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Franić D, Franić Ivanišević M, Verdenik I. Radiofrequency as the New Opportunity in Treating Overactive Bladder and Urge Urinary Incontinence-A Single-Arm Pilot Study. Medicina (Kaunas) 2024; 60:197. [PMID: 38399486 PMCID: PMC10890003 DOI: 10.3390/medicina60020197] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Until now, overactive bladder (OAB) with or without urge urinary incontinence (UUI) has been treated mainly in two ways: with behavioral methods and patient education, or using antimuscarinic drugs and/or beta-3 adrenergic receptor agonists. Unfortunately, these drugs may cause side effects in some women or are insufficiently effective, so patients abandon them. Therefore, in this pilot study, radiofrequency was evaluated as a new option in the treatment of OAB and UUI. Materials and Methods: Nineteen patients were enrolled in this pilot study using radiofrequency (RF), where the level of OAB and UUI was assessed using the validated ICIQ-OAB questionnaire. RF was applied four times for 20 min, once a week. Two weeks after treatment, the level of OAB and UUI was reassessed and processed statistically and the treatment effect evaluated. Results: Using the ICIQ-OAB, the severity of OAB and UUI was assessed: 0-3 mild symptoms; 4-7 moderate symptoms; 8-11 severe symptoms; 12-16 very severe symptoms. Before treatment, 10.5% of patients had mild symptoms, 21.1% moderate symptoms, 63.2% severe symptoms and 5.3% very severe symptoms. After treatment, 42.9% had mild symptoms, 50% moderate symptoms and 7% severe OAB and UUI symptoms. All four main symptoms-frequency, nocturia, urgency and incontinence-decreased statistically significantly, with the best results being found in urgency (p = 0.002). Conclusions: Based on this pilot study, RF seems a very promising method in the treatment of OAB and UUI. To extend our initial findings, it is necessary to perform a prospective, randomized and placebo-controlled study in order to obtain reliable results and to determine for how long one set of treatment maintains the results obtained immediately after the end of that treatment. In this way, we may determine how often the treatment needs to be repeated, if necessary, and when.
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Affiliation(s)
- Damir Franić
- Ginekologija Dr. Franić d.o.o., 3250 Rogaška Slatina, Slovenia
- Medical Faculty, University of Maribor, 2000 Maribor, Slovenia
| | - Maja Franić Ivanišević
- Obstetric and Gynecology Unit, Health Centre Slovenske Konjice, 3210 Slovenske Konjice, Slovenia;
| | - Ivan Verdenik
- Research Unit, University Gynecological Clinic Ljubljana, 1000 Ljubljana, Slovenia;
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Terra L, Heemskerk-Gerritsen BAM, Beekman MJ, Engelhardt E, Mourits MJE, van Doorn HC, de Hullu JA, Mom CH, Slangen BFM, Gaarenstroom KN, van Beurden M, Roeters Van Lennep JE, van Dorst EBL, van der Kolk LE, Collée JM, Wevers MR, Ausems MGEM, van Engelen K, van de Beek I, Berger LPV, van Asperen CJ, Gomez Garcia EB, Maas AHEM, Hooning MJ, Steensma AB, van Leeuwen FE. Urinary incontinence more than 15 years after premenopausal risk-reducing salpingo-oophorectomy: a multicentre cross-sectional study. BJOG 2024; 131:99-108. [PMID: 37394722 DOI: 10.1111/1471-0528.17591] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/09/2023] [Accepted: 06/16/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To study the impact of premenopausal risk-reducing salpingo-oophorectomy (RRSO), compared with postmenopausal RRSO, on urinary incontinence (UI) ≥10 years later. DESIGN Cross-sectional study, nested in a nationwide cohort. SETTING Multicentre in the Netherlands. POPULATION 750 women (68% BRCA1/2 pathogenic variant carriers) who underwent either premenopausal RRSO (≤45 years, n = 496) or postmenopausal RRSO (≥54 years, n = 254). All participants were ≥55 years at the time of the study. METHODS Urinary incontinence was assessed by the urinary distress inventory-6 (UDI-6); a score ≥33.3 indicated symptomatic UI. The incontinence impact questionnaire short form (IIQ-SF) was used to assess the impact on women's health-related quality of life (HR-QoL). Differences between groups were analysed using regression analyses adjusting for current age and other confounders. MAIN OUTCOME MEASURES Differences in UDI-6 scores and IIQ-SF scores between women with a premenopausal and a postmenopausal RRSO. RESULTS Women in the premenopausal RRSO group had slightly higher UDI-6 scores compared with women in the postmenopausal RRSO group (P = 0.053), and their risk of symptomatic UI was non-significantly increased (odds ratio [OR] 2.1, 95% confidence interval [95% CI] 0.93-4.78). A premenopausal RRSO was associated with a higher risk of stress UI (OR 3.5, 95% CI 1.2-10.0) but not with urge UI. The proportions of women with a significant impact of UI on HR-QoL were similar in the premenopausal and postmenopausal RRSO groups (10.4% and 13.0%, respectively; P = 0.46). CONCLUSIONS More than 15 years after premenopausal RRSO, there were no significant differences in overall symptomatic UI between women with a premenopausal and those with a postmenopausal RRSO.
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Affiliation(s)
- Lara Terra
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Maarten J Beekman
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ellen Engelhardt
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marian J E Mourits
- Department of Gynaecologic Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Helena C van Doorn
- Department of Gynaecologic Oncology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joanna A de Hullu
- Department for Gynecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Constantijne H Mom
- Department of Gynaecological Oncology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - Brigitte F M Slangen
- Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Katja N Gaarenstroom
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Marc van Beurden
- Department of Gynaecological Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Eleonora B L van Dorst
- Department of Gynaecologic Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Lizet E van der Kolk
- Family Cancer Clinic, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J Margriet Collée
- Department of Clinical Genetics, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Marijke R Wevers
- Department of Clinical Genetics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Margreet G E M Ausems
- Division Laboratories, Pharmacy and Biomedical Genetics, Department of Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Klaartje van Engelen
- Department of Human Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Irma van de Beek
- Department for Human Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieke P V Berger
- Department of Genetics, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Christi J van Asperen
- Department for Clinical Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Encarna B Gomez Garcia
- Department for Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Maartje J Hooning
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Anneke B Steensma
- Department of Gynaecologic Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Flora E van Leeuwen
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Hutchison D, Zillioux J, Ali M, Farhi J, DeNovio A, Barquin D, Rapp DE. Predictors of urinary outcomes following robotic-assisted laparoscopic prostatectomy. BJUI Compass 2023; 4:722-728. [PMID: 37818018 PMCID: PMC10560616 DOI: 10.1002/bco2.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 04/04/2023] [Accepted: 04/16/2023] [Indexed: 10/12/2023] Open
Abstract
Introduction Incontinence and urgency are common after prostatectomy. The University of Virginia prostatectomy functional outcomes program (PFOP) was developed to comprehensively assess and optimise continence outcomes following robotic-assisted laparoscopic prostatectomy (RALP). Patients are prospectively evaluated by a Female Pelvic Medicine and Reconstructive Surgery specialist. This study assessed for predictors of 3- and 6-month stress urinary incontinence (SUI) and urgency symptom outcomes following RALP. Methods We performed a post hoc review of patients from our PFOP receiving a minimum of 6-month follow-up. Urinary symptoms are prospectively assessed using the validated International Consultation on Incontinence Questionnaire-Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) questionnaire and daily pad use (pads per day [PPD]). Primary study outcomes included ICIQ-MLUTS SUI and urgency domain scores and PPD. Multivariable linear regression was performed to identify variables associated with outcomes at 3 and 6 months postoperatively. Variables included patient, oncologic and surgical factors. Each variable was run in a separate model with pelvic floor muscle therapy and surgeon to reduce confounding and prevent overfitting. Results Forty men were included. In assessment of ICIQ-MLUTS SUI domain score, at 3 months, body mass index (BMI) was associated with worse scores, and at 6 months, BMI, hypertension and estimated blood loss (EBL) were associated with worse scores, whereas bilateral nerve-sparing technique was associated with better scores. For ICIQ-MLUTS Urgency domain score, at 3 months, preoperative use of benign prostatic hyperplasia (BPH) medication was associated with better scores. No covariates predicted 6-month ICIQ-MLUTS Urgency domain scores. For PPD use, at both 3 and 6 months, BMI was a positive predictor, while preoperative use of BPH medication was a negative predictor. Conclusion Increased BMI, EBL and hypertension are associated with worsened SUI outcomes following RALP, whereas bilateral nerve-sparing technique and preoperative BPH medication are associated with improved SUI outcomes. These data may inform patient counselling and help identify patients who may benefit from closer surveillance and earlier anti-incontinence intervention.
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Affiliation(s)
- Dylan Hutchison
- Department of UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | - Marwan Ali
- Department of UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Jacques Farhi
- Department of UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Anthony DeNovio
- School of MedicineUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - David Barquin
- School of MedicineUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - David E. Rapp
- Department of UrologyUniversity of VirginiaCharlottesvilleVirginiaUSA
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Patel UJ, Moureau MK, Neuner JM, Brown HW. Screening and Treating Urinary Incontinence in Primary Care: A Missed Opportunity. OBM Geriat 2023; 7:252. [PMID: 38567050 PMCID: PMC10986360 DOI: 10.21926/obm.geriatr.2304252] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
More than 60% of adult women in the United States have urinary incontinence (UI), with the prevalence increasing to over 80% in women over age 65. Despite its high prevalence, most patients do not seek care and few clinicians screen for UI. The Medicare Health Outcomes Survey queries patients about satisfaction with their provider's discussion and management of UI, but formal recommendations about screening, diagnosis, and treatment are lacking. This review presents a practical algorithm for primary care providers to incorporate management of UI into routine preventive care for women, and outlines UI prevalence, risk factors, screening, and non-surgical treatment options.
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Affiliation(s)
- Ushma J Patel
- University of Wisconsin School of Medicine and Public
Health, Department of Obstetrics and Gynecology, 1010 Mound Street 4th floor,
Madison, WI, USA
| | - Madeline K Moureau
- University of Wisconsin School of Medicine and Public
Health, Department of Obstetrics and Gynecology, 1010 Mound Street 4th floor,
Madison, WI, USA
| | - Joan M Neuner
- Medical College of Wisconsin, Division of General Internal
Medicine, Milwaukee, WI, USA
| | - Heidi W Brown
- Kaiser Permanente, Department of Obstetrics and
Gynecology, 3250 Fordham Street, San Diego, CA, USA
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Paasch C, Soeder S, Lorenz E, Heisler S, Götze M, Borgmann H, Olthoff J, Hünerbein M, Hunger R, Mantke R. The effect of biofeedback pelvic floor training with ACTICORE1 on urinary incontinence: a multicenter randomized clinical pilot trial. Ann Med Surg (Lond) 2023; 85:4860-4865. [PMID: 37811051 PMCID: PMC10553154 DOI: 10.1097/ms9.0000000000001181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/04/2023] [Indexed: 10/10/2023] Open
Abstract
Background Pelvic floor training with biofeedback has been shown to significantly reduce symptoms of urinary incontinence. The present study aimed to evaluate the effectiveness of pelvic floor training with the ACTICORE1 biofeedback device, which uses a noninsertable pelvic floor sensor with a digital interface. Materials and methods A multicenter randomized controlled clinical pilot study in Germany was conducted between October 2021 and January 2022. The intervention group was instructed to use ACTICORE1 for 6 min daily to train the pelvic floor for 12 weeks. The control group was instructed not to do any pelvic floor training. Over 18-year-old men and women with urinary incontinence and an International Consultation on Incontinence Questionnaire score (ICIQ) of ≥5 were included in the study. The primary endpoint was the ICIQ score 12 weeks after enrollment. The secondary endpoints were the ICIQ score and quality of life using the EG-5D-3L questionnaire 4, 8, and 12 weeks after patients' enrollment. Results A total of 40 individuals with urinary incontinence were recruited for the present study (35 females, 5 males; 40% lost to follow-up). In terms of biometric data, both groups did not differ. At 4, 8, and 12 weeks, the ICIQ scores of those in the ACTICORE1 group decreased from 12.9 to 7.5. The ICIQ score in the control group decreased from 11.0 to 10.5. The intraindividual improvement of patients in the ACTICORE group was statistically significant. Conclusion Biofeedback training with ACTICORE1 significantly reduces symptoms of urinary incontinence after 12 weeks.
