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Atik YT, Uysal B, Gul D, Cimen HI, Aydemir H, Bostanci MS, Kose O. Female ventral-onlay buccal mucosal graft urethroplasty supported with martius labial fat pad flap: early results. Int Urol Nephrol 2024; 56:1927-1933. [PMID: 38240930 DOI: 10.1007/s11255-023-03909-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/04/2023] [Indexed: 05/14/2024]
Abstract
PURPOSE There is a growing interest in reconstructive urology and female urethroplasty. We aimed to report our experience in ventral-onlay buccal mucosa graft (BMG) urethroplasty supported with Martius flap (MF) in treating female urethral stricture disease. METHODS We retrospectively evaluated data of 18 female patients (ages 35-78) who were diagnosed with urethral stricture disease and underwent ventral-onlay BMG urethroplasty supported with MF by single surgeon in a tertiary referral centre between February 2019 and October 2022. Detailed history, international prostate symptom score (IPSS), pelvic examination, urine flow rate (rate and pattern), post void residual (PVR), storage and voiding phase urodynamic study, and voiding cystourethrography were recorded. At the last visit; the number of urethral dilatations before urethroplasty, time from urethral dilation to urethroplasty, hospital stay, urethral catheterization time, postoperative IPSS, PVR and uroflowmetry values were recorded. RESULTS The presenting symptoms were obstructive voiding symptoms in 16 patients. While the mean number of urethral dilatation was 2.11 ± 1.93 (1-7), the mean time from dilatation to urethroplasty was 5.83 ± 5.00 (1-19 months) months. Maximum flow rate increased from 8.36 ± 3.26 ml/sec in preoperative uroflowmetry to 21.45 ± 5.27 ml/sec at the last follow-up (p < 0.001). Post-void residual urine (PVR) decreased from preoperative mean 116.66 ± 105.88 cc to 26.94 ± 22.69 cc postoperatively (p < 0.004). None of the patients developed stricture recurrence, incontinence or vaginal fistula until the last follow-up. The mean follow-up period was 17.28 ± 11.65 (1-35) months. CONCLUSIONS A ventral-onlay BMG urethroplasty supported with MF represents an effective and reproducible treatment option for FUS in the present study.
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Affiliation(s)
- Yavuz Tarik Atik
- Department of Urology, Sakarya University, Training and Research Hospital, Sakarya, Turkey.
| | - Burak Uysal
- Faculty of Medicine, Department of Urology, Sakarya University, Sakarya, Turkey
| | - Deniz Gul
- Department of Urology, Sakarya University, Training and Research Hospital, Sakarya, Turkey
| | - Haci Ibrahim Cimen
- Faculty of Medicine, Department of Urology, Sakarya University, Sakarya, Turkey
| | - Huseyin Aydemir
- Department of Urology, Sakarya University, Training and Research Hospital, Sakarya, Turkey
| | - Mehmet Suhha Bostanci
- Faculty of Medicine, Department of Gynecology and Obstetrics, Sakarya University, Sakarya, Turkey
| | - Osman Kose
- Faculty of Medicine, Department of Urology, Sakarya University, Sakarya, Turkey
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Li Marzi V, Musco S, Lombardo R, Cicione A, Gemma L, Morselli S, Gallo ML, Serni S, Campi R, De Nunzio C. Prevalence of lower urinary tract symptoms in taxi drivers: a cross-sectional web-based survey. Prostate Cancer Prostatic Dis 2024; 27:283-287. [PMID: 38160226 DOI: 10.1038/s41391-023-00777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 11/23/2023] [Accepted: 12/06/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Aim of the study was to evaluate the prevalence of LUTS in taxi drivers. METHODS Between February 24th 2021 and March 26th 2021 a web based survey was administered to Taxi drivers in the city of Florence. Taxi drivers were evaluated with baseline characteristics such as: age, BMI, smoking, career length, comorbidities, and treatment. LUTS were evaluated using the international prostate symptom score (IPSS) and the overactive bladder (OAB) score. As well sexual function was evaluated using the international index erectile function (IIEF) and female sexual function index (FSFI) questionnaires. Risk factors for LUTS were evaluated using regression analysis. RESULTS The overall response rate was 64.6% (537/830 taxi drivers filled the questionnaires). Among them, 449 (83.6%) were men and 88 (16.4%) females. Overall, median IPSS was 5 (2/9) and median OAB score was 10 (7/14). On multivariate binary regression analysis age > 50 (OR:1.60; p < 0,05), Smoking (OR:1.57; p < 0,05), chronic treatment (OR:1.57; p < 0,05), recurrent cystitis (OR: 2.66; p < 0,05) and chronic pelvic pain (OR:4.94; p < 0,05) were independent risk factors for moderate/severe LUTS. On multivariate binary logistic regression analysis, risk factors for erectile dysfunction were age older than 50 years (OR = 3.64; p < 0.05) and urinary incontinence (OR = 5.53; p = 0.005). CONCLUSIONS According to our web-based survey, Taxi drivers in the metropolitan city of Florence had non-negligible symptomatic LUTS and even sexual dysfunction. Our data suggest as LUTS are particular influenced by several life-style and behavioural factors as type and duration of work.
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Affiliation(s)
- Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy.
