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Klufah F, Mobaraki G, Shi S, Marcelissen T, Alharbi RA, Mobarki M, Almalki SSR, van Roermund J, zur Hausen A, Samarska I. Human polyomaviruses JCPyV and MCPyV in urothelial cell carcinoma: a single institution experience. Front Oncol 2023; 13:1251244. [PMID: 38192628 PMCID: PMC10773619 DOI: 10.3389/fonc.2023.1251244] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/27/2023] [Indexed: 01/10/2024] Open
Abstract
Objective Urothelial cell carcinoma (UCC) is the most common type of urinary bladder. JCPyV and BKPyV have been detected in the urine and tissue of urothelial cell carcinomas (UCC) in immunocompetent patients. Here, we investigated the presence of several HPyVs in UCC samples using diverse molecular techniques to study the prevalence of HPyVs in UCC. Methods A large single-institution database of urine cytology specimens (UCS; n = 22.867 UCS) has previously been searched for decoy cells (n = 30), suggesting polyomavirus infection. The available urine sediments and formalin-fixed paraffin-embedded (FFPE) tissue samples of UCC patients were tested for the presence of JCPyV-LTAg expression by immunohistochemistry (IHC) labeled with SV40-LTAg antibody (clone: PAb416) and subsequent PCR followed by sequencing. In addition, the presence of the oncogenic Merkel cell polyomavirus (MCPyV) and the presence of human polyomavirus 6 (HPyV6) and 7 (HPyV7) DNA were tested with DNA PCR or IHC. Results Of the 30 patients harboring decoy cells, 14 were diagnosed with UCC of the urinary bladder (14/30; 46.6%) before presenting with decoy cells in the urine. The SV40-LTAg IHC was positive in all 14 UCC urine sediments and negative in the FFPE tissues. JCPyV-DNA was identified in all five available UCS and in three FFPE samples of UCC (three of 14; 21.4%). Two UCC cases were positive for MCPyV-DNA (two of 14; 14.3%), and one of them showed protein expression by IHC (one of 14; 7.1%). All specimens were HPyV6 and HPyV7 negative. Conclusion Our findings show the presence of JCPyV in the urine and UCC of immunocompetent patients. Moreover, MCPyV was detected in two UCC cases. In total, five UCC cases showed the presence of either JCPyV or MCPyV. The evidence here supports the hypothesis that these viruses might sporadically be associated with UCC. Further studies are needed to confirm the relevance of JCPyV or MCPyV as a possible risk factor for UCC development.
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Affiliation(s)
- Faisal Klufah
- Department of Pathology, GROW-School for Oncology and Reproduction, Maastricht University, Medical Centre+, Maastricht, Netherlands
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
| | - Ghalib Mobaraki
- Department of Pathology, GROW-School for Oncology and Reproduction, Maastricht University, Medical Centre+, Maastricht, Netherlands
- Department of Medical Laboratories Technology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Shuai Shi
- Department of Pathology, GROW-School for Oncology and Reproduction, Maastricht University, Medical Centre+, Maastricht, Netherlands
| | - Tom Marcelissen
- Department of Urology, Maastricht University, Medical Centre+, Maastricht, Netherlands
| | - Raed A. Alharbi
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
| | - Mousa Mobarki
- Pathology Department, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Shaia Saleh R. Almalki
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Al-Baha University, Al-Baha, Saudi Arabia
| | - Joep van Roermund
- Department of Urology, Maastricht University, Medical Centre+, Maastricht, Netherlands
| | - Axel zur Hausen
- Department of Pathology, GROW-School for Oncology and Reproduction, Maastricht University, Medical Centre+, Maastricht, Netherlands
| | - Iryna Samarska
- Department of Pathology, GROW-School for Oncology and Reproduction, Maastricht University, Medical Centre+, Maastricht, Netherlands
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Marcelissen T, Vijgen GHEJ. The endoscope. Br J Surg 2023; 110:1641-1643. [PMID: 37537900 DOI: 10.1093/bjs/znad220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/17/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Tom Marcelissen
- Department of Urology, Maastricht University Medical Center+, P. Debyelaan 25, 6229 HX, Maastricht, the Netherlands
| | - Guy H E J Vijgen
- Department of Surgery, Laurentius Hospital, Monseigneur Driessenstraat 6, 6043 CV, Roermond, the Netherlands
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Marcelissen T, Hüsch T, Antunes-Lopes T, Geavlete B, Rieken M, Cornu JN, Rahnama’i MS, Functional Urology Working Group EAUYAU. Storage symptoms after surgical treatment of stress urinary incontinence in women: a clinical review. CLIN EXP OBSTET GYN 2022. [DOI: 10.31083/j.ceog4903061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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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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van Wijk Y, Ramaekers B, Vanneste BGL, Halilaj I, Oberije C, Chatterjee A, Marcelissen T, Jochems A, Woodruff HC, Lambin P. Modeling-Based Decision Support System for Radical Prostatectomy Versus External Beam Radiotherapy for Prostate Cancer Incorporating an In Silico Clinical Trial and a Cost-Utility Study. Cancers (Basel) 2021; 13:cancers13112687. [PMID: 34072509 PMCID: PMC8198879 DOI: 10.3390/cancers13112687] [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: 04/26/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Low–intermediate prostate cancer has a number of viable treatment options, such as radical prostatectomy and radiotherapy, with similar survival outcomes but different treatment-related side effects. The aim of this study is to facilitate patient-specific treatment selection by developing a decision support system (DSS) that incorporates predictive models for cancer-free survival and treatment-related side effects. We challenged this DSS by validating it against randomized clinical trials and assessing the benefit through a cost–utility analysis. We aim to expand upon the applications of this DSS by using it as the basis for an in silico clinical trial for an underrepresented patient group. This modeling study shows that DSS-based treatment decisions will result in a clinically relevant increase in the patients’ quality of life and can be used for in silico trials. Abstract The aim of this study is to build a decision support system (DSS) to select radical prostatectomy (RP) or external beam radiotherapy (EBRT) for low- to intermediate-risk prostate cancer patients. We used an individual state-transition model based on predictive models for estimating tumor control and toxicity probabilities. We performed analyses on a synthetically generated dataset of 1000 patients with realistic clinical parameters, externally validated by comparison to randomized clinical trials, and set up an in silico clinical trial for elderly patients. We assessed the cost-effectiveness (CE) of the DSS for treatment selection by comparing it to randomized treatment allotment. Using the DSS, 47.8% of synthetic patients were selected for RP and 52.2% for EBRT. During validation, differences with the simulations of late toxicity and biochemical failure never exceeded 2%. The in silico trial showed that for elderly patients, toxicity has more influence on the decision than TCP, and the predicted QoL depends on the initial erectile function. The DSS is estimated to result in cost savings (EUR 323 (95% CI: EUR 213–433)) and more quality-adjusted life years (QALYs; 0.11 years, 95% CI: 0.00–0.22) than randomized treatment selection.
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Affiliation(s)
- Yvonka van Wijk
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (I.H.); (C.O.); (A.C.); (A.J.); (H.C.W.); (P.L.)
- Correspondence:
| | - Bram Ramaekers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands;
| | - Ben G. L. Vanneste
- Department of Radiation Oncology (MAASTRO), GROW—School for Oncology and Developmental Biology, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands;
| | - Iva Halilaj
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (I.H.); (C.O.); (A.C.); (A.J.); (H.C.W.); (P.L.)
| | - Cary Oberije
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (I.H.); (C.O.); (A.C.); (A.J.); (H.C.W.); (P.L.)
| | - Avishek Chatterjee
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (I.H.); (C.O.); (A.C.); (A.J.); (H.C.W.); (P.L.)