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Affiliation(s)
- Christoph Paasch
- University Hospital Brandenburg an der Havel, Brandenburg Medical University
| | - Sonja Soeder
- Visceral Vascular Surgery, Minimally Invasive Surgery Alexianer St. Hedwig Hospital
- Physiotherapy Practice Soeder, Berlin
| | - Eric Lorenz
- Visceral Vascular Surgery, Minimally Invasive Surgery Alexianer St. Hedwig Hospital
| | - Sophie Heisler
- University Hospital Brandenburg an der Havel, Brandenburg Medical University
| | - Matthias Götze
- University Hospital Brandenburg an der Havel, Brandenburg Medical University
| | - Hendrik Borgmann
- University Hospital Brandenburg an der Havel, Brandenburg Medical University
| | - Julia Olthoff
- University Hospital Brandenburg an der Havel, Brandenburg Medical University
| | - Michael Hünerbein
- Department of Surgery, Oberhavel Klinik Oranienburg, Oranienburg, Germany
| | - Richard Hunger
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg
| | - René Mantke
- University Hospital Brandenburg an der Havel, Brandenburg Medical University
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg
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Warehime JM, Gaskins JT, Gupta AS, Hattab EM, Feroz RT, Rothenberger RW, Lenger SM, Francis SL, Herring NR. Proximity of percutaneous tibial nerve stimulation needle insertion to surrounding anatomic structures: a cadaveric study. Am J Obstet Gynecol 2023; 229:430.e1-430.e6. [PMID: 37419167 DOI: 10.1016/j.ajog.2023.06.048] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Percutaneous tibial nerve stimulation is a third-line treatment for overactive bladder and urgency urinary incontinence. During the procedure, a needle is inserted cephalad to the medial malleolus and posterior to the tibia. In recent years, permanent implants and leads have been developed for insertion into the medial ankle via a small incision. There are many important structures present in the medial compartment of the ankle, including the great saphenous vein, saphenous nerve, tibial nerve, posterior tibial vessels, and tendons of the posterior compartment leg muscles. OBJECTIVE The primary objective of this study was to identify the proximity of the percutaneous tibial nerve stimulation needle placed per Food and Drug Administration-approved device instructions to nearby important anatomic structures. The secondary objectives were to identify the proximity of the tibial nerve to the needle site, identify clinically relevant ankle anatomic structures, and confirm the tibial nerve and posterior tibial vasculature by histologic analysis. STUDY DESIGN Detailed medial ankle dissections were performed bilaterally on 10 female lightly embalmed anatomic donors (cadavers) obtained from the Willed Body Program at the University of Louisville. A pin was inserted at the percutaneous tibial nerve stimulation needle site, and the medial ankle was minimally dissected so the surrounding anatomic structures were visible but not disrupted. The shortest distance from the pin to the selected structures of the medial ankle region was measured. On completion of each dissection and set of measurements, tissue was harvested for histologic examination. The distances between the pin and each structure were assessed using means and standard deviations. A paired t test was used to assess the difference in the locations between the left and right ankles. Statistical analysis was performed on left-sided, right-sided, and combined measurements. An 80% prediction interval was found to represent the expected range of values for the measurement of a new cadaver or patient, and the 95% confidence interval of the mean was computed to characterize the average distance across all cadavers or patients. RESULTS The medial ankle of 10 adult female lightly embalmed cadavers were examined bilaterally. Dissections were completed from October 2021 to July 2022. Of note, 80% prediction intervals for the tibial nerve, the posterior tibial artery or vein, and the flexor digitorum longus tendon had a lower range of 0.0 mm from the pin and extending to 12.1, 9.5, and 13.9 mm, respectively. Moreover, 2 of the structures were found to be asymmetrical between the right and left ankles. The great saphenous vein was further from the pin on the left (20.5 mm [standard deviation of 6.4 mm] on the left vs 18.1 mm [standard deviation of 5.3 mm] on the right; P=.04). The calcaneal (Achilles) tendon was further from the pin on the right side (13.2 mm [standard deviation of 6.8 mm] vs 7.9 mm [standard deviation of 6.7 mm]; P=.04). Tibial neurovascular structures were confirmed with microscopic analysis. CONCLUSION The anatomic structures within the medial ankle lie unexpectedly close to the percutaneous tibial nerve stimulation needle site as noted per Food and Drug Administration-approved device instructions. There is a possibility that some medial ankle structures are not symmetrical. It is crucial that practitioners understand medial ankle anatomy when performing percutaneous tibial nerve stimulation or permanent device insertion.
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Affiliation(s)
- Jenna M Warehime
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Women's Health, University of Louisville School of Medicine, Louisville, KY.
| | - Jeremy T Gaskins
- Department of Bioinformatics and Biostatistics, University of Louisville School of Public Health and Information Sciences, Louisville, KY
| | - Ankita S Gupta
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Women's Health, University of Louisville School of Medicine, Louisville, KY
| | | | - Rehan T Feroz
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Women's Health, University of Louisville School of Medicine, Louisville, KY
| | - Rodger W Rothenberger
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Women's Health, University of Louisville School of Medicine, Louisville, KY
| | - Stacy M Lenger
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Women's Health, University of Louisville School of Medicine, Louisville, KY
| | - Sean L Francis
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology, and Women's Health, University of Louisville School of Medicine, Louisville, KY
| | - Nicole R Herring
- Anatomical Sciences and Neurobiology, University of Louisville School of Medicine, Louisville, KY
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7
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Apolikhina IA, Teterina TA, Arefieva OA, Kasyan GR, Krivoborodov GG, Romikh VV, Mirkin YB, Fomenko OY, Saidova AS, Yarotskaya EL, Gorodnova EA, Pushkar DY, Apolikhin OI, Gadzhieva ZK, Korshunova ES, Filippova ES, Kuzmin IV, Shornikov PV. [Language, cultural adaptation and validation of the OABSS (Overactive Bladder Symptom Score) questionnaire in patients with overactive bladder]. Urologiia 2023:31-39. [PMID: 37850278] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
AIM To perform language and cultural adaptation and validation of the OABSS (Overactive Bladder Symptom Score) questionnaire among patients with overactive bladder (OAB), proposed as an effective tool for assessing the severity of symptoms and the efficiency of treatment in clinics of the Russian Federation. MATERIALS AND METHODS In accordance with the protocols for carrying out such studies, the procedure of standardized forward-backward translation of the OABSS questionnaire was performed. Further, the intermediate Russian-language version was applied to 15 patients with subsequent correction of deficiencies and approval of the final Russian-language version of the questionnaire. In total, the study group included 176 patients of both sexes with OAB symptoms who filled out the questionnaire twice (test-retest) with an interval of 10-14 days. RESULTS Based on the statistical analysis (Cronbach's alpha = 0.961), there was a significant degree of internal consistency of the sample. This fact is also supported by the very high retest reliability of the questionnaire (ICC >0.9). CONCLUSION Our data showed that the Russian version of the OABSS questionnaire is a reliable and valid tool for subjective assessment of the severity of OAB symptoms.
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Affiliation(s)
- I A Apolikhina
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - T A Teterina
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - O A Arefieva
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - G R Kasyan
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - G G Krivoborodov
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - V V Romikh
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - Ya B Mirkin
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - O Yu Fomenko
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - A S Saidova
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - E L Yarotskaya
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - E A Gorodnova
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - D Yu Pushkar
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - O I Apolikhin
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - Z K Gadzhieva
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - E S Korshunova
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - E S Filippova
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - I V Kuzmin
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
| | - P V Shornikov
- National Medical Research Center of Obstetrics, Gynecology and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia, Moscow, Russia
- FGAOU VO I.M. Sechenov First Moscow State Medical University
- A.I. Evdokimov Moscow State University of Medicine and Dentistry of Ministry of Health of Russia
- N.A. Lopatkin Scientific Research Institute of Urology and Interventional Radiology Branch of the National Medical Research Centre of Radiology of the Ministry of Health of Russian Federation, Moscow, Russia
- FGAOU VO Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of Russia, Moscow, Russia
- International Medical Center URO-PRO, Krasnodar, Russia
- FGBU Ryzhikh State Scientific Center of Coloproctology of the Ministry of Health of Russia, Moscow, Russia
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- FGBOU VO Ural State Medical University of the Ministry of Health of the Russian Federation, Yekaterinburg, Russia
- Academician I.P. Pavlov First St. Petersburg State Medical University of the Ministry of Healthcare of Russian Federation, Saint Petersburg, Russia
- FGBOU VO Kuban State Medical University of Minzdrav of Russia, Krasnodar, Russia
- NIIOZMM DZM, Moscow, Russia
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Qudah S, Abufaraj M, Farah R, Almazeedi A, Ababneh A, Alnabulsi M, Qatawneh A, Hyassat D, Ajlouni K. The prevalence of overactive bladder and its impact on the quality of life: A cross-sectional study. Arab J Urol 2023; 22:39-47. [PMID: 38205386 PMCID: PMC10776079 DOI: 10.1080/2090598x.2023.2221403] [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: 03/25/2023] [Accepted: 05/30/2023] [Indexed: 01/12/2024] Open
Abstract
Objective Overactive bladder (OAB) is a common condition affecting both men and women and has been shown to affect the quality of life. We conducted this study to estimate the prevalence of OAB, and to incorporate symptom severity, symptom bother and health-related quality of life (HRQL) in the assessment of OAB and evaluate associated factors. Methodology A total of 940 participants were categorized into non-OAB and OAB using the Overactive Bladder Symptom Score (OABSS). HRQL and symptom bother were measured using the Overactive Bladder Questionnaire - Short Form (OAB-q SF). Descriptive analyses and multivariable regression analyses were performed. Results The prevalence of OAB among our population was 27.4%. Patients with older age (Odd ratio [OR] = 2.26, 95% confidence interval [CI]: 1.6-3), higher body mass index (BMI) (OR = 2.6, 95% CI: 1.8-3.8), comorbidities (OR = 2.6, 95% CI: 1.9-3.5) and history of recurrent urinary tract infection (UTI) s (OR = 1.9, 95% CI: 1.4-2.6) were significantly associated with increased risk of OAB (p < 0.001). The mean OAB symptom bothers score was 35.7 + 22.9 and increased significantly across OAB severity groups (p < 0.001). The mean HRQL score was 73.3 + 22 and a significant decreased across OAB severity groups (p < 0.001). All OAB symptoms showed significant positive correlation with increased symptom bother (p < 0.001) in addition to significant inverse correlation with HRQL (p < 0.001). Conclusion OAB is a prevalent condition in our population and the associated symptoms negatively affect HRQL. In this study, the detrimental effect is not exclusive to UUI and can be attributed to the other elements in the symptom spectrum of OAB. Screening for OAB should be considered during routine clinical visits using validated and reliable measures for early detection of symptoms and possible modification of risk factors to improve the outcome.
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Affiliation(s)
- Shrouq Qudah
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Mohammad Abufaraj
- Division of Urology, Department of Special Surgery, Jordan University Hospital, Amman, Jordan
| | - Randa Farah
- Department of Internal Medicine, School of Medicine, Jordan University Hospital, Amman, Jordan
| | | | - Ali Ababneh
- Division of Urology, Department of Special Surgery, Jordan University Hospital, Amman, Jordan
| | - Mazen Alnabulsi
- Division of Urology, Department of Special Surgery, Jordan University Hospital, Amman, Jordan
| | - Ayman Qatawneh
- Department of Obstetrics and Gynecology, Faculty of Medicine, The University of Jordan, Amman, Jordan
| | - Dana Hyassat
- The National Center for Diabetes, Endocrinology and Genetic (NCDEG)/The University of Jordan, Amman, Jordan
| | - Kamel Ajlouni
- The National Center for Diabetes, Endocrinology and Genetic (NCDEG)/The University of Jordan, Amman, Jordan
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McPhail C, Carey R, Nambiar S, Willison N, Bahadori S, Aryan P, Nguyen T, Behnia-Willison F. The Investigation of Percutaneous Tibial Nerve Stimulation (PTNS) as a Minimally Invasive, Non-Surgical, Non-Hormonal Treatment for Overactive Bladder Symptoms. J Clin Med 2023; 12:jcm12103490. [PMID: 37240596 DOI: 10.3390/jcm12103490] [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: 01/31/2023] [Revised: 04/26/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Overactive bladder (OAB) syndrome affects 10-15% of women, severely impacting their quality of life. First-line treatments include behavioural and physical therapy, and second-line medical treatments include medications such as vaginal oestrogen, anticholinergic medications, and ß3-adrenergic agonists-with potential adverse side effects including dizziness, constipation, and delirium, particularly affecting elderly populations. Third-line treatments include more invasive measures, including intradetrusor botulinum injections or sacral nerve modulation, with percutaneous tibial nerve stimulation (PTNS) being a potential alternative treatment. AIMS The aim of this study was to explore the long-term efficacy of PTNS treatment for OAB in an Australian cohort. MATERIALS AND METHODS This is a prospective cohort study. Patients underwent Phase 1 treatment, whereby women received PTNS treatment once per week for 12 weeks. Following Phase 1, women entered Phase 2, whereby they received 12 PTNS treatments over 6 months. Their response to treatment was measured by obtaining data before and after each phase using ICIQ-OAB and the Australian Pelvic Floor Questionnaire (APFQ). RESULTS Phase 1 included 166 women, with 51 completing Phase 2. There was a statistically significant reduction in urinary urgency (29.8%), nocturia (29.8%), incontinence (31.0%), and frequency (33.8%) compared to the baseline. Patients who completed Phase 2 also showed a statistically significant reduction in urinary frequency (56.5%). CONCLUSIONS Overall, the results from this study are positive and support that PTNS is a minimally invasive, non-surgical, non-hormonal, and effective treatment for OAB. These results suggest that PTNS may be a second-line treatment for patients with OAB not responding to conservative management or for patients aiming to avoid surgical approaches.
