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Sheyn D, Momotaz H, Hijaz A, Zeleznik O, Minassian V, Penney KL. Effect of Dietary Choline Consumption on the Development of Urinary Urgency Incontinence in a Longitudinal Cohort of Women. Int Urogynecol J 2024; 35:667-676. [PMID: 38334759 DOI: 10.1007/s00192-024-05740-4] [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: 10/05/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to determine whether differences in the cumulative dietary intake of choline, is associated with the risk of developing urge urinary incontinence (UUI). METHODS This was an analysis within the Nurses' Health Study (NHS) I and II. The main exposure was the cumulative daily intake for each choline-containing compound obtained from a detailed daily food frequency questionnaire. The primary outcome was UUI, defined as urine loss with a sudden feeling of bladder fullness or when a toilet is inaccessible, occurring >1/month. Cox proportional hazards regression models were used to calculate multivariate-adjusted relative risks and 95% confidence intervals (CIs) for the association between total choline and choline derivatives and risk of UUI. Fixed effects meta-analyses of results from NHSI and NHSII were performed for postmenopausal women only to obtain a pooled estimate of the impact of choline consumption on UUI. RESULTS There were 33,273 participants in NHSI and 38,732 in NHSII who met all the criteria for inclusion in the analysis. The incidence of UUI was 9.41% (n=3,139) in NHSI and 4.25% (n=1,646) in NHSII. After adjusting for confounders choline was not found to be associated with UUI in postmenopausal women. However, in premenopausal women, relative to the lowest quartile, the highest quartile of consumption of total choline (aRR = 0.79, 95% CI: 0.64-0.99), free choline (aRR = 0.74, 95% CI: 0.58-0.94), and phosphocholine (aRR = 0.77, 95% CI: 0.61-0.96) were associated with a reduced risk of UUI. CONCLUSIONS Increased dietary choline consumption was associated with a reduced risk of UUI among premenopausal women.
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Affiliation(s)
- David Sheyn
- Department of Urology, University Hospitals System, Cleveland, OH, 44104, USA.
- Case Western Reserve University, Cleveland, OH, USA.
| | | | - Adonis Hijaz
- Department of Urology, University Hospitals System, Cleveland, OH, 44104, USA
- Case Western Reserve University, Cleveland, OH, USA
| | - Oana Zeleznik
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Vatche Minassian
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kathryn L Penney
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Harvard TH Chan School of Public Health, Boston, MA, USA
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Sun H, Huang J, Tang H, Wei B. Association between weight-adjusted-waist index and urge urinary incontinence: a cross-sectional study from NHANES 2013 to 2018. Sci Rep 2024; 14:478. [PMID: 38177657 PMCID: PMC10767076 DOI: 10.1038/s41598-024-51216-2] [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: 11/22/2023] [Accepted: 01/02/2024] [Indexed: 01/06/2024] Open
Abstract
This study aimed to investigate the association between urge urinary incontinence (UUI) and weight-adjusted waist circumference index (WWI), a newly developed measure of obesity. Data from the 2013-2018 National Health and Nutrition Examination Survey (NHANES) were included in the present cross-sectional study. Urge urinary incontinence was identified by self-reported urine leakage before reaching the toilet. Weighted multivariate logistic regression and generalized additive models were used to investigate the connection between WWI and UUI and its nonlinearity. The nonlinear relationship was explored using smoothed curve fitting. Additionally, further analyses were performed on subgroups and interaction tests were conducted. In the study, a total of 14,118 individuals were enrolled, with a UUI prevalence rate of 21.18%. Overall UUI was more prevalent with elevated WWI (OR 1.20, 95% CI 1.13-12.8, P < 0.0001), which similar results were observed in weekly (OR 1.32, 95% CI 1.18-1.48, P < 0.0001) and daily (OR 1.27, 95% CI 1.06-1.53, P = 0.0091) UUI. And this connection remained steady among all subgroups (P > 0.05 for all interactions). Smoothed curve fitting showed no nonlinear relationship between WWI and UUI. In addition, a stronger correlation was found between WWI and UUI risk than other obesity indicators such as waist circumference (WC) and body mass index (BMI). Among US adults, weight-adjusted waist circumference index values are positively associated with elevated odds of UUI and show stronger associations than WC and BMI. Further studies are required to elucidate the causal relationship between WWI and UUI.
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Affiliation(s)
- Haohao Sun
- Department of Urology, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China
| | - Jingxi Huang
- Department of Urology, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China
| | - Hao Tang
- Department of Urology, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China
| | - Bingbing Wei
- Department of Urology, Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi, 214023, China.
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Getaneh FW, Ringel N, Kolm P, Iglesia CB, Dieter AA. The effect of 12-month postoperative weight change on outcomes following midurethral sling for stress urinary incontinence: a secondary analysis of the ESTEEM and TOMUS randomized trials. Int Urogynecol J 2023; 34:2809-2816. [PMID: 37750917 DOI: 10.1007/s00192-023-05654-7] [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: 07/10/2023] [Accepted: 09/08/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Prior studies demonstrate mixed results on the impact of obesity on the success of midurethral slings (MUS), with little known about how postoperative weight change affects outcomes. We aimed to examine the effect of postoperative weight change on outcomes 12 months after MUS for stress urinary incontinence (SUI). METHODS This secondary analysis utilized data from two multicenter randomized trials of women undergoing MUS placement. Subjects were categorized into cohorts based on change in body weight at 12 months postoperatively: weight gain (≥5% increase); weight loss (≥5% decrease), and weight stable (<5% change). The primary outcome was SUI cure (no SUI episodes in a 3-day bladder diary). Patients with mixed urinary incontinence (MUI) were analyzed for changes in daily average urge incontinence (UUI) episodes in a 3-day diary. Penalized logistic regression assessed the impact of demographic and perioperative variables on the primary outcome. RESULTS Of the 918 women included, 635 (70%) were weight stable, 144 (15%) had weight gain, and 139 (15%) had weight loss. Patients in the weight loss cohort had a higher smoking rate and a higher baseline body mass index (SD 0.29, 2.7 respectively). All cohorts experienced high SUI cure rates ranging from 77 to 81%, with no significant difference in SUI cure between cohorts (p = 0.607). Of 372 subjects with MUI, the weight loss cohort had significantly greater improvement in UUI episodes. CONCLUSIONS Weight change at 12 months postoperatively did not significantly alter efficacy of MUS for treatment of SUI. Patients with MUI who lost ≥5% body weight had significantly greater improvement in UUI episodes.
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Affiliation(s)
- Feven W Getaneh
- Department of Obstetrics and Gynecology, MedStar Georgetown Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA.
| | - Nancy Ringel
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT, USA
| | - Paul Kolm
- Medstar Health Research Institute, Washington, DC, USA
| | - Cheryl B Iglesia
- Department of Obstetrics and Gynecology, MedStar Georgetown Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA
| | - Alexis A Dieter
- Department of Obstetrics and Gynecology, MedStar Georgetown Washington Hospital Center, 110 Irving St NW, Washington, DC, 20010, USA
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Okada C, Kim JI, Roselli N, Kadam Halani P, Melamed ML, Abraham N. Food Insecurity Is Associated With Urge Urinary Incontinence: An Analysis of the 2005-2010 National Health and Nutrition Examination Survey. J Urol 2023; 210:481-491. [PMID: 37195821 DOI: 10.1097/ju.0000000000003545] [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: 10/19/2022] [Accepted: 05/03/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE Urge urinary incontinence is the involuntary leakage of urine associated with a sudden compelling urge to void. A previous study found an association between urge urinary incontinence and household income, indicating that social determinants of health may influence urge urinary incontinence. Food insecurity is a relevant social determinant of health, as a diet with bladder irritants may worsen urge urinary incontinence symptoms. This study aimed to investigate the association between urge urinary incontinence and food insecurity. MATERIALS AND METHODS We collected data from the 2005-2010 cycles of the National Health and Nutrition Examination Survey, a nationally representative health survey administered by the Centers for Disease Control and Prevention. The association between urge urinary incontinence and food insecurity was analyzed using survey-weighed logistic regression with adjustments for demographic, socioeconomic status, behavioral, and medical comorbidities covariates. RESULTS We included 14,847 participants with mean age 50.4±17.9 years; 22.4% of participants reported at least 1 episode of urge urinary incontinence. We found that participants who reported food insecurity had 55% greater odds of experiencing urge urinary incontinence compared to those who have not (OR=1.55, 95% CI=1.33-1.82, P < .001). When comparing diets, food-insecure participants reported significantly less intake of bladder irritants (caffeine and alcohol) compared to food-secure participants. When the sample was stratified by food insecurity status (yes vs no), consumption of caffeine did not differ by urge urinary incontinence status and consumption of alcohol was lower among participants with vs without urge urinary incontinence. CONCLUSIONS Adults reporting food insecurity in the past year are significantly more likely to experience urge urinary incontinence than those who did not. Consumption of bladder irritants including caffeine and alcohol was significantly less in food-insecure compared to food-secure participants. When the sample was stratified by food insecurity status (yes vs no), consumption of caffeine did not differ by urge urinary incontinence status and consumption of alcohol was lower among participants with vs without urge urinary incontinence. These data indicate that diet alone does not drive the association between urge urinary incontinence and food insecurity. Instead, food insecurity may be a proxy for social inequity, perhaps the greatest driver of disease.
