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Meng L, Hou H, Zhang P, Gu Y, Shi B, Li Y, Wang Q, Zhang Y, Ren L, Chen Q, Yuan Z, Guo F, Li D, Ma Y, Dong S, Liu Z, Shang A, Li B, Xu W, Lv J, Zhang Y. Sacral neuromodulation remote programming in patients with refractory lower urinary tract dysfunction: China’s experience during the COVID-19 pandemic. Front Med (Lausanne) 2023; 10:977433. [PMID: 37035299 PMCID: PMC10081490 DOI: 10.3389/fmed.2023.977433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/16/2023] [Indexed: 03/14/2023] Open
Abstract
ObjectivesSacral neuromodulation is an effective, minimally invasive treatment for refractory lower urinary tract dysfunction. However, regular postoperative programming is crucial for the maintenance of the curative effects of electronic sacral stimulator devices. The outbreak of coronavirus disease 2019 (COVID-19) limited the ability of practitioners to perform traditional face-to-face programming of these stimulators. Therefore, this study aimed to evaluate the application of remote programming technology for sacral neuromodulation during the COVID-19 pandemic in China.Materials and methodsWe retrospectively collected data including baseline and programming information of all patients with lower urinary tract dysfunction who underwent sacral neuromodulation remote programming in China after the outbreak of COVID-19 (i.e., December 2019). The patients also completed a self-designed telephone questionnaire on the subject.ResultsA total of 51 patients from 16 centers were included. They underwent 180 total remote programming visits, and 118, 2, 25, and 54 voltage, current, pulse width, and frequency adjustments, respectively, were performed. Additionally, remote switching on and off was performed 8 times; impedance test, 54 times; and stimulation contact replacement, 25 times. The demand for remote programming was the highest during the first 6 months of sacral neuromodulation (average, 2.39 times per person). In total, 36 out of the 51 patients completed the questionnaire survey. Of these, all indicated that they chose remote programming to minimize unnecessary travel because they had been affected by COVID-19. The questionnaire also showed that remote programming could reduce the number of patient visits to the hospital, save time, reduce financial costs, and would be easy for patients to master. All surveyed patients indicated that they were satisfied with remote programming and were willing to recommend it to other patients.ConclusionRemote programming for sacral neuromodulation is feasible, effective, safe, and highly recommended by patients with refractory lower urinary tract dysfunction. Remote programming technology has great development and application potential in the post-pandemic era.
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Affiliation(s)
- Lingfeng Meng
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Department of Urology, Beijing Hospital Continence Center, Beijing, China
| | - Huimin Hou
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Department of Urology, Beijing Hospital Continence Center, Beijing, China
| | - Peng Zhang
- Department of Urology, Beijing Chaoyang Hospital, Institute of Urology, Capital Medical University, Beijing, China
| | - Yinjun Gu
- Department of Urology, Renji Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Benkang Shi
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Yan Li
- Department of Urology, Qilu Hospital of Shandong University, Jinan, China
| | - Qingwei Wang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yifei Zhang
- Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Lijuan Ren
- Department of Urology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Qi Chen
- Department of Urology, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Zhen Yuan
- Department of Urology, Fuyang People's Hospital, Fuyang, China
| | - Fan Guo
- Department of Urology, Hubei Provincial Hospital of TCM, Wuhan, China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, Medical College, Shanghai Jiaotong University, Shanghai, China
| | - Yunfu Ma
- Department of Neurosurgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Sheng Dong
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Zhijun Liu
- Department of Urology, Qingdao Municipal Hospital, Qingdao, China
| | - Aijia Shang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Bo Li
- Department of Urology, Shandong Provincial Hospital, Jinan, China
| | - Wei Xu
- Department of Urology, Zoucheng People’s Hospital, Zoucheng, China
| | - Jianwei Lv
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
- *Correspondence: Lv Jianwei,
| | - Yaoguang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
- Department of Urology, Beijing Hospital Continence Center, Beijing, China
- Zhang Yaoguang,
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Birder LA, Jackson EK. Purine nucleoside phosphorylase as a target to treat age-associated lower urinary tract dysfunction. Nat Rev Urol 2022; 19:681-687. [PMID: 36071153 PMCID: PMC9842101 DOI: 10.1038/s41585-022-00642-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2022] [Indexed: 01/18/2023]
Abstract
The lower urinary tract (LUT), including the bladder, urethra and external striated muscle, becomes dysfunctional with age; consequently, many older individuals suffer from lower urinary tract disorders (LUTDs). By compromising urine storage and voiding, LUTDs degrade quality of life for millions of individuals worldwide. Treatments for LUTDs have been disappointing, frustrating both patients and their physicians; however, emerging evidence suggests that partial inhibition of the enzyme purine nucleoside phosphorylase (PNPase) with 8-aminoguanine (an endogenous PNPase inhibitor that moderately reduces PNPase activity) reverses age-associated defects in the LUT and restores the LUT to that of a younger state. Thus, 8-aminoguanine improves LUT biochemistry, structure and function by rebalancing the LUT purine metabolome, making 8-aminoguanine a novel potential treatment for LUTDs.
