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Webb K, de Rijk MM, Gajewski JB, Kanai AJ, Perrouin-Verbe MA, van Koeveringe G, Wyndaele JJ, Drake MJ. Developing new ways to assess neural control of pelvic organ function in spinal conditions: ICI-RS 2023. Neurourol Urodyn 2023. [PMID: 38048095 DOI: 10.1002/nau.25347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVES Several central nervous system (CNS) centers affect muscle groups of the lower urinary tract (LUT) and anorectal tract (ART) via autonomic and somatic pathways, working in different modes (storage or expulsion). Hence spinal cord dysfunction can affect the LUT and ART by several possible mechanisms. METHODS This review reports the discussions of a workshop at the 2023 meeting of the International Consultation on Incontinence Research Society, which reviewed uncertainties and research priorities of spinal dysfunction. RESULTS Discussion focussed on the levator ani nerve, mechanisms underpinning sensory function and sensation, functional imaging, dyssynergia, and experimental models. The following key research questions were identified. (1) Clinically, how can we evaluate the levator ani muscle to support assessment and identify prognosis for effective treatment selection? (2) How can we reliably measure levator ani tone? (3) How can we evaluate sensory information and sensation for the LUT and the ART? (4) What is the role of functional CNS imaging in development of scientific insights and clinical evaluation? (5) What is the relationship of detrusor sphincter dyssynergia to renal failure? CONCLUSIONS Spinal cord dysfunction can fundamentally disrupt LUT and ART function, with considerable clinical impact. The evaluation needs to reflect the full scope of potential problems, and new clinical and diagnostic approaches are needed, for prognosis and treatment. The preclinical science evaluating spinal cord function in both LUT and ART storage and elimination remains a major priority, even though it is a challenging experimental context. Without this underpinning evidence, development of new clinical evidence may be held back.
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Affiliation(s)
- Katie Webb
- Physiotherapy Department, Imperial College Healthcare Trust, St Mary's Hospital, London, UK
| | - Mathijs M de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anthony J Kanai
- Departments of Medicine-Renal-Electrolyte Division, and Pharmacology & Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Gommert van Koeveringe
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Marcus J Drake
- Department of Surgery and Cancer, Imperial College, London, UK
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2
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Bodmer NS, Wirth C, Birkhäuser V, Sartori AM, Leitner L, Averbeck MA, de Wachter S, Finazzi Agro E, Gammie A, Goldman HB, Kirschner-Hermanns R, F.W.M. Rosier P, Serati M, Solomon E, van Koeveringe G, Bachmann LM, Kessler TM. Randomised Controlled Trials Assessing the Clinical Value of Urodynamic Studies: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2022; 44:131-141. [PMID: 36110903 PMCID: PMC9469658 DOI: 10.1016/j.euros.2022.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2022] [Indexed: 11/18/2022] Open
Abstract
Context The role of urodynamic studies (UDSs) in the diagnosis of lower urinary tract symptoms (LUTS) is crucial. Although expert statements and guidelines underline their value for clinical decision-making in various clinical settings, the academic debate as to their impact on patient outcomes continues. Objective To summarise the evidence from all randomised controlled trials assessing the clinical usefulness of UDS in the management of LUTS. Evidence acquisition For this systematic review, searches were performed without language restrictions in three electronic databases until November 18, 2020. The inclusion criteria were randomised controlled study design and allocation to receive UDS or not prior to any clinical management. Quality assessment was performed by two reviewers independently, using the Cochrane Collaboration’s tool for assessing the risk of bias. A random-effect meta-analysis was performed on the uniformly reported outcome parameters. Evidence synthesis Eight trials were included, and all but two focused on women with pure or predominant stress urinary incontinence (SUI). A meta-analysis of six studies including 942 female patients was possible for treatment success, as defined by the authors (relative risk 1.00, 95% confidence interval: 0.93–1.07), indicating no difference in efficacy when managing women with UDS. Conclusions Although UDSs are not replaceable in diagnostics, since there is no other equivalent method to find out exactly what the lower urinary tract problem is, there are little data supporting its impact on outcomes. Randomised controlled trials have focussed on a small group of women with uncomplicated SUI and showed no added value, but these findings cannot be extrapolated to the overall patient population with LUTS, warranting further well-designed trials. Patient summary Despite urodynamics being the gold standard to assess lower urinary tract symptoms (LUTS), as it is the only method that can specify lower urinary tract dysfunction, more studies assessing the clinical usefulness of urodynamic studies (UDSs) in the management of LUTS are needed. UDS investigation is not increasing the probability of success in the treatment of stress urinary incontinence.
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van Knippenberg V, Leue C, Vrijens D, van Koeveringe G. Multidisciplinary treatment for functional urological disorders with psychosomatic comorbidity in a tertiary pelvic care center-A retrospective cohort study. Neurourol Urodyn 2022; 41:1012-1024. [PMID: 35347764 PMCID: PMC9313828 DOI: 10.1002/nau.24917] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/23/2022] [Accepted: 02/21/2022] [Indexed: 11/08/2022]
Abstract
Background Functional urological disorders are highly prevalent, frequently interrelated, and characterized by a chronic course and considerable treatment resistance. From our point of view, poor treatment outcomes are often attributable to underlying but undetected mental disorders. Objective To investigate the effect of integrated outpatient care by a urologist and a psychiatrist on the symptomatology of patients with functional urological disorders in a tertiary referral Pelvic Care Centre. Setting Retrospective observational cohort study in functional urological disorders in combination with psychosomatic co‐morbidity. When treatment by a urologist alone was not sufficient, the suitability for a multidisciplinary approach was considered i) if there was a susceptibility for psychiatric comorbidity, ii) if diagnostic procedures did not reveal a treatable somatic cause, or iii) if multiple failed somatic treatments did not relieve complaints. Patients underwent urological treatments before, without reduction of complaints, no treatable somatic cause could be found after diagnostic procedures; or patients suffered from psychiatric comorbidity. Method Outcome was measured using patient global impression of improvement, hospitality anxiety and depression scale (HADS), global assessment of functioning (GAF), and a health consumption questionnaire. Results A significant reduction in HADS‐depression score was found (p = 0.001) after multidisciplinary treatment. The GAF score increased from 61 to 80, leading to no more than slight impairment in social, occupational, or school functioning. Patients reported their situation as better in comparison with before multidisciplinary treatment. An association was found between pelvic pain and anxiety (p = 0.032) and panic disorder (p = 0.040). Psychological trauma was found to be associated with depression (p = 0.044), with an odds ratio of 2.93 (1.01–8.50). Psychological trauma coincided in 62.3% of patients with urological pain syndromes and in 83.3% with pelvic pain. Conclusion Overall results indicate that functional urological patients, previously refractory to urological treatment, benefit from an integrated care approach by urologists and psychiatrists. Explanation about the bladder–brain axis and the alarm falsification model enlightens understanding of urological and psychological contributions to functional syndromes and creates an opportunity for integrated care.