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre+, 6229 HX Maastricht, The Netherlands;
| | - Arthur Jochems
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (I.H.); (C.O.); (A.C.); (A.J.); (H.C.W.); (P.L.)
| | - Henry C. Woodruff
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (I.H.); (C.O.); (A.C.); (A.J.); (H.C.W.); (P.L.)
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University, 6229 ER Maastricht, The Netherlands; (I.H.); (C.O.); (A.C.); (A.J.); (H.C.W.); (P.L.)
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Rahnama'i MS, Marcelissen T, Geavlete B, Tutolo M, Hüsch T. Current Management of Post-radical Prostatectomy Urinary Incontinence. Front Surg 2021; 8:647656. [PMID: 33898508 PMCID: PMC8063855 DOI: 10.3389/fsurg.2021.647656] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 12/30/2020] [Accepted: 03/03/2021] [Indexed: 12/16/2022] Open
Abstract
Prostate cancer is the second most common cancer in men worldwide. Radical prostatectomy and radiation beam therapy are the most common treatment options for localized prostate cancer and have different associated complications. The etiology of post prostatectomy incontinence is multifactorial. There is evidence in the literature that anatomic support and pelvic innervation are important factors in the etiology of post-prostatectomy incontinence. Among the many surgical and technical factors proposed in the literature, extensive dissection during surgery, damage to the neurovascular bundle and the development of postoperative fibrosis have a substantial negative impact on the continence status of men undergoing RP. Sparing of the bladder neck and anterior, and possibly posterior, fixation of the bladder-urethra anastomosis are associated with better continence rates. Overactive bladder syndrome (OAB) is multifactorial and the exact role of prostate surgery in the development of OAB is still under debate. There are several variables that could contribute to detrusor overactivity. Detrusor overactivity in patients after radical prostatectomy has been mainly attributed to a partial denervation of the bladder during surgery. However, together with bladder denervation, other hypotheses, such as the urethrovesical mechanism, have been described. Although there is conflicting evidence regarding the importance of conservative treatment after post-prostatectomy urinary incontinence, pelvic floor muscle training (PFMT) is still considered as the first treatment choice. Duloxetin, either alone or in combination with PFMT, may hasten recovery of urinary incontinence but is often associated with severe gastrointestinal and central nervous side effects. However, neither PFMT nor duloxetine may cure male stress urinary incontinence. The therapeutic decision and the chosen treatment option must be individualized for each patient according to clinical and social factors. During the recent years, the development of new therapeutic choices such as male sling techniques provided a more acceptable management pathway for less severe forms of urinary incontinence related to radical prostatectomy. Following this perspective, technological improvements and the emergence of new dedicated devices currently create the premises for a continuously positive evolution of clinical outcomes in this particular category of patients.
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Affiliation(s)
| | - Tom Marcelissen
- Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | | | - Manuela Tutolo
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
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Vanneste BGL, Van Limbergen EJ, Marcelissen T, Reynders K, Melenhorst J, van Roermund JGH, Lutgens L. Is prostate cancer radiotherapy using implantable rectum spacers safe and effective in inflammatory bowel disease patients? Clin Transl Radiat Oncol 2021; 27:121-125. [PMID: 33604459 PMCID: PMC7875819 DOI: 10.1016/j.ctro.2021.01.007] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/12/2022] Open
Abstract
Radiotherapy in patients with inflammatory bowel disease remains controversial. A biodegradable balloon is inserted between the prostate and the rectal wall. The balloon pushes the anterior rectal wall outside of the high-dose area. No grade 3 or more rectal toxicities were observed.
Background Prostate cancer radiotherapy (RT) in patients with (active) inflammatory bowel disease (IBD) remains controversial. We hypothesized that RT in combination with a biodegradable prostate-rectum spacer balloon implantation, might be a safe treatment approach with acceptable toxicities for these high risk for rectal toxicity patients. Materials and methods We report on a small prospective mono-centric series of 8 patients with all-risk prostate cancer with the comorbidity of an IBD. Four patients had Crohn’s disease and 4 patients had ulcerative colitis. One out of four had an active status of IBD. All patients were intended to be treated with curative high-dose RT: 5 patients were treated with external beam RT (70 Gray (Gy) in 28 fractions), and 3 patients were treated with 125I-implant (145 Gy). Toxicities were scored according to the CTCAE v4.03: acute side effects occur up to 3 months after RT, and late side effects start after 3 months. Results Median follow-up was 13 months (range: 3–42 months). Only one acute grade 2 gastro-intestinal (GI) toxicity was observed: an increased diarrhea (4–6 above baseline) during RT, which resolved completely 6 weeks after treatment. No late grade 3 or more GI toxicity was reported, and no acute and late grade ≥2 genitourinary toxicity events were observed. Conclusion Prostate cancer patients with IBD are a challenge to treat with RT. Our results suggest that RT in combination with a balloon implant in selective patients with (active) IBD may be promising, however additional validation is needed.
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Affiliation(s)
- Ben G L Vanneste
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Evert J Van Limbergen
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Kobe Reynders
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Joep G H van Roermund
- Department of Urology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Ludy Lutgens
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
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Vanneste BG, Van Limbergen EJ, Dubois L, Samarska IV, Wieten L, Aarts MJ, Marcelissen T, De Ruysscher D. Immunotherapy as sensitizer for local radiotherapy. Oncoimmunology 2020; 9:1832760. [PMID: 33194319 PMCID: PMC7605354 DOI: 10.1080/2162402x.2020.1832760] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 05/27/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 12/28/2022] Open
Abstract
The purpose of this report was to systematically review the radiation enhancement factor (REF) effects of immunotherapy on radiotherapy (RT) to the local tumor in comparison with other traditional radiation sensitizers such as cisplatin. PubMed and Medline databases were searched until February 2019. Reports with abscopal effect in the results were excluded. Graphs of the selected papers were digitized using Plot Digitizer (Sourceforge.net) in order to calculate the tumor growth delay (TGD) caused by immunotherapy. To enable comparison between different studies,the TGD were used to define the REF between RT versus the RT/immunotherapy combination. Thirty-two preclinical papers, and nine clinical series were selected. Different mouse models were exposed to RT doses ranging from 1 to 10 fractions of 1.8 to 20 Gray (Gy) per fraction. Endpoints were heterogeneous, ranging from regression to complete local response. No randomized clinical studies were identified. The median preclinical REF effect of different immunotherapy was varying from 1.7 to 9.1. There was no relationship observed either with subclasses of immunotherapy orRT doses. In the clinical studies, RT doses ranged from 1 to 37 fractions of 1.8 to 24 Gy per fraction. Most clinical trials used ipilimumab and interleukin-2. Local control rate in the clinical series ranged from 66% to 100%. A strong REF of immunotherapy (1.7 to 9.1) was observed, this being higher than traditionally sensitizers such as cisplatin (1.1). This result implies that for the same RT dose, a higher local control was achieved with a combination of immunotherapy and RT in preclinical settings. This study therefore supports the use of combined RT and immunotherapy to improve local tumor control in clinical settings without exacerbation of toxicities.