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Affiliation(s)
- Chihiro Okada
- Albert Einstein College of Medicine, Bronx, New York
| | - Joseph I Kim
- Albert Einstein College of Medicine, Bronx, New York
| | - Nicole Roselli
- Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics, Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York
| | - Priyanka Kadam Halani
- Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics, Gynecology and Women's Health, Montefiore Medical Center, Bronx, New York
| | - Michal L Melamed
- Division of Nephrology, Department of Medicine, Montefiore Medical Center, Bronx, New York
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
| | - Nitya Abraham
- Department of Urology, Montefiore Medical Center, Bronx, New York
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Chartier-Kastler E, Le Normand L, Ruffion A, Saussine C, Braguet R, Rabut B, Ragni E, Perrouin-Verbe MA, Pierrevelcin J, Rousseau T, Gamé X, Tanneau Y, Dargent F, Biardeau X, Graziana JP, Stoica G, Brassart E, Fourmarier M, Yaghi N, Capon G, Ferchaud J, Berrogain N, Peyrat L, Pecoux F, Bryckaert PE, Karsenty G, Song S, Keller DUJ, Cornu JN. Five-year Results from the Prospective, Multicenter, Observational SOUNDS Study of Patients with Overactive Bladder Treated with the InterStim System for Sacral Neuromodulation. Eur Urol Focus 2023; 9:765-772. [PMID: 37019729 DOI: 10.1016/j.euf.2023.03.008] [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: 11/25/2022] [Revised: 02/15/2023] [Accepted: 03/06/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Although sacral neuromodulation (SNM) for overactive bladder (OAB) is an established therapy, there is a lack of high-quality, long-term data on real-life practice. OBJECTIVE To report on real-life therapeutic effectiveness, quality of life (QoL), disease severity, and safety as well as patient-reported symptom bother after approximately 5 yr of follow-up. DESIGN, SETTING, AND PARTICIPANTS A total of 291 OAB patients were enrolled at 25 French sites according to local standard of care. Sacral neuromOdUlation with InterStim therapy for intractable lower uriNary tract DySfunctions (SOUNDS) enrolled both de novo and replacement patients, and a total of 229 patients were permanently implanted. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Over the course of the study, patients were followed up six times with two follow-ups in the year after implantation and annually thereafter. Of the patients, 154 completed the final follow-up after a mean of 57.7 ± 3.9 mo. RESULTS AND LIMITATIONS The mean number of daily leaks in urinary urge incontinence (UI) patients was reduced from 4.4 ± 3.3 at baseline to 1.8 ± 2.6 after 5 yr in de novo and from 5.4 ± 4.9 to 2.2 ± 3.0 in replacement patients (both p < 0.001). Likewise, the number of voids in urinary frequency patients was reduced compared with baseline (de novo: reduced from 12.6 ± 4.0 [baseline] to 9.6 ± 4.3 [5 yr]; replacements: reduced from 11.5 ± 4.3 [baseline] to 9.2 ± 3.1 [5 yr]; both p < 0.05). Complete continence rates after 5 yr were 44% (25/57) in de novo and 33% (5/15) in replacement UI patients, and 68% (39/57) and 67% (10/15) of UI patients were categorized as therapy responders by showing a >50% improvement in leaks. Disease severity (Urinary Symptom Profile domain 2), Numeric Rating Scale-based symptom bother, and disease-specific QoL (Ditrovie) improved significantly in both groups at all visits (p < 0.001). Adverse events related to device or procedure occurred in 51% (140/274) of patients, with 66% (152/229) of the events being classified as minor (Clavien-Dindo grade I and II). Surgical revisions were reported in 39% (89/229), which include permanent explants in 15% (34/229) of patients. CONCLUSIONS SOUNDS demonstrates the sustained effectiveness and QoL improvements of SNM in OAB patients after 5 yr in real-world conditions while maintaining an acceptable safety profile consistent with literature. PATIENT SUMMARY This study confirmed that French overactive bladder patients had a sustained symptom and bother reduction, and improvements in quality of life up to 5 yr after sacral neuromodulation device implantation.
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Affiliation(s)
| | | | | | | | | | | | - Evelyne Ragni
- Hôpital de la Timone - Centre Hôspitalier Universitaire de Marseille, France
| | | | | | | | - Xavier Gamé
- CHU Toulouse Hôpital Rangueil, Toulouse, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Gilles Karsenty
- Aix-Marseille University, Academic Hospital la Conception, AP-HM, Marseille, France
| | - Shannon Song
- Medtronic Global Clinical Data Solutions, Minneapolis, MN, USA
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Toia B, Unterberg S, Sihra N, Pakzad M, Hamid R, Ockrim JL, Greenwell TJ. Functional outcomes of vaginal surgery for urethral extrusion of mid-urethral tape in women. Int Urogynecol J 2021; 33:2251-2256. [PMID: 33822257 DOI: 10.1007/s00192-021-04774-2] [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: 05/16/2020] [Accepted: 03/21/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We aim to determine the presentation of and immediate and longer-term outcomes of vaginal surgical excision of urethral extrusion of mid-urethral tape (MUT). METHODS We performed a retrospective analysis of all patients with urethral extrusion of MUT having vaginal surgical excision between 2007 and 2018. The MUT was removed either partially (via vaginal approach) or completely (via combined vaginal and laparoscopic approach). Functional outcomes and any re-interventions are described. RESULTS Thirty-four patients of median age 53 (range 34-82) years were identified. Preoperative symptomatic recurrent/persistent urinary incontinence was present in 29/34(85%) with 24/34(71%) women having recurrent/persistent stress urinary incontinence (SUI) or stress predominant mixed urinary incontinence (s-MUI) on urodynamics. Vaginal surgical excision was performed alone in 33/34(97%) women and in combination with laparoscopic removal of abdominopelvic MUT in 1/34(3%) woman. In the longer term vaginal/urethral pain resolved or improved in all 15/15(100%) patients presenting with this complaint whilst patient reported poor flow resolved in 8/9 (89%) women. Twenty-eight of 34 women (82%) had persistent/recurrent SUI or s-MUI following MUT excision. Twenty-four of 34 women (71%) had further SUI surgery with cure or improvement of SUI in 20/24 (83%) patients. CONCLUSIONS The outcome of vaginal surgical excision of the MUT was cure or improvement of pain in 100% and resolution of poor flow in 89% women. Recurrent/persistent SUI or s-MUI was present in 82% following removal as compared to 71% women prior to removal. Of the 71% of women electing to have further surgery for recurrent/persistent SUI/s-MUI, 83% were dry or improved afterwards.
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Affiliation(s)
- Bogdan Toia
- Department of Urology, University College London Hospital, Westmoreland Street, London, UK.
| | - Stephen Unterberg
- Department of Urology, University College London Hospital, Westmoreland Street, London, UK
| | - Neha Sihra
- Department of Urology, University College London Hospital, Westmoreland Street, London, UK
| | - Mahreen Pakzad
- Department of Urology, University College London Hospital, Westmoreland Street, London, UK
| | - Rizwan Hamid
- Department of Urology, University College London Hospital, Westmoreland Street, London, UK
| | - Jeremy L Ockrim
- Department of Urology, University College London Hospital, Westmoreland Street, London, UK
| | - Tamsin J Greenwell
- Department of Urology, University College London Hospital, Westmoreland Street, London, UK
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Savoie MB, Lee KA, Subak LL, Hernandez C, Schembri M, Fung CH, Grady D, Huang AJ. Beyond the bladder: poor sleep in women with overactive bladder syndrome. Am J Obstet Gynecol 2020; 222:600.e1-600.e13. [PMID: 31836545 DOI: 10.1016/j.ajog.2019.12.005] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/23/2019] [Accepted: 12/01/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nocturnal bladder symptoms and sleep disruption commonly coexist in middle-aged and older women. Although sleep disruption is often attributed to nocturnal bladder symptoms in women with overactive bladder syndrome, nonbladder factors also may influence sleep in this population. Many women with overactive bladder are eager to identify nonpharmacologic strategies for both bladder symptoms and sleep disruption, given the potential adverse effects of sedative and anticholinergic bladder medications in this population. OBJECTIVES To provide greater insight into the complex relationship between nighttime overactive bladder symptoms and sleep disruption, and to evaluate the effects of a guided slow-paced respiration intervention on sleep outcomes in women with overactive bladder. STUDY DESIGN We conducted an ancillary study within a randomized trial of slow-paced respiration in women with overactive bladder symptoms. Ambulatory community-dwelling women who reported ≥3 episodes/day of urgency-associated voiding or incontinence were randomized to use either a portable biofeedback device (RESPeRATE; Intercure, Ltd) to practice guided slow-paced respiration exercises daily for 12 weeks (N=79) or an identical-appearing device programmed to play nonrhythmic music without guiding breathing (N=82). At baseline and after 12 weeks, bladder symptoms were assessed by voiding diary, sleep duration, and disruption were assessed by sleep diary corroborated by wrist actigraphy, and poor sleep quality was determined by a Pittsburgh Sleep Quality Index global score >5. RESULTS Of the 161 women randomized, 31% reported at least twice-nightly nocturia, 26% nocturnal incontinence, and 70% poor sleep quality at baseline. Of the 123 reporting any nighttime awakenings, 89% averaged 1 or more nighttime awakenings, and 83% attributed at least half of awakenings to using the bathroom. Self-reported wake time after sleep onset increased with increasing frequency of nocturnal bladder symptoms (P=.01 for linear trend). However, even among women without nocturia, average sleep quality was poor (Pittsburg Sleep Quality Index global score mean of 7.3; 95% confidence interval, 6.0-8.6). Over 12 weeks, women assigned to slow-paced respiration (N=79) experienced modest improvements in mean nocturnal voiding frequency (0.4 fewer voids/night), sleep quality (1.1 point score decrease), and sleep disruption (1.5% decreased wake time after sleep onset). However, similar improvements were detected in the music control group (N=81), without significant between-group differences. CONCLUSIONS Many women with overactive bladder syndrome experience disrupted sleep, but not all nocturnal awakenings are attributable to bladder symptoms, and average sleep quality tends to be poor even in women without nocturia. Findings suggest that clinicians should not assume that poor sleep in women with overactive bladder syndrome is primarily caused by nocturnal bladder symptoms. Guided slow-paced respiration was associated with modest improvements in nocturia frequency and sleep quality in this trial, but the results do not support clinician recommendation to use this technique over other behavioral relaxation techniques for improving sleep.