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Affiliation(s)
- Vera van Knippenberg
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Carsten Leue
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Division Translational Neuroscience, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience (MeHNs), Maastricht University, Maastricht, The Netherlands
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Division Translational Neuroscience, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience (MeHNs), Maastricht University, Maastricht, The Netherlands
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Division Translational Neuroscience, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience (MeHNs), Maastricht University, Maastricht, The Netherlands
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4
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von Gontard A, Mattheus H, Friese-Jaworsky J, Moritz AM, Thome-Granz S, Roozen S, Curfs L, van Koeveringe G, Hussong J. Incontinence and sleep disturbances in young children: A population-based study. Neurourol Urodyn 2022; 41:633-642. [PMID: 34989456 PMCID: PMC9306626 DOI: 10.1002/nau.24866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/21/2021] [Accepted: 12/06/2021] [Indexed: 11/11/2022]
Abstract
Aims Nocturnal enuresis (NE), daytime urinary incontinence (DUI), fecal incontinence (FI), as well as sleep and behavioral problems are common in young children. The aim of this study was to analyze the association of sleep and psychological parameters for all types of incontinence in a representative sample of young children. Methods Six hundred thirty eight (of 1161) children with a mean age of 5.9 years (50.9% boys) were assessed during their mandatory school entry examination. The participation rate was 55%. Instruments included the Strengths and Difficulties Questionnaire, the Children's Sleep Habits Questionnaire and other clinical questions. Incontinence was diagnosed according to ICCS standards. Constipation was assessed by two questions. Results 17.1% of children had at least one type of incontinence, 14.8% had NE, 5.0% DUI, 2.1% FI, and 4.8% were constipated. 6.7% of children had clinically relevant psychological problems. 22.7% of children had sleep problems regularly (5−7 times/week). A wide variety of sleep problems were reported. Children with incontinence were not affected by a higher rate of sleep problems. Children with NE had fewer night wakings and those with constipation fewer parasomnias. Sleep and psychological problems were significantly associated, especially in children with DUI and FI. Conclusions Sleep and behavioral problems are common in young children. Psychological problems have a clear impact on sleep. Young children with incontinence do not have more sleep problems than continent children. Therefore, both sleep and psychological problems should be addressed in young children with incontinence.
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Affiliation(s)
- Alexander von Gontard
- Department of Urology, Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.,Outpatient Services for Child and Adolescent Psychiatry, Psychiatric Services Graubünden (PDGR), Chur, Switzerland
| | - Hannah Mattheus
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Jana Friese-Jaworsky
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | | | | | - Sylvia Roozen
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Leopold Curfs
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Gommert van Koeveringe
- Department of Urology, Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Justine Hussong
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
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5
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van Barneveld E, Lim A, van Hanegem N, Vork L, Herrewegh A, van Poll M, Manders J, van Osch F, Spaans W, van Koeveringe G, Vrijens D, Kruimel J, Bongers M, Leue C. Patient-Reported Outcome Measure for Real-time Symptom Assessment in Women With Endometriosis: Focus Group Study. JMIR Form Res 2021; 5:e28782. [PMID: 34870608 PMCID: PMC8686475 DOI: 10.2196/28782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/22/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Symptoms related to endometriosis have a significant impact on the quality of life, and symptoms often recur. The experience sampling method (ESM), a digital questioning method characterized by randomly repeated momentary assessments, has several advantages over traditionally used measurements, including the ability to assess the temporal relationship between variables such as physical, mental, and social factors. OBJECTIVE The aim of this study is to develop an ESM tool for patients with endometriosis to accurately measure symptoms and their course over time, allowing for personalized treatment and adequate monitoring of treatment efficacy in individual patients. METHODS On the basis of international guidelines, items from validated questionnaires were selected through a literature review and during focus groups and multidisciplinary expert meetings. Data analysis was conducted using ATLAS.ti (ATLAS.ti Scientific Software Development GmbH). The feasibility and usability of the newly developed momentary assessment tool were tested for 28 consecutive days in 5 patients with endometriosis-related pain symptoms. RESULTS Momentary assessment items contained questions concerning endometriosis symptoms, general somatic symptoms, psychological symptoms, contextual information, and the use of food and medication. A morning questionnaire on sleep and sexuality was included. In a pilot study, the patients considered the tool easy to use but time consuming. The average compliance rate of momentary assessments was 37.8% (106/280), with the highest completion rate during the first week (39/70, 56%). Therefore, it is advisable to use the ESM for a maximum of 7 days. CONCLUSIONS A new digital tool for endometriosis symptom assessment was developed using the ESM, which may help overcome the limitations of current retrospective questionnaires. After validation and testing, future studies will be planned to evaluate the use of this tool in a clinical setting in order to propose a personalized treatment plan for women with endometriosis.
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Affiliation(s)
- Esther van Barneveld
- Department of Gynaecology and Obstetrics, Maastricht University Medical Centre+, Maastricht, Netherlands
| | - Arianne Lim
- Department of Gynaecology and Obstetrics, Maastricht University Medical Centre+, Maastricht, Netherlands.,Grow School of Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Nehalennia van Hanegem
- Department of Gynaecology and Obstetrics, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Lisa Vork
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Alexandra Herrewegh
- Department of Urology, Maastricht University Medical Centre+, Maastricht, Netherlands.,School for Mental Health and Neuroscience (MeHNS), Maastricht University, Maastricht, Netherlands
| | | | | | - Frits van Osch
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands.,Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, Netherlands
| | - Wilbert Spaans
- Department of Gynaecology and Obstetrics, Maastricht University Medical Centre+, Maastricht, Netherlands.,Grow School of Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre+, Maastricht, Netherlands.,School for Mental Health and Neuroscience (MeHNS), Maastricht University, Maastricht, Netherlands
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre+, Maastricht, Netherlands.,School for Mental Health and Neuroscience (MeHNS), Maastricht University, Maastricht, Netherlands
| | - Joanna Kruimel
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Centre+, Maastricht, Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Marlies Bongers
- Department of Gynaecology and Obstetrics, Maastricht University Medical Centre+, Maastricht, Netherlands.,Grow School of Oncology and Developmental Biology, Maastricht University, Maastricht, Netherlands.,Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, Netherlands
| | - Carsten Leue
- School for Mental Health and Neuroscience (MeHNS), Maastricht University, Maastricht, Netherlands.,Department of Psychiatry and Psychology, Maastricht University Medical Centre+, Maastricht, Netherlands
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6
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Jairam R, Drossaerts J, Marcelissen T, van Koeveringe G, Vrijens D, van Kerrebroeck P. Predictive Factors in Sacral Neuromodulation: A Systematic Review. Urol Int 2021; 106:323-343. [PMID: 34058731 DOI: 10.1159/000513937] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Sacral neuromodulation (SNM) is an effective treatment in patients with overactive bladder syndrome or nonobstructive urinary retention when conservative treatment fails. Several factors that could impact outcome with SNM have been studied. This systematic review investigated these predictive factors and their relevance for clinical practice. METHODS Systematic review according to the PRISMA guidelines was conducted. This review is registered in the PROSPERO register (CRD42015016256). RESULTS Seventy-eight studies (of which 11 abstracts) were included. Females, younger patients, and a tined lead procedure tend to be predictive in successful SNM outcome. Factors that did not influence SNM outcome were prior back surgery, surgery for stress urinary incontinence, affective symptoms, and duration of complaints. Reduced detrusor contractility is associated with a lower success rate. The level of evidence of most studies (graded according to the Centre for Evidence-Based Medicine) was 3b. CONCLUSION Even though this systematic review investigated predictive factors (gender, age, type of procedure, type of lead, and detrusor contractility), no general consensus on predictive factors could be made. Most studies are small, retrospective, and involve a heterogeneous population. Therefore, prospective research in larger specific patient groups remains necessary to find predictors of SNM outcome.