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Affiliation(s)
- Ben G.L. Vanneste
- Department of Radiation Oncology (MAASTRO Clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Evert J Van Limbergen
- Department of Radiation Oncology (MAASTRO Clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ludwig Dubois
- The M-Lab, Department of Precision Medicine, GROW - School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Iryna V. Samarska
- Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - L. Wieten
- Department of Transplantation Immunology, Tissue Typing Laboratory, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M. J.B. Aarts
- Department of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - T. Marcelissen
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO Clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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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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Malde S, Marcelissen T, Vrijens D, Apostilidis A, Rahnama'I S, Cardozo L, Lovick T. Sacral nerve stimulation for refractory OAB and idiopathic urinary retention: Can phenotyping improve the outcome for patients: ICI-RS 2019? Neurourol Urodyn 2020; 39 Suppl 3:S96-S103. [PMID: 32662561 DOI: 10.1002/nau.24204] [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: 08/13/2019] [Accepted: 10/20/2019] [Indexed: 11/09/2022]
Abstract
AIMS Sacral nerve stimulation (SNS) is widely used to treat refractory idiopathic overactive bladder (OAB) and idiopathic urinary retention. However, clinical outcomes are variable and understanding predictive factors for success or side-effects would enable personalization of therapy and optimization of outcomes. At the International Consultation on Incontinence-Research Society meeting 2019, a Think Tank was convened to discuss how advances in the basic science study of SNS may be translatable into clinical practice to improve outcomes of patients undergoing SNS treatment. METHODS We conducted a literature review and expert consensus meeting focusing on current methods of phenotyping patients and specifically, how advances in basic science research of the mechanism of action of SNS can be translated into clinical practice to improve patient selection for therapy. RESULTS The terms "Idiopathic OAB" and "idiopathic urinary retention" encompass several underlying pathophysiological phenotypes. Commonly, phenotyping is based on clinical and urodynamic factors. Animal studies have demonstrated that high-frequency stimulation can produce rapid onset, reversible conduction block in peripheral nerves. Altering stimulation parameters may potentially enable personalization of therapy depending upon the clinical indication in the future. Similarly, advances in conditional and closed-loop stimulation may offer greater efficacy for certain patients. Phenotyping based on psychological comorbidity requires further study to potentially optimize patient selection for therapy. CONCLUSIONS Idiopathic OAB and idiopathic urinary retention are heterogenous conditions with multiple potential underlying phenotypes. Tailoring stimulation parameters to the needs of each individual according to phenotype could optimize outcomes. Assessing psychological comorbidity may improve patient selection. Areas for further research are proposed.
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Affiliation(s)
- Sachin Malde
- Department of Urology, Guy's Hospital, London, UK
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Sajjad Rahnama'I
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Thelma Lovick
- School of Physiology, Pharmacology, and Neuroscience, University of Bristol, Bristol, UK
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11
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Russo G, Scandura C, Di Mauro M, Cacciamani G, Albersen M, Capogrosso P, Cimino S, Cornu J, Marcelissen T, Minervini A, Cocci A. P-02-46 Clinical Efficacy of Serenoa Repens vs. Placebo vs. Alpha-Blockers for the Treatment of LUTS/BPE: A Systematic Review and Network Meta-Analysis of Randomized Placebo-Controlled Clinical Trials. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2020.04.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Panicker JN, Marcelissen T, von Gontard A, Vrijens D, Abrams P, Wyndaele M. Bladder-bowel interactions: Do we understand pelvic organ cross-sensitization? International Consultation on Incontinence Research Society (ICI-RS) 2018. Neurourol Urodyn 2020; 38 Suppl 5:S25-S34. [PMID: 31821639 DOI: 10.1002/nau.24111] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/30/2018] [Accepted: 06/30/2019] [Indexed: 12/26/2022]
Abstract
AIMS Mounting evidence from experimental animal and human studies suggests that cross-sensitization exists between different organs. Lower urinary tract (LUT) and bowel dysfunction commonly overlap, and the role of cross-sensitization between pelvic visceral organs is uncertain. METHODS At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2018, a panel of clinicians participated in a discussion on bladder and bowel interactions in the context of pelvic organ cross-sensitization. RESULTS Bladder and bowel problems commonly co-occur in adults and children across different disorders, and the mechanism responsible for overlapping dysfunction is uncertain in most instances. At a neuronal level, cross-sensitization occurs as a result of afferent signaling from the LUT and lower bowel through different central and peripheral mechanisms. Studies in animals and humans have demonstrated evidence for cross-organ sensitization following experimental inflammation or distension of the lower bowel, affecting the LUT. Nerve stimulation is an effective treatment for different functional LUT and bowel disorders, and whether this treatment may influence cross-organ sensitization remains uncertain. The role of physiologically dormant C-fibers, the bladder-gut-brain axis, and gut microbiome in cross-sensitization are speculative. CONCLUSION Recommendations for research were made to explore the role of cross-organ sensitization in the pathogenesis of co-occurring LUT and bowel dysfunction in humans.
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Affiliation(s)
- Jalesh N Panicker
- Department of Uro-Neurology and UCL Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Paul Abrams
- Professor of Urology, Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Michel Wyndaele
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
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13
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Marcelissen T, Anding R, Averbeck M, Hanna-Mitchell A, Rahnama'i S, Cardozo L. Exploring the relation between obesity and urinary incontinence: Pathophysiology, clinical implications, and the effect of weight reduction, ICI-RS 2018. Neurourol Urodyn 2020; 38 Suppl 5:S18-S24. [PMID: 31821633 DOI: 10.1002/nau.24072] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/19/2019] [Accepted: 05/27/2019] [Indexed: 01/10/2023]
Abstract
AIMS To evaluate the relationship between obesity and urinary incontinence (UI) and to determine the effect of weight reduction on the severity of incontinence. METHODS This is a consensus report of the proceedings of a Research Proposal from the annual International Consultation on Incontinence-Research Society, 14 June to 16 June, 2018 (Bristol, UK): "What are the relationships between obesity and UI, and the effects of successful bariatric surgery?" RESULTS Obesity is an increasing problem worldwide and is associated with many adverse effects on health and quality of life. From both translational and clinical studies, there is a strong relationship between obesity and the occurrence of UI. Both mechanical and metabolic factors seem to play an important role including systemic inflammation and oxidative stress due to the release of cytokines in visceral adipose tissue. The success rate of anti-incontinence surgery does not seem to be greatly affected by body mass index (BMI), although reliable data and long-term follow-up are currently lacking. Both weight reduction programs and bariatric surgery can result in amelioration of UI. Various studies have shown that weight loss (particularly that associated with bariatric surgery) can reduce incontinence, and the degree of weight loss is positively correlated with improvement in symptoms. CONCLUSIONS Obesity is strongly associated with an increased prevalence of both stress and urgency UI. The treatment outcome does not seem to be highly dependent on BMI. Weight reduction is positively correlated with improvement of incontinence symptoms and therefore should be advocated in the management.