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Affiliation(s)
| | - Kathryn A Lee
- Department of Family Health Care Nursing, University of California San Francisco, CA
| | - Leslee L Subak
- Department of Obstetrics and Gynecology, Stanford University, Stanford, CA
| | - Cesar Hernandez
- Department of Medicine, University of California San Francisco, CA
| | - Michael Schembri
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California San Francisco, CA
| | - Constance H Fung
- Department of Medicine, University of California at Los Angeles, CA; VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Deborah Grady
- Department of Medicine, University of California San Francisco, CA
| | - Alison J Huang
- Department of Medicine, University of California San Francisco, CA
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Padilha JF, Avila MA, Seidel EJ, Driusso P. Different electrode positioning for transcutaneous electrical nerve stimulation in the treatment of urgency in women: a study protocol for a randomized controlled clinical trial. Trials 2020; 21:166. [PMID: 32046754 PMCID: PMC7014940 DOI: 10.1186/s13063-020-4096-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 01/20/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Urgency is a complaint of sudden, compelling desire to pass urine, which is difficult to defer, caused by involuntary contraction of the detrusor muscle during the bladder-filling stage. To enable detrusor inhibition, electrotherapy resources such as transcutaneous tibial nerve stimulation (TTNS) and parasacral transcutaneous electrical stimulation (PTES) have been used. The objective this study is to publish the study protocol that aims to investigate whether urgency decreases after treatment with both of the techniques. METHODS This randomized controlled clinical trial will include 99 women, aged more than 18 years old, with urgency (score ≥ 8 in the Overactive Bladder-Validated 8-Question Awareness Tool [OAB-V8]). Women will be randomly allocated into three groups: TTNS, PTES, and placebo. The following questionnaires will be applied: the Anamnesis Record, the Incontinence Questionnaire Overactive Bladder, the King's Health Questionnaire, the 24-Hour Voiding Diary, and the OAB-V8, at four different time points: at baseline prior to the first session, at the 6th session, the 12th session and at follow-up. The current used for the transcutaneous electrical stimulation will be a symmetrical balanced biphasic pulsed current, for 12 sessions, twice a week, for 20 minutes. Qualitative variables will be displayed as frequency and percentage, quantitative variables as mean and standard deviation. Comparison of urgency severity among groups will be performed with a repeated measures ANOVA, considering the effect of the three groups and the four evaluations, and interactions among them. DISCUSSION The present study aims to contribute evidence for a more in-depth discussion on electrode positioning for electrostimulation used in urgency treatment. It should be emphasized that, based on the possibility of confirming the hypothesis that urgency will decrease in a similar way after both treatments (TTNS and PTES), the PTES will be used as an option for positioning the electrodes alternatively to the tibial nerve region in special populations, such as amputees or people with severe lower limb sensory impairment. TRIAL REGISTRATION Brazilian Registry of Clinical Trials (ReBEC) ID: RBR-9rf33n, date of registration: 17 May 2018.
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Affiliation(s)
- Juliana Falcão Padilha
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo CEP 13565-905 Brazil
| | - Mariana Arias Avila
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo CEP 13565-905 Brazil
| | - Enio Júnior Seidel
- Department of Statistics, Federal University of Santa Maria (UFSM), Av Roraima 1000, Santa Maria, Rio Grande do Sul CEP 97105-900 Brazil
| | - Patricia Driusso
- Physical Therapy Department, Federal University of Sao Carlos (UFSCar), Rodovia Washington Luis Km 235, São Carlos, São Paulo CEP 13565-905 Brazil
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Choi JB, Cho KJ, Park WH, Lee DH, Kim YH, Cho IR, Yoon H, Kim YS, Kim JC. Treatment Satisfaction with Flexible-dose Fesoterodine in Patients with Overactive Bladder who were Dissatisfied with Previous Anticholinergic Therapy: A Multicenter Single-Arm Clinical Study. Urol J 2020; 17:97-101. [PMID: 30882160 DOI: 10.22037/uj.v0i0.4650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE We investigated treatment satisfaction with flexible-dose fesoterodine in patients with overactive bladder (OAB) who were dissatisfied with previous anticholinergic therapy. MATERIALS AND METHODS The subjects were prescribed fesoterodine 4 mg for 4 weeks and fesoterodine 4 mg or 8 mg for another 8 weeks. The primary end point of this study was patients' satisfaction after 12 weeks of fesoterodine treatment on a five-point Likert scale. Secondary end points included a change in the number of daytime micturition, urgency incontinence episodes, urgency episodes, and nocturnal micturition in a 24-hour period from baseline to final assessment. RESULTS Overall, 84 patients were assigned to the treatment group in this study and 63 patients completed the 12-week treatment course. A final fesoterodine dose of 4 mg and 8 mg was used by 45 (71.4%) and 18 (28.6%) patients, respectively. The satisfaction and dissatisfaction rates at 12 weeks were 69.9% and 14.2%, respectively. Mean changes in the daytime micturitions (9.73 ± 4.72 vs. 7.76 ± 2.86), urgency episodes (7.73 ± 5.68 vs. 3.71 ± 4.09), and nocturnal micturitions (2.13 ± 1.36 vs. 1.68 ± 1.12) in 24 hours improved significantly with flexible-dose fesoterodine treatment (P < .05). Most adverse events were mild and none were severe. CONCLUSION The flexible dose fesoterodine represents an alternative treatment modality in patients with OAB who are dissatisfied with previous anticholinergic therapy in Korea.
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Affiliation(s)
- Jin Bong Choi
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea.
| | - Kang Jun Cho
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Won Hee Park
- Department of Urology, Inha University College of Medicine, Incheon, Republic of Korea
| | - Dong Hwan Lee
- Department of Urology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Republic of Korea
| | - Young-Ho Kim
- Department of Urology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - In Rae Cho
- Department of Urology, Ilsanpaik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Hana Yoon
- Department of Urology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Young Sik Kim
- Department of Urology, National Health Insurance Service, Ilsan Hospital, Goyang, Republic of Korea
| | - Joon Chul Kim
- Department of Urology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
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Ng KL, Ng KWR, Thu WPP, Kramer MS, Logan S, Yong EL. Risk factors and prevalence of urinary incontinence in mid-life Singaporean women: the Integrated Women's Health Program. Int Urogynecol J 2019; 31:1829-1837. [PMID: 31781824 DOI: 10.1007/s00192-019-04132-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/04/2019] [Accepted: 09/19/2019] [Indexed: 01/30/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to identify the prevalence and risk factors for urinary incontinence (UI) in healthy midlife Singaporean women. METHODS Healthy women, aged 45-69 years, were assessed for UI and sociodemographic characteristics, including ethnicity, menopausal status, parity, and body mass index (BMI). UI subtypes corresponding to stress (SUI) alone, urge (UUI) alone, mixed (MUI), and leakage (drops only) incontinence were classified using the Urinary Distress Inventory 6 (UDI-6). Risk factors were examined using Chi-squared tests, followed by sequential multivariate logistic regression to estimate adjusted odds ratios (aOR and 95% confidence intervals). RESULTS A total of 1,119 women (mean age 56.2 ± 5.2) completed the UDI-6. 52.3% reported any UI; MUI and SUI were the most common, each affecting 20% of women. Post-menopausal women had a lower risk (aOR 0.5 [0.3-0.9]) of SUI, but a higher risk (aOR 4.4 [1.0-19.9]) of UUI compared with premenopausal women. Higher education was negatively associated (aOR 0.3 [0.2-0.7]) with UUI, but positively associated with MUI (aOR 2.3 [1.3-4.0]). Parity (1-2 children) increased the risk of SUI (aOR 1.8 [1.0-3.1]), but reduced the risk of UUI (aOR 0.4 [0.2-0.9]). Obesity was associated with increased risk for MUI (aOR 2.2 [1.4-3.4]) and leakage (aOR 2.0 [1.0-4.1]). Malays and Indians had a higher risk of MUI, having (aOR 2.1 (1.2-3.7) and 1.7 (1.1-2.7) respectively compared with Chinese, a difference mediated by higher BMI. CONCLUSION Urinary incontinence is a major morbidity prevalent in healthy midlife Asian women. Post-menopausal status, education level, parity, BMI (and its link with ethnicity) are independent risk factors in this population, and should be incorporated into counseling and targeted interventions.
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Affiliation(s)
- Kai Lyn Ng
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, 119228, Singapore
| | - K W Roy Ng
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, 119228, Singapore
| | - Win Pa Pa Thu
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, 119228, Singapore
| | - Michael S Kramer
- Departments of Epidemiology, Biostatistics & Occupational Health and of Pediatrics, McGill University Faculty of Medicine, Montreal, Quebec, H3G 1Y6, Canada
| | - Susan Logan
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, 119228, Singapore
| | - Eu-Leong Yong
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, Singapore, 119228, Singapore.
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Shaffer RK, Dobberfuhl AD, Vu KN, Fast AM, Dababou S, Marrocchio C, Lum DA, Hovsepian DM, Ghanouni P, Chen B. Are fibroid and bony pelvis characteristics associated with urinary and pelvic symptom severity? Am J Obstet Gynecol 2019; 220:471.e1-471.e11. [PMID: 30711512 DOI: 10.1016/j.ajog.2019.01.230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 01/16/2019] [Accepted: 01/26/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Urinary and pelvic floor symptoms often are attributed to size and location of uterine fibroid tumors. However, direct supporting evidence that links increased size to worsening symptoms is scant and limited to ultrasound evaluation of fibroid tumors. Because management of fibroid tumors is targeted towards symptomatic relief, the identification of fibroid and pelvic characteristics that are associated with worse symptoms is vital to the optimization of therapies and prevention needless interventions. OBJECTIVE We examined the correlation between urinary, pelvic floor and fibroid symptoms, and fibroid size and location using precise uterine fibroid and bony pelvis characteristics that were obtained from magnetic resonance imaging. STUDY DESIGN A retrospective review (2013-2017) of a multidisciplinary fibroid clinic identified 338 women who had been examined via pelvic magnetic resonance imaging, Pelvic Floor Distress Inventory questionnaire (score 0-300), and a Uterine Fibroid Symptoms questionnaire (score 1-100). Multiple linear regression analysis was used to assess the influence of clinical factors and magnetic resonance imaging findings on scaled Pelvic Floor Distress Inventory and Uterine Fibroid Symptoms scores. Data were analyzed with statistical software. RESULTS Our cohort of 338 women had a median Pelvic Floor Distress Inventory of 72.7 (interquartile range, 41-112.3). Increased Pelvic Floor Distress Inventory score was associated with clinical factors of higher body mass index (P<.001), noncommercial insurance (P<.001), increased parity (P=.001), and a history of incontinence surgery (P=.003). Uterine volume, dominant fibroid volume, dimension and location, and fibroid tumor location relative to the bony pelvis structure did not reach significance when compared with pelvic floor symptom severity. The mean Uterine Fibroid Symptoms score was 52.0 (standard deviation, 23.5). An increased Uterine Fibroid Symptoms score was associated with dominant submucosal fibroid tumors (P=.011), body mass index (P<.0016), and a clinical history of anemia (P<.001) or any hormonal treatment for fibroid tumors (P=.009). CONCLUSION Contrary to common belief, in this cohort of women who sought fibroid care, size and position of fibroid tumors or uterus were not associated with pelvic floor symptom severity. Whereas, bleeding symptom severity was associated with dominant submucosal fibroid tumor and previous hormonal treatment. Careful attention to clinical factors such as body mass index and medical history is recommended when pelvic floor symptoms are evaluated in women with uterine fibroid tumors.
