Clinical & Prevention Urinary Incontinence Trials: Is there a Sensible Path Forward?
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1 Clinical & Prevention Urinary Incontinence Trials: Is there a Sensible Path Forward? Ananias C. Diokno, M.D. Professor of Urology, Oakland University William Beaumont School of Medicine, Rochester, MI Ret. EVP-CMO, Beaumont Health System, Royal Oak, MI
2 DISCLOSURES Current Funding: NIH-NIA & Beaumont Health Foundation (Philanthropy) Other Financial Relationship: None Conflict Of Interest: None
3 CLINICAL & PREVENTION UI TRIALS IS THERE A SENSIBLE PATH FORWARD? What do we want to accomplish? Our GOALS What are the barriers in achieving our goals? BARRIERS TO BREAK How can we achieve our goals? Our STRATEGY
4 GOALS FOR GERIATRIC UI RESEARCH Provide Means To Drastically Reduce The Incidence Of UI & Cure/Control UI Among Sufferers Improve QOL Science of UI Need - Improve knowledge in basic science dealing with the LUT - An accurate assessment of the incidence and remission rates - Reliable information regarding risk factors - Effective standardized clinical and preventive intervention for UI
5 GOALS FOR GERIATRIC UI RESEARCH PROVIDE MEANS TO SUPPORT SCHOLARS OF UI RESEARCH Unification of the various disciplines and institutions working in Geriatric UI research Soliciting and encouraging new disciplines for new ideas and solutions Focus the efforts by defining common goals Establish a strategy to raise adequate funds to support Geriatric UI research Establish a clearing house for collection & dissemination of accurate validated information for public consumption
6 MAJOR ISSUES (BARRIERS) MOVING FORWARD Lack of Focus/Coherence Wide ranging publications in this topic - No consensus Duplication of Efforts Too many cross-sectional survey & duplicative intervention studies Gaps of Basic Knowledge Limited longitudinal studies (incidence, remission, risk factors, etc.) and under-utilization of voluminous data Disparate Groups and Ideas Duplication of efforts with conflicting results
7 MAJOR ISSUES (BARRIERS) MOVING FORWARD Shortage of Funds and Scholars Lack of Authoritative Clearing House for Collection & Dissemination of Information Professional organizations, medical centers, governmental agencies, private enterprise, etc. Focus/Efforts/Ideas Basic Science Molecular, biochemical, pharmacologic, cellular, neuronal, etc. Clinical Epidemiology, diagnostic, therapy intervention
8 Barriers con t. Focus/Efforts/Ideas Prevention Primary, secondary, both and with what Participants (Subjects/Patients) & Care Settings Best model for basic science research Gender differences and focus Settings: Community, Assisted living, Nursing homes, In-patients, Palliative/Hospice care
9 BARRIERS con t. TECHNOLOGY: MINING THE DATA BASES Utilization of electronic technology in data mining & clinical application Mining the MESA data base to identify risk factors for geriatric UI NIH Funded Grant * Established continence index: A new questionnaire to predict UI in elderly women in the community Diokno AC, Ogunyemi T, Siadat MR, Arslanturk S, Killinger KA. Continence Index. A new screening questionnaire to predict the probability of future incontinence in older women in the community. Int Urol Nephrol Jul;47(7):
10 OUTCOMES OF MINING THE MESA DATA BASE EIGHT RISK FACTORS FOR GERIATRIC UI 1. BMI >24 2. Sneeze often/sometimes 3. Post-partum UI 4. Trouble getting to toilet 5. Wetting soiling 1/wk.+ 6. Can t shut off stream 7. Memory problems 8. Possible future UI COMBINATION COMBINATION FACTORSCOMBINATION PROBABILITY UI FACTORS FACTORS (LL OF CI) 1 Factor 50-58% 2 factors 56-69% 3 factors 66-78% 4 factors 74-87% 5 factors 85-89% 6 factors 87-92% 7 factors 93-95% 8 factors 96%
11 BARRIERS Funding Issues Governmental Agencies: NIH, DOD, CDC etc., Philanthropy, Private Enterprise: Pharma, insurance companies, etc. Scientific Expertise Centers of Excellence Specialists & Specialties multiple disciplines Institutional support
12 STRATEGY TO ACCOMPLISH GOALS Need to establish a consensus among stake holders Convene a consensus conference Under the auspices of a government agency & other organizations Open to multiple participants (institution & disciplines) Establish known facts & current status Identify and prioritize gaps of knowledge Establish a focused comprehensive research agenda Establish a clearing house to disseminate information
13 CONCLUSION Knowledge on Geriatric UI has advanced Significant knowledge gaps still exist Prevalence of UI is still high Major barriers include issues with content, infrastructure, personnel and funding Need for a consensus to develop a strategy to Improve dissemination of information Identify and prioritize solving gaps of knowledge Establish a focused comprehensive research agenda
14 Thank you! Ananias C. Diokno, M.D. Professor, Oakland University William Beaumont School of Medicine Beaumont Health Royal Oak, MI
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