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Affiliation(s)
- Ranjana Jairam
- Department of Urology, Maastricht University Medical Centre (MUMC+), Mastricht, The Netherlands
| | - Jamie Drossaerts
- Department of Urology, Maastricht University Medical Centre (MUMC+), Mastricht, The Netherlands
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre (MUMC+), Mastricht, The Netherlands
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre (MUMC+), Mastricht, The Netherlands.,Pelvic Care Centre Maastricht, Maastricht University Medical Centre (MUMC+), Mastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre (MUMC+), Mastricht, The Netherlands.,Pelvic Care Centre Maastricht, Maastricht University Medical Centre (MUMC+), Mastricht, The Netherlands
| | - Philip van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre (MUMC+), Mastricht, The Netherlands.,Pelvic Care Centre Maastricht, Maastricht University Medical Centre (MUMC+), Mastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
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7
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De Nunzio C, Brucker B, Bschleipfer T, Cornu JN, Drake MJ, Fusco F, Gravas S, Oelke M, Peyronnet B, Tutolo M, van Koeveringe G, Madersbacher S. Reply to Satoshi Funada, Takashi Yoshioka, and Yan Luo's Letter to the Editor re: Cosimo De Nunzio, Benjamin Brucker, Thomas Bschleipfer, et al. Beyond Antimuscarinics: A Review of Pharmacological and Interventional Options for Overactive Bladder Management in Men. Eur Urol 2021;79:492-504. Eur Urol 2021; 79:e147-e148. [PMID: 33685837 DOI: 10.1016/j.eururo.2021.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Cosimo De Nunzio
- Urology Unit, Ospedale Sant'Andrea, Sapienza University of Rome, Rome, Italy.
| | | | - Thomas Bschleipfer
- Clinic for Urology, Andrology and Pediatric Urology, Clinics of Nordoberpfalz AG, Weiden, Germany
| | - Jean-Nicolas Cornu
- Urology Department, Charles Nicolle University Hospital, University of Rouen, Rouen, France
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Ferdinando Fusco
- Urology Unit, University of Campania L. Vanvitelli, Naples, Italy
| | - Stavros Gravas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Matthias Oelke
- Department of Urology, Pediatric Urology & Urological Oncology, St. Antonius Hospital, Gronau, Germany
| | | | - Manuela Tutolo
- Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stephan Madersbacher
- Department of Urology, Clinic Favoriten and Sigmund Freud Private University, Vienna, Austria
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8
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De Nunzio C, Brucker B, Bschleipfer T, Cornu JN, Drake MJ, Fusco F, Gravas S, Oelke M, Peyronnet B, Tutolo M, van Koeveringe G, Madersbacher S. Beyond Antimuscarinics: A Review of Pharmacological and Interventional Options for Overactive Bladder Management in Men. Eur Urol 2021; 79:492-504. [PMID: 33402296 DOI: 10.1016/j.eururo.2020.12.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/17/2020] [Indexed: 12/20/2022]
Abstract
CONTEXT The role of overactive bladder (OAB) treatment in women beyond antimuscarinics has been evaluated extensively. Beta-3 agonists, botulinum toxin-A (BTX-A), and nerve stimulation are indicated in these patients. However, data on male patients in this clinical scenario are scarce. OBJECTIVE The aim of this systematic review was to evaluate the evidence on treatment options beyond antimuscarinics in men with OAB. EVIDENCE ACQUISITION A search of PubMed, EMBASE, Scopus, Web of science, Cochrane Central Register of Controlled Trials, and Cochrane Central Database of Systematic Reviews databases was performed for relevant articles published between January 2000 and October 2020, using the following Medical Subject Headings: "male/man," "LUTS," "overactive bladder," "storage symptoms," "urgency," "nocturia," "incontinence," "beta-3 agonist," "PDE-5 inhibitors," "botulinum toxin," "sacral nerve stimulation/neurostimulation," "percutaneous/transcutaneous tibial nerve stimulation," "PTENS," and "combination therapy." Evidence acquisition was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. PROSPERO registration number is CRD42020201223. EVIDENCE SYNTHESIS Overall, 24 studies were retrieved. In male OAB, mirabegron (MIRA) is the most intensively investigated pharmacological option. A pooled analysis of five randomized clinical trials (RCTs), including 1187 patients, concluded that MIRA 50 mg was associated with a greater reduction in frequency versus placebo (-0.37, 95% confidence interval [CI]: -0.74, -0.01, p < 0.05). A pooled analysis of three RCTs, including 1317 male patients, has also shown that the addition of MIRA 50 mg in men receiving the α1-blocker tamsulosin improved the mean number of micturitions per day (-0.27, 95% CI: -0.46 to -0.09, p < 0.05), urgency episodes (-0.50, 95% CI: -0.77 to -0.22, p < 0.05), total OAB symptom score (-0.66, 95% CI: -1.00 to -0.38, p < 0.05), and mean volume voided (+10.76 ml, 95% CI: 4.87-16.64, p < 0.05). MIRA treatment is well tolerated in men. Other pharmacological treatment options, such as phosphodiesterase-5 (PDE-5) inhibitors, should be considered investigational. BTX-A seems to be effective as third-line treatment in male OAB patients. A higher rate of intermittent self-catheterization (5-42%) is observed in male than in female patients. Data on nerve stimulation are scarce. CONCLUSIONS MIRA has the most robust data in terms of safety and efficacy in this patient population. Preliminary data in men suggest that BTX-A is indicated as an interventional treatment. Evidence for PDE-5 inhibitors and nerve stimulation is too limited to provide recommendations. Future studies in this population should aim to better define the best treatment sequence and to identify predictors for treatment response and failure, to determine a therapeutic approach tailored to patients' characteristics. PATIENT SUMMARY Overactive bladder is highly prevalent in men. Mirabegron 50 mg is the treatment option supported by the highest level of evidence when antimuscarinics failed. Botulinum toxin A injections seems to be an effective treatment as interventional option. Roles of nerve stimulation and phosphodiesterase inhibitors in male OAB patients are still to be defined.