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Stefania Musco
- Unit of Neuro-Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Lombardo
- Department of Urology, Ospedale Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Antonio Cicione
- Department of Urology, Ospedale Sant'Andrea, Sapienza University of Rome, Rome, Italy
| | - Luca Gemma
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Simone Morselli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Lucia Gallo
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cosimo De Nunzio
- Department of Urology, Ospedale Sant'Andrea, Sapienza University of Rome, Rome, Italy
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El-Tholoth HS, Alsulihem A. Bladder outflow obstruction in women: Clinical and basic evaluation. Neurourol Urodyn 2024. [PMID: 38197725 DOI: 10.1002/nau.25386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 11/07/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024]
Abstract
AIM Female bladder outflow obstruction is an underdiagnosed and undermanaged condition. This review article aims to illustrate the basic and clinical evaluation of patients who might have this condition. REVIEW Clinical evaluation includes clinical history, examination, and basic investigations, including uroflowmetry and postvoid residual, urinalysis and culture, renal function assessment, ultrasound of kidneys and bladder, voiding cystourethrography, and magnetic resonance imaging. Based on the initial evaluation, if the concern of obstruction is high, the clinician might undergo further advanced evaluation. CONCLUSION Basic evaluation is the initial step in the diagnosis of female bladder outflow obstruction, the clinician need to have a high index of suspicion and often further advanced evaluation is needed to confirm the diagnosis.
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Affiliation(s)
- Hossam S El-Tholoth
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ali Alsulihem
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Bouchard B, Campeau L. Bladder outlet obstruction in women: Scope of the problem and differential diagnosis. Neurourol Urodyn 2023. [PMID: 38108542 DOI: 10.1002/nau.25359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
INTRODUCTION The prevalence, formal definition, and diagnostic criteria of bladder outlet obstruction in owmen have not been clearly defined. METHODS This is a literature review of the definition of BOO in women, its prevalence, as well as its differential diagnosis. RESULTS The main causes of BOO in women are divided into functional and anatomic conditions. Functional etiologies include detrusor external sphincter dyssynergia, dysfunctional voiding, Fowler's syndrome, and primary bladder neck obstruction. Anatomic causes can be further divided into extrinsinc and intrinsic conditions. Intrinsic etiologies include urethral stricture and urethral diverticula, whereas extrinsic causes comprise pelvic organ prolapse, post anti-incontinence surgery, and Skene's gland cyst or abscess. CONCLUSIONS There are multiple etiologies to BOO in women, and this condition is most probably underdiagnosed, owing to a lack of consensus for a standard definition.
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Affiliation(s)
- Béatrice Bouchard
- Division of Urology, Université de Montréal, Montréal, Quebec, Canada
| | - Lysanne Campeau
- Department of Surgery, Division of Urology, Montreal Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Ali AA, Badreldin I. Recurrent urethral obstruction secondary to large vulval inclusion cyst: a remote complication of female genital mutilation: a case report. BMC Womens Health 2023; 23:495. [PMID: 37723436 PMCID: PMC10506292 DOI: 10.1186/s12905-023-02653-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/12/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Female genital mutilation/cutting (FGM/C) is a major public health problem, particularly in developing countries. CASE PRESENTATION The authors reported a case of 48-year old multiparous woman presented to Kassala Hospital, east Sudan, with recurrent urine retention resulting from urethral obstruction, which was caused by large vulval inclusion cyst. A traditional birth attendant circumcised her when she was 5 year old. Five years before her presentation the patient observed a painless swelling in her vulva, which was gradually increasing in size. She presented to the hospital with urine retention seeking medical care. Local examination showed a large cystic swelling originating in the circumcision line and covering the introitus. A diagnosis of inclusion cyst at the site of circumcision was made. The cyst was large enough causing bladder outlet obstruction and when the patient advised to tilt it away from the urethral orifice she passed urine without difficulties. The cyst was surgically removed by dissection along the lines of cleavage, which measured 10 × 9.2 cm and weighed 1.2 kg. CONCLUSION This case report indicates that FGM is a serious public health problem and there should an urgent intervention such as planned health education campaigns to end FGM practice.
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Affiliation(s)
- AbdelAziem A Ali
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kassala University, P.O. Box 496, Kassala, Sudan.
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Yoshiyama A, Tsujimura A, Hiramatsu I, Morino J, Anno Y, Kurosawa M, Kure A, Uesaka Y, Nozaki T, Shirai M, Kiuchi H, Horie S. Circadian Rhythm of Voided Volume, Maximum Flow Rate, and Voiding Time Evaluated by Toilet Uroflowmetry in Hospitalized Women With Nocturia. Urology 2023; 179:50-57. [PMID: 37353090 DOI: 10.1016/j.urology.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To clarify the circadian rhythm of urination in hospitalized women with nocturia measured by toilet uroflowmetry and its age-related change. METHODS We evaluated 2602 urinations of 58 female patients (age, 68.4 ± 15.2 years) who were hospitalized in our institution for urological disease. We assessed voided volume (VV) as averages of every hour by generalized linear mixed models with an identity link function to adjust for personal bias and age. Maximum flow rate and voiding time were analyzed by the same method after adjustment for age, personal bias, and VV. We also compared these circadian rhythms between women <70 and ≥70 years. RESULTS VVs in the nighttime were significantly higher than that from 06:00-07:00 (205.6 ± 11.7 ml). Maximum flow rates in the afternoon were significantly higher than that from 06:00-07:00 (18.8 ± 0.93 ml/sec). Voiding time showed no statistically significant difference between the values at any time of day and that from 06:00-07:00. We also showed that the circadian rhythm of VV becomes less clear in the elderly women (P interaction = .0057). However, no significant difference was found in the maximum flow rate and voiding time regarding the pattern of the circadian rhythm between women <70 and ≥70 years old. CONCLUSION The present study clearly showed a circadian rhythm of VV and maximum flow rate in hospitalized women with nocturia. In addition, the pattern of the circadian rhythm of VV was attenuated in women ≥70 years old.
