a workshop
of diverse, interdisciplinary researchers and health professionals to identify known
and hidden burdens of NCGUCs that must be measured to estimate the comprehensive burden.
Following the meeting, a subgroup of attendees (authors of this article) continued
to meet to conceptualize burden.
Results
The Hidden Burden of Noncancerous Genitourinary Conditions Framework includes impacts across multiple levels of well-being and social ecology, including
individual (ie, biologic factors, lived experience, behaviors), interpersonal (eg,
romantic partners, family members), organizational/institutional (eg, schools, workplaces),
community (eg, public restroom infrastructure), societal (eg, health care and insurance
systems, national workforce/economic output), and ecosystem (eg, landfill waste) effects.
The framework acknowledges that NCGUCs can be a manifestation of underlying biological
dysfunction, while also leading to biological impacts (generation and exacerbation
of health conditions, treatment side effects).
Conclusion
NCGUCs confer a large, poorly understood burden to individuals and society. An evidence-base
to describe the comprehensive burden is needed. Measurement of NCGUC burdens should
incorporate multiple levels of well-being and social ecology, a life course perspective,
and potential interactions between NCGUCs and genetics, sex, race, and gender. This
approach would elucidate accumulated impacts and potential health inequities in experienced
burdens. Uncovering the hidden burden of NCGUCs may draw attention and resources (eg,
new research and improved treatments) to this important domain of health.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence and trends of urinary incontinence in adults in the United States, 2001 to 2008.J Urol. 2011; 186: 589-593
- Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction.BJU international. 2011; 108: 1132-1138
- Imaging studies after a first febrile urinary tract infection in young children.N Eng J Med. 2003; 348: 195-202
- EAU guidelines on neurogenic lower urinary tract dysfunction.Eur Urol. 2009; 56: 81-88
- Urinary retention.Urologia. 2013; 80: 257-264
- The prevalence and causes of nocturia.J Urol. 2010; 184: 440-446
- The association between lower urinary tract symptoms and falls: forming a theoretical model for a research agenda.Neurourol Urodyn. 2018; 37: 501-509
- Urinary tract infection during pregnancy: current concepts on a common multifaceted problem.Journal of obstetrics and gynaecology: the journal of the Institute of Obstetrics and Gynaecology. 2018; 38: 448-453
U.S. Department of Health and Human Services. Multiple chronic conditions: A strategic framework – Optimum health and quality of life for individuals with multiple chronic conditions. Accessed March 15, 2021, https://www.hhs.gov/sites/default/files/ash/initiatives/mcc/mcc_framework.pdf
- Comorbidities and personal burden of urgency urinary incontinence: a systematic review.Int J Clin Pract. 2013; 67: 1015-1033
- Costs of managing urinary and faecal incontinence in a sub-acute care facility: a "bottom-up" approach.Neurourol Urodyn. 2005; 24: 56-62
- The effect of social determinants of health on overactive bladder symptom severity.J Urol. 2021; 205: 1415-1420https://doi.org/10.1097/JU.0000000000001545
U.S. Department of Health and Human Services National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases. Urologic diseases. Accessed March 15, 2021, https://www.niddk.nih.gov/about-niddk/research-areas/urologic-diseases
- Paper presented at: Uncovering the Hidden Burden of Benign Genitourinary Conditions.Final Meeting Summary. Bethesda, MD2019
- The Prevention of Lower Urinary Tract Symptoms (PLUS) in girls and women: developing a conceptual framework for a prevention research agenda.Neurourol Urodyn. Nov 2018; 37: 2951-2964
- Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions.Health Educ & Behav. Jun 2012; 39: 364-372
- A scoping review of the economic burden of non-cancerous GU conditions.Urology. 2021; (Submitted for publication)
- The Inflection Point Model: A model to explore the hidden burdens of non-cancerous genitourinary conditions.Urology. 2021; https://doi.org/10.1016/j.urology.2021.07.030
- Behavioral science at the crossroads in public health: extending horizons, envisioning the future.Soc Sci Med. 2006; 62: 1650-1671