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Affiliation(s)
- Lori A Birder
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Edwin K Jackson
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Rao Y, Gao Z, Li X, Li X, Li J, Liang S, Li D, Zhai J, Yan J, Yao J, Chen X. Ventrolateral Periaqueductal Gray Neurons Are Active During Urination. Front Cell Neurosci 2022; 16:865186. [PMID: 35813503 PMCID: PMC9259957 DOI: 10.3389/fncel.2022.865186] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
The ventrolateral periaqueductal gray (VLPAG) is thought to be the main PAG column for bladder control. PAG neurons (especially VLPAG neurons) and neurons in the pontine micturition center (PMC) innervating the bladder detrusor have anatomical and functional synaptic connections. The prevailing viewpoint on neural control of the bladder is that PAG neurons receive information on the decision to void made by upstream brain regions, and consequently activate the PMC through their direct projections to initiate urination reflex. However, the exact location of the PMC-projecting VLPAG neurons, their activity in response to urination, and their whole-brain inputs remain unclear. Here, we identified the distribution of VLPAG neurons that may participate in control of the bladder or project to the PMC through retrograde neural tracing. Population Ca2+ signals of PMC-projecting VLPAG neurons highly correlated with bladder contractions and urination as shown by in vivo recording in freely moving animals. Using a RV-based retrograde trans-synaptic tracing strategy, morphological results showed that urination-related PMC-projecting VLPAG neurons received dense inputs from multiple urination-related higher brain areas, such as the medial preoptic area, medial prefrontal cortex, and lateral hypothalamus. Thus, our findings reveal a novel insight into the VLPAG for control of bladder function and provide a potential therapeutic midbrain node for neurogenic bladder dysfunction.
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Affiliation(s)
- Yu Rao
- Brain Research Center and State Key Laboratory of Trauma, Burns, and Combined Injury, Third Military Medical University, Chongqing, China
| | - Ziyan Gao
- Center for Neurointelligence, School of Medicine, Chongqing University, Chongqing, China
| | - Xianping Li
- Brain Research Center and State Key Laboratory of Trauma, Burns, and Combined Injury, Third Military Medical University, Chongqing, China
| | - Xing Li
- School of Physical Science and Technology, Guangxi University, Nanning, China
| | - Jun Li
- School of Physical Science and Technology, Guangxi University, Nanning, China
| | - Shanshan Liang
- Brain Research Center and State Key Laboratory of Trauma, Burns, and Combined Injury, Third Military Medical University, Chongqing, China
| | - Daihan Li
- Center for Neurointelligence, School of Medicine, Chongqing University, Chongqing, China
| | | | - Junan Yan
- Center for Neurointelligence, School of Medicine, Chongqing University, Chongqing, China
- Department of Urology, Southwest Hospital, Third Military Medical University, Chongqing, China
- Guangyang Bay Laboratory, Chongqing Institute for Brain and Intelligence, Chongqing, China
- *Correspondence: Junan Yan Jiwei Yao Xiaowei Chen
| | - Jiwei Yao
- Center for Neurointelligence, School of Medicine, Chongqing University, Chongqing, China
- *Correspondence: Junan Yan Jiwei Yao Xiaowei Chen
| | - Xiaowei Chen
- Brain Research Center and State Key Laboratory of Trauma, Burns, and Combined Injury, Third Military Medical University, Chongqing, China
- Guangyang Bay Laboratory, Chongqing Institute for Brain and Intelligence, Chongqing, China
- *Correspondence: Junan Yan Jiwei Yao Xiaowei Chen