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Affiliation(s)
- Azusa Yoshiyama
- Department of Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan; Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Akira Tsujimura
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan.
| | - Ippei Hiramatsu
- Department of Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan; Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Junki Morino
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Yuta Anno
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Makoto Kurosawa
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Akimasa Kure
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Yuka Uesaka
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Taiji Nozaki
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Masato Shirai
- Department of Urology, Juntendo University Urayasu Hospital, Urayasu, Chiba, Japan
| | - Hiroshi Kiuchi
- Osaka University Graduate School of Medicine Department of Urology, Suita, Osaka, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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Anderson DJ, Aucoin A, Toups CR, Cormier D, McDonald M, Hasoon J, Viswanath O, Kaye AD, Urits I. Lower Urinary Tract Symptoms in Depression: A Review. Health Psychol Res 2023; 11:81040. [PMID: 37465591 PMCID: PMC10351871 DOI: 10.52965/001c.81040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Lower Urinary Tract Symptoms (LUTS) are frequently present in the general population as patients age with approximately a third of individuals experiencing LUTS during their lifetime. LUTS can be further defined as having any of the following symptoms: urinary hesitancy, straining, nocturia, increased urination frequency, and dysuria. LUTS has the potential for patients to contribute their symptoms to what can normally occur as we age. This can lead to a decrease in patients seeking care and could negatively impact patients' health-related quality of life (HRQL). In conjunction with LUTS, we obtained from our analysis that LUTS and depression are closely related and worsening depressive symptoms may increase the severity of LUTS. We also discerned three categories of factors that can yield major depression namely adversity, internalizing, and externalizing factors. Within these categories, trauma, social support, genetic factors, and minimal education appeared to increase the risk of depression in patients. With the recent increase in mental health awareness and more access to mental health care amid the COVID-19 Pandemic, further screening, and collaboration between providers to treat both urological and psychiatric symptoms could improve patient outcomes. It is important for providers to have an increased understanding of the mental and physical impact both LUTS and depression can have on patients' wellbeing. This has the potential to help patients be more open about their symptoms with the aim of better addressing LUTS and depression to positively impact their HRQL.
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Affiliation(s)
| | - Alise Aucoin
- Department of Anesthesiology Louisiana State University Health
| | - Colton R Toups
- Department of Anesthesiology Louisiana State University Health
| | - Devin Cormier
- Department of Anesthesiology Louisiana State University Health
| | | | - Jamal Hasoon
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Alan D Kaye
- Department of Anesthesiology Louisiana State University Health
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Arevalo-Vega D, Ponce L, Valdevenito JP, Gallegos H, Dell'Oro A, Santis-Moya F, Calvo CI. Defining bladder outlet obstruction and detrusor underactivity in females with overactive bladder: Are we forgetting about the free uroflowmetry? Neurourol Urodyn 2023. [PMID: 37092803 DOI: 10.1002/nau.25188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 04/09/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION Both detrusor underactivity (DU) and bladder outlet obstruction (BOO) can coexist in patients with overactive bladder. Definitions of both DU and BOO are based on pressure-flow study (PFS) data. However, invasive urodynamics study can differ from a natural micturition, in fact, discrepancies between free uroflowmetry (UFM) and PFS have been largely described. Our goal is to assess the correlation of free-flowmetry and PFS among patients with OAB and to evaluate how different definitions of DU/BOO are able to discriminate patients with different free UFMs. METHODS A retrospective review of urodynamics performed at a single institution was conducted. Females with OAB who voided more than 150 mL in both UFM and PFS were included. Parameters from both voiding episodes were compared with nonparametric test. Two definitions of DU were applied; PIP1: Pdet@Qmax+Qmax < 30 and Gammie: Pdet@Qmax < 20 cmH2 O, Qmax < 15 mL/s, and BVE < 90% (Bladder voiding efficiency). Also, two definitions of obstruction were chosen; Defretias: Pdet@Qmax ≥25 cmH2 O and Qmax ≤ 12 mL/s and Solomon-Greenwell female BOO index ≥ 18. Patients who matched with each definition were compared to those who did not, to assess if any definitions were able to discriminate different noninvasive uroflowmetries. RESULTS A total of 195 patients were included. Overall, mean age was 55 ± 12 years, 90.8% had mixed urinary incontinence, and 39% complained of at least one voiding symptom. Globally, Qmax and BVE correlated poorly between UFM and PFS, showing that most of the variation corresponded to a systematic error. Twenty-two individuals were found to have DU, they had a difference of 13 mL/s on both maximum flows. Fifty-four patients showed BOO, with a difference between their Qmax of 19 mL/s. Among the four definitions analyzed, only PIP1 and Defreitas were able to discriminate patients with actually a lower Qmax on the free UFM. CONCLUSIONS Patients with overactive bladder seem to have a systematic discordance between the urine flow of the free and invasive studies. Current definitions of DU and BOO, which are based on the PFS parameters, are not consistently able to discriminate patients who actually void deficiently on the free UFM.