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Affiliation(s)
| | | | | | | | - Susan Dababou
- Department of Radiology, Sapienza University, Rome, Italy
| | | | | | | | | | - Bertha Chen
- Department of Obstetrics & Gynecology, Stanford, CA.
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12
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Markland AD, Tangpricha V, Beasley TM, Vaughan CP, Richter HE, Burgio KL, Goode PS. Comparing Vitamin D Supplementation Versus Placebo for Urgency Urinary Incontinence: A Pilot Study. J Am Geriatr Soc 2019; 67:570-575. [PMID: 30578542 PMCID: PMC6403014 DOI: 10.1111/jgs.15711] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 08/07/2018] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To estimate the efficacy of vitamin D supplementation to reduce urgency urinary incontinence (UUI) episodes. DESIGN Pilot, two-arm, randomized trial conducted from 2013 to 2017. Interventions were 12 weeks of weekly oral 50,000 IU vitamin D3 or placebo. SETTING Academic, university-based outpatient clinic. PARTICIPANTS Community-dwelling postmenopausal women, 50 years or older, with at least three UUI episodes on 7-day bladder diary and serum vitamin 25-hydroxyvitamin D (25[OH]D) of 30 ng/mL or less. MEASUREMENTS The primary efficacy estimate was the percentage change in UUI episodes. Secondary estimates included changes in other lower urinary tract symptoms, along with exploratory subgroup analysis by race/ethnicity and obesity. RESULTS We randomized 56 women (aged 50-84 years; mean = 60.5 ± 8.2 years), 28 to vitamin D and 28 to placebo; 51 completed treatments. Mean serum 25(OH)D at baseline (21.2 ± 5.2 and 18.2 ± 5.6, P = .30) improved to 57.9 ± 16.3 ng/mL with vitamin D3 and 21.9 ± 8.2 ng/mL with placebo (P < .001). UUI episodes per 24-hour day decreased by 43.0% with vitamin D3 compared to 27.6% with placebo (P = .22). Among black women (n = 33), UUI episodes decreased by 63.2% with vitamin D3 compared to 22.9% with placebo (P = .03). Among obese women, UUI episodes decreased by 54.1% with vitamin D compared to 32.7% with placebo (P = .29). For all women, changes in voiding frequency (P = .40), nocturia (P = .40), urgency (P = .90), incontinence severity (P = .81), and overactive bladder symptom severity (P = .47) were not different between arms. CONCLUSIONS Postmenopausal women with UUI and vitamin D insufficiency demonstrated a greater than 40% decrease in UUI episodes, which did not reach statistical significance compared to placebo, except in the subset of black women. The results of this pilot study support further investigation of vitamin D3 alone or in combination with other treatments for UUI, particularly for women in higher-risk subgroups. J Am Geriatr Soc 67:570-575, 2019.
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Affiliation(s)
- Alayne D. Markland
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | | | - T. Mark Beasley
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- University of Alabama at Birmingham, School of Public Health, Birmingham, AL
| | - Camille P. Vaughan
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- Department of Medicine, Emory University, Atlanta, GA
| | - Holly E. Richter
- University of Alabama at Birmingham, Department of Obstetrics and Gynecology, Birmingham, AL
| | - Kathryn L. Burgio
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
| | - Patricia S. Goode
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Department of Veterans Affairs, Birmingham, AL and Atlanta, GA
- University of Alabama at Birmingham, Department of Medicine, Birmingham, AL
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Abstract
The last 2 decades have brought an explosion of research, new products, and general attention to the problem of urinary urgency, and yet patients continue to be plagued by this symptom - especially the elderly. What is it? What does it mean? How can we guide patients successfully through this challenge? This paper presents a review of current thinking about urgency relevant to the practicing clinician, including the epidemiology, pathophysiology, evaluation, and treatment of these patients.
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Özdemir K, Şahin S, Özerdoğan N, Ünsal A. Evaluation of urinary incontinence and quality of life in married women aged between 20 and 49 years (Sakarya, Turkey). Turk J Med Sci 2018; 48:100-109. [PMID: 29479966 DOI: 10.3906/sag-1605-73] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: This study aimed to determine the prevalence of urinary incontinence and to evaluate the relationship between urinary incontinence and quality of life in married women. Materials and methods: This is a cross-sectional study conducted among married women aged 20-49 years living in the vicinity of the Çökekler Community Clinic (Family Health Center) in Sakarya, Turkey, from 1 November 2011 to 15 April 2012. The study group consisted of 1161 women. Results: The frequency of urinary incontinence was 71.5% (n = 830). Out of a total of 830 patients with symptoms of urinary incontinence, mixed was the most frequently determined type (60.4%), followed by urge (33.9%) and then stress urinary incontinence (5.8%). The mean scores obtained by women with urinary incontinence from the general health perceptions and social functioning domains of the SF-36 survey were lower (P < 0.05 for each domain). Conclusion: Urinary incontinence was found to be a common problem among women, and it affects quality of life adversely. Recurrent urinary tract infection and advancing age were the key risk factors in the development of urinary incontinence.
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Kulhan M, Kulhan NG, Ata N, Nayki UA, Nayki C, Ulug P, Yilmaz N. Should the visceral peritoneum be closed over mesh in abdominal sacrocolpopexy? Eur J Obstet Gynecol Reprod Biol 2018; 222:142-145. [PMID: 29408745 DOI: 10.1016/j.ejogrb.2018.01.027] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/16/2017] [Accepted: 01/24/2018] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Peritonisation of mesh during Abdominal sacrocolpopexy is generally advocated to prevent adhesions to the viscera; however, randomized clinical trials are lacking. In this study; we aimed to investigate whether the mesh peritonisation is clinically significant or not. MATERIAL METHOD Thirty-four patients who were operated for the reason of pelvic organ prolapse were included in the study. Patients were divided into two groups by retrospective scanning from the files and surgical reports. Group 1 patients consisted of those who underwent peritonisation and group 2 patients consisted of those who did not in abdominal sacrocolpopexy. RESULTS Operative time and the amount of blood lost were statistically less in the group 2. Postoperative pain and analgesic drug requirements were obviously higher in the group 1. Postoperative De novo dyspareunia and urinary urgency were higher in the group 1. There were no statistical differences between the groups in terms of other complications. CONCLUSION We noticed that there was no difference between the patients who were peritonized and those who were not in terms of postoperative complications.
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Affiliation(s)
- M Kulhan
- Erzincan University Medical Faculty, Gynaecology and Obstetrics Department, Erzincan, Turkey
| | - N G Kulhan
- Erzincan University Medical Faculty, Gynaecology and Obstetrics Department, Erzincan, Turkey
| | - N Ata
- Erzincan University Medical Faculty, Gynaecology and Obstetrics Department, Erzincan, Turkey
| | - U A Nayki
- Erzincan University Medical Faculty, Gynaecology and Obstetrics Department, Erzincan, Turkey
| | - C Nayki
- Erzincan University Medical Faculty, Gynaecology and Obstetrics Department, Erzincan, Turkey
| | - P Ulug
- Erzincan University Medical Faculty, Gynaecology and Obstetrics Department, Erzincan, Turkey
| | - N Yilmaz
- Erzincan University Medical Faculty, Gynaecology and Obstetrics Department, Erzincan, Turkey
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Abstract
IMPORTANCE Urinary incontinence, the involuntary loss of urine, is a common health condition that may decrease quality of life. Ten to twenty percent of women and up to 77% of women residing in nursing homes have urinary incontinence, yet only 25% seek or receive treatment. OBSERVATIONS This review summarizes the evaluation and therapeutic options for women affected by urinary incontinence. The initial assessment should focus on understanding the effect of incontinence on quality of life, the patient's goals and preferences for treatment, the results of previous treatments, and the presence of concomitant conditions, such as advanced pelvic organ prolapse, that may require referral. Infection and hematuria need to be ruled out. In the absence of urinary infection or serious underlying pathology (such as cancer or serious neurologic disease) associated with urinary incontinence, the clinician should initiate unsupervised pelvic muscle exercises and lifestyle modifications appropriate to the patient to reduce her symptoms. These recommendations can include weight loss, adequate hydration, avoidance of excessive fluids, and regular voiding intervals that reduce urgency incontinence episodes. Urgency incontinence medications, with timely reassessment of symptoms, can be started without extensive evaluation. Specialist treatments for urgency incontinence include onabotulinumtoxinA and percutaneous or implanted neuromodulators. Stress incontinence surgery, the midurethral sling, is associated with symptom improvement in 48% to 90% of women and has low rates of mesh complications (<5%). CONCLUSIONS AND RELEVANCE Urinary incontinence is common in women, although few seek care despite many effective treatment options. Clinicians should prioritize urinary incontinence detection, identify and treat modifiable factors, incorporate patient preference into evaluation and treatment, initiate conservative and medical therapy, and refer to specialists when underlying pathology is identified or conservative measures are ineffective.
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Affiliation(s)
- Emily S Lukacz
- Department of Reproductive Medicine, University of California-San Diego, La Jolla
| | | | - Michael E Albo
- Department of Urology, University of California-San Diego, La Jolla
| | - Linda Brubaker
- Department of Reproductive Medicine, University of California-San Diego, La Jolla
- Associate Editor
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17
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Xu D, Gao J, Wang X, Huang L, Wang K. Prevalence of overactive bladder and its impact on quality of life in 1025 patients with type 2 diabetes in mainland China. J Diabetes Complications 2017; 31:1254-1258. [PMID: 28533105 DOI: 10.1016/j.jdiacomp.2017.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/26/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
Abstract
AIMS This study examined the prevalence of overactive bladder (OAB) and investigated the impact of OAB on quality of life (QOL) in patients with type 2 diabetes in Mainland China. METHODS A total of 1025 patients with type 2 diabetes were surveyed. Patients were grouped into no OAB, dry OAB, and wet OAB groups according to the presence of OAB and urge incontinence. Descriptive analyses, one-way analysis of variance (ANOVA) and multivariable regression models were conducted to assess the prevalence of OAB and the effect of OAB on QOL. RESULTS The prevalence of OAB among patients with type 2 diabetes was 13.9% (with dry OAB, 6.1%; with wet OAB, 7.8%). Multivariable regression models showed that OAB symptoms caused significant deterioration of the physical and mental aspects of QOL. Compared with dry OAB, wet OAB further decreased the mental aspect of QOL. Moreover, the effect sizes of the impacts of dry and wet OAB on QOL were larger than those of diabetic neuropathy or retinopathy, diabetes duration, or urinary tract infection history. CONCLUSIONS OAB is more common in patients with type 2 diabetes than in the general population and substantially decreases patient QOL.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Purdue University, West Lafayette, IN, USA.
| | - Jie Gao
- School of Nursing, Shandong University, Jinan, Shandong Province, China.
| | - Xiaojuan Wang
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China.
| | - Liqun Huang
- School of Nursing, Shandong University, Jinan, Shandong Province, China.
| | - Kefang Wang
- School of Nursing, Shandong University, Jinan, Shandong Province, China.