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Affiliation(s)
- Cosimo De Nunzio
- Urology Unit, Ospedale Sant'Andrea, Sapienza University of Rome, Rome, Italy.
| | | | - Thomas Bschleipfer
- Clinic for Urology, Andrology and Pediatric Urology, Clinics of Nordoberpfalz AG, Weiden, Germany
| | - Jean-Nicolas Cornu
- Urology Department, Charles Nicolle University Hospital, University of Rouen F-76000, Rouen, France
| | - Marcus J Drake
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Bristol Urological Institute, North Bristol NHS Trust, Bristol, UK
| | - Ferdinando Fusco
- Urology Unit, University of Campania L. Vanvitelli, Naples, Italy
| | - Stavros Gravas
- Department of Urology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Matthias Oelke
- Department of Urology, Pediatric Urology & Urological Oncology, St. Antonius Hospital, Gronau, Germany
| | | | - Manuela Tutolo
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stephan Madersbacher
- Department of Urology, Clinic Favoriten and Sigmund Freud Private University, Vienna, Austria
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9
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Bels J, de Vries P, de Beij J, Marcelissen T, van Koeveringe G, Rademakers K. Long-term Follow-up of Intravesical Onabotulinum Toxin-A Injections in Male Patients with Idiopathic Overactive Bladder: Comparing Surgery-naïve Patients and Patients After Prostate Surgery. Eur Urol Focus 2020; 7:1424-1429. [PMID: 32919951 DOI: 10.1016/j.euf.2020.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 08/06/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence regarding long-term results in male idiopathic overactive bladder (iOAB) patients is limited and rarely focuses on the effects of prior prostatic surgery. OBJECTIVE This study aims to identify the long-term treatment persistency and occurrence of adverse events of intravesical onabotulinum toxin-A (BoNT-A) injections in male iOAB patients after prostatic surgery (ie, transurethral resection of the prostate [TURP] or radical prostatectomy [RP]) compared with surgery-naïve patients. DESIGN, SETTING, AND PARTICIPANTS In this retrospective, single-centre study, data from 477 patients treated with intravesical BoNT-A injections were collected. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcome data of 120 male patients with iOAB, with collectively 207 BoNT-A injections, were analysed and presented in this study. RESULTS AND LIMITATIONS At the last point of follow-up, 35 patients (29.2%) were still on active treatment. Twenty patients (16.7%) required de novo clean intermittent self-catheterisation (CISC). Three groups were identified: 56 patients without prostate surgery, 40 patients with TURP, and 24 patients with RP prior to treatment. Discontinuation rates and patient-reported outcomes of BoNT-A treatment (none, insufficient, or satisfactory) were similar, but a significant difference was seen in de novo CISC (p=0.004): 28.6% in the group without prior surgery, 7.5% in the TURP subgroup, and 4.2% in the RP subgroup. Odds of de novo CISC was significantly higher for the group without prior surgery than for both the TURP subgroup (odds ratio [OR] 4.9; 95% confidence interval [CI]: 1.33-18.31; p=0.017) and the RP subgroup (OR 9.2; 95% CI: 1.14-73.96; p= 0.037). CONCLUSIONS The data of this retrospective, single-centre cohort suggest that BoNT-A treatment leads to lower CISC rates in male patients after prior desobstructive surgery than in surgery-naïve patients. PATIENT SUMMARY This study describes the results of onabotulinum toxin-A (BoNT-A) injections in the bladder of male patients with idiopathic overactive bladder after initial prostate surgery compared with surgery-naïve patients. The results showed that BoNT-A treatment leads to lower catheterisation rates in patients after prior prostate surgery than in men without prior prostate surgery.
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Affiliation(s)
- Julia Bels
- Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands.
| | - Peter de Vries
- Department of Urology, Zuyderland Medisch Centrum, Sittard/Heerlen, The Netherlands
| | - Jeltje de Beij
- Department of Urology, Zuyderland Medisch Centrum, Sittard/Heerlen, The Netherlands
| | - Tom Marcelissen
- Department of Urology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Gommert van Koeveringe
- Department of Urology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Kevin Rademakers
- Department of Urology, Zuyderland Medisch Centrum, Sittard/Heerlen, The Netherlands
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10
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von Gontard A, Vrijens D, Selai C, Mosiello G, Panicker J, van Koeveringe G, Apostolidis A, Anding R. Are psychological comorbidities important in the aetiology of lower urinary tract dysfunction-ICI-RS 2018? Neurourol Urodyn 2019; 38 Suppl 5:S8-S17. [PMID: 31059602 DOI: 10.1002/nau.24016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/10/2019] [Accepted: 04/11/2019] [Indexed: 12/19/2022]
Abstract
AIMS To review studies on the comorbid psychological symptoms and disorders in patients with lower urinary tract disorders (LUTD) over the life-span, to analyse how they contribute toward the aetiology of LUTD and to discuss optimal service implementation. MATERIALS AND METHODS A review of relevant literature was conducted and presented during the ICI-RS meeting in 2018. Open questions and future directions were discussed. RESULTS On the basis of current research, there is overwhelming evidence in all age groups that psychological comorbidities are more common in patients with LUTD. Vice versa, patients with psychiatric disorders have higher rates of LUTD. The types of LUTDs and psychiatric disorders are heterogeneous. Complex aetiological models best explain specific associations of comorbidity. Irrespective of aetiology, it is advisable to address both urological and psychological issues in patients of all age groups with LUTD. CONCLUSIONS Psychological symptoms and disorders play a decisive role in the development of LUTD in all age groups and need to be considered in the assessment and treatment of LUTD.