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Affiliation(s)
| | - Robert Carey
- Department of Obstetrics & Gynaecology, Flinders Medical Centre, Bedford Park 5042, Australia
| | | | | | - Saghi Bahadori
- Adelaide Medical School, University of Adelaide, Adelaide 5005, Australia
| | - Pouria Aryan
- FBW Gynaecology Plus, Adelaide 5035, Australia
- School of Electrical & Electronic Engineering, University of Adelaide, Adelaide 5005, Australia
| | - Tran Nguyen
- FBW Gynaecology Plus, Adelaide 5035, Australia
- Adelaide Medical School, University of Adelaide, Adelaide 5005, Australia
| | - Fariba Behnia-Willison
- FBW Gynaecology Plus, Adelaide 5035, Australia
- Department of Obstetrics & Gynaecology, Flinders Medical Centre, Bedford Park 5042, Australia
- Flinders University, Adelaide 5042, Australia
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10
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Yates A. Identification, assessment and treatment of urinary incontinence and bowel control issues. Nurs Stand 2023; 38:75-82. [PMID: 36794519 DOI: 10.7748/ns.2023.e11977] [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] [Accepted: 05/11/2022] [Indexed: 02/17/2023]
Abstract
Urinary incontinence and bowel control issues are prevalent within the general population and have significant adverse effects on peoples' daily lives and quality of life. This article examines the prevalence of urinary incontinence and bowel control issues and describes some of the more common types of issues. The author explains how to undertake a basic urinary and bowel continence assessment and outlines some of the treatment options, including lifestyle interventions and medicines.
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Affiliation(s)
- Ann Yates
- Cardiff and Vale University Health Board, St David's Hospital, Cardiff, Wales
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11
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Bretschneider CE, Liu Q, Smith AR, Kirkali Z, Amundsen CL, Lai HH, Geynisman-Tan J, Kirby A, Cameron AP, Helmuth ME, Griffith JW, Jelovsek JE. Treatment patterns in women with urinary urgency and/or urgency urinary incontinence in the symptoms of Lower Urinary Tract Dysfunction Research Network Observational Cohort Study. Neurourol Urodyn 2023; 42:194-204. [PMID: 36579974 PMCID: PMC9811511 DOI: 10.1002/nau.25067] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/19/2022] [Accepted: 10/06/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Limited epidemiological data exist describing how patients engage with various treatments for overactive bladder (OAB). To improve care for patients with OAB, it is essential to gain a better understanding of how patients interface with OAB treatments longitudinally, that is, how often patients change treatments and the pattern of this treatment change in terms of escalation and de-escalation. OBJECTIVES To describe treatment patterns for women with bothersome urinary urgency (UU) and/or urgency urinary incontinence (UUI) presenting to specialty care over 1 year. STUDY DESIGN The Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) study enrolled adult women with bothersome UU and/or UUI seeking care for lower urinary tract symptoms (LUTS) between January 2015 and September 2016. An ordinal logistic regression model was fitted to describe the probabilities of escalating or de-escalating level of treatment during 1-year follow-up. RESULTS Among 349 women, 281 reported UUI and 68 reported UU at baseline. At the end of 1 year of treatment by a urologist or urogynecologist, the highest level of treatment received by participants was 5% expectant management, 36% behavioral treatments (BT), 26% physical therapy (PT), 26% OAB medications, 1% percutaneous tibial nerve stimulation, 3% intradetrusor onabotulinum toxin A injection, and 3% sacral neuromodulation. Participants using BT or PT at baseline were more likely to be de-escalated to no treatment than participants on OAB medications at baseline, who tended to stay on medications. Predictors of the highest level of treatment included starting level of treatment, hypertension, UUI severity, stress urinary incontinence, and anticholinergic burden score. CONCLUSIONS Treatment patterns for UU and UUI are diverse. Even for patients with significant bother from OAB presenting to specialty clinics, further treatment often only involves conservative or medical therapies. This study highlights the need for improved treatment algorithms to escalate patients with persistent symptoms, or to adjust care in those who have been unsuccessfully treated.
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Affiliation(s)
| | - Q. Liu
- Arbor Research Collaborative for Health, Ann Arbor, MI USA
| | | | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD USA
| | | | - H. Henry Lai
- Division of Urologic Surgery, Departments of Surgery and Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Anna Kirby
- University of Washington Medical Center, Seattle, WA, USA
| | | | | | - James W. Griffith
- Northwestern University – The Feinberg School of Medicine, Chicago, IL, USA
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12
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Muacevic A, Adler JR, Beyatlı M, Bedir S, Özgök Y. The Efficiency and Safety of Mirabegron Monotherapy for the Treatment of Urge Incontinence in Women Aged >80 Years. Cureus 2023; 15:e33685. [PMID: 36793804 PMCID: PMC9924700 DOI: 10.7759/cureus.33685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/15/2023] Open
Abstract
Objective We aimed to evaluate the efficacy and safety of mirabegron monotherapy in very older (>80 years) women with overactive bladder (OAB) who were discontinued anticholinergic drugs by the other departments. Material and methods The present retrospective study evaluated very older (>80 years) women with OAB who were discontinued anticholinergic drugs by the other departments between May 2018 and January 2021. Efficacy assessments were performed using Overactive Bladder-Validated Eight-Question (OAB-V8) scores before and after mirabegron monotherapy (12 weeks). Safety was evaluated based on adverse events (hypertension, nasopharyngitis, and urinary tract infection), electrocardiography, hypertension measure, uroflowmetry (UFM), and post-voiding. Patient data including demographic characteristics, diagnoses, values before and after mirabegron monotherapy, and adverse events were evaluated. Results A total of 42 very older (>80 years) women with OAB who used mirabegron monotherapy (50 mg per day) were included in this study. Frequency, nocturia, urgency, and total OAB-V8 scores were significantly lower after mirabegron monotherapy than before mirabegron monotherapy (p < 0.05, p < 0.05, p < 0.05, and p < 0.05, respectively). There was no significant difference between systolic-diastolic blood pressure and heart rate before and after mirabegron monotherapy treatment. Conclusion Mirabegron monotherapy is an effective and safe therapy in very older (>80 years) women with OAB.
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Ellis-Jones J. Clinical assessment of lower urinary tract symptoms in adults. Nurs Stand 2022; 37:75-81. [PMID: 35312242 DOI: 10.7748/ns.2022.e11821] [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] [Accepted: 01/12/2022] [Indexed: 11/09/2022]
Abstract
Lower urinary tract symptoms (LUTS) result from conditions and diseases that affect the bladder and the urethra, and can occur in men and women of all ages. LUTS can be debilitating and affect a person's quality of life significantly. This article describes the definitions and classification of various LUTS, explains the aspects of an initial LUTS assessment and outlines the validated tools that can be used to support this process, including questionnaires and bladder diaries. It also provides information about the contributing factors associated with LUTS and the effects of these symptoms on patients' quality of life.
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Affiliation(s)
- Julie Ellis-Jones
- University of the West of England, Bristol, England, and Florence Nightingale Foundation scholar
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Te Dorsthorst M, Digesu A, van Kerrebroeck P, Elneil S, van Breda J, Janssen D, Martens F, van Balken M, Heesakkers J. Patient-tailored healthcare and tibial nerve neuromodulation in the treatment of patients with overactive bladder symptoms. Neurourol Urodyn 2022; 41:679-684. [PMID: 35019163 PMCID: PMC9306561 DOI: 10.1002/nau.24873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/14/2022]
Abstract
Purpose The aim of this study was to demonstrate features predictive of treatment response for patient‐tailored overactive bladder (OAB) intervention with an implantable tibial neurostimulator using patient and technical prediction factors. Materials and Methods This study was designed as a follow‐up study based on parameter settings and patients' preferences during the pilot and extended study of the implantable tibial nerve stimulator (RENOVA™ iStim system). For this study, we compared all treatment parameters (stimulation amplitude, frequency, and pulse width) and usage data (duration of treatment) during the different follow‐up visits. Results We obtained usage data from a total of 32 patients who were implanted with the system between February and September 2015. Age, sex, body mass index (BMI) and previous experience with percutaneous tibial nerve stimulation (PTNS) treatment were considered as possible prediction factors for treatment success. However, only BMI was considered a statistically significant prediction factor (p = 0.042). A statistically significant increase in mean treatment level was seen in the responder group during the 3 month follow‐up visit (mean: 6.7 mA, SD 0.416) as compared with the initial system activation visit (mean: 5.8 mA, SD 0.400) (p = 0.049). No other visits demonstrated statistically significant changes in both groups (responders and nonresponders) during the defined timepoints. Conclusion This data underscores the need to use patient‐tailored OAB treatment. BMI was found to be a negative predictive factor for treatment success. However, it was not possible to develop a specific responder model. A model predicting response to treatment could be useful for implementing shared decision making.
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Affiliation(s)
| | - Alex Digesu
- Department of Urogynaecology, Imperial College NHS Healthcare, London, UK
| | - Philip van Kerrebroeck
- Department of Urology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Sohier Elneil
- Department of Uro-Neurology, National Hospital of Neurology and Neurosurgery, London, UK
| | | | - Dick Janssen
- Department of Urology, RadboudUMC, Nijmegen, The Netherlands
| | - Frank Martens
- Department of Urology, RadboudUMC, Nijmegen, The Netherlands
| | | | - John Heesakkers
- Department of Urology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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15
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Martinez S, Martel P, Roth B, Grilo N. [Urinary incontinence: a good diagnosis as a basis for treatment]. Praxis (Bern 1994) 2022; 110:32-37. [PMID: 34983203 DOI: 10.1024/1661-8157/a003800] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Urinary incontinence: a good diagnosis as a basis for treatment Abstract. Abtract: Everyone has experienced incontinence at an early age. However, it also affects approximately 200 million people worldwide at the adult age. This common condition is frequently underreported by patients but can dramatically limit their social life. Subject to appropriate differential diagnosis, urinary incontinence is a condition that can be treated with good results in the majority of patients. This article provides a review of the essential symptomatology and current treatments, so that clinicians confronted with the problem may adopt the appropriate management.