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Affiliation(s)
- Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ralf Anding
- Department of Neurourology, University Hospital Bonn, Bonn, Germany
| | - Marcio Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | | | | | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
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14
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Averbeck MA, Marcelissen T, Anding R, Rahnama'i MS, Sahai A, Tubaro A. How can we prevent postprostatectomy urinary incontinence by patient selection, and by preoperative, peroperative, and postoperative measures? International Consultation on Incontinence-Research Society 2018. Neurourol Urodyn 2020; 38 Suppl 5:S119-S126. [PMID: 31821626 DOI: 10.1002/nau.23972] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 11/26/2018] [Revised: 01/19/2019] [Accepted: 02/25/2019] [Indexed: 02/01/2023]
Abstract
AIMS To review current prevention strategies for urinary incontinence among patients undergoing radical prostatectomy (RP). METHODS This is a consensus report of the proceedings of a research proposal from the annual International Consultation on Incontinence-Research Society (ICI-RS), 14 to 16 June 2018 (Bristol, UK): "How can we prevent postprostatectomy incontinence by patient selection, and by preoperative, peroperative, and postoperative measures?" RESULTS Several baseline parameters were proposed as predicting factors for postprostatectomy urinary incontinence (PPUI), including age, tumor stage, prostate volume, preoperative lower urinary tract symptoms, maximum urethral closure pressure, and previous transurethral resection of the prostate. More recently, magnetic resonance imaging has been used to measure the membranous urethral length and sphincter volume. Peroperative techniques include preservative and reconstructive approaches. Bladder neck preservation improved early (6 months), as well as long-term (>12 months) continence rates. Several prospective studies have reported earlier return of continence following preservation of puboprostatic ligaments, although no long-term data are available. Preservation of the urethral length yielded controversial outcomes. Concerning postoperative strategies, it is probably optimal to remove the catheter in a window between 4 and 7 days if clinically appropriate; however, more research in this regard is still required. Postoperative PFME (preoperative pelvic floor muscle exercise) appears to speed up the recovery of continence after RP. CONCLUSIONS Conservative strategies to prevent PPUI include proper patient selection and PFME. Peroperative techniques have largely shown benefit in the short term. Postoperative complications and timing of trial without catheter can influence continence status. Future research initiatives must assess peroperative and postoperative measures, with longer-term follow-up.
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Affiliation(s)
- Marcio A Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ralf Anding
- Department of Neurourology, University Hospital Bonn, Bonn, Germany
| | - Mohammad S Rahnama'i
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arun Sahai
- Department of Urology, Guy's Hospital, London, UK
| | - Andrea Tubaro
- Department of Urology, La Sapienza University 2nd School of Medicine, Sant Andrea Hospital, Rome, Italy
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15
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Marcelissen T, Rademakers K. Treatment of Elderly Patients with Overactive Bladder: Has Mirabegron Come of Age? Eur Urol 2020; 77:221-222. [DOI: 10.1016/j.eururo.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
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16
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Rademakers K, Gammie A, Yasmin H, Cardozo L, Greenwell T, Harding C, Kirschner-Hermanns R, Marcelissen T, Finazzi-Agro E. Can multicentre urodynamic studies provide high quality evidence for the clinical effectiveness of urodynamics? ICI-RS 2019. Neurourol Urodyn 2020; 39 Suppl 3:S30-S35. [PMID: 31961959 PMCID: PMC7497217 DOI: 10.1002/nau.24280] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/20/2019] [Indexed: 02/06/2023]
Abstract
Aims Lower urinary tract (LUT) function can be investigated by urodynamic studies (UDS) to establish underlying functional abnormalities in the LUT. A multicentre registry could present an opportunity to improve the scientific evidence base for UDS. During the International Consultation on Incontinence Research Society (ICI‐RS) meeting in Bristol, United Kingdom 2019, an expert panel discussed the potential of a multicentre urodynamic registry to improve the quality of urodynamic output. Methods the potential importance of a multicentre urodynamic registry, parameter inclusion, quality control, and pitfalls during a registry roll‐out were reviewed and discussed. Results and Conclusions The clinical utility, evaluation, and effectiveness of UDS remain poorly defined due to a lack of high quality evidence and large study populations. Therefore, the ICI‐RS proposes formation of a urodynamic panel for future roll‐out of a registry. The inclusion of basic parameters was discussed and the essential parameters were defined as well as the potential pitfalls of a registry roll‐out. The discussion and recommendations in this paper form the base for future urodynamic registry development.
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Affiliation(s)
- Kevin Rademakers
- Department of Urology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Andrew Gammie
- Department of Urology, Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Habiba Yasmin
- Department of Urology, University College London Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | | | - Ruth Kirschner-Hermanns
- Department of Urology/Neuro-Urology, University Clinic, Rheinische Friedrich-Wilhelms-Universität Bonn, Bonn, Germany.,Department of Neuro-Urology, Neurological Rehabilitation Center Godeshoehe e.V., Bonn, Germany
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Enrico Finazzi-Agro
- Department of Experimental Medicine and Surgery, Department of Surgery, Policlinico Tor Vergata, University of Rome "Tor Vergata" and Urology Unit, Rome, Italy
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17
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Russo GI, Scandura C, Di Mauro M, Cacciamani G, Albersen M, Hatzichristodoulou G, Fode M, Capogrosso P, Cimino S, Marcelissen T, Cornu JN, Gacci M, Minervini A, Cocci A. Clinical Efficacy of Serenoa repens Versus Placebo Versus Alpha-blockers for the Treatment of Lower Urinary Tract Symptoms/Benign Prostatic Enlargement: A Systematic Review and Network Meta-analysis of Randomized Placebo-controlled Clinical Trials. Eur Urol Focus 2020; 7:420-431. [PMID: 31952967 DOI: 10.1016/j.euf.2020.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 12/04/2019] [Revised: 12/26/2019] [Accepted: 01/07/2020] [Indexed: 11/29/2022]
Abstract
CONTEXT International guidelines do not make any specific recommendations on Serenoa repens (SeR) for the treatment of male lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE), due to product heterogeneity and methodological limitations of the published trials and meta-analyses. OBJECTIVE We aimed to compare the clinical efficacy of hexanic extract of SeR (HESr) versus non-HESr (nHESr) versus placebo versus alpha-blockers (ABs) in patients affected by LUTS secondary to BPE through a network meta-analysis method. EVIDENCE ACQUISITION The search was conducted until December 31, 2018 using Medline, Scopus, and Web of Science databases without restriction. We included randomized controlled trials (RCTs) with at least one comparison between SeR, ABs, or placebo for the treatment of LUTS/BPE. Outcomes of the study were the mean change in the International Prostate Symptom Score (IPSS) and peak flow (PF). This systematic review has been registered on PROSPERO (CRD42018084360). EVIDENCE SYNTHESIS In total, 2115 articles were identified. After the global assessment, 22 RCTs matched with the inclusion criteria, including 8564 patients. For IPSS, the mean efficacies against placebo were +0.48 and -1.69 for HESr and nHESr, respectively, at 3 mo; 0.59 for nHESr at 6 mo; and -1.31 and -3.30 for nHESr and HESr, respectively, at 12 mo. For PF, the mean efficacies against placebo were +0.53 and +2.82 for HESr and nHESr, respectively, at 3 mo; +1.85 for nHESr at 6 mo; and +4.05 and +5.52 for HESr and nHESr, respectively, at 12 mo. Based on the surface under the cumulative ranking curve rankograms, terazosin showed the highest score (99.6%), while alfuzosin, tamsulosin, silodosin, HESr, and nHESr showed scores of 53.7%, 42.3%, 68.5%, 36.7%, and 47.3%, respectively. CONCLUSIONS In this network meta-analysis, we demonstrated that SeR did not show clinically meaningful improvement in LUTS and PF. PATIENT SUMMARY In the present study, we found no clinically meaningful improvement of Serenoa repens for the treatment of lower urinary tract symptoms/benign prostatic enlargement. The analysis showed that the benefit over placebo was minimal and may not justify its clinical use before higher level of evidence will be available.