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Affiliation(s)
- Diego Arevalo-Vega
- Centro de Innovación en Piso Pélvico, Complejo asistencial Sótero del Rio, Santiago, Chile
| | - Lucas Ponce
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Héctor Gallegos
- Departamento de Urología, Complejo asistencial Sótero del Rio, Santiago, Chile
| | - Arturo Dell'Oro
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernanda Santis-Moya
- Centro de Innovación en Piso Pélvico, Complejo asistencial Sótero del Rio, Santiago, Chile
| | - Carlos Ignacio Calvo
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
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Bilé Silva A, Dinis PJ, Abranches Monteiro L. Systematic review of urinary biomarkers of female bladder outlet obstruction (fBOO). Arch Ital Urol Androl 2022; 94:355-359. [DOI: 10.4081/aiua.2022.3.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022] Open
Abstract
Objective: Diagnosis of bladder outlet obstruction (BOO) in females is often challenging, not only because of the overlap in storage and voiding symptoms in women with various etiologies of lower urinary tract (LUT) dysfunction but also due to the lack of standardized urodynamic criteria to define the condition. There is an unmet need of biologic markers to evaluate BOO in females as an adjunct to other clinical criteria. We sought to elucidate the role of urinary biomarkers in female BOO. Material and methods: We performed a systematic review of studies involving urinary biomarkers in female BOO. The search was performed in PubMed. A total of 58 papers were retrieved and 2 were included for final analysis.Results: Currently, there are no validated biologic markers for female BOO available. Having a biomarker that can be obtained through a urine sample will be an invaluable tool to evaluate and counsel patients with LUT symptoms and possible BOO. The use of NGF as an indicator of BOO in female patients seems to be promising: NGF levels are elevated in women with BOO when compared with normal controls. Conclusions: We found that NGF levels may be applied as a useful biomarker in the diagnosis and evaluation of female patients with BOO symptoms. It will not completely replace other clinical diagnostic tools such as formal urodynamic testing but play a role as a supplement to it. Nevertheless, further studies should be conducted to establish NGF levels as a female BOO biomarker and a routine testing modality.
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Peyronnet B, Lapitan MC, Tzelves L, O'Connor E, Nic An Riogh A, Manso M, Yuhong Yuan C, Arlandis S, Bo K, Costantini E, Farag F, Groen J, Nambiar A, Phé V, van der Vaart H, Imran Omar M, Harding C. Benefits and Harms of Conservative, Pharmacological, and Surgical Management Options for Women with Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel. Eur Urol Focus 2022; 8:1340-1361. [PMID: 34702649 DOI: 10.1016/j.euf.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/11/2021] [Accepted: 10/05/2021] [Indexed: 12/16/2022]
Abstract
CONTEXT While the management of bladder outlet obstruction (BOO) in men has been a topic of several systematic reviews and meta-analyses, no such evidence base exists for female BOO. OBJECTIVE The aim of this systematic review was to evaluate the benefits and harms of therapeutic interventions for the management of BOO in women. EVIDENCE ACQUISITION This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The study protocol was registered with PROSPERO (CRD42020183839). A systematic literature search was performed and updated by a research librarian in May 2021. The study population consisted of adult female patients diagnosed with BOO, who underwent treatment. EVIDENCE SYNTHESIS Out of 6344 records, we identified 33 studies enrolling 1222 participants, of which only six randomized controlled trials (RCTs) were found. One placebo-controlled crossover randomized trial assessed the role of baclofen in 60 female patients with dysfunctional voiding. The trial met its primary endpoint with a significantly greater decrease in the number of voids per day in the baclofen group (-5.53 vs -2.70; p = 0.001). The adverse events were mild and comparable in both groups (25% vs 20%). One placebo-controlled crossover randomized trial assessed the role of sildenafil in 20 women with Fowler's syndrome. There were significant improvements from baseline in maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual (PVR), but with no statistically significant difference when compared with placebo. In a large RCT including 197 female patients with functional BOO, the alpha-blocker alfuzosin significantly improved IPSS, Qmax, and PVR compared with baseline, but the differences were not statistically significant compared with the placebo group. Several small single-arm prospective series reported improvement of BOO-related symptoms and voiding parameters with urethroplasty, sling revision, urethral dilation, vaginal pessary, and pelvic organ prolapse repair. CONCLUSIONS Evidence to support the use of conservative, pharmacological, and surgical treatments for BOO is scarce. PATIENT SUMMARY According to the present systematic review of the literature, evidence to support the use of conservative, pharmacological, and surgical treatments for either anatomical or functional bladder outlet obstruction is scarce.
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Affiliation(s)
| | | | - Lazaros Tzelves
- Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | - Cathy Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Kari Bo
- Norwegian School of Sport Sciences, Department of Sports Medicine, Oslo and Akershus University Hospital, Lørenskog, Norway
| | | | | | - Jan Groen
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Véronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpetrière Academic Hospital, Sorbonne University, Paris, France
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11
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Defining Bladder Outlet Obstruction in Women. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00654-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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12
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Bladder Dysfunction in Older Adults: The Botulinum Toxin Option. Drugs Aging 2022; 39:401-416. [PMID: 35696022 DOI: 10.1007/s40266-022-00950-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/03/2022]
Abstract
Bladder dysfunction, which involves inadequacies of urine storage or emptying, increases with age. Conventional medications may have insufficient efficacy for patients with refractory lower urinary tract symptoms, and their concomitant adverse events (AEs) may be intolerable for the older adult population. For decades, the botulinum toxin type A (BoNT-A) injection has been an option for managing urine frequency, urge incontinence, and voiding dysfunction in the general population refractory to conventional management. This review focuses on studies of BoNT-A application in the management of bladder dysfunction in older adult patients aged ≥ 65 years. In this target population, intravesical BoNT-A injections provide similar efficacy in idiopathic overactive bladder to that in younger adults. Good clinical response has also been demonstrated in older adult patients presenting with storage dysfunction and with various concomitant underlying neurological diseases. However, caution must be taken for the AEs that occur after intravesical BoNT-A injection, including increased post-void residual urine, acute urine retention, and urinary tract infection. Most evidence shows that age is not a major determinant of AEs after adjusting for other factors. In contrast to its application in storage dysfunction, evidence for voiding dysfunction in older adults is scarce. In general, BoNT-A may be a reasonable option for older adult patients with refractory storage dysfunction because of its promising clinical response without significant systemic AEs. Overall, clinicians should be aware of the balance between the therapeutic efficacy of BoNT-A and local AEs in vulnerable members of this population.