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Affiliation(s)
- Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Caroline Selai
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Giovanni Mosiello
- Department of Surgery, Urology and Neuro-Urology, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Jalesh Panicker
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Apostolos Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ralf Anding
- Department of Urology, Pediatric Urology and Neuro-Urology, University Hospital Bonn, Bonn, Germany
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11
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Drossaerts J, Rademakers KLJ, Rahnama'i SM, Marcelissen T, Van Kerrebroeck P, van Koeveringe G. The Value of Ambulatory Urodynamics in the Evaluation of Treatment Effect of Sacral Neuromodulation. Urol Int 2019; 102:299-305. [PMID: 30612126 DOI: 10.1159/000493988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/21/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the improvement of symptoms by sacral neuromodulation (SNM) in an objective way by carrying out an ambulatory urodynamic study (ambulatory-UDS). Until now, successful treatment has been defined as a ≥50% improvement recorded on voiding diaries. Voiding diaries are a patient reported outcome tool. A tool with less bias is desired to evaluate the treatment results before an expensive permanent system is implanted. METHODS Between 2002 and 2015, a total of 334 patients with lower urinary tract symptoms were included consecutively in an ambulatory-UDS database. From this database, a subgroup of patients was selected which underwent SNM. RESULTS In 51 patients, an ambulatory-UDS was performed both at baseline and during the SNM test period. A positive treatment outcome after test stimulation based on the patients' voiding diary, correlated (p < 0.0001) with an improvement on ambulatory-UDS. Twenty-six of the 30 patients, who have showed improvement of more than 50% on voiding diary parameters and who had subjective improvement of their symptoms, showed an early improvement on ambulatory-UDS. CONCLUSIONS Ambulatory-UDS can be used in clinical decision making, as it is associated with voiding diary improvement during the SNM test period. Using ambulatory-UDS to confirm success could in the future justify the shortening of the test period.
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Affiliation(s)
- Jamie Drossaerts
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands, .,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands,
| | - Kevin L J Rademakers
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Sajjad M Rahnama'i
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.,Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
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12
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Chapple CR, Osman NI, Birder L, Dmochowski R, Drake MJ, van Koeveringe G, Nitti VW, Oelke M, Smith PP, Yamaguchi O, Wein A, Abrams P. Terminology report from the International Continence Society (ICS) Working Group on Underactive Bladder (UAB). Neurourol Urodyn 2018; 37:2928-2931. [DOI: 10.1002/nau.23701] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/05/2018] [Indexed: 11/07/2022]
Affiliation(s)
| | - Nadir I. Osman
- Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield United Kingdom
| | - Lori Birder
- Pittsburgh University; Pittsburgh Pennsylvania
| | | | - Marcus J. Drake
- University of Bristol and Bristol Urological Institute; Bristol United Kingdom
| | | | | | | | | | | | - Alan Wein
- University of Philadelphia; Philadelphia Pennsylvania
| | - Paul Abrams
- Bristol Urological Institute; Bristol United Kingdom
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13
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Herrewegh A, Vork L, Eurelings E, Leue C, Kruimel J, van Koeveringe G, Vrijens D. The development of a patient-reported outcome measure for real-time symptom assessment in a population with functional urologic complaints-A focus group study. Neurourol Urodyn 2018; 37:2893-2903. [PMID: 30187953 DOI: 10.1002/nau.23808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/09/2018] [Indexed: 12/12/2022]
Abstract
AIMS In the current diagnostic process for overactive bladder syndrome (OAB), biased retrospective questionnaires are often used. There is a need for a new assessment tool that embraces the heterogeneity of the OAB complex. A momentary assessment tool, the Experience Sampling Method (ESM) is promising, capturing random repetitive measurements during the day in the context of daily life and is capable to measure potential contextual triggers and psychological aspects. A focus group study was set up to evaluate which items should be implemented in a urological ESM. METHODS Focus group interviews were arranged, to assess the suitability and comprehensibility of a newly developed urological patient-reported outcome measurement (PROM), "Uromate." "Uromate" was created based on ESM literature. A multidisciplinary expert meeting was conducted to gain consensus on item relevance. RESULTS The initial ESM questionnaire contained 58 items, but was eventually reduced to 39 items after focus group sessions and expert meeting. Thirty-seven items are repeated questions, including three gender-dependent items. Two items are one-time questions about the use of incontinence material. Additionally, a morning questionnaire was included. Depending on the symptom pattern, a minimum of 26 items and a maximum of 36 items will be repeatedly assessed with "Uromate." CONCLUSION There is a need for a modern assessment tool for OAB which overcomes the limitations of today's retrospective questionnaires. Therefore, a urological ESM tool, the "Uromate," is being developed as a PROM, following the FDA PROM development guidelines, to measure real-time symptoms in the context of daily life.
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Affiliation(s)
- Alexandra Herrewegh
- Department of Urology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Pelvic Care Center, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Lisa Vork
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Eline Eurelings
- Department of Psychiatry and Medical Psychology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Carsten Leue
- Pelvic Care Center, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Psychiatry and Medical Psychology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Joanna Kruimel
- Pelvic Care Center, Maastricht University Medical Center+, Maastricht, The Netherlands.,Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Pelvic Care Center, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Pelvic Care Center, Maastricht University Medical Center+, Maastricht, The Netherlands
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14
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Finazzi-Agro E, Gammie A, Kessler TM, van Koeveringe G, Serati M, Solomon E, de Wachter S, Kirschner-Hermanns R. Urodynamics Useless in Female Stress Urinary Incontinence? Time for Some Sense-A European Expert Consensus. Eur Urol Focus 2018; 6:137-145. [PMID: 30061075 DOI: 10.1016/j.euf.2018.07.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/15/2018] [Accepted: 07/20/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Routine use of urodynamics (UDS) for the assessment of female stress urinary incontinence (SUI) appears to be in decline across Europe. The reasons for this trend appear multifactorial, but the implications are of significant concern. OBJECTIVES To achieve an expert consensus viewpoint on the value of UDS in female SUI and current barriers to its use. METHODOLOGY A multidisciplinary group of UDS experts from six European countries was convened, and a modified version of the Delphi method was utilised to reach a consensus viewpoint structured around five key questions. RESULTS Consensus was achieved on all five questions. The group was unanimous that the decline in routine use of UDS is unjustified and misguided, driven by restrictions in funding and accelerated by the publication-and subsequent influence-of two trials that had major limitations. LIMITATIONS The authors comprised a selected group of UDS experts and the analysis is not a formal systematic review. CONCLUSIONS Extensive experience and observational studies have demonstrated the value of UDS for the assessment of female SUI and the dangers of empiric management. This evidence base should not be eclipsed by the findings of two randomised controlled trials that had numerous shortcomings. PATIENT SUMMARY A group of experts were worried that, even though the cause of incontinence varies, doctors seem to be skipping a diagnostic test called urodynamics (UDS) in some patients and just providing treatment-even surgery-without knowing exactly what is wrong. These experts analysed the situation in detail and reached agreement that UDS testing should not be skipped.