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Affiliation(s)
| | | | | | - Giovanni Cacciamani
- USC Institute of Urology, University of Southern California, Los Angeles, CA, USA
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Mikkel Fode
- Department of Urology, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Mauro Gacci
- Department of Urology, University of Florence, Florence, Italy
| | | | - Andrea Cocci
- Department of Urology, University of Florence, Florence, Italy
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18
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Osman NI, Pang KH, Martens F, Atunes-Lopes T, Geavlete B, Husch T, Tutolo M, Rahnama’i MS, Marcelissen T. Detrusor Underactivity and Underactive Bladder in Women: What Is New? Curr Bladder Dysfunct Rep 2019. [DOI: 10.1007/s11884-019-00531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose of Review
Detrusor underactivity (DU) and its symptom-based correlation, the underactive bladder (UAB), are common problems encountered in urological practice. Whilst DU has been defined for many years, only recently has UAB received a formal definition and there is now accumulating literature based on this condition. In this article, we reviewed the recent literature on the aetiology, pathogenesis, diagnosis and management of DU/UAB in women.
Recent Findings
Detrusor underactivity is diagnosed on urodynamic studies but there still remains a lack of widely recognised and accepted diagnostic criteria. Commencing treatment based on the diagnosis of UAB, with or without a PVR measurement, is perhaps feasible due to the lower occurrence of BOO in women and specific clinical features that may distinguish this group. Prospective studies attempting to correlate UAB with the underlying DU are needed before this approach could be considered.
Summary
Detrusor underactivity/UAB in women requires a separate consideration from men due to the anatomical and functional differences in the lower urinary tracts between both genders and consequent differences in pathologies affecting them. The aetiology of DU remains largely unknown, but is probably multifactorial, including myogenic, neurogenic and vasculogenic factors. There remains a lack of any simple effective drug treatments, whilst apart from sacral neuromodulation for the specific subgroup with non-obstructive urinary retention, no safe and effective surgical treatment is currently available. Often, permanent or intermittent bladder drainage with a catheter is the final solution.
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19
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Malde S, Apostilidis A, Selai C, Rahnama'i MS, Marcelissen T, Cardozo L, Lovick T. Botulinum toxin A for refractory OAB and idiopathic urinary retention: Can phenotyping improve outcome for patients: ICI-RS 2019? Neurourol Urodyn 2019; 39 Suppl 3:S104-S112. [PMID: 31692092 DOI: 10.1002/nau.24207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 08/13/2019] [Accepted: 10/20/2019] [Indexed: 12/17/2022]
Abstract
AIMS Botulinum toxin A (BTX-A) is a well-established treatment for refractory idiopathic overactive bladder (OAB). It has also been used with short-term success in treating idiopathic urinary retention. However, efficacy and complication rates are variable and predicting those likely to benefit most from treatment would enable personalization of therapy and optimization of outcomes. At the International Consultation on Incontinence-Research Society (ICI-RS) meeting in 2019 a Think Tank addressed the question of how we can improve the way we phenotype patients undergoing BTX-A treatment. METHODS The Think Tank conducted a literature review and expert consensus meeting focussing on how advances in basic science research of the mechanism of action of BTX-A, as well as assessment of psychological comorbidity, can be translated into clinical practice to improve patient selection for therapy. RESULTS Idiopathic OAB and idiopathic urinary retention are heterogenous conditions encompassing several phenotypes with multiple potential pathophysiological mechanisms. Animal models have demonstrated a central nervous system mechanism of action of intravesically injected BTX-A and this has been confirmed in human functional MRI studies, but whether this tool can be used to predict outcome from treatment remains to be determined. Phenotyping based on psychological comorbidity using validated screening tools should be studied as a way to potentially optimize patient selection for therapy. CONCLUSIONS Advances in basic science research into the mechanism of action of BTX-A have improved our understanding of the pathophysiology of OAB and may lead to novel ways to phenotype patients. Psychological assessment is another way in which phenotyping may be improved. Areas for further research are proposed.
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Affiliation(s)
- Sachin Malde
- Department of Urology, Guy's Hospital, London, UK
| | - Apostolos Apostilidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Caroline Selai
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Mohammad Sajjad Rahnama'i
- Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany.,Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tom Marcelissen
- Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Thelma Lovick
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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20
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Ankolekar A, Vanneste BGL, Bloemen-van Gurp E, van Roermund JG, van Limbergen EJ, van de Beek K, Marcelissen T, Zambon V, Oelke M, Dekker A, Roumen C, Lambin P, Berlanga A, Fijten R. Development and validation of a patient decision aid for prostate Cancer therapy: from paternalistic towards participative shared decision making. BMC Med Inform Decis Mak 2019; 19:130. [PMID: 31296199 PMCID: PMC6624887 DOI: 10.1186/s12911-019-0862-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/02/2019] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Patient decision aids (PDAs) can support the treatment decision making process and empower patients to take a proactive role in their treatment pathway while using a shared decision-making (SDM) approach making participatory medicine possible. The aim of this study was to develop a PDA for prostate cancer that is accurate and user-friendly. METHODS We followed a user-centered design process consisting of five rounds of semi-structured interviews and usability surveys with topics such as informational/decisional needs of users and requirements for PDAs. Our user-base consisted of 8 urologists, 4 radiation oncologists, 2 oncology nurses, 8 general practitioners, 19 former prostate cancer patients, 4 usability experts and 11 healthy volunteers. RESULTS Informational needs for patients centered on three key factors: treatment experience, post-treatment quality of life, and the impact of side effects. Patients and clinicians valued a PDA that presents balanced information on these factors through simple understandable language and visual aids. Usability questionnaires revealed that patients were more satisfied overall with the PDA than clinicians; however, both groups had concerns that the PDA might lengthen consultation times (42 and 41%, respectively). The PDA is accessible on http://beslissamen.nl/ . CONCLUSIONS User-centered design provided valuable insights into PDA requirements but challenges in integrating diverse perspectives as clinicians focus on clinical outcomes while patients also consider quality of life. Nevertheless, it is crucial to involve a broad base of clinical users in order to better understand the decision-making process and to develop a PDA that is accurate, usable, and acceptable.
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Affiliation(s)
- Anshu Ankolekar
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Ben G. L. Vanneste
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Esther Bloemen-van Gurp
- Fontys University of Applied Sciences, Eindhoven, The Netherlands
- Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Joep G. van Roermund
- Department of Urology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Evert J. van Limbergen
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Kees van de Beek
- Department of Urology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | | | - Matthias Oelke
- Department of Urology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- St. Antonius-Hospital Gronau, Gronau, Germany
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Cheryl Roumen
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Philippe Lambin
- The D-Lab, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands
| | - Adriana Berlanga
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
| | - Rianne Fijten
- Department of Radiation Oncology (MAASTRO Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Dr. Tanslaan 12, 6229 ET Maastricht, The Netherlands
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21
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Bosch R, Abrams P, Averbeck MA, Finazzi Agró E, Gammie A, Marcelissen T, Solomon E. Do functional changes occur in the bladder due to bladder outlet obstruction? - ICI-RS 2018. Neurourol Urodyn 2019; 38 Suppl 5:S56-S65. [PMID: 31278801 PMCID: PMC6915908 DOI: 10.1002/nau.24076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 02/05/2019] [Accepted: 05/27/2019] [Indexed: 01/24/2023]
Abstract
Studies on bladder dysfunction (BD), more specifically functional‐urodynamic changes in the bladder as a result of bladder outlet obstruction (BOO) have been summarized for this TT. Based on available, but limited evidence from human studies a three‐stage model can be hypothesized to characterize BOO‐induced bladder remodeling: hypertrophy, compensation (increased detrusor contractility during the voiding phase, often in combination with filling phase detrusor overactivity) followed by the phase of decompensation [detrusor underactivity]. The time between the start of compensation and eventual decompensation seems to be determined by age of onset, severity, and type of obstruction and clinical mitigating factors such as vascular and metabolic problems. Understanding the relative contributions of these factors may allow the development of personalized timelines and probabilities for these obstructed patients.