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18
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Saeedi P, Ahmadnia H, Akhavan Rezayat A. Evaluation of the Effect of Meatal Stenosis on the Urinary Tract by using Ultrasonography. Urol J 2017; 14:3071-3074. [PMID: 28537045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/18/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE Circumcision is one of the oldest surgical procedures that originated for religious purposes. Circumcision in infancy is a common procedure in our country and secondary meatal stenosis due to circumcision is a common complication. The aim of our study is to determine the effect of meatal stenosis on the lower and upperurinary tract of circumcised boys by using ultrasonography. MATERIALS AND METHODS In this cross-sectional study, we enrolled 87 circumcised boys between 4 to 8 years old with severe meatal stenosis. Clinical findings of our subjects were gathered by a checklist that included: thin stream of urine, upward urine stream deviation, infrequent voiding, urinary tract infections, voiding dysfunction, and urge incontinency. In lab data analysis, complete blood cell count (CBC), urine analysis, urine culture, blood urea nitrogen (BUN), and plasma creatinine level were evaluated. Ultrasonography detected hydronephrosis, hydroureter, bladder wall thickening in a full and empty bladder, bladder volume, and residual urine volume. RESULT Narrowing of urine stream is commonly seen (about 54%) among patients with severe meatal stenosis, and similarly in sonographic evaluations the most common symptoms among patients was thickening of the bladder wall that increased in an empty and a full bladder (about 82%). CONCLUSION The author of this study recommends performing long-term follow up after circumcision and ultrasonographyto detect meatal stenosis before permanent renal damage occurs.
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Affiliation(s)
- Parisa Saeedi
- Assistant professor of Urology, Mashhad University of Medical Science, Mashhad, Iran
| | - Hassan Ahmadnia
- Professor of Urology, Mashhad University of Medical Science, Mashhad, Iran
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Švabík K, Mašata J, Krhut J, Zachoval R, Hanuš T, Halaška M, Horčička L, Krofta L, Hanáková M, Martan A. [Degree of satisfaction of patients continuing overactive bladder treatment with mirabegron]. Ceska Gynekol 2017; 82:48-52. [PMID: 28252310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Overactive bladder syndrome is chronic disease with high prevalence rate (9-42%). This syndrome requires long term therapy, but the treatment persistence is after 3 months over all 26% with further decline in one-year period as low as 18.5%. Main reasons for stopping the treatment are low efficacy, the medication didnt work as expected and side effects. How much satisfied are patients with mirabegron persisting on its treatment? To answer this question, we provided secondary analysis of multicentre follow-up study of patients on mirabegron. We compared subjective and objective parameters between patients continuing mirabegron treatment and those who discontinued the medication. DESIGN Secondary analysis multicentre prospective follow-up. SETTINGS Ob/Gyn department First Faculty of Medicine, Charles University and General University Hospital, Prague. METHODS It is secondary analysis of multicentre prospective study following patients with mirabegron 50 mg treatment. We have analysed objective data from micturition diary and subjective data using visual analogue scales (UB-VAS - urgency bother visual analogue scale, and TS-VAS - treatment satisfaction visual analogue scale) and compared data between the group of patients continuing mirabegron treatment and patients who stopped the medication during the study. RESULTS We included 206 patients (176 women, 30 men) with diagnosis of overactive bladder. Patients continuing the treatment (group n1) had baseline UB-VAS 70.1 vs. 75.0 (p = n.s.) in patients who stopped the medication during the follow-up period (group n2). Baseline episodes of severe urgency and urge incontinence where n1 - 5.1 vs. n2 - 6.2 (p = n.s.). Six months urgency bother score UB-VAS was n1 - 32.4 vs. n2 - 58.9 (p < 0,001). Treatment satisfaction TS-VAS was n1 - 80.3 vs. n2 - 57.7 (p < 0,001). Number of severe urgencies with or without urge incontinence was after 6 months n1 - 2.1 vs. n2 - 3.3 (p = n.s.), lower in group continuing the treatment. When comparing the data between patients stopping the medication for reason of low efficacy (group s1) with patients stopping for other reasons (group s2) UB-VAS bas: s1 - 68.5 vs. s2 - 43.9 (p = 0.001); TS VAS s1 - 45.1 vs. s2 - 58.4 (p = n.s.) and number of severe urgency with or without incontinence s1 - 5.9 vs. s2 - 3.2 (p = 0.009). CONCLUSION Our data shows that patients expectation on treatment with mirabegron is not low. Patients accept treatment either without side effects or with decrease of severe urgency with or without urge incontinence around 50%. Regardless the reason the patients continuing the treatment scale treatment satisfaction - TS-VAS over 70 points.
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20
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Furukawa S, Sakai T, Niiya T, Miyaoka H, Miyake T, Yamamoto S, Kanzaki S, Maruyama K, Tanaka K, Ueda T, Senba H, Torisu M, Minami H, Onji M, Tanigawa T, Matsuura B, Hiasa Y, Miyake Y. Macrovascular Complications and Prevalence of Urgency Incontinence in Japanese Patients with Type 2 Diabetes Mellitus: The Dogo Study. Intern Med 2017; 56:889-893. [PMID: 28420835 PMCID: PMC5465403 DOI: 10.2169/internalmedicine.56.8063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective Macrovascular diseases and urgency incontinence are common among Japanese patients with type 2 diabetes mellitus. However, little evidence exists regarding the association between stroke and urgency incontinence among patients with type 2 diabetes mellitus. We examined the associations between macrovascular complications and urgency incontinence among Japanese patients with type 2 diabetes mellitus. Methods The study subjects were 818 Japanese patients with type 2 diabetes mellitus. Urgency incontinence was defined as present when a subject answered "once a week or more" to the question: "Within one week, how often do you leak urine because you cannot defer the sudden desire to urinate?" We adjusted our analyses for sex, age, body mass index, duration of type 2 diabetes, current smoking, current drinking, hypertension, dyslipidemia, glycated hemoglobin, diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy. Results The prevalence of urgency incontinence was 9.2%. Stroke was independently positively associated with urgency incontinence, with an adjusted odds ratio of 2.34 (95% confidence interval: 1.03-4.95). The associations between ischemic heart disease or peripheral artery disease and the prevalence of urgency incontinence were not significant. Conclusion In Japanese patients with type 2 diabetes mellitus, stroke, but not ischemic heart diseases or peripheral artery disease, was independently positively associated with urgency incontinence.
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Affiliation(s)
- Shinya Furukawa
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Japan
- Epidemiology and Medical Statistics Unit, Translational Research Center, Ehime University Hospital, Japan
| | - Takenori Sakai
- Department of Internal Medicine, Yawatahama General City Hospital, Japan
| | - Tetsuji Niiya
- Department of Internal Medicine, Matsuyama Shimin Hospital, Japan
| | - Hiroaki Miyaoka
- Department of Internal Medicine, Saiseikai Matsuyama Hospital, Japan
| | - Teruki Miyake
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Shin Yamamoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Sayaka Kanzaki
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Koutatsu Maruyama
- Department of Public Health, Juntendo University School of Medicine, Japan
| | - Keiko Tanaka
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Japan
- Epidemiology and Medical Statistics Unit, Translational Research Center, Ehime University Hospital, Japan
| | - Teruhisa Ueda
- Department of Internal Medicine, Ehime Prefectural Central Hospital, Japan
| | - Hidenori Senba
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Japan
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Masamoto Torisu
- Department of Internal Medicine, Saiseikai Saijo Hospital, Japan
| | - Hisaka Minami
- Department of Internal Medicine, Ehime Niihama Hospital, Japan
| | - Morikazu Onji
- Department of Internal Medicine, Saiseikai Imabari Hospital, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Juntendo University School of Medicine, Japan
| | - Bunzo Matsuura
- Department of Lifestyle-related Medicine and Endocrinology, Ehime University Graduate School of Medicine, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Japan
| | - Yoshihiro Miyake
- Department of Epidemiology and Preventive Medicine, Ehime University Graduate School of Medicine, Japan
- Epidemiology and Medical Statistics Unit, Translational Research Center, Ehime University Hospital, Japan
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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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Williams JR, Thompson SE(B, Fenoughty M. A Clinical Nurse's Walk Through Research: Relieving Postoperative Urinary Urgency. Medsurg Nurs 2017; 26:44-46. [PMID: 30351574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A clinical nurse at a small community hospital recognized a need to help patients with urinary urgency following laparoscopic-assisted vaginal hysterectomy. The subsequent continuous quality improve- ment project is described.
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Niemczyk J, von Gontard A, Equit M, Bauer K, Naumann T, Wagner C, Curfs L. Detailed assessment of incontinence in boys with fragile-X-syndrome in a home setting. Eur J Pediatr 2016; 175:1325-34. [PMID: 27567619 DOI: 10.1007/s00431-016-2767-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 08/15/2016] [Accepted: 08/19/2016] [Indexed: 11/27/2022]
Abstract
UNLABELLED Fragile-X-syndrome (FXS) is caused by a mutation on the X chromosome (Xq27.3). Males with a full mutation have typical dysmorphic signs, moderate intellectual disability and psychological disorders. Twenty-five to fifty percent are affected by incontinence. The aim of the study was to assess subtypes of incontinence and psychological problems in children with FXS in their home environments. Twenty-two boys with FXS (mean age 11.0 years) and 22 healthy controls (mean age 11.1 years) were examined with sonography, uroflowmetry, 48-h bladder diary, physical examination, IQ test, parental psychiatric interview and questionnaires regarding incontinence and psychological symptoms in a home setting. Boys with FXS had higher rates of incontinence than controls (59.1 vs. 4.8 %). The most common subtypes in FXS boys were primary non-monosymptomatic nocturnal enuresis, urge incontinence and nonretentive faecal incontinence. 90.9 % boys with FXS had a psychological comorbidity. Incontinence and behavioural symptoms were not associated. CONCLUSION Boys with FXS have a higher risk for physical disabilities, psychological disorders and incontinence than healthy boys. Constipation is not a major problem in FXS. As effective treatment is available for children with ID, we recommend offering assessment and therapy to all children with FXS and incontinence. WHAT IS KNOWN • Boys with fragile-X-syndrome (FXS) have higher rates of incontinence, psychological disorders and somatic conditions than typically developing boys. What is New: • Constipation is a rare condition in FXS in contrast to other genetic syndromes. • Although incontinence rates are higher, urological findings (uroflowmetry, sonography) are not more pathological per se in FXS.