- A 25-year prospective mortality study in the spinal cord injured patient: comparison with the long-term living paraplegic.J Urol. 1977; 117: 486-488
- Bladder management after spinal cord injury in the United States 1972 to 2005.J Urol. 2010; 184: 213-217
- Incidence of symptomatic autonomic dysreflexia varies according to the bowel and bladder management techniques in patients with spinal cord injury.Spinal Cord. 2011; 49: 49-54
- Nocturia and disturbed sleep in the elderly.Sleep Med Rev. 2009; 10: 540-548
- Are sleep and depression independent or overlapping risk factors for cardiometabolic disease?.Sleep Med Rev. 2011; 15: 51-63
- Slow-wave sleep and the risk of type 2 diabetes in humans.Proc Natl Acad Sci U S A. 2008; 105: 1044-1049
- Sleep and hypertension.Chest. 2010; 138: 434-443
- Sleep and mortality: a population-based 22-year follow-up study.Sleep. 2007; 30: 1245-1253
- The impact of falls in the elderly.Trauma. 2013; 15: 29-35
- Urinary tract infections in older women: a clinical review.JAMA. 2014; 311: 844-854
- Risk factors for urinary tract infections in postmenopausal women.Arch Intern Med. 2004; 164: 989-993
- Anticholinergic drugs and negative outcomes in the older population: from biological plausibility to clinical evidence.Aging Clin Exp Res. 2016; 28: 25-35
- Updated AGS Beers Criteria® for potentially inappropriate medication use in older adults.J Am Geriatr Soc. 2019; 67: 674-694
- Adverse effects and safety of 5-alpha reductase inhibitors (Finasteride, Dutasteride): a systematic review.J Clin Aesthet Dermatol. 2016; 9: 56-62
- Alpha blockers for the treatment of benign prostatic hyperplasia.Rev Urol. 2007; 9: 181-190
- Urinary tract infections: microbial pathogenesis, host-pathogen interactions and new treatment strategies.Nat Rev Microbiol. 2020; 18: 211-226
- U.S. Department of Health and Human Services Centers for Disease Control.Antibiotic resistance threats in the United States. 2019; (Accessed October 7, 2021)
- Transurethral procedures in the treatment of benign prostatic hyperplasia: a systematic review and meta-analysis of effectiveness and complications.Medicine. 2018; 97: e13360
- The impact of ureteral access sheath use on the development of abnormal postoperative upper tract imaging after ureteroscopy.J Urol. Nov 2020; 204: 976-981
- Endoscopic balloon dilatation in the treatment of benign ureteral strictures: a meta-analysis and systematic review.J Endourol. 2019; 33: 255-262
- Mesh complications in female pelvic floor reconstructive surgery and their management: a systematic review.Indian J Urol. 2012; 28: 129-153
- Inaccuracies in news media reporting about the 2019 US Food and Drug Administration ban on transvaginal mesh for pelvic organ prolapse repair.Urology. 2021; 150: 194-200
- Indications and risk factors for midurethral sling revision.Int Urogynecol J. 2016; 27: 117-122
- FIGO review of statements on use of synthetic mesh for pelvic organ prolapse and stress urinary incontinence.Int J Gynaecol Obstet. Nov 2019; 147: 147-155
- Sex differences and stress across the lifespan.Nat Neurosci. 2015; 18: 1413-1420
- Enduring impact of childhood adversity on lower urinary tract symptoms in adult women.Neurourol Urodyn. 2020; 39: 1472-1481
- Impact of overactive bladder on women in the United States: results of a national survey.Curr Med Res Opin. 2007; 23: 65-76
- Effect of bothersome overactive bladder symptoms on health-related quality of life, anxiety, depression, and treatment seeking in the United States: results from EpiLUTS.Urology. 2012; 80: 90-96
- The temporal relationship between anxiety disorders and urinary incontinence among community-dwelling adults.J Anxiety Disord. 2011; 25: 203-208
- Anxiety and depression associated with urinary incontinence. A 10-year follow-up study from the Norwegian HUNT study (EPINCONT).Neurourol Urodyn. 2017; 36: 322-328
- The association of lower urinary tract symptoms, depression and suicidal ideation: data from the 2005-2006 and 2007-2008 National Health and Nutrition Examination Survey.J Urol. May 2014; 191: 1333-1339
- Association of suicidality and depression with 5α-reductase inhibitors.JAMA Int Med. 2017; 177: 683-691
- The association between urinary and fecal incontinence and social isolation in older women.Amer J Obstet Gynecol. 2013; 208: 146.e1-146.e7