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Affiliation(s)
- Ruud Bosch
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Paul Abrams
- Department of Urology, Bristol Urological Institute, Bristol, United Kingdom
| | | | - Enrico Finazzi Agró
- Department of Experimental Medicine and Surgery, Department of Surgery, Policlinico Tor Vergata, University of Rome "Tor Vergata" and Urology Unit, Rome, Italy
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Eskinder Solomon
- Department of Urology, Guy's and St Thomas' NHS Trust, London, United Kingdom
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22
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Vale L, Jesus F, Marcelissen T, Rieken M, Geavlete B, Rahnama'i MS, Martens F, Cruz F, Antunes‐Lopes T. Pathophysiological mechanisms in detrusor underactivity: Novel experimental findings. Low Urin Tract Symptoms 2019; 11:92-98. [DOI: 10.1111/luts.12257] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/29/2018] [Accepted: 01/07/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Luís Vale
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
| | - Filipa Jesus
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
| | - Tom Marcelissen
- Department of UrologyMaastricht University Medical Centre Maastricht The Netherlands
| | - Malte Rieken
- Department of UrologyMedical University of Vienna Vienna Austria
| | - Bogdan Geavlete
- Department of UrologySaint John Emergency Clinical Hospital Bucharest Romania
| | - Mohammad Sajjad Rahnama'i
- Department of UrologyMaastricht University Maastricht The Netherlands
- Department of UrologyUniklinik Aachen RWTH Aachen Germany
| | - Frank Martens
- Department of Urology, Rabdoud University Medical Centre Nijmegen The Netherlands
| | - Francisco Cruz
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
| | - Tiago Antunes‐Lopes
- Faculty of Medicine, University of PortoDepartment of Urology, Hospital São João Porto Portugal
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D'Ancona C, Haylen B, Oelke M, Abranches-Monteiro L, Arnold E, Goldman H, Hamid R, Homma Y, Marcelissen T, Rademakers K, Schizas A, Singla A, Soto I, Tse V, de Wachter S, Herschorn S. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn 2019; 38:433-477. [PMID: 30681183 DOI: 10.1002/nau.23897] [Citation(s) in RCA: 334] [Impact Index Per Article: 66.8] [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: 11/04/2018] [Accepted: 11/07/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION In the development of terminology of the lower urinary tract, due to its increasing complexity, the terminology for male lower urinary tract and pelvic floor symptoms and dysfunction needs to be updated using a male-specific approach and via a clinically-based consensus report. METHODS This report combines the input of members of the Standardisation Committee of the International Continence Society (ICS) in a Working Group with recognized experts in the field, assisted by many external referees. Appropriate core clinical categories and a subclassification were developed to give a numeric coding to each definition. An extensive process of 22 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS A Terminology Report for male lower urinary tract and pelvic floor symptoms and dysfunction, encompassing around 390 separate definitions/descriptors, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in male lower urinary tract and pelvic floor dysfunction. Male-specific imaging (ultrasound, radiology, CT, and MRI) has been a major addition whilst appropriate figures have been included to supplement and help clarify the text. CONCLUSIONS A consensus-based Terminology Report for male lower urinary tract and pelvic floor symptoms and dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
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Affiliation(s)
| | | | | | | | | | | | - Rizwan Hamid
- University College Hospitals, London, United Kingdom
| | - Yukio Homma
- Japanese Red Cross Medical Centre, Tokyo, Japan
| | | | | | | | - Ajay Singla
- Massachusetts General Hospital, Harvard, Boston
| | - Irela Soto
- Complejo Hospitalario, Panama City, Panama
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24
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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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25
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Antunes-Lopes T, Vale L, Coelho AM, Silva C, Rieken M, Geavlete B, Rashid T, Rahnama'i SM, Cornu JN, Marcelissen T. The Role of Urinary Microbiota in Lower Urinary Tract Dysfunction: A Systematic Review. Eur Urol Focus 2018; 6:361-369. [PMID: 30270128 DOI: 10.1016/j.euf.2018.09.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 07/14/2018] [Revised: 08/30/2018] [Accepted: 09/16/2018] [Indexed: 01/01/2023]
Abstract
CONTEXT Until 2012, the urinary tract of healthy individuals was considered to be sterile. The advent of metagenomic sequencing revealed a unique urinary microbiota (UM). This paradigm shift appears to have prolific implications in the etiology of several functional lower urinary tract (LUT) disorders. OBJECTIVE To systematically summarize recent data on the role of UM in LUT dysfunction. EVIDENCE ACQUISITION We performed a critical review according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. We conducted a search on PubMed/MEDLINE and SCOPUS with the following MESH terms/keywords: "Microbiome OR Microbiota AND (urinary disorder OR urinary tract symptom OR overactive bladder OR urinary incontinence OR interstitial cystitis OR chronic prostatitis)." The range of search was placed between January 2010 and April 2018, and articles with no full text available or those not written in English were excluded. All retrieved papers were first reviewed by title and abstract, yielding a total of 303 papers. Additional manuscripts, such as those referenced by reviews, were further included. Thirty-six publications were included. EVIDENCE SYNTHESIS Analysis by 16S rRNA sequence and expanded quantitative urine culture provided evidence for the presence of live bacteria in urine, nondetectable by standard culture protocols. Moreover, differences in the UM between healthy individuals and patients with LUT dysfunction were demonstrated. CONCLUSIONS In the near future, urologists must consider urinary dysbiosis as a possible cause of different functional LUT disorders, with potential clinical implications in their diagnosis and treatment. PATIENT SUMMARY Development of metagenomic sequencing revealed a unique urinary microbiota nondetectable by standard culture protocols. This systematic review summarizing recent data on the role of urinary microbiota in lower urinary tract (LUT) dysfunction supports urinary dysbiosis as a possible cause of different functional LUT disorders.
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Affiliation(s)
- Tiago Antunes-Lopes
- Faculty of Medicine, University of Porto, Porto, Portugal; Department of Urology, Hospital S. João, Porto, Portugal.