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Identifying occult bladder outlet obstruction in women with detrusor-underactivity-like urodynamic profiles. Sci Rep 2021; 11:23242. [PMID: 34853346 PMCID: PMC8636520 DOI: 10.1038/s41598-021-02617-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/19/2021] [Indexed: 01/22/2023] Open
Abstract
Voiding dysfunction can result from detrusor underactivity (DU), bladder outlet obstruction (BOO), or both. Conceptually, women with high-pressure low-flow urodynamic profiles are diagnosed with BOO without DU. However, the possibility of BOO is often neglected in women with DU-like (low-pressure low-flow) urodynamic (UDS) profiles. By reviewing the videourodynamic studies (VUDS) of 1678 women, our study identified the key factors suggesting urodynamic BOO (determined by radiographic evidence of obstruction) in women with DU-like UDS profiles (Pdet.Qmax < 20 cmH2O and Qmax < 15 mL/s). In 355 women with DU-like UDS profiles, there were 70 (19.7%) with BOO and 285 (80.3%) without BOO. The BOO group had predominantly obstructive symptoms. The BOO group showed significantly decreased bladder sensation, lower detrusor pressure (Pdet.Qmax), lower flow rate (Qmax), smaller voided volume, and larger post-voiding residual (PVR) compared to the non-BOO group. In multivariate analysis, volume at first sensation, Qmax, PVR, and detrusor overactivity (DO) remained independent factors for BOO. The receiver operating characteristic (ROC) areas for the parameters were largest for PVR (area = 0.786) and Qmax (area = 0.742). The best cut-off points were 220 mL for PVR and 4 mL/s for Qmax. Our findings provide simple indicators for BOO in women with DU.
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Fang JJ, Wu MP, Yen YC, Wu JC, Chin HY. Overactive bladder syndrome is associated with detrusor overactivity and abnormal voiding pattern in nulliparous women. J Chin Med Assoc 2021; 84:865-869. [PMID: 34433190 DOI: 10.1097/jcma.0000000000000611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pregnancy and childbirth are frequently associated with overactive bladder syndrome (OAB). However, the role of parous effects in OAB among nulliparous (NP) women remains controversial. METHODS This study investigated abnormal voiding patterns and detrusor overactivity (DO) among NP women with OAB in comparison with parous women. From August 2011 to December 2018, 906 patients met the inclusion criteria for participation and were divided into three groups: 221 patients in the NP group, 571 patients in the normal spontaneous delivery (NSD) group, and 114 patients in the cesarean section (CS) group. Urodynamic study examinations were performed, and the presence of DO, abnormal voiding patterns, and maximum urethral closure pressure (MUCP) was recorded. Data were analyzed using analysis of variance, χ2 tests, and independent t tests. RESULTS Compared with parous women in the NSD and CS groups, patients in the NP group had a significantly higher prevalence of abnormal voiding patterns, DO, and MUCP. Furthermore, abnormal voiding patterns were significantly associated with DO and MUCP, respectively, especially in the NP group. CONCLUSION We hypothesized that hypertonicity or poor relaxation of the pelvic muscle in NP women may cause functional BOO, which is related to their OAB.
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Affiliation(s)
- Jessica Jay Fang
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Ming-Ping Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan and College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan, ROC
| | - Yu-Chun Yen
- Biostatistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan, ROC
| | - Jeng-Cheng Wu
- Department of Urology, Taipei Medical University Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Hung-Yen Chin
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, Taipei Country Hospital, Taipei, Taiwan, ROC
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Ou YC, Huang KH, Jan HC, Kuo HC, Kao YL, Tsai KJ. Therapeutic Efficacy of Urethral Sphincteric Botulinum Toxin Injections for Female Sphincter Dysfunctions and a Search for Predictive Factors. Toxins (Basel) 2021; 13:toxins13060398. [PMID: 34199493 PMCID: PMC8226632 DOI: 10.3390/toxins13060398] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/25/2021] [Accepted: 05/31/2021] [Indexed: 11/16/2022] Open
Abstract
External urethral sphincter (EUS) dysfunction is a common, bothersome female voiding dysfunction. This study aims to analyze the characteristics of different types of female EUS dysfunction, as well as to determine the outcome predictors of sphincteric botulinum toxin A (BoNT-A) injection. Women receiving sphincteric BoNT-A injections for refractory EUS dysfunction were retrospectively reviewed. A comparison of the baseline clinical, urodynamic parameters and the treatment responses were made for patients with different EUS dysfunctions. A total of 106 females were included. Significantly increased detrusor overactivity, detrusor contracting pressure and the bladder outlet obstruction index with decreased urge sensation were noted in patients diagnosed with dysfunctional voiding or detrusor sphincter dyssynergia comparing to those diagnosed with poor relaxation of the external urethral sphincter. The average subjective improvement rate was 67% for the injection. The therapeutic effect was not affected by the type of EUS dysfunction. The multivariate analysis revealed that bladder neck narrowing and catheterization history were predictive of negative outcomes. There is a distinct urodynamic presentation for each type of female EUS dysfunction. Sphincteric BoNT-A injection provides a good therapeutic outcome for refractory EUS dysfunction. A narrowing bladder neck and a history of catheterization suggest poor therapeutic outcomes.