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Chen S, Wang S, Gao Y, Lu X, Yan J, Xuan L, Wang S. Bilateral electrical pudendal nerve stimulation as additional therapy for lower urinary tract dysfunction when stage II sacral neuromodulator fails: a case report. BMC Urol 2021; 21:37. [PMID: 33691669 PMCID: PMC7945661 DOI: 10.1186/s12894-021-00808-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Sacral neuromodulation (SNM) has become an effective therapy for patients with lower urinary tract dysfunction (LUTD) who do not respond to conservative treatment. However, an effective treatment strategy for patients who fail SNM has not yet been identified. An option for LUTD is needed when the clinical response to the SNM diminishes. Case presentation A 51-year-old Chinese man presented to an outpatient clinic complaining of difficulty in urination for > 3 years. The patient also complained of urinary frequency and urgency, accompanied by perineal discomfort. He was diagnosed with LUTD based on his symptoms and previous examinations. The patient underwent sacral neuromodulation with a permanent implantable pulse generator (IPG) (provided free of charge by Chengnuo Medical Technology Co., Ltd.; General Stim, Hangzhou, China) in the left buttock, as he participated in the company’s clinical trial to test the long-term effects of IPG. He reported loss of efficacy of the device 3 months after the implantation. We performed bilateral electrical pudendal nerve stimulation (EPNS) therapy for him. After 2 weeks of treatment, he began to report smooth voiding within 2 h after EPNS, and a moderate improvement in urinary frequency, urgency, and perineal discomfort. After 4 weeks of EPNS, the patient reported > 50% improvement in his urination, evaluated with the short form of the International Consultation on Incontinence Questionnaire for Male Lower Urinary Tract Symptoms. He reported smooth voiding, moderate improvements in urinary frequency and urgency, and the disappearance of the perineal discomfort. He also reported improved sleep and erections. The patient was discharged after 8 weeks of EPNS treatment. Conclusion EPNS could be an option as an additional therapy for patients with LUTD who have failed SNM. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-021-00808-5.
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Affiliation(s)
- Shan Chen
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Siyou Wang
- Clinical Research Section, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Yunqiu Gao
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou, 310006, Zhejiang Province, China
| | - Xiaolian Lu
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiasheng Yan
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou, 310006, Zhejiang Province, China
| | - Lihua Xuan
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shenhong Wang
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou, 310006, Zhejiang Province, China.
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Hervé F, Delabie L, Mylle T, Weiss J, Bower W, Everaert K. Effect of diuresis on bother related to lower urinary tract symptoms. Int J Clin Pract 2019; 73:e13299. [PMID: 30489004 DOI: 10.1111/ijcp.13299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/19/2018] [Accepted: 11/24/2018] [Indexed: 12/01/2022] Open
Abstract
AIMS To explore and objectify the impact of diuresis on the presence of daytime and nighttime LUTS, and associated bother. METHODS Participants (healthy volunteers and patients referred to our hospital for a urologic consultation) were asked to complete a 72-hour bladder diary and also had to fill in a Likert scale (0: no bother; 10: maximal bother) to evaluate the LUTS-associated bother during daytime and nighttime. Three groups were defined: no/mild bother (Bother ≤2), moderate bother (3 ≤ Bother ≤ 6), and strong bother (Bother ≥7). Questionnaires in order to assess LUTS (ICIQ MLUTS and ICIQ FLUTS), quality of life (SF-36, NqOL), and quality of sleep (PSQI) were completed. RESULTS During daytime and nighttime, the study of participants with a strong bother associated with LUTS revealed a statistically significant higher fluid intake than those without bother (1640 mL vs 1800 mL during daytime, P = 0.007). Also, those with higher diuresis rate had more bother related to LUTS than the others (71.3 mL/h in group 1 vs 87.3 mL/h in group 3 (P < 0.001) during daytime). As might be expected, lower urinary tract such as bladder, for example, studied through maximal voided volume does play a role. The lower the maximal voided volume is, the more bother the participants described. CONCLUSIONS This study pointed out the implication of diuresis in bother related to LUTS. Our findings showed that there was an increase in bother by 1 when diuresis increased by 100 mL/h.