- A review of social isolation: an important but underassessed condition in older adults.J Prim Prev. 2012; 33: 137-152
- The impact of OAB on physical activity in the United States: results from OAB-POLL.Urology. 2013; 82: 799-806
- Sedentary behavior, exercise, and cardiovascular health.Circ Res. 2019; 124: 799-815
- Reducing urinary tract infections in care homes by improving hydration.BMJ Open Qual. 2019; 8e000563
- Frequency of urinary incontinence in people with chronic heart failure.Heart Lung. 2013; 42: 26-31
- Urinary incontinence and diuretic avoidance among adults with chronic kidney disease.Int Urol Nephrol. 2016; 48: 1321-1326
- Ecological models revisited: their uses and evolution in health promotion over two decades.Annu Rev Public Health. 2011; 32: 307-326
- Continence care for obese nursing home residents.Urol Nurs. 2010; 30: 121-129
- The burden of bladder pain in five european countries: a cross-sectional study.Urology. 2017; 99: 84-91
- Adult women's experiences of urinary incontinence: a systematic review of qualitative evidence.JBI Database System Rev Implement Rep. 2017; 15: 1350-1408
- Urogenital infections and male sexuality: effects on ejaculation and erection.Andrologia. 2008; 40: 125-129
- Men's experiences after prostatectomy: a meta-synthesis.Int J Nurs Studies. 2017; 74: 162-171
- Cognitive, affective, and behavioral dimensions of the lower urinary tract symptom experience in men with Parkinson's Disease.J Wound Ostomy Continence Nurs. 2016; 43: 80-87
Wild DJ, Clayson DJ, Keating K, Gondek K. Validation of a patient-administered questionnaire to measure the activity impairment experienced by women with uncomplicated urinary tract infection: the Activity Impairment Assessment (AIA). Health Qual Life Outcomes.2005;3:42. doi:10.1186/1477-7525-3-42
- An introduction to the epidemiology and burden of urinary tract infections.Health Qual Life Outcomes. 2019; 111756287219832172
- Addressing quality of life in the patient with interstitial cystitis/bladder pain syndrome.Asian J Urol. 2017; 4: 50-54
- Impact of incontinence on the quality of life of caregivers of older persons with incontinence: a qualitative study in four European countries.Arch Gerontol Geriatr Suppl. 2016; 63: 92-101
- The experience of women who care for spouses with Parkinson's Disease and lower urinary tract symptoms.JOGNN-J Obst Gyn Neo. 2016; 45: 737-748
- Costs of urinary incontinence and overactive bladder in the United States: a comparative study.Urology. 2004; 63: 461-465
- Urinary incontinence in older adults takes collaborative nursing efforts to improve.Cureus. 2020; 12: e9161
- Mobility and other predictors of hospitalization for urinary tract infection: a retrospective cohort study.BMC Geriatr. 2008; 8: 31
- Prevalence, management and impact of urinary incontinence in the workplace.Occup Med. 2005; 55: 552-557
United States Department of Labor Occupational Safety and Health Administration. 1915.88 - Sanitation. Occup Safety and Health Standards for Shipyard Employment. Accessed March 16, 2021. https://www.osha.gov/laws-regs/regulations/standardnumber/1915/1915.88,
- Delaying voiding, limiting fluids, urinary symptoms, and work productivity: a survey of female nurses and midwives.J Adv Nurs. 2019; 75: 2579-2590
- School toileting environment, bullying, and lower urinary tract symptoms in a population of adolescent and young adult girls: Preventing lower urinary tract symptoms consortium analysis of Avon longitudinal study of parents and children.Urology. 2021; 151: 86-93https://doi.org/10.1016/j.urology.2020.06.060
- Perceptions of school toilets as a cause for irregular toilet habits among schoolchildren aged 6 to 16 years.J Sch Health. 2005; 75: 125-128
- U.S. Adolescent and adult women’s experiences accessing and using toilets in schools, workplaces, and public spaces: a multi-site focus group study to inform future research in bladder health.Int J Environ Res Public Health. 2019; 16: 3338https://doi.org/10.3390/ijerph16183338
- The constraints of a normal life: the management of urinary incontinence by middle aged women.Women Health. 2003; 37: 37-51
Schneider B. The dirty truth about San Francisco's sidewalks. Is the city really drowning in filth? In: Lab BC, ed2018. Accessed March 16, 2021. https://www.bloomberg.com/news/articles/2018-08-02/san-francisco-s-sidewalk-poop-crisis-explained.