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Affiliation(s)
- Yin-Chien Ou
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Kuan-Hsun Huang
- Department of Urology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 622, Taiwan;
| | - Hau-Chern Jan
- Division of Urology, Department of Surgery, National Cheng Kung University Hospital Dou-Liou Branch, Yunlin 640, Taiwan;
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien 970, Taiwan;
| | - Yao-Lin Kao
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Correspondence: (Y.-L.K.); (K.-J.T.)
| | - Kuen-Jer Tsai
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
- Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Correspondence: (Y.-L.K.); (K.-J.T.)
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Santis-Moya F, Calvo CI, Rojas T, Dell'Oro A, Baquedano P, Saavedra A. Urodynamic and clinical features in women with overactive bladder: When to suspect concomitant voiding dysfunction? Neurourol Urodyn 2021; 40:1509-1514. [PMID: 34036625 DOI: 10.1002/nau.24688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/08/2021] [Accepted: 04/20/2021] [Indexed: 12/27/2022]
Abstract
AIM The aim of this study is to describe the prevalence and type of female voiding dysfunction (FVD) in patients with overactive bladder (OAB) who were studied by urodynamics and its relationship with voiding symptoms. METHODS This is a cross-sectional study of female adult patients with OAB syndrome who underwent UDS in a University Hospital in Chile between January 2015 and April 2020. FVD was defined either as bladder outlet obstruction (BOO) or detrusor underactivity (DU). BOO was established if the Solomon-Greenwell BOO index was higher than 18. DU was diagnosed when the invasive maximum flow rate (Qmax) was ≤15 ml/sec, detrusor pressure at Qmax (Pdet@Qmax) was ≤20 cmH2 O and postvoid residual (PVR) was greater than 10%. Urodynamic data and clinical features were compared between groups. RESULTS Two hundred and ninety-nine UDS were selected and analyzed. Bladder outlet obstruction was diagnosed in 59 patients (19.7%), whereas DU was found in 10 patients (3.3%). In the multivariate analysis, the logistic regression to predict BOO demonstrated that night-time frequency, the presence of detrusor overactivity and a higher PVR were independent predictors of BOO. Instead, for DU, the only independent predictor was a smaller voided volume in the pressure-flow study. CONCLUSION Female voiding dysfunction was found in 23% of patients with overactive bladder. BOO is more frequent than DU, and should be suspected in patients with higher night-time frequency, presence of detrusor overactivity and a high PVR. Instead, DU should be suspected in patients with a smaller voided volume.
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Affiliation(s)
- Fernanda Santis-Moya
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos Ignacio Calvo
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tania Rojas
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Arturo Dell'Oro
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paulina Baquedano
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alvaro Saavedra
- Departamento de Urología, Pontificia Universidad Católica de Chile, Santiago, Chile.,Departamento de Urología, Clínica Alemana/Universidad del Desarrollo, Santiago, Chile
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Katiyar VK, Sood R, Sharma U, Goel HK, Gahlawat S, Desai DS. Critical Analysis of Outcome Between Ventral and Dorsal Onlay Urethroplasty In Female Urethral Stricture. Urology 2021; 157:79-84. [PMID: 34029605 DOI: 10.1016/j.urology.2021.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/24/2021] [Accepted: 05/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate and compare the 2 surgical approaches of urethral reconstruction for management of refractory female urethral strictures (FUS) in a prospective randomized setting. Early surgical reconstruction is becoming the preferred management strategy for recurrent FUS. Reconstructive techniques have been described as using either dorsal (12-o'clock) or ventral approach (6-o'clock), each with their own advantages. To our best knowledge, a direct comparison between the 2 techniques to prospectively compare outcomes hasn't been made. METHODS We performed a prospective randomized study in a single tertiary care center on a total of 24 patients, randomizing them into 2 groups of 12 patients each. One group underwent dorsal onlay and other underwent ventral onlay urethroplasty. Preoperative, intraoperative and postoperative outcomes were evaluated and compared for the 2 approaches. RESULTS There was high success rate (91%) with significant but comparable improvements in flow rates, post void residue and symptomatic outcomes without any major complication. There was 1 recurrence of stricture each in both groups. Important technical differences were noted with easier meatus preservation, lesser bleeding and wider operative field in the ventral approach, while the dorsal approach proving better in distal urethral strictures requiring meatal reconstruction. CONCLUSION Both approaches of urethroplasty present a very promising modality of management of FUS with comparable outcomes but with important technical differences which must be considered to best tailor the approach for each patient.