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Affiliation(s)
- Justine Niemczyk
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany.
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany
| | - Monika Equit
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany
| | - Katharina Bauer
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany
| | - Teresa Naumann
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany
| | - C Wagner
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, 66421, Homburg, Germany
| | - Leopold Curfs
- Department of Clinical Genetics, Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, The Netherlands
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Abstract
Emphysematous cystitis is found in diabetic patients and in individuals with urinary stasis and immunosuppression. We report a 58-year-old male with hypertension, type 2 Diabetes on insulin treatment and central nervous system vasculitis on immunosuppressive therapy. He was admitted with weight loss and gait instability. A PET-CT showed a circumscribed image of air in the bladder contour without involving the upper urinary tract, suggesting emphysematous cystitis. Re-interrogated, the patient referred pneumaturia, dysuria and febrile sensation one week before admission. Urine culture showed Enterobacter aerogenes. He was treated with a urinary catheter, metabolic control and parenteral antimicrobials. The patient was discharged without symptoms 21 days after admission, with the bladder catheter.
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Hubert KC, Sideridis G, Sherlock R, Rosoklija I, Kringle G, Johnson K, Bauer SB, Nelson CP. Urinary incontinence in spina bifida: Initial instrument validation. Res Dev Disabil 2015; 40:42-50. [PMID: 25841183 DOI: 10.1016/j.ridd.2015.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 11/19/2014] [Revised: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 06/04/2023]
Abstract
The purpose of this study was to perform a psychometric assessment of the Incontinence Symptom Index-Pediatric (ISI-P) in a cohort of adolescents with spina bifida (SB) and neuropathic urinary incontinence (UI) to test its validity and reliability. The ISI-P, an 11-item instrument with domains for symptom severity and impairment, was self-administered by subjects 11-17 years old with SB and UI. Controls were 11-17 years old, with nephrolithiasis and no history of UI. Formal psychometric assessment included an evaluation of internal consistency, test re-test reliability and factor analysis. Of 78 study-eligible subjects we attempted to contact, 33 (66.7% female) with a median age of 13.1 years completed the ISI-P (42.3% response rate). 21 control patients also completed the ISI-P. Cronbach's alpha was 0.936 and 0.792 for the severity and bother factors respectively. The delta Chi-square test for the two-factor (vs. one-factor) model was significantly [χ(2)(89) = 107.823, p < 0.05] in favor of the former model with descriptive fit indices being excellent (e.g., comparative fit index = 0.969). Furthermore, category information analysis showed that all categories were associated with different threshold values, namely that each category contributed unique information for the measurement of the latent trait. In conclusion, the ISI-P has desirable psychometric properties for the measurement of UI symptom severity and impairment in adolescents with SB.
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MESH Headings
- Adolescent
- Child
- Cohort Studies
- Cross-Sectional Studies
- Diurnal Enuresis/diagnosis
- Diurnal Enuresis/etiology
- Diurnal Enuresis/psychology
- Factor Analysis, Statistical
- Female
- Humans
- Male
- Psychometrics
- Quality of Life
- Reproducibility of Results
- Severity of Illness Index
- Social Participation/psychology
- Spinal Dysraphism/complications
- Surveys and Questionnaires
- Urinary Bladder, Neurogenic/diagnosis
- Urinary Bladder, Neurogenic/etiology
- Urinary Bladder, Neurogenic/psychology
- Urinary Incontinence/diagnosis
- Urinary Incontinence/etiology
- Urinary Incontinence/psychology
- Urinary Incontinence, Stress/diagnosis
- Urinary Incontinence, Stress/etiology
- Urinary Incontinence, Stress/psychology
- Urinary Incontinence, Urge/diagnosis
- Urinary Incontinence, Urge/etiology
- Urinary Incontinence, Urge/psychology
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Affiliation(s)
- Katherine C Hubert
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Georgios Sideridis
- Clinical Research Program, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Rebecca Sherlock
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Ilina Rosoklija
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Greta Kringle
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Kathryn Johnson
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Stuart B Bauer
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Caleb P Nelson
- Department of Urology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States; Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
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Wang L, Wang L, Shi G, Zeng L, Yang Y, Zhang T, Liu H. Efficacy and safety of ginger-salt-indirect moxibustion for urge urinary incontinence after stroke: protocol for a pilot multicentre randomised controlled trial. BMJ Open 2014; 4:e006326. [PMID: 25335962 PMCID: PMC4208054 DOI: 10.1136/bmjopen-2014-006326] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/19/2014] [Accepted: 09/24/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Ginger-salt-indirect moxibustion is widely applied to treat urge urinary incontinence after stroke, which is a common complication in stroke survivors. Moxa cone moxibustion and moxa box moxibustion are the main techniques of ginger-salt-indirect moxibustion. Our previous study had shown that ginger-salt-indirect moxibustion using moxa cones was feasible and effective for urination disorders post-stroke. This pilot study aims to assess the feasibility of conducting research to evaluate the efficacy and safety of ginger-salt-indirect moxibustion for patients with post-stroke urge urinary incontinence. METHODS AND ANALYSIS This is a multicentre, prospective, single-blinded, pilot randomised controlled trial. 120 eligible patients will be randomly allocated to three groups. Treatment group A (n=40) will receive moxa cone moxibustion and routine care; treatment group B (n=40) will receive moxa box moxibustion and routine care; control group (n=40) will only receive routine care for stroke recovery. The entire moxibustion treatment will consist of a total of 28 sessions during the course of 4 weeks. The primary outcome measure will be the increase in mean volume per void assessed at week 4 from the first moxibustion session (baseline). Secondary outcome measures will include mean frequency of urination per day and quality of life assessments measured by completion of the Incontinence Quality of Life Questionnaire and Barthel Index. All outcome measures will be assessed at baseline and at 4 and 16 weeks from baseline. Adverse events in the three groups will be recorded to assess the safety of moxibustion. ETHICS AND DISSEMINATION Research ethics was approved by the Research Ethical Committee of Beijing Hospital of Traditional Chinese Medicine Affiliated to the Capital Medical University (ref: 2013BL-094). Written informed consent will be obtained from all participants. Study results will be published in peer reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN 44706974.
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Affiliation(s)
- Linpeng Wang
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Lichen Wang
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Guangxia Shi
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Lin Zeng
- Research Center of Clinical Epidemiology Affiliated to Peking University, Beijing, China
| | - Yi Yang
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Tao Zhang
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Huilin Liu
- Acupuncture and Moxibustion Department, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
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Futyma K, Miotła P, Bartuzi A, Winkler I, Lis E, Kulik-Rechberger B, Rechberger T. Does a midurethral sling inserted at the time of pelvic organ prolapse mesh surgery increase the rate of de novo OAB? A prospective longitudinal study. Ginekol Pol 2014; 85:652-657. [PMID: 25322535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES Approximately 20% of women suffer from pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Furthermore, POP and overactive bladder (OAB) symptoms often coexist. Midurethral slings and mesh surgeries are both considered to be risk factors for de novo OAB symptoms. The aim of our study was to determine whether simultaneous midurethral sling insertion at the time of pelvic organ prolapse mesh surgery further increases the risk of de novo OAB. MATERIALS AND METHODS The study group consisted of 234 women who underwent surgery in our department between August 2007 and October 2009 (114 patients underwent surgery because of coexisting POP and SUI, and 120 underwent surgery because POP alone). The patients were evaluated at follow-up visits scheduled after 6-8 weeks and after 12 months. All women underwent surgery using the Gynecare Prolift Pelvic Floor Repair System, whereas in women with additional overt or occult SUI after restoration of the pelvic anatomy monofilament midurethral slings were simultaneously inserted. The chi-squared test was used to compare the study groups. RESULTS De novo OAB symptoms were significantly more pronounced among women in the Prolift only surgery group (23.3%) compared to the Prolift with IVS04M group (10.5%; p = 0.0093). CONCLUSIONS Midurethral sling insertion at the time of pelvic organ prolapse surgery significantly decreases the rate of postoperative de novo OAB symptoms. The lack of anatomical success of the mesh-based reconstructive surgery is a risk factor for the development of de novo OAB symptoms.
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Khandwala S, Williams C, Reeves W, Dai J, Jayachandran C. Role of vaginal mesh hysteropexy for the management of advanced uterovaginal prolapse. J Reprod Med 2014; 59:371-378. [PMID: 25098027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the role of vaginal mesh hysteropexy in the management of advanced genital organ prolapse as assessed by subjective and objective parameters. STUDY DESIGN Retrospective case series of 77 women followed for at least 1 year after vaginal mesh hysteropexy performed for stage III or greater uterovaginal prolapse. The primary outcome was Pelvic Organ Prolapse Quantification (POP- Q) stage < II and no subjective bothersome bulge and no further interventions for prolapse. Secondary outcomes assessed were complications such as intraoperative bleeding, injuries, and postoperative complications such as mesh exposure, mesh retraction, dyspareunia, urinary incontinence, and voiding dysfunction. RESULTS Mean follow-up was 13.7 +/- 4.1 months. Our composite success score was 85.7%. The anatomic (POP-Q) success score was 90.9%. Most failures (all but 1) were stage II with cervix as leading edge. Incidence of de novo dyspareunia was 3.7% and vaginal mesh erosion was 6.5%. Most patients 68/77 (88.3%) were discharged home voiding normally. CONCLUSION Vaginal mesh hysteropexy offers good success; however, comparative studies are required to validate its true role.