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Affiliation(s)
- Silvia Martinez
- Service d'urologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne
| | - Paul Martel
- Service d'urologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne
| | - Beat Roth
- Service d'urologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne
| | - Nuno Grilo
- Service d'urologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne
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AlAzab R, Alomari RA, Khader YS, Gharaibeh M. Stress urinary incontinence among Jordanian women living in rural areas: Prevalence, associated factors and self-management behaviours. Arab J Urol 2021; 19:469-472. [PMID: 34881064 PMCID: PMC8648036 DOI: 10.1080/2090598x.2021.1926751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives: To assess the prevalence of stress urinary incontinence (SUI) among Jordanian women aged 35–65 years living in in rural areas and its associated risk factors. Patients and methods: A cross-sectional study utilising a convenience sample of 1000 non-pregnant women who were recruited from healthcare centres and community settings. Participants completed a structured questionnaire that included demographic and gynaecological data, and questions about SUI. Descriptive analysis and logistic regression were used to analyse the data. Results: Overall, 551 women (55.1%) reported having SUI with a duration of 37.9–47.6 months. The mean age of the women was 45.38 years and 29.6% were post-menopausal. Moreover, 40.6% were overweight, 38.9% obese, and 16.9% were smokers. Married women comprised 81.8%; with 37.1% having four to six children and 92.8% had a normal delivery, whereas 28% had a history of caesarean section. Coughing was the major precipitating factor for SUI (87.7%). In addition, 64.8% of women with SUI did not avoid activities that precipitated SUI such as housekeeping and lifting, and 78.6% did not seek any medical care. The major significant correlates for SUI were: high body mass index (odds ratio [OR] 2.506, 95% confidence interval [CI] 1.744–3.600, P < 0.001), being aged >50 years (OR 1.716, 95% CI 1.183–2.489, P = 0.004), a history of gynaecological/pelvic surgery (OR 1.631, 95% CI 1.206–2.205, P = 0.001), and vaginal delivery (OR 1.052, 95% CI 1.004–1.101, P = 0.033). Conclusion: SUI prevalence among Jordanian women is high with symptoms reported in more than a half of study participants. Older age, obesity, a history of gynaecological surgery, and history of vaginal delivery were the major correlates of SUI. Public awareness is needed to identify the condition for early diagnosis and treatment of SUI. Abbreviations: BMI: high body mass index; OR: odds ratio; (M)(S)(U)UI: (mixed) (stress) (urge) urinary incontinence
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Affiliation(s)
- Rami AlAzab
- Division of Urology, Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Reema Ahmad Alomari
- Clinical Nurse Specialist in Maternal New-born Nursing, Ibn-Hayyan Pharma, Irbid, Jordan
| | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Muntaha Gharaibeh
- Secretary General of the Jordanian Nursing Council, Jordan University of Science and Technology, Irbid, Jordan
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Pipitone F, Sadeghi Z, DeLancey JO. Urethral function and failure: A review of current knowledge of urethral closure mechanisms, how they vary, and how they are affected by life events. Neurourol Urodyn 2021; 40:1869-1879. [PMID: 34488242 PMCID: PMC8556259 DOI: 10.1002/nau.24760] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/15/2021] [Accepted: 07/18/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION A critical appraisal of the literature regarding female urethral function and dysfunction is needed in light of recent evidence showing the urethra's role in causing stress and urge urinary incontinence. METHODS An evidence assessment was conducted using selected articles from the literature that contained mechanistic data on factors affecting urethral function and failure. RESULTS Maximal urethral closure pressure (MUCP) is 40% lower in stress urinary incontinence (SUI) than normal controls. Evidence from five women shows relatively equal contributions to MUCP from striated/smooth muscle, vascular-plexus, connective tissue. MUCP varies twofold in individuals of similar age and declines 15% per decade even in nulliparous women. Age explains 57% of the variance in MUCP. This parallels with striated/smooth muscle loss and reduced nerve density. Factors influencing pressure variation minute-to-minute and decade-to-decade are poorly understood. Connective tissue changes have not been investigated. MUCP in de novo SUI persisting 9-months postpartum is 25% less than in age and parity-matched controls. Longitudinal studies do not show significant changes in urethral function after vaginal birth suggesting that changes in urethral support from birth may unmask pre-existing sphincter weakness and precipitate SUI. Mechanisms of interaction between support injury, pre-existing urethral weakness, and neuropathy are unclear. CONCLUSION Urethral failure is the predominant cause of SUI and a contributing factor for UUI; potentially explaining why mixed symptoms predominate in epidemiological studies. Age-related striated muscle loss and differences between women of similar age are prominent features of poor urethral closure. Yet, connective tissue changes, vasculature function, and complex interactions among factors are poorly understood.
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Affiliation(s)
- Fernanda Pipitone
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
- Hospital das Clínicas da FMUSP, University of São Paulo, São Paulo, Brazil
| | - Zhina Sadeghi
- Division of Neurourology and Pelvic Reconstructive Surgery, Department of Urology University of Michigan, Ann Arbor, MI
| | - John O.L. DeLancey
- Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
- Department of Obstetrics and Gynecology, Michigan Medicine, Ann Arbor, MI, USA
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Karim F, Rantell A. Understanding the basic assessment and treatment of lower urinary tract symptoms in older women. Nurs Older People 2021; 33:33-41. [PMID: 34494411 DOI: 10.7748/nop.2021.e1305] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 11/09/2022]
Abstract
Lower urinary tract symptoms (LUTS) are prevalent in older women. These symptoms are often under-reported due to the potentially embarrassing nature of the symptoms and a belief that they are an inevitable consequence of ageing. LUTS such as urinary incontinence have a significant negative effect on people's quality of life; however, with the appropriate assessment and management, improvements can be achieved. This article reviews the different types of LUTS and their causes, assessment and treatment, focusing on older women. It aims to provide nurses with an understanding of LUTS so that they can identify appropriate interventions.
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Affiliation(s)
- Faisal Karim
- obstetrics and gynaecology, King's College Hospital NHS Foundation Trust, London, England
| | - Angela Rantell
- King's College Hospital NHS Foundation Trust, London, England
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19
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Affiliation(s)
- Peter Petros
- University of Western Australia School of Mechanical and Mathematical Engineering, Perth, Australia
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20
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Borisov VV. [Overactive bladder pathogenetic features and choice of drug therapy]. Urologiia 2021:120-127. [PMID: 33960171] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The information about the founders of studies of the bladder function in our country, the features of the nervous and humoral regulation of the lower urinary tract activity, the cholinergic and adrenergic effects of mediators are presented in the article in the form of a clinical lecture. The pathogenetic features of detrusor dysfunction in overactive bladder and the principles of choosing drug therapy are described. Special attention is paid to the comparative characteristics of modern M-anticholinergics.
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Affiliation(s)
- V V Borisov
- FGAOU VO I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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21
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Járomi P, Banyó T, Boros M, Papp F, Szabó A. Clinical aspects and therapeutic possibilities of neurogenic bladder. Orv Hetil 2021; 162:135-143. [PMID: 33486465 DOI: 10.1556/650.2021.31974] [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: 06/28/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. Az alsó húgyutak fő funkciója a vizelet tárolása és ürítése, amely működések zavara az úgynevezett alsó húgyúti tünetegyüttes kialakulásához vezet, ami a kiváltó októl függően vizeletürítési zavarral és vizeletretencióval is járhat. Kezeletlen esetekben a felső húgyutak károsodása következik be a magas hólyagnyomás által kiváltott vesicoureteralis reflux következtében, amely ureter- és veseüregrendszeri tágulat kialakulására, illetve fertőzésekre és kőképződésre hajlamosít. A vizelettárolási/vizeletürítési zavarokat három fő csoportba sorolhatjuk, úgymint stressz- (terheléses) inkontinencia , hiperaktív hólyag (nedves/száraz) és neurogén hólyag. A jelen összefoglaló közlemény tárgyát képező neurogén hólyag egy gyűjtőfogalom, mely magában foglal minden, releváns neurológiai kórkép talaján kialakult vizelettárolási és vizeletürítési zavart. Mivel a húgyhólyag mellett a záróizomzat és a hátsó húgycső is érintett, ezt a kórképet napjainkban "neurogén alsó húgyúti diszfunkció" elnevezéssel is szokás illetni. A kórállapotot a neurológiai diszfunkciók széles spektruma okozhatja, kezdve a helyi funkcionális zavartól a helyi idegi sérülésen át a felső és alsó motoneuron-sérülésig vagy a centrális degeneratív folyamatokig. Az eltérő etiológia ellenére a klinikai tünetek rendszerint két alapvető klinikai típusban manifesztálódhatnak: túlműködő (fokozott detrusorkontraktilitást okozó automata) hólyag vagy alulműködő hólyag formájában. Tekintettel a neurogén alsó húgyúti diszfunkció következtében létrejövő felső húgyúti komplikációkra, a közlemény egyik célja a betegség diagnózisát segítő algoritmus bemutatása a legújabb nemzetközi szakirodalmi ismeretek alapján. A neurogén hólyag kezelése jobbára nem terjedhet ki a kiváltó ok kezelésére, ezért a jelen összefoglaló másik célja azon gyógyszeres és invazív terápiás beavatkozások összefoglalása, melyek a felső húgyutak védelmét szolgálják az alacsony hólyagnyomás fenntartása révén. Orv Hetil. 2021; 162(4): 135-143. Summary. Storage and urination are the main functions of the lower urinary tract and its lesions lead to the so-called lower urinary tract syndrome causing either urinary incontinence or retention. In untreated cases, the upper urinary tract becomes injured via a vesicoureteral reflux resulting from increased bladder pressure and resultant dilations of the ureter and the renal pelvis which predispose to infection and stone formation. Lower urinary tract storage/urination disorders can be classified as stress incontinence, hyperactive bladder (wet/dry) and neurogenic bladder. Neurogenic bladder which is the subject of this review, is a collective term that encompasses all urinary storage and emptying disorders which develop on the basis of neurological diseases. Being not only the bladder, but also the sphincter and posterior urethra (generally termed as the "bladder outlet") affected, nowadays this condition is referred to as "neurogenic lower urinary tract dysfunction". A wide range of neurological dysfunctions could contribute to the development of this condition, ranging from local dysfunction (autonomic dysreflexia) or local nerve injury to upper/lower motoneuron injury or central degenerative processes. Regardless of the diverse etiology, the clinical symptoms eventually manifest in two major forms, i.e., overacting (automatic bladder with increased detrusor contractility) and underactive bladder. Considering the severity of complication occurring in the upper urinary tract in response to the pathophysiological changes in the lower urinary tract, one of the aims of this paper was to present an algorithm aiming to build up a state of the art diagnosis of the disease based on current international literature data. Since treatment of the neurogenic bladder usually can not target elimination of the underlying cause, the other goal of the present paper is to summarize the pharmacological treatment regimen and invasive therapeutic interventions that protect the upper urinary tract by maintaining low pressure values in the bladder. Orv Hetil. 2021; 162(4): 135-143.
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Affiliation(s)
- Péter Járomi
- 1 Bács-Kiskun Megyei Kórház, Urológiai Osztály, Kecskemét
| | - Tamás Banyó
- 2 Országos Orvosi Rehabilitációs Intézet, Urodinamikai Labor, Budapest
| | - Mihály Boros
- 3 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Sebészeti Műtéttani Intézet, Szeged, Pulz u. 1., 6724
| | - Ferenc Papp
- 1 Bács-Kiskun Megyei Kórház, Urológiai Osztály, Kecskemét
| | - Andrea Szabó
- 3 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Sebészeti Műtéttani Intézet, Szeged, Pulz u. 1., 6724
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Chen Z, Moore KH, Mansfield KJ, Ognenovska S, Allen W, Parkin K, Mukerjee C, Aryal NR, Gebski V. Effect of antibiotics on urine leakage in women with refractory detrusor overactivity: A phase IIb randomized trial. Neurourol Urodyn 2020; 40:158-167. [PMID: 32990349 DOI: 10.1002/nau.24525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/04/2020] [Revised: 07/13/2020] [Accepted: 09/15/2020] [Indexed: 01/31/2023]
Abstract
AIM Because bacterial cystitis is common in women with refractory detrusor overactivity, the aim was to compare the efficacy of 6 weeks of rotating antibiotics versus placebo, in conjunction with an anticholinergic, in controlling the symptoms of urge incontinence. METHODS In a multicenter phase IIb double-blinded randomized placebo-controlled trial, women with urodynamically proven refractory detrusor overactivity were randomized in a 2:1 ratio of antibiotics versus placebo for 6 weeks, in addition to darifenacin for 6 months. Any woman with disabling cystitis symptoms was given appropriate antibiotics ("clinical override"). The primary outcome was the degree of urge incontinence change at 6 weeks and 6 months on 24-h pad test. Secondary outcomes were changes in leaks and voids per day measured on 3-day bladder diary and quality of life measures. Microbiological data were collected at all visits. RESULTS Although 278 women were screened, only 36 were randomized and 33 (91.7%) completed the trial. Leakage on 24-h pad test decreased at 6 months by 75 g in patients receiving antibiotics versus 35 g in placebo. Cure of urge incontinence occurred at 6 months in 10/21 (48%) of antibiotics versus 2/12 (17%) of placebo. Clinical override, necessitating treatment of cystitis, occurred in 41.6% of placebo versus 16.7% of the antibiotic group by 6 months. CONCLUSION Despite the small sample size, the study showed a significant reduction in pad leakage and leaks per day over 24 h in the active treatment group over a 6-month period. Nearly half of patients on placebo had disabling urinary tract infection symptoms that required clinical override treatment.