- Does urinary incontinence affect middle-aged and older women's time use and activity patterns?.Obstet Gynecol. 2004; 104: 1327-1334
- Racial disparities in bladder management in veterans with spinal cord injury and disorders.Neurourol Urodyn. 2019; 38: 968-974
- Nonclinical barriers to care for neurogenic patients undergoing complex urologic reconstruction.Urology. 2019; 124: 271-275
- Prediction of institutionalization in the elderly. A systematic review.Age Ageing. 2010; 39: 31-38
Wagner TH MK, Subak LL, de Wachter S, Dudding T. Incontinence. Paper presented at: 6th International Consultation on Incontinence; 2017, 2017; Tokyo.
- The "costs" of urinary incontinence for women.Obstet Gynecol. 2006; 107: 908-916
- Perceptions and behaviours of women with bladder control problems.Fam Pract. 2006; 23: 568-577
- Economic burden of urgency urinary incontinence in the United States: a systematic review.J Manag Care Pharm. 2014; 20: 130-140
- Use of the National Health and Nutrition Examination Survey to calculate the impact of obesity and diabetes on cost and prevalence of urolithiasis in 2030.Eur Urol. 2014; 66: 724-729
United States Environmental Protection Agency. Facts and Figures About Materials, Waste and Recycling. Guide to the Facts and Figures About Materials, Waste and Recycling. Accessed March 22, 2021. https://www.epa.gov/facts-and-figures-about-materials-waste-and-recycling/guide-facts-and-figures-report-about-materials
- Life cycle assessment of the closed-loop recycling of used disposable diapers.Resources. 2020; 9: 34https://doi.org/10.3390/resources9030034
- Resource efficiency of consumables - Life cycle assessment of incontinence products.Resour Conserv Recy. 2019; 144: 13-23
- The future: Energy-producing diapers.The EPA Blog. 2021;https://blog.epa.gov/tag/disposalbe-diapers/Date accessed: October 7, 2021
- Nocturia in arterial hypertension: a prevalent, underreported, and sometimes underestimated association.J Am Soc Hypertens. 2013; 7: 75-84
- Frequent nocturnal urination in older men is associated with arterial stiffness: The Nagahama study.Hypertens Res. 2019; 42: 1996-2001
- Nocturia is an independent predictor of abdominal aortic calcification in women: Results from the National Health and Nutrition Examination Survey.J Community Health. 2020; 45: 1111-1115
- Nocturia. A rarely recognized symptom of sleep apnea and other occult sleep disorders.Arch Intern Med. 1996; 156: 545-550
- Sleep apnea in heart failure.Curr Treat Options Cardiovasc Med. 2018; 20: 33
- Nocturia as an unrecognized symptom of uncontrolled hypertension in black men aged 35 to 49 years.J Am Heart Assoc. 2019; 8e010794
- The artery size hypothesis: a macrovascular link between erectile dysfunction and coronary artery disease.Am J Cardiol. 2005; 96: 19m-23m
- Erectile dysfunction predicts cardiovascular events as an independent risk factor: a systematic review and meta-analysis.J Sex Med. 2019; 16: 1005-1017
- Lower urinary tract dysfunction in the neurological patient: clinical assessment and management.Lancet: Neurol. 2015; 14: 720-732
- Assessment of patients with lower urinary tract symptoms where an undiagnosed neurological disease is suspected: a report from an International Continence Society consensus working group.Neurourol Urodyn. 2020; 39: 2535-2543
- Diabetic bladder dysfunction: current translational knowledge.J Urol. 2009; 182 (ppl): S18-526
- Bladder health experiences, perceptions and knowledge of sexual and gender minorities.Int J Environ Res Public Health. 2019; 16: 3170https://doi.org/10.3390/ijerph16173170
- Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: a systematic review.Am J Public Health. 2015; 105: e60-e76
Article info
Publication history
Published online: September 15, 2021
Accepted:
August 30,
2021
Received:
April 1,
2021
Footnotes
Financial and Personal Disclosures: C. Neill Epperson: Asarina Pharma (advisory board); Sage Therapeutics (consultant, advisory board, site principle investigator Sage 217-PPD-301 and Sage 547-PPD-304). Adonis K. Hijaz: Collamedix Inc. (equity) and Astellas (speaker). Christine K. Liu: AgeBold (consultant). The remaining authors declare that they have no relevant financial interests.
Declaration of Competing Interest: There are no reported financial or personal relationships that could bias this work.
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