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Castro-Diaz D, Cardozo L, Chapple CR, Espuña M, Kelleher C, Kirby M, Milsom I, Sievert KD, Tubaro A. Urgency and pain in patients with overactive bladder and bladder pain syndrome. What are the differences? Int J Clin Pract 2014; 68:356-62. [PMID: 24373133 DOI: 10.1111/ijcp.12317] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Overactive Bladder Syndrome (OAB) and the Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) are different urological conditions sharing 'urgency' as a common symptom. The aim of this review is to address our existing knowledge and establish how these symptoms are interrelated and to determine whether or not there is a common link between both symptoms complexes that help to distinguish one from the other. METHODS Pubmed was used to obtain references for this non-systematic review aiming to discuss differences between OAB and BPS/IC. Guidelines of several professional associations and discussions based on expert opinion from the authors were implemented. RESULTS Whilst in BPS the hallmark symptom is pain on bladder filling, urgency is the defining symptom of OAB. Whilst it is likely that the pain in BPS/IC arises from local inflammation in the bladder wall, the nature of urgency as a symptom, its origin, and the relationship between urgency and pain, as well as the different afferent mechanisms associated with the genesis of these sensory symptoms, remains unknown. Although the aetiology of both OAB and PBS/IC is unclear, the influence of environmental factors has been suggested. Both are chronic conditions with very variable symptom resolution and response to therapy. The relationship with voiding dysfunction, gynaecological causes of chronic pelvic pain or the possible alteration of the hypothalamic-pituitary-adrenal axis and psychological disorders has not been established. Inflammation has been suggested as the common link between OAB and BPS/IC. CONCLUSIONS OAB and BPS/IC are different symptoms complexes that share urgency as a common symptom. None of them have a specific symptom although pain on bladder filling is the hallmark symptom in BPS/IC. Bladder pain with urgency should be a trigger for referral to the provider with appropriate knowledge and expertise in this disease state, whereas the management of OAB should be part of normal routine care in the community.
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Affiliation(s)
- D Castro-Diaz
- Servicio de Urologia, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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Kosilov KV, Loparev SA, Krasnykh MA, Kosilova LV. [Treatment of overactive bladder in older women increased doses of antimuscarinic drugs safe and effective alternative to existing methods]. Adv Gerontol 2014; 27:149-155. [PMID: 25051773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The study included 95 female patients of 65 to 74 years (average age 67,1 years), who previously (more than 6 months before this study) took a course of monotherapy with hydrochloride trospium in higher dosages with unstable or weak effect. In this study, all patients were divided into three groups and were treated with two antimuscarinic drugs. The majority of older women suffering from OAB and treatment-resistant taking one antimuscarinic drug in high doses showed a significant positive progress in a state by adding a second antimuscarinic agent. The received side effects do not exceed thereof in comparison with treatment with a single drug.
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Affiliation(s)
- K V Kosilov
- Far Eastern University, Vladivostok, Russian Federation
| | - S A Loparev
- Department of Urology, City Hospital No. 3, Vladivostok, Russian Federation
| | - M A Krasnykh
- Far Eastern National Fisheries University, Vladivostok, Russian Federation
| | - L V Kosilova
- Medical Association No. 2 of Vladivostok, Vladivostok, Russian Federation
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Abstract
Urinary incontinence, the involuntary leakage of urine, can result from abnormalities of the urinary tract or may be caused by other conditions and is sub-divided into a number of classifications including stress incontinence and urge urinary incontinence.(1) Urge urinary incontinence (UUI) is involuntary urine leakage accompanied by urgency of micturition.(2) Overactive bladder (OAB) syndrome is defined as urgency occurring with or without UUI and usually occurs with frequency and nocturia.(1) Wet OAB is associated with UUI, while dry OAB is not associated with incontinence. Current drug therapy for OAB involves the use of an antimuscarinic drug, of which there are a number available, such as oxybutynin, darifenacin, solifenacin and tolterodine.(1,3) ▾Mirabegron is the first of a new class of drug, beta-3-adrenoreceptor agonists, licensed for symptomatic treatment of urgency, increased micturition frequency and/or urgency incontinence as may occur in adult patients with OAB syndrome.(4) Here we review the evidence for mirabegron.
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Cornu JN. Actual treatment of overactive bladder and urge urinary incontinence. MINERVA UROL NEFROL 2013; 65:21-35. [PMID: 23538308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Overactive bladder (OAB) is defined by its hallmark symptom, urgency. It can be associated with urge urinary incontinence (UUI), and dramatically impact the patients' quality of life. Etiologies of OAB are numerous, and under this common wording, virtually all the population is covered (men as well as women, patients with or without neurogenic disease, and all age categories). OAB and UUI management have been historically based on non-interventional therapies, antimuscarinics, and surgery. In the last decade, innovations in the treatment of this highly prevalent condition have been multiple, and further insights came from various horizons (drug invention, innovative use of existing drugs, new medical devices, tissue engineering, gene and cell therapy). Notably, the use of BoNT and neuromodulation techniques have deeply modified the algorithm of specialized OAB management, delaying surgery indications and offering mini-invasive alternatives to patient refractory to behavioral and medical treatment. Whilst some of these techniques are about to reach maturity, numerous questions remain unsolved about their indications, long term effects, rank in the armamentarium, cost-effectiveness, hypothetical combination or sequential use. The present review depicts the actual wide range of options available for OAB management in adults, focusing on the latest evolutions. When relevant, a distinction was made between genders and OAB subtypes (idiopathic vs neurogenic) regarding treatment outcomes.
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MESH Headings
- Acetanilides/therapeutic use
- Botulinum Toxins, Type A/therapeutic use
- Caffeine/adverse effects
- Caffeine/therapeutic use
- Clinical Trials, Phase III as Topic
- Drinking Behavior
- Electric Stimulation Therapy
- Electrodes, Implanted
- Exercise Therapy
- Female
- Humans
- Male
- Multicenter Studies as Topic
- Muscarinic Antagonists/therapeutic use
- Neurokinin-1 Receptor Antagonists
- Pelvic Floor Disorders/complications
- Pelvic Floor Disorders/therapy
- Phosphodiesterase Inhibitors/therapeutic use
- Randomized Controlled Trials as Topic
- Therapies, Investigational
- Thiazoles/therapeutic use
- Urinary Bladder Neck Obstruction/complications
- Urinary Bladder Neck Obstruction/surgery
- Urinary Bladder, Neurogenic/complications
- Urinary Bladder, Neurogenic/drug therapy
- Urinary Bladder, Neurogenic/therapy
- Urinary Bladder, Overactive/etiology
- Urinary Bladder, Overactive/therapy
- Urinary Incontinence, Urge/etiology
- Urinary Incontinence, Urge/therapy
- Urologic Surgical Procedures
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Yazdany T, Bhatia NN, Nguyen JN. Urinary retention and voiding dysfunction in women with uterine leiomyoma: a case series. J Reprod Med 2012; 57:384-389. [PMID: 23091984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To examine urinary retention as an underreported complication of uterine leiomyoma. Reproductive-aged women with uterine leiomyoma often describe pelvic pressure and menorrhagia, however few complain of complete urinary retention. STUDY DESIGN We dis-cuss the cases of 8 women who presented to our emergency room with acute urinary retention over a 4-year period. RESULTS Patients had a mean age of 39 (range, 25-51) and median parity of 1 (range, 0-5). Seven of 8 patients (88%) had posterior-fundal leiomyomas. All patients underwent either myomectomy or hysterectomy with resolution of their urinary retention. CONCLUSION Incarceration of the posterior or fundal leiomyoma beyond the pelvic brim can push the cervix against the pubic bone, resulting in compression of the bladder neck or urethra. This may explain the etiology of retention and/or voiding dysfunction in some cases. Urinary retention, as a result of leiomyoma, may be overlooked in the initial management of symptomatic patients.
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Affiliation(s)
- Tajnoos Yazdany
- Division of Female Pelvic Medicine and Reconstructive Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, Torrance, CA 90509, USA.
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Bradley CS, Nygaard IE, Mengeling MA, Torner JC, Stockdale CK, Booth BM, Sadler AG. Urinary incontinence, depression and posttraumatic stress disorder in women veterans. Am J Obstet Gynecol 2012; 206:502.e1-8. [PMID: 22631867 PMCID: PMC3381607 DOI: 10.1016/j.ajog.2012.04.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [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: 11/22/2011] [Revised: 03/03/2012] [Accepted: 04/10/2012] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To study associations between urinary incontinence (UI) symptoms, depression, and posttraumatic stress disorder in women veterans. STUDY DESIGN This cross-sectional study enrolled women 20 to 52 years of age registered at 2 midwestern US Veterans Affairs Medical Centers or outlying clinics within 5 years preceding study interview. Participants completed a computer-assisted telephone interview assessing urogynecologic, medical, and mental health. Multivariable analyses studied independent associations between stress and urgency UI and depression and posttraumatic stress disorder. RESULTS Nine hundred sixty-eight women mean aged 38.7 ± 8.7 years were included. Of these, 191 (19.7%) reported urgency/mixed UI and 183 (18.9%) stress UI. Posttraumatic stress disorder (odds ratio, 1.8; 95% confidence interval, 1.0-3.1) but not depression (odds ratio, 1.2; 95% confidence interval, 0.73-2.0) was associated with urgency/mixed UI. Stress UI was not associated with posttraumatic stress disorder or depression. CONCLUSION In women veterans, urgency/mixed UI was associated with posttraumatic stress disorder but not depression.
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Affiliation(s)
- Catherine S. Bradley
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - Ingrid E. Nygaard
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT
| | - Michelle A. Mengeling
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA
- Midwest Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, IA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - James C. Torner
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA
| | - Colleen K. Stockdale
- Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Brenda M. Booth
- Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System and Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AK
| | - Anne G. Sadler
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, IA
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Leone Roberti Maggiore U, Soligo M, Ferrero S. Should conservative management be considered in women with mixed urinary incontinence prior to surgery? BJOG 2011; 118:1538; author reply 1538-9. [PMID: 21988847 DOI: 10.1111/j.1471-0528.2011.03135.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cho MC, Park JH, Jeong MS, Yi JS, Ku JH, Oh SJ, Kim SW, Paick JS. Predictor of de novo urinary incontinence following holmium laser enucleation of the prostate. Neurourol Urodyn 2011; 30:1343-1349. [PMID: 21538499 DOI: 10.1002/nau.21050] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Accepted: 11/15/2010] [Indexed: 09/20/2023]
Abstract
AIMS To investigate the incidence of de novo urinary incontinence (UI) after holmium laser enucleation of the prostate (HoLEP) for benign prostatic hyperplasia and to determine predictors of postoperative de novo UI. METHODS A total of 204 men who underwent HoLEP and in whom 12-month follow-up data on UI were available were included in this study. The efficacy of HoLEP was assessed at 1-, 3-, 6-, and 12-month postoperatively using the International Prostate Symptom Score (IPSS) and with uroflowmetry. The presence or absence of UI was recorded at each follow-up visit. All definitions of UI corresponded to recommendations of the International Continence Society. RESULTS The mean preoperative total prostate and transition zone volumes were 53.3 (range 20-162) g and 27.2 (range 4-107) g, respectively. The mean enucleated weight was 23.0 (range 3.0-82.3) g. The IPSS and uroflowmetry showed that all micturition parameters improved significantly starting at 1-month postoperatively. After HoLEP, 29 patients (16.2%) had de novo UI, most of which resolved within 1-6 months; 11 had stress UI, 12 had urgency UI, and the remaining 6 had mixed UI. On logistic regression analysis, bladder mucosal injury during morcellation and maximum urethral closure pressure on baseline urodynamics were the independent predictors of de novo UI after surgery. CONCLUSIONS Our data suggest that HoLEP is effective in improving micturition, but de novo postoperative UI occurred in some patients although usually transient. Surgeons should be careful to not injure the bladder mucosa during morcellation.