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Affiliation(s)
- Enrico Finazzi-Agro
- Department of Experimental Medicine and Surgery, Unit for Functional Urology, Tor Vergata University Hospital, Rome, Italy
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Thomas M Kessler
- Neuro-urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Maurizio Serati
- Department of Obstetrics and Gynaecology, Urogynaecology Unit, University of Insubria, Varese, Italy.
| | | | - Stefan de Wachter
- Department of Urology, University Hospital Antwerpen, University of Antwerp, Belgium
| | - Ruth Kirschner-Hermanns
- Neuro-urology/Urology, University Clinic, Friedrich Wilhelms University Bonn and Neurological Rehabilitation Centre, Bonn, Germany
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15
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Jairam R, Drossaerts J, Marcelissen T, van Koeveringe G, van Kerrebroeck P. Onset of Action of Sacral Neuromodulation in Lower Urinary Tract Dysfunction—What is the Optimal Duration of Test Stimulation? J Urol 2018; 199:1584-1590. [DOI: 10.1016/j.juro.2017.12.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Ranjana Jairam
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jamie Drossaerts
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Gommert van Koeveringe
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Philip van Kerrebroeck
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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16
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Jairam R, Drossaerts J, Vrijens D, Leue C, van Kerrebroeck P, van Koeveringe G. Affective symptoms and quality of life in patients with voiding or storage dysfunction: Results before and after sacral neuromodulation: A prospective follow-up study. Neurourol Urodyn 2018; 37:1801-1808. [DOI: 10.1002/nau.23527] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Ranjana Jairam
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
| | - Jamie Drossaerts
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
| | - Desiree Vrijens
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Carsten Leue
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
- Departmentof Psychiatry and Psychology, South Limburg Mental Health Research Teaching Network, EURON; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Philip van Kerrebroeck
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Gommert van Koeveringe
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
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17
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Jairam R, Marcelissen T, van Koeveringe G, van Kerrebroeck P. Optimal Lead Positioning in Sacral Neuromodulation: Which Factors Are Related to Treatment Outcome? Neuromodulation 2017; 20:830-835. [PMID: 28877395 DOI: 10.1111/ner.12649] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/19/2017] [Accepted: 07/19/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Sacral neuromodulation (SNM) is a well-established treatment for overactive bladder (OAB) and non-obstructive urinary retention (NOR). During test stimulation, the lead is positioned along the third sacral nerve, which ideally results in a response in all four contact points (active electrodes). However, it is unclear whether the position of the lead (depth, angle, deflection) and the number of active electrodes is related to the outcome of SNM. METHODS All patients who underwent test stimulation using the tined lead between January 2011 and September 2016 were included in this retrospective study. Success was defined as >50% improvement in voiding diary parameters compared to baseline. The correlation between lead position and outcome of test stimulation was evaluated. The lead position was determined by evaluating the depth, angle and deflection with respect to the sacral foramen. Binary logistic regression was used in order to determine the predictive value of these factors. RESULTS We included 189 patients of whom 105 were diagnosed with OAB and 84 with NOR. After a SNM test period of 4 weeks, 111 patients (59%) were successful and received a permanent implant. The position of the lead and the number of active electrodes did not predict success of test stimulation in neither the OAB group nor the NOR. However, lateral deflection of the lead was associated with finding more active electrodes (p = 0.01). CONCLUSION In our study, the position of the lead or the number of active electrodes did not predict the outcome of SNM test stimulation. However, the impact of lead positioning and number of active electrodes on long-term outcome remains to be proven.
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Affiliation(s)
- Ranjana Jairam
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.,Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Philip van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.,Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
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18
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Vrijens D, Marcelissen T, Drossaerts J, Heeringa R, Degaillier S, Leue C, van Koeveringe G. Self-consciousness/awareness and bladder sensations: Comparative study of overactive bladder patients and healthy volunteers. Low Urin Tract Symptoms 2017; 11:3-7. [DOI: 10.1111/luts.12186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/25/2017] [Accepted: 05/09/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Desiree Vrijens
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
- School of Mental Health and Neuroscience (MHeNS); Maastricht University; Maastricht The Netherlands
| | - Tom Marcelissen
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Jamie Drossaerts
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
| | - Rhea Heeringa
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
| | - Sam Degaillier
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
| | - Carsten Leue
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
- School of Mental Health and Neuroscience (MHeNS); Maastricht University; Maastricht The Netherlands
- Department of Psychiatry; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
| | - Gommert van Koeveringe
- Department of Urology; Maastricht University Medical Centre (MUMC+); Maastricht The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
- School of Mental Health and Neuroscience (MHeNS); Maastricht University; Maastricht The Netherlands
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19
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Jairam R, Drossaerts J, van Koeveringe G, van Kerrebroeck P. The Impact of Duration of Complaints on Successful Outcome of Sacral Neuromodulation. Urol Int 2017; 99:51-55. [PMID: 28478446 DOI: 10.1159/000456079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 01/09/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The study aimed to evaluate whether the duration of complaints in patients with overactive bladder syndrome or non-obstructive urinary retention predicts the outcome of sacral neuromodulation (SNM). METHODS All patients that underwent a SNM test period evaluation between 2011 and 2014, were included in this study. The duration of complaints was listed in 3 categories: (a) 0-5 years, (b) 5-10 years and (c) 10 years or longer. Analyses with chi square tests were performed to evaluate whether the duration of complaints are associated with outcome of SNM. RESULTS In total, 130 patients were included. Most patients had a complaint duration of 0-5 years (n = 60). The test period was successful in 56% (n = 74) of the total group. Analyses showed that the duration of complaints is not significantly associated with outcome of SNM (p = 0.752), even when subdivided per indication, and also when possible confounders such as age at test and indication are taken into account (p = 0.720). CONCLUSION Based on the results of this study, there is no relationship between duration of complaints and SNM outcome. SNM seems to remain a feasible treatment option, despite of possible anatomical or physiological changes within the lower urinary tract.