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Affiliation(s)
- Zhuoran Chen
- Department of Urogynaecology, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Kate H Moore
- Department of Urogynaecology, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Kylie J Mansfield
- Illawarra Health and Medical Research Institute and School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Samantha Ognenovska
- Department of Urogynaecology, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Wendy Allen
- Department of Urogynaecology, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Katrina Parkin
- Department of Urogynaecology, St. George Hospital, University of New South Wales, Sydney, New South Wales, Australia
| | - Chinmoy Mukerjee
- Division of Microbiology, SEALS, St. George Hospital, Sydney, New South Wales, Australia
| | - Nanda R Aryal
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, New South Wales, Australia
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Sakalis V, Gkotsi A. Do Drugs Work for ΟΑΒ Following Prostate Cancer Surgery. Curr Drug Targets 2020; 21:1515-1526. [PMID: 32674729 DOI: 10.2174/1389450121666200716202103] [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: 02/10/2020] [Revised: 04/15/2020] [Accepted: 05/18/2020] [Indexed: 11/22/2022]
Abstract
There is evidence that post-radical prostatectomy (post-RP) incontinence is not just the insufficiency of the external urethral sphincter mechanism. Up to a third of men with post-RP incontinence suffer from bladder dysfunction, namely overactive bladder (OAB). OAB is a complex symptom syndrome with poorly defined pathophysiology. It causes a significant burden to patients, negatively affects the quality of their life and its management might be difficult and challenging. The incidence of post-RP OAB ranges from 15.2 to 37.8%. The aetiology is multifactorial and includes the partial decentralization of the bladder, the detrusor underactivity, the bladder outlet obstruction and the co-existence with stress urinary incontinence (SUI). Post-RP SUI may lead to defunctionalized bladder and activation of urethrovesical reflex which further deteriorate post-RP continence. The diagnostic work-up of men with post-RP OAB should aim to identify potential aetiologic factors and personalize the treatment accordingly. Until now, there is no robust data from literature with regards to post-RP OAB management. It seems that anticholinergics and PDE5 inhibitors are effective in improving OAB parameters.
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Tkaczynska Z, Becker S, Maetzler W, Timmers M, Van Nueten L, Sulzer P, Salvadore G, Schäffer E, Brockmann K, Streffer J, Berg D, Liepelt-Scarfone I. Executive Function Is Related to the Urinary Urgency in Non-demented Patients With Parkinson's Disease. Front Aging Neurosci 2020; 12:55. [PMID: 32210789 PMCID: PMC7069351 DOI: 10.3389/fnagi.2020.00055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 02/18/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: Evidence suggests urinary urgency is associated with cognitive impairment in a subtype of Parkinson’s disease (PD) patients. This study investigates if cognitive impairment independently predicts the presence of urinary dysfunction. Methods: We report data of 189 idiopathic PD patients, excluding those with concomitant diseases or medication interacting with bladder function. A standardized questionnaire was used to define the presence of urinary urgency. All patients underwent a comprehensive motor, cognitive non-motor and health-related quality of life (HRQoL) assessment. Multivariable linear regression analysis was performed to identify independent variables characterizing urinary urgency in PD (PD-UU), which were assigned as discriminant features to estimate their individual contribution to the phenotype of the PD-UU group. Results: Of 189 PD patients, 115 (60.8%) reported PD-UU. The linear regression analysis showed that among cognitive domains, executive function (EF; p = 0.04) had a significant negative association with PD-UU. In a second model, scores of the Montreal Cognitive Assessment (MoCA) significantly differentiated between study groups (p = 0.007) and also non-motor symptom (NMS) burden (p < 0.001). The third model consisted of reports of HRQoL, of which stigma was the only subscale of the Parkinson’s Disease Questionnaire (PDQ-39) differentiating between patients with and without PD-UU (p = 0.02). The linear discriminant analysis provided evidence that the combination of EF, NMS burden, nocturia, and stigma discriminated between groups with 72.4% accuracy. Conclusion: In our large, non-demented PD cohort, urinary urgency was associated with executive dysfunction (EF), supporting a possible causative link between both symptoms. A combination of neuropsychological and non-motor aspects identified patients with PD-UU with high discriminative accuracy.
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Affiliation(s)
- Zuzanna Tkaczynska
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Sara Becker
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Walter Maetzler
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Maarten Timmers
- Janssen Research and Development, Janssen-Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Luc Van Nueten
- Janssen Research and Development, Janssen-Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium
| | - Patricia Sulzer
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Giacomo Salvadore
- Janssen Research and Development LLC, Janssen-Pharmaceutical Companies of Johnson & Johnson, Titusville, NJ, United States
| | - Eva Schäffer
- Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Kathrin Brockmann
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
| | - Johannes Streffer
- Janssen Research and Development, Janssen-Pharmaceutical Companies of Johnson & Johnson, Beerse, Belgium.,Reference Center for Biological Markers of Dementia (BIODEM), Institute Born-Bunge, University of Antwerp, Antwerp, Belgium
| | - Daniela Berg
- German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany.,Department of Neurology, Christian-Albrechts-University, Kiel, Germany
| | - Inga Liepelt-Scarfone
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), University of Tübingen, Tübingen, Germany
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Abstract
AIMS To identify epidemiological studies of mechanical low back pain and urinary dysfunction, and to identify potential evidence supporting a mechanism for this relationship. METHODS A systematic online search was conducted of EmBASE, Medline, CINAHL, and PEDro databases. We excluded studies where an obvious link between low back pain and urinary dysfunction exists (such as cauda equina syndrome). Two reviewers used inclusion/exclusion criteria to screen the articles. Data were extracted and summarised with a narrative review, and study quality was assessed. RESULTS We included 22/930 studies. Twelve studies addressed the epidemiological link between low back pain and urinary symptoms. The studies all found a statistically significant association between the diagnosis of urinary incontinence or urinary symptoms and low back pain, (aOR's 1.1 to 3.1). Results were consistent when stratified by sex, age, and when adjusted for confounders. The study quality was good in 4/12. Eight studies reported on an assessment/intervention related to pelvic floor function, urinary symptoms and low back pain. Pelvic floor dysfunction was common in women with low back pain, however randomized studies and pre-post studies reported mixed results for pelvic floor physiotherapy improving low back pain. The study quality was good in 3/8. CONCLUSIONS Low back pain and urinary incontinence are associated in large epidemiological studies, and the presence of one condition seems to predispose the development of the other. There is limited evidence to suggest pelvic floor interventions are useful for low back pain in this patient population, therefore the mechanism for this relationship is still unclear.
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Affiliation(s)
- Blayne Welk
- Department of Surgery and Epidemiology & Biostatistics, Western University, London, Ontario, Canada
| | - Richard Baverstock
- Division of Urology, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Reitz A, Hüsch T, Haferkamp A. Persistent storage symptoms after TURP can be predicted with a nomogram derived from the ice water test. Neurourol Urodyn 2019; 38:1844-1851. [PMID: 31286547 DOI: 10.1002/nau.24068] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/20/2019] [Indexed: 11/07/2022]
Abstract
PURPOSE To predict the persistence of storage symptoms after transurethral resection of the prostate (TURP) using a nomogram derived from the ice water test (IWT). METHODS The IWTs of 73 men with lower urinary tract symptoms and prostatic bladder outlet obstruction were retrospectively analyzed. The strength of the detrusor contraction was approximated by using the detrusor gradient of Δpdet /Δt at maximum detrusor pressure and the area under the curve. The parameters were utilized in a nomogram, which facilitated a severity categorization from 1 to 10. Patients with a positive IWT in the categories 1 to 2 were assigned to group A, categories 3 to 4 to group B and categories 5 and higher to group C. After TURP, patients with persisting storage symptoms were offered a botulinum toxin injection. RESULTS There were 32 patients (44%) with negative and 41 patients (56%) with positive IWTs. Patients with negative IWTs were classified in category 1. Regarding patients with positive IWTs, 14 (34%) were correlated to group A, 14 (34%) to group B, and 13 (32%) to group C. The necessity of a subsequent botulinum toxin injection correlated significantly with a higher nomogram category (P < .001) as well as higher severity categorization (P < .001). In multivariate analysis, the nomogram category was an independent predictor for botulinum toxin injection (P = .002, OR, 6.9, CI, 2.0-23.9). CONCLUSION The quantification of the detrusor contraction during the IWT allowed stratification of patients in risk categories for persistent storage symptoms after TURP and the potential need for later botulinum toxin injections.
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Affiliation(s)
- André Reitz
- KontinenzZentrum Hirslanden, Zurich, Switzerland
| | - Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
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27
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Shaw J, Negbenebor N, Wohlrab K, Raker C, Sung V. Audiovisual stimulus during urodynamics to provoke detrusor overactivity: A randomized trial. Low Urin Tract Symptoms 2018; 11:127-132. [PMID: 30565422 DOI: 10.1111/luts.12248] [Citation(s) in RCA: 2] [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: 07/02/2018] [Revised: 08/27/2018] [Accepted: 10/26/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This study estimated the effect of adding an audiovisual (AV) intervention during urodynamic evaluation (UDE) on increasing detrusor contractions (DO) versus routine UDE testing without AV cues. METHODS A randomized trial was conducted of women with overactive bladder (OAB) undergoing UDE with and without AV intervention. The AV intervention was a 1-minute video on continuous loop showing common OAB triggers. A continuous running waterfall provided auditory stimulation. The primary outcome was the proportion of patients who had DO on UDE, interpreted by masked clinicians. Secondary outcomes included the number, amplitude, and duration of DO and urinary leakage associated with DO. A sample size of 109 per group was calculated to have 80% power to detect a 20% difference with a significance level of 0.05. RESULTS In all, 109 women each were randomized to standard UDE and to the AV intervention. There was no difference in the proportion of patients with DO on UDE between the intervention and control groups (35% vs 32%, respectively; P = 0.8). Furthermore, there were no differences between the intervention and control groups in leakage with DO on UDE (24% vs 21%, respectively), mean duration of detrusor contractions (23.9 vs 25.3 s, respectively), or mean maximum detrusor pressure during involuntary contractions (18.1 vs 20.6 cm H2 O, respectively). Clinical severity of OAB symptoms was not associated with the detection of DO or other UDE parameters. CONCLUSIONS Addition of AV intervention during UDE did not increase the finding of detrusor contractions. The relationship between OAB triggers, urge incontinence, and urodynamic findings remains unclear.
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Affiliation(s)
- Jonathan Shaw
- Division of Urogynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Nicole Negbenebor
- Division of Urogynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kyle Wohlrab
- Division of Urogynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Christine Raker
- Division of Research, Women and Infants Hospital of Rhode Island, Providence, Rhode Island
| | - Vivian Sung
- Division of Urogynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Mühlstädt S, Mischner S, Kranz J, Anheuser P, Mohammed N, Steffens JA, Fornara P. Quo Vadis Botulinum Toxin: Normative Constraints and Quality of Life for Patients With Idiopathic OAB? Front Surg 2018; 5:61. [PMID: 30386782 PMCID: PMC6198085 DOI: 10.3389/fsurg.2018.00061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 09/14/2018] [Indexed: 01/10/2023] Open
Abstract
Background: Idiopathic overactive bladder (iOAB), with or without urge incontinence (UI), has significant psychosocial effects on patients' quality of life (QoL). The first choice of treatment for iOAB is anticholinergics and, alternatively, the β-3-adrenoceptor agonist mirabegron. However, systemic side effects and contraindications should be considered for both medications. Objective: We report the efficacy, safety and effects on QoL of botulinum toxin therapy (onabotulinum toxin type A, BOTOX®, Allergan) among patients with iOAB ± UI. Patients and Methods: Between 2005 and 2013, 51 patients were treated with onabotulinum toxin A (100 units). The inclusion criteria were the presence of confirmed iOAB ± UI with previous use of anticholinergic medication. Micturition frequency, pad count, postvoid residual volume and QoL were evaluated using two validated questionnaires [the Client Satisfaction Questionnaire-8 (CSQ-8) and the King's Health Questionnaire (KHQ)]. Statistical analysis was performed with SPSS 24.0 (p < 0.05). Results: After botulinum toxin injection, a significant improvement in iOAB ± UI symptoms was observed. The micturition frequency decreased from 10.4 ± 0.5 to 5.2 ± 0.4 micturitions per day (p = 0.026), and the pad count decreased from 3.6 ± 1.0 to 1.2 ± 0.3 pads per day (p = 0.033). Anticholinergics were not used during the administration of botulinum toxin therapy. Complications and postoperative need for intermittent self-catheterization (ISC) were not observed. Overall, 72 and 24% of patients reported being “satisfied” or “very satisfied” with the treatment. Additionally, 66% of patients would choose botulinum toxin again for the treatment of iOAB. Conclusion: Botulinum toxin therapy is an efficient, safe, and life-improving treatment for iOAB.