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Affiliation(s)
- Varun Kumar Katiyar
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Rajeev Sood
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Umesh Sharma
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Hemant Kumar Goel
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India.
| | - Sumit Gahlawat
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Dhaval Sagarbhai Desai
- Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
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Faure Walker N, Gall R, Gall N, Feuer J, Harvey H, Taylor C. The Postural Tachycardia Syndrome (PoTS) Bladder-Urodynamic Findings. Urology 2021; 153:107-112. [PMID: 33676954 DOI: 10.1016/j.urology.2021.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the urodynamics (UDS) of patients with postural tachycardia syndrome (PoTS). METHODS Patients with a confirmed diagnosis of PoTS referred by the department of neuro-cardiology to the neuro-urology were identified and their UDS were retrospectively reviewed. RESULTS In total, 50 patients (47 = 94.0% female) with confirmed PoTS and available UDS were identified. Mean age of females and males was 32.4 and 28.2 years, P = .15. Intermittent self-catheterisation was being used by 15/47 (31.9%) females at assessment. Detrusor overactivity was observed in 6 females (12.8%) (all at end fill and associated with urgency). In total, 14 (29.8%) females had no sensation of filling. No patients had an "unsafe" bladder. In total, 15/47 (31.9%) of women were unable to void with UDS catheters. Straining was reported in 22/35 (68.8%) of females. The female bladder outflow obstruction index = PDetQmax - 2.2(Qmax) was over 5 in 10/28 (35.7%) and over 18 in 5 (17.9%). The bladder contractility index = PDetQmax + 5Qmax was under 100 in 18/28 (28.6%) women. CONCLUSION The UDS of patients with "PoTS bladder" often demonstrate a poorly sensate but stable and safe bladder with functional obstruction and impaired bladder contractility that may necessitate straining or intermittent self-catheterisation.
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Affiliation(s)
| | - Robert Gall
- Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Nicholas Gall
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Jane Feuer
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Hannah Harvey
- King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Claire Taylor
- King's College Hospital NHS Foundation Trust, London, United Kingdom; Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
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19
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Jenks J. Voiding dysfunction and the experience of intermittent self-catheterisation. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:1314-1316. [PMID: 33325286 DOI: 10.12968/bjon.2020.29.22.1314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Julie Jenks
- Advanced Nurse Practitioner, University College London Hospitals NHS Foundation Trust
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20
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Sarin I, Narain TA, Panwar VK, Bhadoria AS, Goldman HB, Mittal A. Deciphering the enigma of female urethral strictures: A systematic review and meta-analysis of management modalities. Neurourol Urodyn 2020; 40:65-79. [PMID: 33617047 DOI: 10.1002/nau.24584] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the management methods of female urethral stricture (FUS) and analyze the outcomes of surgical treatments. A meta-analysis was done in an attempt to identify the best approach of urethroplasty and the graft-of-choice. MATERIALS AND METHODS A systematic search of Pubmed/Medline and Embase databases was performed according to the Preferred Reporting Items For Systematic Review And Meta-Analysis statement, for articles reporting on FUS management in the last decade. The Newcastle-Ottawa scale was used to assess the quality of 28 included non-randomized studies. The data on FUS management was summarized and pooled success rates (taken as symptom improvement and no need for further instrumentation) were compared. The secondary outcome was to establish a diagnostic modality of choice and define a "successful-outcome" of repair. RESULTS The outcome was separately reported for 554 women undergoing surgical intervention for FUS in the literature. The criteria defining FUS were varied. A combination of tests was used for diagnosis as none was singularly conclusive. A total of 301 patients had previous urethral instrumentations. The pooled success rate of urethral dilatation (234 women) was 49% at a mean follow-up of 32 months; flap urethroplasty (108 cases) was 92% at a mean follow-up of 42 months; buccal mucosal graft (BMG) urethroplasty (133 cases) was 89% at a mean follow-up of 19 months; vaginal graft augmentation (44 cases) was 87% at a mean follow-up of 15 months; and labial graft reconstruction (19 cases) was 89% at a mean follow-up of 18.4 months. The dorsal approach of graft augmentation met with 88% (95% confidence interval [CI] 0.79-0.95) success compared with 95% (95% CI 0.86-1) for the ventral approach. CONCLUSION FUS is a rare condition requiring a meticulous diagnostic workup using multiple tests. All urethroplasties have shown better pooled success rates (86%-93%) compared with dilatation (49%). BMG is equally effective as vaginal graft urethroplasty.
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Affiliation(s)
- Indira Sarin
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, India
| | - Tushar A Narain
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, India
| | - Vikas K Panwar
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, India
| | - Ajeet S Bhadoria
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Howard B Goldman
- Department of Urology, Glickman Urologic and Kidney Institute, Cleveland Clinic, Lerner College of Medicine, Cleveland, Ohio, USA
| | - Ankur Mittal
- Department of Urology, All India Institute of Medical Sciences, Rishikesh, India
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Verhovsky G, Rappaport YH, Baberashvili I, Neheman A, Zisman A, Stav K. Bladder outlet obstruction is associated with bladder oversensitivity in women. Int Urogynecol J 2020; 32:2771-2776. [PMID: 33084961 DOI: 10.1007/s00192-020-04561-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/02/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Bladder outlet obstruction (BOO) in women might be associated with significant lower urinary tract storage symptoms such as increased frequency, urgency, and incontinence. This prospective study was designed to assess whether there is an objective association between BOO and abnormal parameters during filling cystometry in women. METHODS A total of 169 consecutive women (mean age 56 ± 14 years) who were referred for urodynamic investigation were prospectively recruited. Comprehensive medical, obstetric, and gynecological histories were recorded. All patients underwent physical examination, renal and bladder ultrasound, and filled out the International Prostate Symptoms Score (IPSS) questionnaire. The cohort was divided into obstructed and un-obstructed groups based on pressure flow results (Obstruction: Qmax <12 ml/s and Pdet @ Qmax >25 cmH2O). RESULT There was no significant difference in the frequency of detrusor overactivity between the obstructed and non-obstructed group (37% vs 32%, p = 0.71). All bladder sensation volumes were significantly lower in obstructed women than non-obstructed women in univariate and multivariate logistic regression analyses. Of the sensation parameters, first desire to void (FDV) had the highest area under the curve (AUC = 0.75, 95% CI = 0.672-0.837, p < 0.001) for predicting BOO. FDV < 105 ml showed a strong association with BOO with OR = 9.84 (95% CI 4.122-23.508, p < 0.0001). On univariate and multivariate analyses adjusted to 50 cc reduction in sensation volume, all sensation parameters, were associated with bladder outlet obstruction. CONCLUSION Our results suggest that there might be a strong association between bladder oversensitivity and BOO in women. This may shed light on the pathophysiological connection between obstruction and enhanced afferent signaling from the bladder.