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Affiliation(s)
- François Hervé
- Urology Department, Ghent University Hospital, Gent, Belgium
| | | | - Toon Mylle
- Ghent University Hospital, Ghent, Belgium
| | - Jeff Weiss
- Department of Urology, SUNY Downstate College of Medicine, New York City, New York
| | - Wendy Bower
- Department of Medicine and Community Care, Faculty of Medicine, Dentistry and Health Science, Melbourne Health, University of Melbourne, Melbourne, Vic., Australia
| | - Karel Everaert
- Urology Department, Ghent University Hospital, Gent, Belgium
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Mevorach Zussman N, Gonen N, Kovo M, Miremberg H, Bar J, Condrea A, Ginath S. Protracted postpartum urinary retention-a long-term problem or a transient condition? Int Urogynecol J 2019; 31:513-519. [PMID: 30783707 DOI: 10.1007/s00192-019-03903-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/05/2019] [Indexed: 01/25/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Protracted postpartum urinary retention (P-PUR) is a rare puerperal complication of overt urinary retention that proceeds beyond the 3rd postpartum day. Long-term consequences of P-PUR are poorly reported. The objective of the study was to compare the long-term outcome of patients with P-PUR with a matched control group, using a validated pelvic floor distress questionnaire. METHODS All medical files of women diagnosed with P-PUR between 2005 and 2016 were reviewed. The control group was comprised of women who had a consecutive birth, matched in a 1:2 ratio, by maternal age, parity, neonatal birth weight, analgesia, and route of delivery. All women were evaluated for long-term symptoms of urinary or fecal incontinence and pelvic-organ-prolapse-related complaints by a telephone interview, at least 1 year following their delivery, using the Pelvic Floor Distress Inventory-Short Form (PFDI-20) questionnaire. RESULTS During the study period, there were 27 cases of P-PUR out of 52,662 deliveries (0.051%). There were no differences between the study group (n = 27) and controls (n = 54) in age, BMI (kg/m2), parity, birth weight, route of delivery, and rate of episiotomy. The majority of patients in both groups opted for epidural analgesia. Second stage of labor was longer in the study group than in controls, 134.1 ± 74.6 min vs. 73.4 ± 71.6 min, respectively, p < 0.001. The scores of the PFDI-20, UDI-6, and POPDI-6 did not differ between the groups. However, the study group had minimally elevated scores on the CARDI-8 scale (1.0 ± 2.6 vs. 0.0 ± 0.0, p = 0.012). CONCLUSIONS P-PUR is a rare postpartum complication, yet this disturbing condition has negligible if any clinical impact on long-term urogynecologic disorders. These findings carry a reassuring message to both patients and their health care providers.
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Affiliation(s)
- Noa Mevorach Zussman
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Ha'Lochamim 62, PO Box 5, 58100, Holon, Israel.
| | - Noa Gonen
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Ha'Lochamim 62, PO Box 5, 58100, Holon, Israel
| | - Michal Kovo
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Ha'Lochamim 62, PO Box 5, 58100, Holon, Israel
| | - Hadas Miremberg
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Ha'Lochamim 62, PO Box 5, 58100, Holon, Israel
| | - Jacob Bar
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Ha'Lochamim 62, PO Box 5, 58100, Holon, Israel
| | - Alexander Condrea
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Ha'Lochamim 62, PO Box 5, 58100, Holon, Israel
| | - Shimon Ginath
- Department of Obstetrics and Gynecology, the Edith Wolfson Medical Center, Holon, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Ha'Lochamim 62, PO Box 5, 58100, Holon, Israel
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Abstract
Urinary incontinence (UI) is an international problem, affecting a high percentage of geriatric women. Nurses caring for geriatric women of all ages should be aware of the problem of UI and familiarize themselves with the potential treatment options for these patients. This article focuses on the prevalence, burden, clinical application, and management recommendations for the different types of UI.
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Affiliation(s)
- Jessica A R Searcy
- Women's Health Nurse Practitioner Program, Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
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