| | - Luis Vale
- Faculty of Medicine, University of Porto, Porto, Portugal; Department of Urology, Hospital S. João, Porto, Portugal
| | | | - Carlos Silva
- Faculty of Medicine, University of Porto, Porto, Portugal; Department of Urology, Hospital S. João, Porto, Portugal
| | - Malte Rieken
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Bogdan Geavlete
- Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania
| | - Tina Rashid
- Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Sajjad M Rahnama'i
- Maastricht University, Maastricht, The Netherlands; Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany
| | | | - Tom Marcelissen
- Maastricht University Medical Centre, Maastricht, The Netherlands
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26
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Malde S, Fry C, Schurch B, Marcelissen T, Averbeck M, Digesu A, Sahai A. What is the exact working mechanism of botulinum toxin A and sacral nerve stimulation in the treatment of overactive bladder/detrusor overactivity? ICI-RS 2017. Neurourol Urodyn 2018; 37:S108-S116. [DOI: 10.1002/nau.23552] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/19/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Sachin Malde
- Department of Urology; Guy's Hospital; London United Kingdom
| | - Christopher Fry
- School of Physiology, Pharmacology & Neuroscience; University of Bristol; Bristol United Kingdom
| | - Brigitte Schurch
- Department of Clinical Neurosciences; Neuropsychology and Neurorehabilitation Service Vaudois University Hospital of Lausanne; Switzerland
| | - Tom Marcelissen
- Department of Urology; Maastricht University Medical Centre; Netherlands
| | | | - Alex Digesu
- Department of Urogynaecology; St. Mary's Hospital; United Kingdom
| | - Arun Sahai
- Department of Urology; Guy's Hospital; London United Kingdom
- King's College London; King's Health Partners; United Kingdom
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27
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Panicker JN, Anding R, Arlandis S, Blok B, Dorrepaal C, Harding C, Marcelissen T, Rademakers K, Abrams P, Apostolidis A. Do we understand voiding dysfunction in women? Current understanding and future perspectives: ICI-RS 2017. Neurourol Urodyn 2018; 37:S75-S85. [DOI: 10.1002/nau.23709] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/05/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Jalesh N. Panicker
- Department of Uro-Neurology; The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology; Queen Square London United Kingdom
| | - Ralf Anding
- Neurourology; Department of Urology and Pediatric Urology; University Hospital Bonn; Bonn Germany
| | - Salvador Arlandis
- Department of Urology; Hospital Universitario y Politécnico La Fe; Valencia Spain
| | - Bertil Blok
- Department of Urology; Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Chris Harding
- Department of Urology; Freeman Hospital; Newcastle Upon-Tyne United Kingdom
| | - Tom Marcelissen
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Kevin Rademakers
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Paul Abrams
- Department of Urology; University of Bristol; Bristol United Kingdom
- Department of Teaching and Research, Bristol Urological Institute; International Consultation on Urological Diseases; Bristol United Kingdom
| | - Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
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28
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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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29
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Marcelissen T, Cornu JN, Antunes-Lopes T, Geavlete B, Delongchamps NB, Rashid T, Rieken M, Rahnama'i MS. Management of Idiopathic Overactive Bladder Syndrome: What Is the Optimal Strategy After Failure of Conservative Treatment? Eur Urol Focus 2018; 4:760-767. [PMID: 29807823 DOI: 10.1016/j.euf.2018.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/15/2018] [Accepted: 05/11/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT A considerable number of patients affected by the overactive bladder syndrome (OAB) do not respond to pharmacotherapy and bladder training due to unsatisfactory response or intolerability. OBJECTIVE To review the available literature assessing therapeutic effect of the available third-line treatment modalities for OAB. EVIDENCE ACQUISITION PubMed, Medline, and Cochrane databases were searched for all studies comparing outcomes of the available third-line treatment modalities for OAB. EVIDENCE SYNTHESIS Several minimally invasive surgical procedures are available for patients with refractory OAB. These therapies include intravesical botulinum toxin type A, posterior tibial nerve stimulation, and sacral neuromodulation. CONCLUSIONS None of the mentioned therapeutic modalities shows strong superiority over another. If the results of one therapy are not satisfactory, switching to another third-line treatment can be attempted. The treatment algorithm is dependent on several factors, including age, comorbidity, patient preference, surgical expertise, and financial concerns. All these factors should be taken into consideration before initiation of treatment. PATIENT SUMMARY In the management of drug-resistant overactive bladder syndrome, the different minimally invasive treatments that are available are equal. If the results of one therapy are not satisfactory, switching to another treatment can be attempted. The treatment algorithm is dependent on several factors, including age, comorbidity, patient preference, surgical expertise, and financial concerns.
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Affiliation(s)
- Tom Marcelissen
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jean-Nicolas Cornu
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Service d'urologie, CHU de Rouen, Rouen, France
| | - Tiago Antunes-Lopes
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Faculty of Medicine of Porto University, Centro Hospitalar São João, Porto, Portugal; Department of Urology, Centro Hospitalar São João, Porto, Portugal
| | - Bogdan Geavlete
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Department of Urology, Saint John Emergency Clinical Hospital, Bucharest, Romania
| | - Nicolas Barry Delongchamps
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Department of Urology, Université Paris Descartes, Hôpital Cochin, Service d'Urologie, Paris, France
| | - Tina Rashid
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Malte Rieken
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Mohammad Sajjad Rahnama'i
- European Association of Urology (EAU) Young Academic Urologists (YAU), Functional Urology Working Group, The Netherlands; Maastricht University, Maastricht, The Netherlands; Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany.
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30
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Rieken M, Antunes-Lopes T, Geavlete B, Marcelissen T. What Is New with Sexual Side Effects After Transurethral Male Lower Urinary Tract Symptom Surgery? Eur Urol Focus 2018; 4:43-45. [PMID: 29803559 DOI: 10.1016/j.euf.2018.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/25/2018] [Accepted: 05/03/2018] [Indexed: 10/16/2022]
Abstract
Transurethral resection of the prostate as well as laser prostatectomy (by either holmium laser enucleation of the prostate or Greenlight laser vaporization) is associated with risks of sexual dysfunction such as antegrade ejaculation and occasionally erectile dysfunction. While ejaculation-sparing variations of these techniques show promising results, larger multicenter studies are needed to confirm promising data. Prostatic urethral lift maintains erectile and ejaculatory function at 5-yr follow-up. The same is true for the 3-yr data on the Rezum system. Recently, Aquablation has shown promising results; however, these 6-mo data need to be confirmed during longer follow-up. An individualized, shared decision-making process based on clinical parameters and patient preference is warranted to select the ideal treatment option for each patient. PATIENT SUMMARY Sexual dysfunction such as loss of ejaculation and, less frequently, erectile dysfunction can occur after transurethral prostate surgery. Ejaculation-sparing modifications as well as minimally invasive alternatives show promising results. An individualized approach is warranted to select the ideal technique for each patient.
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Affiliation(s)
- Malte Rieken
- alta uro AG, Basel, Switzerland; University Basel, Basel, Switzerland.
| | - Tiago Antunes-Lopes
- Hospital de S. João, Porto, Portugal; Faculty of Medicine, University of Porto, Porto, Portugal
| | - Bogdan Geavlete
- Department of Urology, "Saint John" Emergency Clinical Hospital, Bucharest, Romania; "Carol Davila" University of Medicine, Bucharest, Romania
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
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31
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Marcelissen T, Rashid T, Antunes Lopes T, Delongchamps NB, Geavlete B, Rieken M, Cornu JN, Rahnama'i MS. Oral Pharmacologic Management of Overactive Bladder Syndrome: Where Do We Stand? Eur Urol Focus 2018; 5:1112-1119. [PMID: 29625926 DOI: 10.1016/j.euf.2018.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 12/06/2017] [Revised: 03/08/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
Abstract
Overactive bladder syndrome (OAB) is a prevalent disorder with a significant impact on quality of life. Despite this high prevalence, there is significant underdiagnosis and undertreatment due to several barriers, including embarrassment, poor communication and low patient adherence. Currently, various antimuscarinic are available in the treatment of OAB. The introduction of mirabegron has broadened the therapeutic approach and combination therapy of both agents can be valuable in clinical practice. Yet, patient adherence to most drugs for OAB is still relatively poor. Healthcare providers need to identify and utilise strategies to improve treatment adherence by defining clear treatment goals, implement educational methods and frequently communicate with patients to identify problems with adherence. The elderly population form need special attention as in these patients, anticholinergics should be prescribed with care and adequate knowledge regarding pharmacokinetics and drug interactions in essential. Furthermore, patient expectations should be clearly discussed. In this narrative review, the current advances in oral pharmacotherapy are evaluated and the most important factors involved in the management of OAB are discussed.
