A crucial prevalence study on female UI conducted in Milan

EAUN aids in urological nursing research project

The chance to participate and win the nursing research competition in order to promote our study has aroused our group’s interest and enthusiasm. As Italian nurses, being part of this competition judged by international expert colleagues is a once-in-a-lifetime opportunity for many reasons. The competition creates an open forum where we can present our research idea, and allows us to share and build better research because the competition is based on the comparison and suggestions of an international audience. Therefore, the competition allows us to build more effective research for our patients.

The European Association of Urology Nurses (EAUN), among its many important roles, is also active in supporting and improving clinical practice through research. Indeed, the EAUN supports the competition every year; thus, enables the advancement of knowledge in urology nursing through the promotion of research studies.

A great deal of work has been done in recent years to promote nursing research in urology, and the research project that we as a group have presented fulfils this purpose.

The reasons behind the construction of this research project are manifold. The first reason is that this project wants to give voice and relevance to an issue that affects many women globally urinary incontinence (UI). Bladder problems and urinary diseases, also known as lower urinary tract symptoms (LUTS), are common in women worldwide (Todhunter-Brown et al., 2022). One of these problems is UI which is defined as “the complaint of any involuntary leakage of urine” (Abrams et al., 2003; Hylen et al., 2010).

UI has been identified as a World Health Organization health priority because it negatively influences the physical, psychological and social life of the affected people (Batmani et al., 2021), who comprise both women (Sussman, Syan and Brucker, 2020) and men (Gacci et al., 2022). UI affects more women (51.1%) than men (13.9%) (Markland et al., 2011). These data indicate the need to further investigate the topic concerning the female condition. Although UI is a discussed literature topic, it is an underestimated problem (Tran & Puckett, 2022). For these reasons, epidemiological information is needed to plan and evaluate treatment practices to counteract UUI.

There are limited data concerning middle-aged (40 to 65 years old) women even though this age range is central in women’s lives and should be characterised by a high quality of life. Healthcare professionals often overlook UI. It is essential for urology nurses to know the prevalence of UI among women because nurses could educate these women on non-pharmacological approaches to this disease, prevent urinary tract infections, skin ulceration falls and fractures, improve return to social activities, independence and quality of life (Nelson et al., 2018).

According to statistics produced by the Italian Institute for Statistics (ISTAT), the population is aging, and the average age of the population ranges between 40 and 65 years old (ISTAT, 2021).

Statistics suggest focusing on this specific range of age, in which high quality of life and healthy lifestyle is expected, also because they are socially active women. In addition, the range 40 to 65 represents the starting point of significant occurrence of UI in the female population (Wieland et al., 2019; Fincopp, 2022). Currently, the Italian epidemiology for UI is approximately 3 million women (Fincopp, 2022), but the last published Italian prevalence studies date back to the first decade of the new millennium (Bortolotti et al., 2000; Siracusano et al., 2003). For this reason, a prevalence study focused on UI in Italy could provide significant information.

The objectives of the research project are to calculate the prevalence and investigate the costs and predisposing factors of UI in a university and research hospital in Milan, Italy. This study will be the first of a sequence. Subsequent studies will explore non-pharmacological strategies to support women with UI, and the experiences of women with UI. The primary outcome is to calculate the prevalence of middle-aged women with urinary incontinence.

There are two secondary outcomes:
1. To describe the UI and related predictors, quality of life, social impact and costs
2. To describe the association between UI and related predictors, quality of life, social impact and costs.

About the study
An observational, prospective, prevalence study will be conducted to investigate and describe UI prevalence among female hospitalised patients and female healthcare personnel in a university and research hospital in the Milan metropolitan area. It is not possible to decide the population sample in advance. All female patients and professionals that fit inclusion criteria will be included.

The inclusion criteria are female sex, middle age (40 to 65 years old), informed consent signed, comprehension of written and spoken Italian language, female hospitalised patient (outpatient, day surgery, and day hospital included), female hospitalised patients before surgical procedure if they should undergo surgery, female personnel. The exclusion criteria are male sex, pregnant women, post-partum women, and women who had undergone surgery for UI.

A prevalence study is essential for establishing the distribution of the condition in the population and projecting the need for health and medical services. The study will follow the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Checklist (Vandenbroucke et al., 2007). The collected data will be completely anonymous. The decision not to participate in the survey will not impact future nursing care. All patients receive the same care and support from healthcare personnel. The study will be approved by the Hospital Ethical Committee. The project will start in the autumn of 2023. The EAUN budget will be allocated for the support of the study.

A survey will collect demographic and clinical characteristics using standardised data entry forms. All the data will be collected based on a series of variables derived from an accurate review of the UI predictors, costs, and quality of life of the women affected (Goren et al., 2014; Harding et al., 2023).

The information included the following:
• Demographics (age, ethnicity, level of education, and body mass index)
• Presence of comorbidity (diabetes, chronic respiratory disease, anxiety, depression and asthma);
• Pelvic or uro-gynaecological surgery undergone
• Incidence of menopause
• Parity
• Lifestyle factors
• UI prevalence and symptomatology (frequency, quantity, type of urine leakage, time of onset urine leakage)
• UI quality of life (social impact and interference with sexual life)
• Costs (work productivity, weekly costs of hygiene care products, and healthcare-resource utilisation)

The Italian version of the International Consultation of Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ UI-SF) (Avery et al., 2004; Tubaro et al., 2006) will be used to investigate the urological symptoms in women and to screen the different subtypes of incontinence. The questionnaire is not gender-dependent and allows the assessment of the prevalence, frequency, and perceived cause of UI and its impact on everyday life.

The questionnaire comprises four questions centred on the frequency of UI, the amount of leakage, the overall impact of UI and a self-diagnostic item. The ICIQ-UI-SF scale is appropriate
for estimating national prevalence in representative samples (Bedretdinova et al., 2016).

This prevalence study should give us more information about UI in middle-aged women living in the Milan metropolitan area and will allow us to make new individualised pathways. The research team comprises different healthcare professionals such as nurses and midwives, because UI is multifactorial and requires a multi-professional approach.

Every healthcare professional represents an additional contribution to this study because he/she can see the UI from different points of view according to his/her expertise and skills. In addition, this study will be the first of other future studies about UI: a qualitative study exploring the living experiences with UI and a systematic review of non-pharmacological treatment for UI will be

The research team will continue investigating this disease, searching for new strategies and methods to treat the UI with non-pharmacological interventions (including mindfulness-based and cognitive-behavioural-based interventions). After the monocentre first period, this study could be expanded to become a multicentre prevalence study to evaluate the phenomenon better and investigate the prevalence in a larger population.

Conflict of interest
The research team declared that they have no competing interest or relationship, financial or otherwise, or personal, religious, or political beliefs that might be perceived as influencing an investigator’s objectivity.


Dr. Giulia Villa, Nurse, Ass. Prof. in Nursing, Vita-Salute San Raffaele University, Milan (IT) – villa.giulia@hsr.it

Research Team:
S. Trapani, Midwife, PhD Student, Milan/Rome, IT; S. Gnecchi, Nurse, MScN Student, Milan, IT; A. Poliani, Nurse, MScN Student, Milan, IT; D.F. Manara, Nurse, Midwife, Prof. in Nursing, Milan, IT