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Affiliation(s)
- Ranjana Jairam
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
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20
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Vrijens D, Berghmans B, Nieman F, van Os J, van Koeveringe G, Leue C. Prevalence of anxiety and depressive symptoms and their association with pelvic floor dysfunctions-A cross sectional cohort study at a Pelvic Care Centre. Neurourol Urodyn 2017; 36:1816-1823. [DOI: 10.1002/nau.23186] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/12/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Desiree Vrijens
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Bary Berghmans
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Fred Nieman
- Department of Clinical Epidemiology and Medical Technology Assessment; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON; Maastricht University Medical Centre; Maastricht The Netherlands
- King's Health Partners, Institute of Psychiatry; King's College London; London United Kingdom
- MeHNS, Research School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
| | - Gommert van Koeveringe
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
- MeHNS, Research School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
| | - Carsten Leue
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON; Maastricht University Medical Centre; Maastricht The Netherlands
- MeHNS, Research School for Mental Health and Neuroscience; Maastricht University; Maastricht The Netherlands
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Leue C, Kruimel J, Vrijens D, Masclee A, van Os J, van Koeveringe G. Functional urological disorders: a sensitized defence response in the bladder-gut-brain axis. Nat Rev Urol 2016; 14:153-163. [PMID: 27922040 DOI: 10.1038/nrurol.2016.227] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Functional urological and gastrointestinal disorders are interrelated and characterized by a chronic course and considerable treatment resistance. Urological disorders associated with a sizeable functional effect include overactive bladder (OAB), interstitial cystitis/bladder pain syndrome (IC/BPS), and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Poor treatment outcomes might be attributable to untreated underlying psychological and psychiatric disorders, as the co-occurrence of functional urological and gastrointestinal disorders with mood and anxiety disorders is common. The hypothetical bladder-gut-brain axis (BGBA) is a useful framework under which this interaction can be studied, suggesting that functional disorders represent a sensitized response to earlier threats such as childhood adversity or previous traumatic events, resulting in perceived emotional and bodily distress - the symptoms of functional disorders. Psychological and physical stress pathways might contribute to such alarm falsification, and neuroticism could be a risk factor for the co-occurrence of functional disorders and affective conditions. Additionally, physical threat - either from external sources or internal sources such as infection - might contribute to alarm falsification by influencing body-brain crosstalk on homeostasis and, therefore, affecting mood, cognition, and behaviour. Multidisciplinary research and an integrated care approach is, therefore, required to further elucidate and remediate functional urological and gastrointestinal polymorphic phenotypes.
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Affiliation(s)
- Carsten Leue
- Department of Psychiatry and Psychology, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Joanna Kruimel
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Adrian Masclee
- Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Center (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Pelvic Care Centre (PCC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.,Neuro-intervention Centre (NIC) Maastricht, Maastricht University Medical Centre (MUMC), P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
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Jacoby K, De Wachter S, Wyndaele JJ, Rovner E, Dmochowski R, Tommaselli G, Kalota S, van Koeveringe G. MP65-09 ANALYSIS OF UTI RESOLUTION AND SEDIMENT FORMATION ON INTRAVESICAL BALLOON FOR THE TREATMENT OF SUI FROM TWO MULTICENTER RANDOMIZED CONTROLLED STUDIES. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Drossaerts J, Vrijens D, Leue C, Schilders I, Van Kerrebroeck P, van Koeveringe G. Screening for depression and anxiety in patients with storage or voiding dysfunction: A retrospective cohort study predicting outcome of sacral neuromodulation. Neurourol Urodyn 2015; 35:1011-1016. [DOI: 10.1002/nau.22871] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 08/10/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Jamie Drossaerts
- Department of Urology; Maastricht University Medical Centre (MUMC+); The Netherlands
| | - Desiree Vrijens
- Department of Urology; Maastricht University Medical Centre (MUMC+); The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Carsten Leue
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
- Department of Psychiatry and Psychology; South Limburg Mental Health Research and Teaching Network; EURON, Maastricht University Medical Centre; Maastricht The Netherlands
| | - Isabelle Schilders
- Department of Urology; Maastricht University Medical Centre (MUMC+); The Netherlands
| | - Philip Van Kerrebroeck
- Department of Urology; Maastricht University Medical Centre (MUMC+); The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Gommert van Koeveringe
- Department of Urology; Maastricht University Medical Centre (MUMC+); The Netherlands
- Pelvic Care Centre Maastricht; Maastricht University Medical Centre; Maastricht The Netherlands
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Drossaerts J, Rademakers K, van Koeveringe G, Van Kerrebroeck P. The value of urodynamic tools to guide patient selection in sacral neuromodulation. World J Urol 2015; 33:1889-95. [PMID: 25680936 PMCID: PMC4617837 DOI: 10.1007/s00345-015-1479-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/03/2015] [Indexed: 12/01/2022] Open
Abstract
Purpose
The aim of this study is to explore whether urodynamics, with the addition of ambulatory urodynamic study (ambulatory-UDS), will be able to better predict and assess sacral neuromodulation (SNM) treatment outcome. Selection of patients is a critical element in achieving optimal outcome in SNM. Quantitative and qualitative results of urodynamic tests are used to justify surgical therapy and to evaluate treatment for lower urinary tract dysfunction. Therefore, these tests should be representative and subsequently offer a correct prognosis.
Methods Between December 2002 until May 2013 selected patients with lower urinary tract symptoms (storage and/or voiding dysfunction) were included in an ambulatory urodynamic measurement database. From this database, the total subgroup of patients that underwent a sacral neuromodulation test evaluation was selected. Results A total of 98 patients were included. Success rate of SNM in patients with storage dysfunction was around 70 %, according to either conventional-UDS or ambulatory-UDS diagnosis. Based on conventional-UDS, success rate of SNM in patients with hypocontractility was 67 % and in acontractile patients 35 %. According to ambulatory-UDS diagnosis, success rates were 32 and 17 %, respectively. Conclusions This study shows that conventional-UDS overestimates the amount of patients diagnosed with hypocontractile or acontractile bladder. Patients with reduced contractility on ambulatory-UDS have a lower chance of SNM success. Hence, ambulatory-UDS allows us to select patients with a real acontractile bladder and predict SNM failure. In patients with storage dysfunction, additional ambulatory-UDS does not seem to contribute in predicting SNM outcome.
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Affiliation(s)
- Jamie Drossaerts
- Department of Urology, Maastricht University Medical Centre (MUMC+), The Netherlands and School of Mental Health and Neuroscience (MHeNS), Maastricht University, P. Debyelaan 25, POB 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Kevin Rademakers
- Department of Urology, Maastricht University Medical Centre (MUMC+), The Netherlands and School of Mental Health and Neuroscience (MHeNS), Maastricht University, P. Debyelaan 25, POB 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre (MUMC+), The Netherlands and School of Mental Health and Neuroscience (MHeNS), Maastricht University, P. Debyelaan 25, POB 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre (MUMC+), The Netherlands and School of Mental Health and Neuroscience (MHeNS), Maastricht University, P. Debyelaan 25, POB 5800, 6202 AZ, Maastricht, The Netherlands.