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Affiliation(s)
- Sandra Mühlstädt
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
| | - Shahidul Mischner
- Department of Orthopaedics, Berufsgenossenschaftliche Kliniken Bergmannstrost, Halle (Saale), Germany
| | - Jennifer Kranz
- Department of Urology and Paediatric Urology, St. Antonius Hospital, Eschweiler, Germany
| | - Petra Anheuser
- Department of Urology, Asklepios Clinic, Hamburg, Germany
| | - Nasreldin Mohammed
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
| | - Joachim A Steffens
- Department of Urology and Paediatric Urology, St. Antonius Hospital, Eschweiler, Germany
| | - Paolo Fornara
- Department of Urology and Kidney Transplantation, Martin-Luther-University, Halle (Saale), Germany
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29
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Abstract
Urinary incontinence is a common and usually hidden issue that can affect women of all ages. It is often ignored by the patient because of their misconception that incontinence is an inevitable consequence of ageing and their low expectations of successful treatment. There are various types of incontinence, with symptoms that can significantly affect patients' quality of life. This article aims to enhance nurses' understanding of the types of urinary incontinence affecting women, associated risk factors and continence assessment, as well as the initial investigations and conservative treatments that can be instigated by general nurses. It also discusses some of the advanced treatments offered by specialist services. The article emphasises the importance of undertaking a holistic continence assessment to ensure appropriate continence care is provided, and how tailoring this care to the individual can improve adherence to treatment plans.
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Affiliation(s)
- Ellie Stewart
- Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, England
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30
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Abello A, Das AK. Electrical neuromodulation in the management of lower urinary tract dysfunction: evidence, experience and future prospects. Ther Adv Urol 2018; 10:165-173. [PMID: 29623108 DOI: 10.1177/1756287218756082] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 11/05/2017] [Accepted: 12/23/2017] [Indexed: 11/16/2022] Open
Abstract
Lower urinary tract dysfunction (LUTD) is common and causes a spectrum of morbidity and decreased quality of life (QoL) for patients. LUTD can range from urinary retention to urge incontinence, and includes a variety of syndromes, with the most common and widely recognized being overactive bladder (OAB). The classic treatments of LUTD and OAB comprise different strategies including behavioral therapies, medications and minimally invasive or invasive surgical procedures. Generally, once patients have tried behavioral modifications and oral medical therapy, and have not experienced adequate relief of their symptoms, the next step is to consider minimally invasive therapies. In the last two decades since FDA approval, sacral nerve stimulation (SNS) has become an accepted intervention, with increasing use and evidence of effectiveness for LUTD, specifically OAB and non-obstructive urinary retention. SNS has shown both objective and subjective improvement in voiding symptoms in several randomized controlled trials (RCTs) when compared to sham or standard medical therapy. The main limitations for more extensive use include relatively high cost, implantation of a device and possibly reoperation secondary to adverse events (AE). Percutaneous tibial nerve stimulation (PTNS) is a less invasive, less direct and less expensive method for neuromodulation, which has also shown effectiveness in several randomized and non-randomized trials, including comparable improvement rates to anticholinergics in OAB management. However, the efficacy of PTNS is only maintained for a short period after the stimulation is delivered. This technique has a much lower rate of AE compared to SNS, but with the inconvenience of weekly visits for stimulation, although implantable devices are on the horizon. In this article we review the mechanism of action, indications, effectiveness and complications related to SNS and PTNS therapy for LUTD.
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Affiliation(s)
- Alejandro Abello
- Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anurag K Das
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston MA 02215, USA
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32
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Petros P. A ligamentous explanation for overactive bladder symptoms as defined by International Continence Society in the female. Cent European J Urol 2017; 71:105-107. [PMID: 29732215 PMCID: PMC5926643 DOI: 10.5173/ceju.2017.1597] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 11/24/2017] [Accepted: 11/26/2017] [Indexed: 01/22/2023] Open
Abstract
The International Continence Society (ICS) committee has defined overactive bladder (OAB) as "a syndrome characterized by symptoms of urgency, with or without urgency incontinence, usually with increased daytime frequency and nocturia (increased night time urination). The term OAB can only be used if there is no proven infection or other obvious pathology". Though the ICS gives no anatomical basis for OAB, it is suggested that the cause is from the detrusor itself. In this review, urodynamic evidence is presented that OAB in the female may be a prematurely activated but normal micturition reflex, as predicted by the Integral Theory. Anatomically, a trampoline analogy explains how loose ligaments prevent the vaginal stretching so important for support of the bladder base stretch receptors which control the reflex. Surgical cure of OAB by repair of loose cardinal/ uterosacral ligaments are an important proof that the origins of OAB are outside the bladder, laxity of the suspensory ligaments which in turn, inactivate the striated muscle vector forces which contract against them. This concept is not in in conflict with the definitions of the ICS. Rather it provides a causative anatomical background to the definitions.
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Affiliation(s)
- Peter Petros
- University of Western Australia, Perth, Australia Professorial Department of Surgery University of NSW St. Vincent's Hospital Sydney, Australia
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33
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Krivoborodov GG, Tur EI. [Comprehensive pharmacologic management of overactive bladder]. Urologiia 2017:82-88. [PMID: 28394529 DOI: 10.18565/urol.2017.1.82-88] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Overactive bladder (OAB) is a common and bothersome condition manifested by urgency, frequent urination, significantly impairing patients quality of life. The article presents an overview of the evidence on pharmacotherapy of neurogenic and idiopathic OAB. Selective M3 receptor blockers have been shown to be the medications of choice in treating these patients. Many studies have shown that solifenacin 10 mg is a starting dose for patients with OAB. Mirabegron (Betmiga) is the only 3-adrenergic receptor agonist approved for primary treatment of OAB patients refractory to anticholinergics or have their side effects. It seems promising to use this drug, both as monotherapy and concurrently with anticholinergic agents to improve treatment results in patients with idiopathic and neurogenic OAB.
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Affiliation(s)
- G G Krivoborodov
- Department of Urology and Andrology, Medical Faculty of N.I. Pirogov RNRMU of Minzdrav of Russia, Moscow.,Department of Urology, Russian Gerontology Research and Clinical Center, Moscow, Russia
| | - E I Tur
- Universita degli studi di Firenze, Florence, Italy
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Liedl B, Inoue H, Sekiguchi Y, Haverfield M, Richardson P, Yassourides A, Wagenlehner F. Is overactive bladder in the female surgically curable by ligament repair? Cent European J Urol 2017; 70:53-59. [PMID: 28461989 PMCID: PMC5407336 DOI: 10.5173/ceju.2017.938] [Citation(s) in RCA: 18] [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: 10/23/2016] [Revised: 11/23/2016] [Accepted: 01/16/2017] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Overactive bladder (OAB) symptoms (urge, frequency, nocturia) are not generally considered surgically curable by learning institutions. The Integral Theory hypothesizes that OAB is a prematurely activated, but normal micturition reflex caused by loose suspensory ligaments and potentially curable surgically by repairing such ligaments. To test this hypothesis by surgical repair of loose cardinal and uterosacral ligaments in patients with 2nd degree or greater uterine/apical prolapse. MATERIAL AND METHODS Multicenter prospective case control audit. 611 females, mean age 70. Inclusions: symptomatic apical prolapse of 2nd or greater degree, (POPQ stages 2-4), and at least two pelvic symptoms. Exclusions: Comorbid medical problems known to cause chronic pelvic pain (e.g., infection), sphincter tears, neurological bladder conditions. Surgery: minimally invasive cardinal/uterosacral ligament repair using the TFS (Tissue Fixation System). Primary outcome: Uterine prolapse cure; Secondary outcomes; bladder, bowel, and pain symptoms improvement. RESULTS 90% prolapse cure in 611 patients. Symptom incidence (% Cure at 12 months in brackets) was: urge incontinence: n = 310 (85%); frequency: n = 317 (83%); nocturia: n = 254 (68%); chronic pelvic pain (CPP): n = 194 (77%); fecal incontinence: n = 93 (65%). Statistics: McNemar x2-tests to test for significant changes in the symptoms' incidence-frequency from baseline (preoperative) to the postoperative phase. For each symptom the null hypothesis H0: P(baseline) = P(12 months after surgery)versus H1: P(baseline) ≠ P(12 months after surgery) was tested, with P indicating prevalence or incidence rate. CONCLUSIONS Bladder & bowel incontinence and chronic pelvic pain occur in predictable groupings and are associated with apical prolapse. OAB symptom improvement with the TFS ligament repair provides a good alternative to anticholinergics, especially when considering their association with dementia causation. Application of the Integral Theory System has the potential to significantly improve clinical practice, QoL for ageing women, delaying entry into Nursing Homes and creating new scientific research directions. The take home message is that symptoms of chronic pelvic pain, bladder and bowel dysfunction occur in relatively predictable groups, caused by lax suspensory ligaments and can be cured or improved by TFS mini sling ligament repair.
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Affiliation(s)
- Bernhard Liedl
- Zentrum für Urogenital Chirurgie BBZ, Fachkliniken München AG, Germany
| | - Hiromi Inoue
- Urogynaecology Center, Shonan Kamakura General Hospital, Kamakura, Japan
- LUNA Pelvic Floor Total Support Clinic, Women’s Clinic LUNA Group, Yokohama, Japan
| | - Yuki Sekiguchi
- LUNA Pelvic Floor Total Support Clinic, Women’s Clinic LUNA Group, Yokohama, Japan
| | - Max Haverfield
- Department of Gynaecology, The Northern Hospital, Melbourne Victoria, Australia
| | - Peter Richardson
- Department of Health, Medical and Applied Sciences, University of Central Queensland, Australia University of Central Queensland, Australia
| | | | - Florian Wagenlehner
- Clinic for Urology, Pediatric Urology und Andrology, Justus-Liebig-University Giessen, Germany
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Abstract
OBJECTIVES Urinary incontinence (UI) is more prevalent in the elderly populations with dementia than without dementia, and Alzheimer's disease (AD) is the most common cause of dementia. Urinary incontinence may complicate AD morbidity and mortality. Therefore, this study aimed to evaluate the prevalence and annual incidence and determine the risk possibility of UI, which is the main type of incontinence in patients with AD in Taiwan. METHODS A total of 933 patients with AD were included in the study cohort, and a total of 2799 patients without AD by 1:3 proportion compared to the study cohort were used as a matched cohort. All participants were selected from the National Health Insurance Research Database in 2000 sample population. We utilize Cox proportional hazard regression to evaluate the risk of UI and cumulative incidence ratio curve to analyze the cumulative incidence function. Prevalence and annual incidence rate are calculated in individual medication including rivastigmine, donepezil, galantamine, and memantine only being initiated in patients with AD. RESULTS The risk of UI is higher in AD cohort (hazard ratio: 1.54, 95% confidence interval: 1.13-2.09). The cumulative incidence ratio of UI event between AD cohort and matched cohort presents statistical significance ( P < .001). Annual incidence and prevalence of UI in patients with AD are 6.2% and 4.2%, respectively. CONCLUSION The present results suggest that the risk of UI is higher in patients with AD than in the general population.
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Affiliation(s)
- Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Shun Juan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Yu-Han Chang
- Management Office, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Hsin-Chih Yeh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Chun Tsai
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Kuang-Shun Chueh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
- Department of and Master’s Program in Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Perucchini D, Betschart C, Fink D, Scheiner DA. [Not Available]. Praxis (Bern 1994) 2017; 106:37-44. [PMID: 28055318 DOI: 10.1024/1661-8157/a002573] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Zusammenfassung. OAB (overactive bladder syndrome) ist zwar ein häufiges Leiden, doch wird es oft nicht diagnostiziert und deshalb nicht behandelt. Die Behandlung erfolgt symptomatisch. Im Praxisalltag muss vorgängig eine Basis-(Ausschluss)-Diagnostik durchgeführt werden. Das Führen eines Blasentagebuchs ist sowohl für die Diagnostik als auch für den Verlauf wichtig. Eine urogynäkologische Abklärung mit Urodynamik empfiehlt sich in unklaren Situationen und beim Vorliegen einer gemischten Symptomatik mit Symptomen einer Belastungsinkontinenz oder bei gleichzeitigem Vorliegen einer Blasenentleerungsstörung. Die Therapie erfolgt Schritt für Schritt. Schon einfache Verhaltensänderungen und ein Blasen- und Beckenbodentraining können die Symptomatik deutlich verbessern. Viele Patientinnen profitieren aber zusätzlich von der medikamentösen Therapie. Jahrzehntelang standen dazu alleinig Anticholinergika zur Verfügung. Doch die Langzeitcompliance ist unter diesen Medikamenten gering. Neu erweitern β3-Adrenorezeptor-Agonisten das therapeutische Spektrum: Bei ähnlicher Wirkung unterscheidet sich das Nebenwirkungsprofil unter anderem durch das Fehlen von Mundtrockenheit. Bei therapierefraktärer OAB steht die intravesikale Injektion von Onabotulinumtoxin A als sehr effektive Therapie zur Verfügung. In seltenen Fällen ist auch eine Neuromodulation indiziert.