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Affiliation(s)
- Guy Verhovsky
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel.
| | - Yishai Hode Rappaport
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel
| | - Ilia Baberashvili
- Department of Nephrology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Neheman
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel
| | - Kobi Stav
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, Affiliated to the Sackler School of Medicine, Tel Aviv University, 7030000, Tel Aviv, Israel
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Understanding and Redefining the Role of Urodynamics in Pelvic Floor Disorders. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00591-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Méndez-Rubio S, López-Pérez E, Laso-Martín S, Vírseda-Chamorro M, Salinas-Casado J, Esteban-Fuertes M, Moreno-Sierra J. The role of clean intermittent catheterization in the treatment for detrusor underactivity. Actas Urol Esp 2020; 44:233-238. [PMID: 32151472 DOI: 10.1016/j.acuro.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/04/2019] [Accepted: 11/19/2019] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To study the influence of clean intermittent catheterization (CIC) on the lower urinary tract function in patients with urinary retention (UR) due to detrusor underactivity (DU). MATERIAL AND METHODS A longitudinal study was carried out on 49 patients (28 men, 21 women) of mean age 55years, who underwent CIC for UR secondary to DU. The mean CIC frequency was 3.15 times/day. Patients' clinical data were collected, and they underwent urodynamic study before and after CIC, with a mean interval of 4years. Fisher's exact test was used for the analysis of categorical variables and Student's t test for parametric variables. The level of significance was set at 0.05 for a two-tailed test. RESULTS The second urodynamic study showed a significantly increased bladder compliance, the Bladder Outlet Obstruction Index (BOOI) and the Bladder Contractility Index (BCI) also increased but without reaching statistical significance. There was a significantly higher percentage of benign prostatic hyperplasia (BPH) and acontractile detrusor cases among the group of patients whose BCI improved after CIC, with significantly lower CIC time. CONCLUSIONS CIC improved bladder compliance in the patients of our series. The BCI improved in BPH patients and in patients with acontractile detrusor.
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Lindsay J, Solomon E, Nadeem M, Pakzad M, Hamid R, Ockrim J, Greenwell T. Treatment validation of the Solomon-Greenwell nomogram for female bladder outlet obstruction. Neurourol Urodyn 2020; 39:1371-1377. [PMID: 32249980 DOI: 10.1002/nau.24347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/17/2020] [Indexed: 11/07/2022]
Abstract
AIM Bladder outflow in women (bladder outlet obstruction [BOO]) has no well-accepted defining diagnostic criteria. Various nomograms exist based on flow rates, pressure-flow data, and fluoroscopy. We have prospectively evaluated the Solomon-Greenwell bladder outflow obstruction nomogram (SG BOO nomogram) as a measurement of BOO resolution following targeted surgical intervention. METHODS The routine posttreatment urodynamics of 21 unselected women with an original urodynamic diagnosis of BOO on fluoroscopy and the SG BOO nomogram (BOO boundary defined as Qmax > 2.2 Pdet.Qmax + 5) were reviewed. All women had symptomatic BOO secondary to anterior pelvic organ prolapse (aPOP), urethrovaginal fistula (UVF), previous stress urinary incontinence (SUI) surgery, urethral stricture (US), or urethral diverticulum (U Div). Following treatment, all presenting symptoms resolved and simple urodynamics were performed as part of routine follow-up. RESULTS The urodynamic findings preoperatively and postoperatively showed statistically significant changes posttreatment in mean flow rate which increased from 9.38 to 14.71 mL/s, mean Pdet.Qmax which decreased from 38 to 18.38 cmH2 O, and mean SG BOO nomogram probability (PBOO) which reduced from PBOO = 0.68 to 0.08. Mean SG BOO nomogram PBOO was significantly reduced posttreatment in all individual categories except UVF where a nonsignificant reduction from PBOO = 0.55 to 0.05 occurred. CONCLUSIONS All urodynamic parameters significantly improve in women who become asymptomatic following surgical treatment of BOO. This improvement is best demonstrated by the change in probability of BOO according to the Solomon-Greenwell nomogram. These findings underline the validity of the Solomon-Greenwell female BOO nomogram for diagnosing and monitoring BOO in women.
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Affiliation(s)
- Jamie Lindsay
- Department of Female, Functional and Restorative Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Eskinder Solomon
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mehwash Nadeem
- Department of Female, Functional and Restorative Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mahreen Pakzad
- Department of Female, Functional and Restorative Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rizwan Hamid
- Department of Female, Functional and Restorative Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jeremy Ockrim
- Department of Female, Functional and Restorative Urology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tamsin Greenwell
- Department of Female, Functional and Restorative Urology, University College London Hospitals NHS Foundation Trust, London, UK
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