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Affiliation(s)
- Min Chul Cho
- Department of Urology, College of Medicine, Dongguk University, Gyeonggi, Korea
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Bauer RM, Dannecker C, Füllhase C, Roosen A, Stief CG, Friese K, Gratzke C. [Diagnostics for female incontinence: two-stage assessment]. MMW Fortschr Med 2011; 153:35-36. [PMID: 21644290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Ricarda M Bauer
- Urologische Klinik und Poliklinik Klinikum der Universität München - Grosshadern Ludwig-Maximilians-Universität München.
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Füllhase C, Gratzke C, Dannecker C, Stief CG, Friese K, Bauer RM. [Non-surgical treatment of female incontinence]. MMW Fortschr Med 2011; 153:37-39. [PMID: 21644291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- Claudius Füllhase
- Urologische Klinik und Poliklinik Klinikum der Universität München - Grosshadern Ludwig-Maximilians-Universität München
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Lindner UK. [Dysuria as the leading symptom. When urination malfunctions]. Pflege Z 2011; 64:310-312. [PMID: 21638884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Bauer RM, Gozzi C, Hübner W, Nitti VW, Novara G, Peterson A, Sandhu JS, Stief CG. Contemporary management of postprostatectomy incontinence. Eur Urol 2011; 59:985-96. [PMID: 21458914 DOI: 10.1016/j.eururo.2011.03.020] [Citation(s) in RCA: 180] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 03/10/2011] [Indexed: 11/19/2022]
Abstract
CONTEXT In recent years, despite improvement in the surgical technique, the prevalence of postprostatectomy incontinence has increased due to a rise in the number of radical prostatectomies performed annually. OBJECTIVE The aim of this review is to evaluate contemporary noninvasive and invasive treatment options for postprostatectomy incontinence. EVIDENCE ACQUISITION In August 2010, a review of the literature was performed using the Medline database. EVIDENCE SYNTHESIS All articles concerning noninvasive and invasive treatment for postprostatectomy incontinence were included. CONCLUSIONS No randomised controlled trials exist to compare currently used noninvasive and invasive treatments for postprostatectomy incontinence. Pelvic floor muscle training is recommended for the initial treatment of stress urinary incontinence (SUI). Additionally, antimuscarinic therapy should be applied for urgency or urge incontinence. For decades, the artificial urinary sphincter was the reference standard for persistent SUI. Nowadays, male slings are an alternative for men with mild to moderate postprostatectomy SUI.
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Affiliation(s)
- Ricarda M Bauer
- Department of Urology, Ludwig-Maximilian-University, Munich, Germany.
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Kaplan SA, Schneider T, Foote JE, Guan Z, Carlsson M, Gong J. Superior efficacy of fesoterodine over tolterodine extended release with rapid onset: a prospective, head-to-head, placebo-controlled trial. BJU Int 2010; 107:1432-40. [PMID: 20860717 DOI: 10.1111/j.1464-410x.2010.09640.x] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Steven A Kaplan
- Department of Urology, Weill Cornell Medical College, Cornell University, New York, NY, USA.
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Abstract
AIMS Urethral stricture disease in females is uncommon and is often treated with repeat dilation or internal urethrotomies. Various surgical techniques requiring tissue transfer or grafting to repair strictures have been described with successful results. The vaginal inlay flap is simple and easy to learn. In this follow-up report of the use of this flap with additional patients more complications with urge symptoms and difficulties with catheterization are reported. METHODS Twelve symptomatic women with a history of traumatic or difficult catheterization, a history of at least 1 urethral dilation or urethrotomy and difficult or a failed attempt at catheter placement underwent urethroplasty. The technique consisted of incising the posterior aspect of the stricture and advancing a vaginal inlay flap. A retrospective chart review was performed. RESULTS Follow-up was 3 months to 9 years. All patients had subjective relief of most of their symptoms and were able to catheterize with a 14Fr catheter. One patient underwent repeat dilation 3 weeks after the primary procedure with no recurrence and another woman required a cystoscopy and catheter insertion in the OR fifty-eight months post operatively. No patient had stress urinary incontinence. Irritative symptoms, particularly urge, and difficulties with catheterization persisted in some patients post operatively despite having a technically good repair. CONCLUSION Urethral stricture disease in females is an uncommon entity that can cause voiding symptoms, recurrent infections, retention and renal impairment. This method of surgical repair offers a durable result with a low incidence of complications.
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Affiliation(s)
- E Ann Gormley
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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Lemcke J, Meier U. [Idiopathic normal pressure hydrocephalus--who benefits from surgery?]. MMW Fortschr Med 2010; 152:48-49. [PMID: 20557004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Neĭmark AI, Riapolova MV, Mel'nik MA. [Treatment of overactive urinary bladder with imperative urinary incontinence in women]. Urologiia 2010:36-38. [PMID: 20967993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The clinic at the nephrology and urology chair of the State Altai Medical University admitted 40 females aged 20-74 years with overactive bladder (OAB) symptoms and imperative urinary incontinence (IUI) in 2008-2009. The patients were divided into two groups: 20 patients of group 1 received an anticholinesterase drug solifenacin (vesikar) in a dose 5 mg/day; 20 patients of group 2 received combined treatment. The course of treatment lasted for 1-3 months. As shown by the voiding diary and uroflowmetry, vesikar noticeably reduced or eliminated the rate and intensity of imperative voiding. Urodynamic parameters also changed positively. The treatment prolonged voiding time and volume, lowered Qmax. The effect was persistent.
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Schwab C, Frei R, Schmid HP. [What is your diagnosis? Urothelial carcinoma pT1. Retroperitoneal cyst of unknown etiology]. Praxis (Bern 1994) 2010; 99:15-16. [PMID: 20052634 DOI: 10.1024/1661-8157/a000063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- C Schwab
- Klinik für Urologie, Kantonsspital St. Gallen.
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Herschorn S, Swift S, Guan Z, Carlsson M, Morrow JD, Brodsky M, Gong J. Comparison of fesoterodine and tolterodine extended release for the treatment of overactive bladder: a head-to-head placebo-controlled trial. BJU Int 2010; 105:58-66. [PMID: 20132103 DOI: 10.1111/j.1464-410x.2009.09086.x] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sender Herschorn
- Sunnybrook Health Sciences Centre, Division of Urology, University of Toronto, Toronto, Ontario, Canada.
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Cardozo L, Chapple CR, Dmochowski R, Fitzgerald MP, Hanno P, Michel MC, Staskin D, Van Kerrebroeck P, Wyndaele JJ, Yamaguchi O, Yoshida M. Urinary urgency - translating the evidence base into daily clinical practice. Int J Clin Pract 2009; 63:1675-82. [PMID: 19930329 DOI: 10.1111/j.1742-1241.2009.02205.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
AIM To consider the currently available knowledge and understanding of the symptom of urgency. MATERIALS & METHODS Each faculty member reviewed the literature base of a different aspect of urgency and along with their personal clinical experience provided a base of evidence for discussion. RESULTS This overview summarises relevant published literature and the current clinical experience of the authors. DISCUSSION Whilst the mechanisms producing the sensation of urgency are still not fully understood and we are working within a definition that may complicate measurement and treatment, our pressing need is to effectively manage our patients for whom the practical nature of urgency can be all too apparent. CONCLUSION Health care professionals have an important role to play today in helping to alleviate the widespread problem of urgency and its consequences.
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Affiliation(s)
- L Cardozo
- King's College Hospital, London, UK.
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Viktrup L, Lose G. [Urinary incontinence during 12 years after delivery]. Ugeskr Laeger 2009; 171:3073-3077. [PMID: 19852893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION First pregnancy and delivery often result in urinary incontinence. The aim of this 12-year cohort study was to estimate the impact of incontinence and the need for treatment. MATERIAL AND METHODS A total of 305 women were questioned about lower urinary tract symptoms a few days, three months, five years and 12 years after their first delivery. RESULTS A total of 242 women (79%) answered a questionnaire 12 years after their first delivery. Urinary incontinence increased significantly (p < 0.05) during the 12-year period to a total of 114 symptomatic women (47%); 25 of 102 women had stress incontinence (SI) and seven of 49 women had urge incontinence (UI) for at least 12 years. Three of 114 incontinent women (2.6%) had received treatment, while 162 women had exercised the pelvic floor the previous three months. None underwent SI surgery. Eighteen incontinent women wanted treatment; six of whom had SI alone and 12 of whom had both SI and UI. Among the 18 SI women ten had daily symptoms, while nine experienced social or hygienic inconvenience. Among the 86 incontinent women who did not want treatment, 51 had SI alone, 24 had both SI and UI, and 11 women had UI alone. Among the 75 SI women, five had daily symptoms, while ten experienced social or hygienic inconvenience. CONCLUSION Urinary incontinence is prevalent 12 years after first delivery, though few receive treatment. Incontinence severity is associated with a desire for treatment.
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Affiliation(s)
- Lars Viktrup
- Københavns Universitet og Glostrup Hospital, Gynaekologisk og Obstetrisk Afdeling, Denmark.
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Altman D, Melin I, Falconer C, Rössner S. [Weight reduction as treatment of urinary incontinence]. Lakartidningen 2009; 106:1826-1828. [PMID: 19685623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Daniel Altman
- Institutionen för kliniska vetenskaper, Danderyds sjukhus.
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