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Affiliation(s)
- Daniele Perucchini
- 1 Blasenzentrum Zürich Stadelhofen und Klinik für Gynäkologie, Universitätsspital Zürich
| | - Cornelia Betschart
- 1 Blasenzentrum Zürich Stadelhofen und Klinik für Gynäkologie, Universitätsspital Zürich
| | - Daniel Fink
- 1 Blasenzentrum Zürich Stadelhofen und Klinik für Gynäkologie, Universitätsspital Zürich
| | - David A Scheiner
- 1 Blasenzentrum Zürich Stadelhofen und Klinik für Gynäkologie, Universitätsspital Zürich
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Kaptan H, Kulaksızoğlu H, Kasımcan Ö, Seçkin B. The Association between Urinary Incontinence and Low Back Pain and Radiculopathy in Women. Open Access Maced J Med Sci 2016; 4:665-669. [PMID: 28028410 PMCID: PMC5175518 DOI: 10.3889/oamjms.2016.129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/05/2016] [Accepted: 11/06/2016] [Indexed: 12/21/2022] Open
Abstract
AIM Urinary incontinence (UI) is a common dysfunction, affecting especially women of all ages. The terminology of low back pain (LBP) and radiculopathy (RP) may be misused interchangeably with each other. There are many reports of the association with LBP and incontinence but those involving compression of nerve root(as RP), has not been distinguished from isolated low back pain. This study was structured to analyse the association of UI, LBP and RP. METHODS One hundred twenty patients were included in the study. Patients with spinal or urinary infection, tumour (spinal or others), cauda equine, pelvic operation, spinal trauma, spinal surgery, urogenital pathology were not accepted for this study. Age and weight of all patients were determined. Oswestry Disability Index (ODI) was utilised for assessment of loss of function and SEAPI incontinence index was used for urinary incontinence. All patients were examined for neurological pathology to differentiate between the LBP and RP by department of neurosurgery. Student t-test and Mann-Whitney-U tests were used for statistical significance. RESULTS There was no statistical significance between low back pain with overall urinary incontinence (p = 0.131), urge (p = 0.103) or stress incontinence (p = 0.68), respectively. However; The statistical aspects were identified relationship between overall (p = 0.026) and urge (p = 0.001) urinary incontinence with radiculopathy. The association of urge incontinence and radiculopathy seems to show a more significant relationship. Yet there was no correlation between radiculopathy and stress incontinence (P = 0.062). CONCLUSION Low back pain should not be regarded as a predisposing factor for urinary incontinence; however, radiculopathy has a statistically positive correlation between overall incontinence and urge incontinence.
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Affiliation(s)
- Hulagu Kaptan
- Dokuz Eylül University, Medical Faculty, Department of Neurosurgery, Izmir, Turkey
| | | | - Ömür Kasımcan
- Liv Hospital, Department of Neurosurgery, Istanbul, Turkey
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Kazilov YB, Gadzhieva ZK. [Prevalence of various voiding disorders]. Urologiia 2016:109-114. [PMID: 28248031] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The article presents the data of Russian and international epidemiological studies on the prevalence of various lower urinary tract symptoms (LUTS) among male and female populations. The overall summary of these data highlights the need for the national data on LUTS prevalence, severity and impact on quality of life to project the spending for LUTS management.
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Affiliation(s)
- Yu B Kazilov
- Research Institute for Uronephrology and Human Reproductive Health, Clinic of Urology, Sechenov First Moscow State Medical University of Minzdrav of Russia
| | - Z K Gadzhieva
- Research Institute for Uronephrology and Human Reproductive Health, Clinic of Urology, Sechenov First Moscow State Medical University of Minzdrav of Russia
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Abstract
Overactive bladder (OAB) symptoms of urgency, frequency, and urge incontinence currently affect a substantial portion of the population, especially as age increases. Sacral neuromodulation has become a popular option for refractory OAB symptoms over the past 2 decades. Studies have demonstrated that it is an effective treatment for OAB and urge incontinence as indicated by decreased number of voids, increased bladder capacity, and fewer leakage events. In addition, the effects have proved to be durable to multiple years following implantation. These benefits come at the expense of a high rate of adverse events, although with comparable long-term cost-effectiveness to botulinum toxin A. We aimed to review the literature that demonstrates that sacral neuromodulation continues to be an efficacious treatment for refractory OAB wet and dry patients, with continuously expanding indications.
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Affiliation(s)
- Troy Sukhu
- Department of Urology, University of North Carolina, Chapel Hill
| | | | - Raj Kurpad
- Department of Urology, University of North Carolina, Chapel Hill
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Kazilov YB, Gadzhieva ZK, Mugutdinov TM, Kazilov BR. [Prevalence of various urination disorders in residents of the Republic of Dagestan]. Urologiia 2016:42-47. [PMID: 28247725] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE to evaluate the prevalence of various urination disorders in residents of the Republic of Dagestan, and, thus, to improve their diagnosis and treatment. MATERIALS AND METHODS 584 residents (264 men and 320 women) from different regions of the Republic of Dagestan took part in an anonymous questionnaire survey: 165 residents of Makhachkala, including 92 men and 73 women; 86 residents of Derbent and villages of Southern Dagestan, including 30 men and 56 women; 73 residents of Khasavyurt and Kizilyurt, including 34 men and 39 women; 53 residents of Buynaksk, including 19 men and 34 women; 42 residents of Izberbash, including 19 men and 23 women; 58 residents of the Kaspiysk, 29 men and 29 women; 42 residents of Kayakent, 4 men and 38 women; 65 residents of other regions of the Republic of Dagestan (Karabudakhkent, Gumbet, Gunibsk, Shamil, Khunzakh, Botlikh, Kazbek, Levashin, Tlyaratin, and Tsumadin regions), 37 men and 28 women. RESULTS According to the survey of the residents of the Republic of Dagestan, a significant prevalence of various urinary disorders (63.5%) was found among both men (61.7%) and women (65.0%). Unfortunately, not all patients seek medical advice with complaints of dysuria (55.5%). The fact that 18.8% of patients do not know that they can get help, and 24.1% believe that they do not have a good doctor in their region can be considered as the most an unfavorable moment in terms of the reasons for the refusal of visiting a doctor.. CONCLUSIONS All this findings suggest the need for educational programs both for physicians and the population (educative activities).
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Affiliation(s)
- Yu B Kazilov
- SRI of Uronephrology and Human Reproductive Health
- SBI RD Republican Urological Centre
| | - Z K Gadzhieva
- Urology Clinic of the SBEI HPE First Moscow State Medical University n.a. I.M. Sechenov of RMH
| | - T M Mugutdinov
- Department of Neurology FSBEI HPE Dagestan State Medical University of RMH
| | - B R Kazilov
- FSBEI HPE Dagestan State Medical University of RMH
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Abstract
Overactive bladder (OAB) is a common condition affecting millions of men and women worldwide. It is an embarrassing condition with far-reaching consequences. Although many treatment options exist, no single treatment has been proven to be most effective. Often a combination of therapy is required to successfully manage OAB symptoms. In this review, we provide an overview of OAB, including risk factors for development of OAB; keys to diagnosis; therapeutic options including conservative and medical management, as well as treatments for refractory OAB; when to consider referral to a specialist; and resources for clinicians and patients. The aim of this review is to inform clinicians regarding OAB management in order to improve patient counseling and care.
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Affiliation(s)
- Marcella G Willis-Gray
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Alexis A Dieter
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth J Geller
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
INTRODUCTION Several studies have indicated that erectile dysfunction (ED) patients also suffer from lower urinary tract symptoms (LUTS). We investigated a group of men with LUTS and assessed their sexual function with the aim of being able to predict ED risk factors and introduce ED treatments earlier for this patient group. METHODS International Prostate Symptom Score (IPSS), Overactive Bladder Symptoms Score (OABSS) and Sexual Health Inventory for Men (SHIM) score were obtained from 236 men with LUTS at their first out-patients visit. Clinical parameters such as body mass index, prostate volume, residual urine volume and prostate specific antigen were also evaluated. The relationship between the SHIM score and other clinical data was analyzed. RESULTS According to the SHIM score, ED in men with LUTS was severe 15%, moderate 19%, moderate to mild 28%, mild 17%, normal 7% and data was incomplete in 14%. Based on the results of a multivariate analysis, aging (p < 0.001) and OAB severity (p = 0.024) were significantly correlated to severe and moderate ED. Furthermore, among OAB symptoms score items, urge urinary incontinence was a risk factor for severe and moderate ED (p = 0.005). CONCLUSION Aging and OAB (notably urinary urge incontinence) are risk factors for severe and moderate ED in men with LUTS.
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Affiliation(s)
- Toshiyasu Amano
- a Department of Urology , Nagano Red Cross Hospital , Nagano , Japan and
| | - Carolyn Earle
- b Private Practice , Nedlands, Western Australia , Australia
| | - Tetsuya Imao
- a Department of Urology , Nagano Red Cross Hospital , Nagano , Japan and
| | - Katsuro Takemae
- a Department of Urology , Nagano Red Cross Hospital , Nagano , Japan and
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Mankowski C, Ikenwilo D, Heidenreich S, Ryan M, Nazir J, Newman C, Watson V. Men's preferences for the treatment of lower urinary tract symptoms associated with benign prostatic hyperplasia: a discrete choice experiment. Patient Prefer Adherence 2016; 10:2407-2417. [PMID: 27920507 PMCID: PMC5125770 DOI: 10.2147/ppa.s112161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To explore and quantify men's preferences and willingness to pay (WTP) for attributes of medications for lower urinary tract symptoms associated with benign prostatic hyperplasia using a discrete choice experiment. SUBJECTS AND METHODS Men in the UK aged ≥45 years with moderate-to-severe lower urinary tract symptoms/benign prostatic hyperplasia (based on self-reported International Prostate Symptom Score ≥8) were recruited. An online discrete choice experiment survey was administered. Eligible men were asked to consider different medication scenarios and select their preferred medication according to seven attributes: daytime and nighttime (nocturia) urinary frequency, urinary urgency, sexual and nonsexual side effects, number of tablets/day, and cost/month. A mixed-logit model was used to estimate preferences and WTP for medication attributes. RESULTS In all, 247 men completed the survey. Men were willing to trade-off symptom improvements and treatment side effects. Men preferred medications that reduced urinary urgency and reduced day- and nighttime urinary frequency. Men preferred medications without side effects (base-case level), but did not care about the number of tablets per day. WTP for symptomatic improvement was £25.33/month for reduced urgency (urge incontinence to mild urgency), and £6.65/month and £1.39/month for each unit reduction in night- and daytime urination frequency, respectively. The sexual and nonsexual side effects reduced WTP by up to £30.07/month. There was significant heterogeneity in preferences for most attributes, except for reduced urinary urgency from urge incontinence to mild urgency and no fluid during ejaculation (dry orgasm). CONCLUSION To compensate for side effects, a medicine for lower urinary tract symptoms/benign prostatic hyperplasia must provide a combination of benefits, such as reduced urgency of urination plus reduced nighttime and/or reduced daytime urination.
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Affiliation(s)
- Colette Mankowski
- Health Economics and Outcomes Research, Astellas Pharma Europe Ltd., Chertsey
- Correspondence: Colette Mankowski, Astellas Pharma Europe Ltd., Astellas Medical Affairs, EMEA, HEOR, 2000 Hillswood Drive, Chertsey, Surrey KT16 0PS, UK, Tel +44 78 8194 0638, Email
| | - Divine Ikenwilo
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Jameel Nazir
- Health Economics and Outcomes Research, Astellas Pharma Europe Ltd., Chertsey
| | - Cathy Newman
- Health Economics and Outcomes Research, Astellas Pharma Europe Ltd., Chertsey
| | - Verity Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
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Abstract
INTRODUCTION Overactive bladder affects a significant portion of the population and results in prescribing of numerous medications for its treatment. Traditional drug delivery systems used in therapy are associated with multiple commonly reported side effects. Adherence rates with use of these medications are low. It is likely that low adherence rates with the use of these drugs are due in some part to drug side effects. It is therefore important that alternate methods for drug delivery be explored to reduce side effect profiles and improve patient compliance. AREAS COVERED This article addresses the various forms of drug delivery for overactive bladder medications, focusing on those currently in use. Newer systems of drug delivery are also discussed. Through thorough review of research data, randomized trials and meta analyses, drug delivery systems were evaluated. EXPERT OPINION EXPERT OPINION favors the use of the transdermal patch and recognizes the necessity for further research and development of other delivery methods. The patch delivery method offers the most effective means of treating symptoms and minimizing drug related adverse side effects leading to treatment discontinuation. Development of OAB medications aimed at alternate receptor targets has the potential to facilitate the creation of new treatment methods to compete with the current standard of care used in OAB treatment.