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Affiliation(s)
- Tom Marcelissen
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tina Rashid
- University Hospitals of Leicester National Health Service Trust, Leicester, UK
| | | | | | - Bogdan Geavlete
- Urological Department, Saint John Hospital Bucharest, Bucharest, Romania
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32
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Rahnama'i MS, Marcelissen T, Apostolidis A, Veit-Rubin N, Schurch B, Cardozo L, Dmochowski R. The efficacy of botulinum toxin A and sacral neuromodulation in the management of interstitial cystitis (IC)/bladder pain syndrome (BPS), what do we know? ICI-RS 2017 think thank, Bristol. Neurourol Urodyn 2018; 37:S99-S107. [PMID: 29363792 DOI: 10.1002/nau.23493] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 09/19/2017] [Accepted: 12/19/2017] [Indexed: 12/21/2022]
Abstract
AIMS This manuscript aims to address the evidence availale in the literature on the efficacy of Botulinum Toxin A (BoNT-A) and sacral neuromodulation (SNM) in patients suffering from Interstitial Cystitis (IC)/BPS and propose further research to identify mechanisms of action and establish the clinical efficacy of either therapy. METHODS At the International Consultation on Incontinence-Research Society (ICI-RS) in 2017, a panel of Functional Urologists and Urogynaecologists participated in a Think Tank (TT) discussing the management of IC/BPS by BoNT-A and SNM, using available data from both PubMed and Medicine literature searches. RESULTS The role of BoNT-A and SNM in the treatment of IC/BPS are discussed and mechanisms of actions are proposed. Despite the available randomized trial data on the effect of intravesical BoNT-A treatment on symptoms of IC/BPS, a consistent conclusion of a positive effect cannot be drawn at the moment, as the published studies are small and heterogeneous in design. There is substantive evidence for the positive effects of SNM on symptoms of IC/BPS patients however, during patient selection, it is important to distinguish the degree and the location of pain in order to tailor the best therapy to the right patients. CONCLUSIONS Both intravesical BoNT-A treatment and SNM have been shown to have positive effects in patients with IC/BPS. However, firm conclusions cannot yet be drawn. Patient-reported outcomes and quality of life should be assessed in addition to urinary and pain symptoms. Since current treatments mainly focus on symptomatic relief, future research should also focus on clarifying the pathogenic mechanisms involved in IC/BPS.
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Affiliation(s)
| | - Tom Marcelissen
- Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Apostolos Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Brigitte Schurch
- Department of Clinical Neuroscience, Neuropsychology & Neurorehabilitation Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Linda Cardozo
- Department of Urogynaecology, Kings College Hospital, London, United Kingdom
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University, Nashville, Tennesse
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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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34
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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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Abstract
INTRODUCTION Overactive bladder syndrome (OAB) including urgency and urgency urinary incontinence (UUI) occurs frequently after stress urinary incontinence (SUI) surgery. It is important to identify the risk factors for the occurrence of OAB symptoms in order to adequately inform the patient before surgery. Furthermore, when facing OAB after sling surgery it is crucial to know how to manage these symptoms. METHODS We conducted a literature review in order to assess the risk factors and management of OAB symptoms after SUI surgery. We searched for relevant articles in PubMed that specifically addressed the topic of OAB symptoms after midurethral sling surgery. RESULTS The incidence of de novo and persistent urgency and UUI is reported around 15% and 30%, respectively. Several studies demonstrated that women with mixed incontinence who have a predominant urge component will have worse outcomes after surgery. Older age was also found to be a predictive factor in three studies. Furthermore, urodynamic signs of overactive bladder (eg, DO, low bladder capacity, elevated detrusor pressure) can predict postoperative urgency or UUI. The management of OAB symptoms after SUI surgery is essentially the same as in idiopathic OAB. However, before commencing therapy it is crucial to rule out other factors than can cause urgency, including bladder outlet obstruction, urinary tract infection, or sling erosion. CONCLUSIONS OAB symptoms are frequently reported after sling surgery. Women with mixed incontinence and older women are at risk of developing post-operative OAB symptoms. We have proposed an algorithm for the treatment of these symptoms which can be useful in clinical practice.
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Affiliation(s)
- Tom Marcelissen
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
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36
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Oerlemans DJAJ, van Voskuilen AC, Marcelissen T, Weil EHJ, de Bie RA, Van Kerrebroeck PEV. Is on-demand sacral neuromodulation in patients with OAB syndrome a feasible therapy regime? Neurourol Urodyn 2011; 30:1493-6. [PMID: 21826713 DOI: 10.1002/nau.21070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 01/06/2011] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Sacral neuromodulation (SNM) of the lower urinary tract has proven to be safe and effective in patients with complaints of OAB syndrome who are not responding to conservative therapy. After 5 years of treatment the implanted system is still effective in 56-71% of patients. The loss of effect could be caused by adaptation of the nerve system to prolonged stimulation of the sacral nerves. MATERIALS AND METHODS We set up a pilot intervention study. After a run-in period of 2 weeks patients were randomized into two groups: one group with on-demand neuromodulation (intervention group) and one group with continuous neuromodulation (control group). Patients in the intervention group were instructed to switch their INS off by default and to switch it on again when they felt recurrent symptoms, patients in the control group were asked to use their system as normally. RESULTS After 2 weeks 10 out of 16 subjects reported a comparable symptom score during on-demand use of their neuromodulation system. Patients appreciated the comfort of being self-determent in the need for therapy. CONCLUSIONS Possible benefits for patients could be: more autonomy, longer battery life of the implanted INS, decreasing the chance of adaptation by the nervous system.
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Affiliation(s)
- Dennis J A J Oerlemans
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
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37
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Abstract
PURPOSE Chronic pelvic pain syndrome is a debilitating disease which often has a major impact on quality of life. A significant number of patients do not respond to conservative treatment and often no good alternative can be offered except radical surgery. Sacral neuromodulation is a well established therapy for patients with lower urinary tract dysfunction. This therapy has also been suggested to be useful in the treatment of chronic pelvic pain. Although currently no Food and Drug Administration approval exists for this indication, several studies have demonstrated promising results. We provide an overview of the published literature on sacral neuromodulation as a treatment for chronic pelvic pain. MATERIALS AND METHODS A PubMed® search was performed to identify articles in English from 1990 to February 2010 reporting treatment of pelvic pain with sacral neuromodulation. In addition, the current definitions of pelvic pain syndromes and the mechanisms of action are discussed. RESULTS A total of 12 relevant articles were identified. Of these articles 10 mainly addressed the efficacy of sacral neuromodulation in patients with interstitial cystitis/bladder pain. The percentage of patients who responded to test stimulation was reported between 51% and 77%. Of the 10 articles 7 reported treatment outcome after implantation. The duration of followup ranged between 5 and 87 months. The mean reduction in pain scores was reported between 40% and 72%. The reoperation rate ranged between 27% and 50% after long-term followup. Two articles included patients with miscellaneous urogenital pain syndromes. The success rates after implantation ranged from 60% to 77% with followup ranging between 19 and 36 months. CONCLUSIONS Currently there is insufficient evidence to determine the role of sacral neuromodulation in the treatment of chronic pelvic pain. Larger prospective trials with long-term evaluation are required to determine the ultimate efficacy of this treatment.
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Affiliation(s)
- T Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
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