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Vrijens D, Drossaerts J, van Koeveringe G, Van Kerrebroeck P, van Os J, Leue C. Affective symptoms and the overactive bladder - a systematic review. J Psychosom Res 2015; 78:95-108. [PMID: 25499886 DOI: 10.1016/j.jpsychores.2014.11.019] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 11/17/2014] [Accepted: 11/20/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Overactive bladder syndrome (OAB) is characterised by urgency symptoms, with or without urgency incontinence, usually with frequency and nocturia. Although literature suggest an association between OAB, depression and anxiety, no systematic review has been presented. OBJECTIVE Systematically review the literature on the association of affective conditions with OAB. METHODS Systematic review according to the PRISMA guidelines. This review is registered in the PROSPERO register (CRD4201400664). RESULTS Forty-three articles were included, describing more than 80,000 subjects. Depression and OAB were positively associated in 26 studies, anxiety and OAB in 6 studies. Longitudinal studies reported: a) OAB subjects who developed depression/anxiety or b) depressed/anxious subjects developing OAB, or c) both. The quality of evidence in studies reporting an association between the co-occurrence of OAB and depression was rated level 3 in accordance with the GRADE framework. Evidence reporting on the co-occurrence of anxiety and OAB was rated GRADE level 2. Longitudinal associations between new onset of OAB in depressive subjects was GRADE level 2. Evidence reporting association of OAB with anxiety in longitudinal studies was of GRADE level 1. CONCLUSION To our knowledge, this systematic review is the first to give a comprehensive qualitative overview on the association between OAB and affective symptoms. Many evaluated studies failed to note longitudinal changes and lacked evidence of causality. Still, results revealed an association between OAB and affective symptoms and there is evidence for new onset of OAB in depressive subjects, but further research is necessary to examine the strength of the effect.
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Affiliation(s)
- Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Jamie Drossaerts
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands; Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; King's College London, King's Health Partners, London, Institute of Psychiatry, United Kingdom.
| | - Carsten Leue
- Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands; Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Renterghem KV, Rosette JJMCHDL, Thijs H, Wisanto E, Achten R, Ory JP, Koeveringe GV. Alternative mechanisms for prostate-specific antigen elevation: A prospective analysis of 222 transurethral resections of prostate patients. World J Clin Urol 2014; 3:144-151. [DOI: 10.5410/wjcu.v3.i2.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/14/2014] [Accepted: 03/12/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the relationship between prostate-specific antigen (PSA) levels and (1) bladder outlet obstruction (BOO) and (2) the severity of prostate inflammation.
METHODS: Two hundred and twenty-two consecutive patients undergoing transurethral resection of the prostate (TURP) were prospectively included. Patients with proven urinary tract infection and/or known prostate cancer were excluded. PSA levels, International Prostate Symptoms Score (IPSS), prostate weight, post residual volume and pressure flow parameters were determined. A histopathological assessment of the presence and severity of inflammation was also performed.
RESULTS: Patients had a mean age of 69.1 ± 8.6 years (45-90 years), with mean preoperative PSA levels of 4.7 ± 5.4 ng/mL (0.2-32.5 ng/mL) and IPSS of 15.7 ± 6.9 (0-32). Mean PdetQmax was 96.3 ± 34.4 cmH2O (10-220 cmH2O). The mean resected prostate weight was 39.4 ± 27.3 g (3-189 g). Correlations were observed between PSA (logarithmic) and resected prostate weight (r = 0.54; P < 0.001), PSA (logarithmic) and PdetQmax (r = 0.17; P = 0.032), and resected prostate weight and PdetQmax (r = 0.39; P < 0.001). Furthermore, low correlations were observed between PSA (logarithmic) and active (r = 0.21; P < 0.0001) and chronic (r = 0.19; P = 0.005) inflammation.
CONCLUSION: In this study we showed a correlation between BOO (PdetQmax) and PSA (logarithmic). Furthermore, we demonstrated a weak correlation between PSA (logarithmic) and active as well as chronic prostatic inflammation.
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Rademakers K, van Koeveringe G, Oelke M. MP76-10 OBSTRUCTION DEPENDENT BLADDER CONTRACTILITY - RESULTS FROM A LARGE URODYNAMIC CROSS-SECTIONAL STUDY IN MEN WITH LOWER URINARY TRACT SYMPTOMS. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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van Koeveringe G, Rademakers K, Stenzl A. Latissimus dorsi detrusor myoplasty to restore voiding in patients with an acontractile bladder - fact or fiction? Curr Urol Rep 2013; 14:426-34. [PMID: 23775469 DOI: 10.1007/s11934-013-0349-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Multiple causes at any level between the brain and the bladder can lead to diminished voiding efficiency and bladder acontractility. Treatment options for patients with an acontractile bladder have been limited as most patients were forced to perform lifelong self-catheterization at the moment. The latissimus dorsi detrusor myoplasty (LDDM) is a recent and promising therapeutic surgical option to restore adequate bladder emptying on demand. This article critically reviews the available literature on LDDM and focuses particularly on the preoperative diagnostic evaluation and patient selection, treatment outcome and the postoperative contractility measurement.
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Affiliation(s)
- Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre, P. Debyelaan 25, POB 5800, 6202, AZ, Maastricht, The Netherlands,
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van Renterghem K, van Koeveringe G, Achten R, van Kerrebroeck P. Long-term clinical outcome of diagnostic transurethral resection of the prostate in patients with elevated prostate-specific antigen level and minor lower urinary tract symptoms. Urol Int 2009; 83:60-5. [PMID: 19641361 DOI: 10.1159/000224870] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Accepted: 07/03/2008] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In patients with minor lower urinary tract symptoms (LUTS), elevated prostate-specific antigen (PSA) levels and (multiple) negative multi-site biopsies, therapy decision is complex. Long-term outcome of a diagnostic transurethral resection of the prostate (TURP) in these patients needs to be determined. METHODS We retrospectively evaluated patients with minor LUTS, elevated PSA levels (>or=4 ng/ml) and no signs of prostate cancer. Patients with bladder outlet obstruction (BOO) underwent TURP. When TURP showed no malignancy, patients were annually evaluated by PSA testing and the International Prostate Symptom Score (IPSS). RESULTS The study included 82 consecutive patients satisfying the inclusion criteria. All patients underwent TURP. No malignancy was encountered in 74 patients (90.2%). Of this group, 36 patients were followed >3 years (mean 62.1 months). One patient (2.8%) showed a persistently rising PSA level with positive extended multi-site biopsies 4 years after TURP, implying further treatment. 35 patients (97.2%) had a permanent complete normalization of PSA levels (<4 ng/ml) together with normalized IPSS. CONCLUSIONS We consider an elevated PSA level in patients with minor LUTS and (multiple) negative multi-site biopsies as a sign of BOO. If these patients receive a diagnostic TURP, long-term outcome is excellent.
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