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Affiliation(s)
- Katie Scott
- a School of Medicine , The University of Kansas , Kansas City , KS , USA
| | | | - Priya Padmanabhan
- c Department of Urology , The University of Kansas , Kansas City , KS , USA
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Abstract
BACKGROUND Abdominoplasty is indicated in cosmetic surgery to improve body contour. Results from several studies suggest that abdominoplasty also could be therapeutic for certain individuals with urinary incontinence. OBJECTIVES The authors sought to determine the potential therapeutic effect of abdominoplasty on urinary incontinence in a large population to confirm the findings of smaller studies and to identify common characteristics of patients who experience the greatest improvement in these symptoms postoperatively. METHODS Through a retrospective chart review, the authors identified 250 patients who underwent cosmetic abdominoplasty. These patients were invited to participate in a survey to ascertain changes in stress urinary incontinence (SUI) symptoms after abdominoplasty. Patients were subgrouped according to postoperative changes in their urinary incontinence symptoms, and the subgroups were evaluated for common within-group characteristics. RESULTS Of the 250 patients who underwent abdominoplasty during the period of interest, 100 (40%) completed the survey, half of whom (n=50) reported incontinence preoperatively. After abdominoplasty, 30 (60%) of these 50 patients noted improvement in their symptoms, and the other 20 (40%) reported no improvement. Lack of previous cesarean section was a predictor of improvement in SUI symptoms after abdominoplasty. CONCLUSIONS Abdominoplasty to improve body contour also may alleviate symptoms of SUI, especially among patients who have not undergone previous cesarean section. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Katherine H Carruthers
- Ms Carruthers is a medical student at The University of Toledo College of Medicine in Toledo, OhioDr Kocak is a plastic surgeon in private practice in Dublin, OhioDr Hulsen is a clinical house staff member in the Department of Plastic Surgery at The Ohio State University in Columbus, OhioDr McMahan is a plastic surgeon in private practice in Columbus, Ohio
| | - Ergun Kocak
- Ms Carruthers is a medical student at The University of Toledo College of Medicine in Toledo, OhioDr Kocak is a plastic surgeon in private practice in Dublin, OhioDr Hulsen is a clinical house staff member in the Department of Plastic Surgery at The Ohio State University in Columbus, OhioDr McMahan is a plastic surgeon in private practice in Columbus, Ohio
| | - John H Hulsen
- Ms Carruthers is a medical student at The University of Toledo College of Medicine in Toledo, OhioDr Kocak is a plastic surgeon in private practice in Dublin, OhioDr Hulsen is a clinical house staff member in the Department of Plastic Surgery at The Ohio State University in Columbus, OhioDr McMahan is a plastic surgeon in private practice in Columbus, Ohio
| | - James D McMahan
- Ms Carruthers is a medical student at The University of Toledo College of Medicine in Toledo, OhioDr Kocak is a plastic surgeon in private practice in Dublin, OhioDr Hulsen is a clinical house staff member in the Department of Plastic Surgery at The Ohio State University in Columbus, OhioDr McMahan is a plastic surgeon in private practice in Columbus, Ohio
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von Gontard A, Niemczyk J, Weber M, Equit M. Specific behavioral comorbidity in a large sample of children with functional incontinence: Report of 1,001 cases. Neurourol Urodyn 2014; 34:763-8. [PMID: 25111368 DOI: 10.1002/nau.22651] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 02/24/2014] [Accepted: 06/03/2014] [Indexed: 12/28/2022]
Abstract
AIMS Psychological comorbidity among children with functional incontinence is high: 20-30% of children with nocturnal enuresis (NE), 20-40% of those with daytime urinary incontinence (DUI) and 30-50% of those with fecal incontinence (FI) have clinically relevant comorbid disorders. The aim of this study was to analyze specific comorbid behavioral symptoms for different subtypes of incontinence in a large group of children. METHODS All 1,001 consecutive children and adolescents (67.5% boys) with a mean age of 8.5 years presented at a tertiary outpatient department between 2004 and 2011 were examined with a full pediatric and child psychiatric assessment. Prevalence of different subforms of incontinence and associated behavioral symptoms were analyzed. The internalizing, externalizing, and total problem scores of the Child Behavior Checklist (CBCL) were evaluated. RESULTS Of all children, 70.1% (702 children) had NE, 36.1% (361 children) had DUI, and 36.8% (368 children) were affected by FI. More than 43% of all children had clinically relevant psychological symptoms (CBCL total score, cut-off at 90th percentile). Children with non-retentive FI had highest rates of clinically relevant psychological symptoms (58.8%). Children with combined subtypes of incontinence (any combination of NE, DUI, and FI) were more affected by psychological comorbidities than children with isolated subtypes (NE or DUI or FI). CONCLUSIONS Children with incontinence have high rates of comorbid behavioral symptoms-three to six times higher than norms. Especially children with FI and combined subtypes of incontinence were affected. As behavioral symptoms and disorders will interfere with incontinence treatment, a general screening is recommended.
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Affiliation(s)
- Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Justine Niemczyk
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Michaela Weber
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Monika Equit
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
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Bani-Issa W, Almomani F, Eldeirawi K. Urinary incontinence among adult women with diabetes in Jordan: epidemiology, correlates and perceived impact on emotional and social well-being. J Clin Nurs 2013; 23:2451-60. [PMID: 24112089 DOI: 10.1111/jocn.12392] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2013] [Indexed: 01/18/2023]
Abstract
AIMS AND OBJECTIVES To assess the epidemiology and correlates of urinary incontinence and its perceived impact on the emotional and social well-being of Jordanian women. BACKGROUND Diabetes is a chronic disease with rising prevalence in women worldwide. Although urinary incontinence is a complication of diabetes, it is not commonly assessed with limited nurses' knowledge available on its prevalence, correlates and its perceived impact on lives of women. DESIGN A cross-sectional survey design using probability sampling approach was used to collect information on incontinence. METHODS A total of 1011 adult women, 20-65 years old, attending primary healthcare centres in Jordan were interviewed using a standardised incontinence questionnaire. Questionnaire included items to assess the perceived impact of incontinence on social and emotional well-being of women. The study outcome included weekly or more any, stress and urge incontinence. RESULTS Of 435 (43%) diabetic and 576 (57%) nondiabetic women, a total of 676 (66·8%) women reported incontinence. The prevalence of weekly or more any, urge and stress incontinence was significantly higher in diabetic than in nondiabetic women, 31·5, 13·8 and 20% versus 18·2, 5·9 and 14·2%, respectively. After adjusting for age, body mass index, parity and history of urinary tract infections, in multiple logistic regression analyses, diabetes was significantly associated with any (OR: 1·99; 95% CI: 1·44-2·74) urge (OR: 2·23; 95% CI: 1·38-3·61) and stress incontinence (OR: 1·54; CI: 1·07-2·22). Obesity and age were found to be significant correlates for urge incontinence in diabetics. Women with incontinence perceived incontinence as bothersome condition with negative impact on social well-being. CONCLUSIONS Incontinence is a common and distressing problem in diabetic women, especially for those who are older and obese. Prospective cohort studies are needed to assess how nurse-led interventions may impact the negative consequences of incontinence on women well-being. RELEVANCE TO CLINICAL PRACTICE Nurses are in the right position to assess urinary incontinence in diabetic women. Proper communications, culturally sensitive screening and tailored interventions may assist nurses in providing care and support to alleviate the impact of incontinence on women well-being.
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Affiliation(s)
- Wegdan Bani-Issa
- Department of Nursing, College of Health Sciences, University of Sharjah, Sharjah, UAE
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Singh U, Agarwal P, Verma ML, Dalela D, Singh N, Shankhwar P. Prevalence and risk factors of urinary incontinence in Indian women: A hospital-based survey. Indian J Urol 2013; 29:31-6. [PMID: 23671362 PMCID: PMC3649597 DOI: 10.4103/0970-1591.109981] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and Objectives: Urinary incontinence is a problem that creates both physical and psychological nuisance to a woman. This problem needs to be studied in detail in Indian population because of lack of precise data. The objectives of this study were to study the prevalence and risk factors of urinary incontinence in Indian women. Materials and Methods: This hospital-based cross-sectional study conducted from August 2005 to June 2007 included women attending gynecology OPD (consulters) and hospital employees (nonconsulters). Subjects who were incontinent were asked a standard set of questions. Incontinence was classified as urge, stress, or mixed based on symptoms. A univariate followed by multivariate analysis was done to look for risk factors. Results: Of 3000 women enrolled, 21.8% (656/3000) women were incontinent. There was no significant difference in incontinence rate between consulters and nonconsulters [618/2804 (22.1%) vs. 38/196 (19.4%); P value = 0.6). Of the total women having incontinence, highest numbers were found to have stress incontinence [73.8% (484/656)] followed by mixed [16.8% (110/656)] and urge incontinence [9.5% (62/656)]. Age more than 40 years; multiparity; postmenopausal status; body mass index more than 25; history of diabetes and asthma; and habit of taking tea, tobacco, pan, and betel are risk factors found to be associated with increased prevalence of urinary incontinence in univariate analysis. On multivariate analysis, age more than 40 years, multiparity, vaginal delivery, hysterectomy, menopause, tea and tobacco intake, and asthma were found to be significantly associated with overall incontinence. Stress incontinence was separately not associated with menopause. Urge incontinence was not associated with vaginal delivery. Conclusion: Urinary incontinence is a bothersome problem for women. Simple questionnaire can help to detect this problem and diagnose associated risk factors, so that necessary steps can be taken in its prevention and treatment.
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Affiliation(s)
- Uma Singh
- Department of Obstetrics and Gynecology, Chatthrapati Shahuji Maharaj Medical University, Lucknow, India
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Abstract
Over the last 50 years, botulinum toxin has been transformed from a cause of life-threatening disease to an effective medical therapy. It has been used in a variety of specialties for different indications, significantly improving patient quality of life. A recent growing body of evidence suggests that intra-detrusor injection of botulinum toxin may have beneficial effects in patients with medication refractory detrusor overactivity and may offer a new minimally invasive alternative to patients with severe overactive bladder symptoms. To review current data regarding the effects of botulinum toxin in patients with overactive bladder, a MEDLINE®/PubMed® literature search was carried out. The mechanism of action, clinical usage, adverse effects, and treatment efficacy were reviewed and the results are presented in this paper.
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Affiliation(s)
- Bogdan Orasanu
- Departments of Urology and Obstetrics and Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH, USA
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Bani-issa W, Fakhry R, Al Momani F. Urinary incontinence in Emirati women with diabetes mellitus type 2: prevalence, risk factors and impact on life. J Clin Nurs 2013; 22:3084-94. [PMID: 23551584 DOI: 10.1111/jocn.12176] [Citation(s) in RCA: 3] [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] [Accepted: 10/31/2012] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To evaluate prevalence, risk factors for urinary incontinence and its impact on lives of Emirati women with diabetes mellitus type 2 (DM2). Risk factors examined were age, parity, history of urinary tract infections, body mass index (BMI) and DM2 duration. BACKGROUND Incontinence is a known complication of DM2 with impact on women's lives. Less is known about incontinence problem among Emirati women with DM2. DESIGN A cross-sectional survey design using probability sampling approach was employed to assess urinary incontinence in Emirati women with DM2. METHODS A total of 300 women with DM2, aged 20-65 years, were recruited from six healthcare centres. Data were collected over an 18-month period. A standardised incontinence questionnaire was used to assess type and frequency of incontinence within the past 12 months. Presence of weekly incontinence was the main outcome. RESULTS Of the 300 women, 188 (63%) reported any incontinence, of which 48% had at least weekly episode. Both stress (n = 154, 51·3%) and urge (n = 181, 60·3%) were reported by participants, with 48 (31·1%) reporting at least weekly stress and 85 (46·9%) expressing at least weekly urge incontinence. Diabetes duration was a significant risk factor for any, stress and urge incontinence followed by age for only any and stress incontinence. BMI was a risk factor for urge incontinence. Women perceived incontinence as bothersome, disturbing their social activities and daily prayers. CONCLUSIONS The prevalence of incontinence in Emirati women with DM2 is higher than that reported by women in other cultures. Risk factors identified were DM2 duration, age and obesity. Emirati women found incontinence to be a bothersome problem influencing their daily lives and prayers. RELEVANCE TO CLINICAL PRACTICE Nurses in general practice should be alert to the incontinence problem by considering it as part of the routine diabetes evaluation of women, especially of those with longer duration of diabetes, obese and older. Cultural knowledge, sensitivity and individualised treatment plans need to be adopted by nurses working in the UAE to encourage the reporting of incontinence by Emirati Muslim women with DM2.
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Affiliation(s)
- Wegdan Bani-issa
- Department of Nursing, University of Sharjah, College of Health Sciences, Sharjah, UAE
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