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Schönburg S. [Botulinum toxin in male lower urinary tract symptoms (LUTS): What can we expect?]. Urologie 2024:10.1007/s00120-024-02352-0. [PMID: 38698262 DOI: 10.1007/s00120-024-02352-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
During the last two decades botulinum toxin has also conquered urology. Botulinum toxin reduces the contractility and sensitivity of the detrusor muscle and relieves pain. It is therefore a promising drug whose use in men also appears promising. The following article highlights the practical relevance of botulinum toxin for male lower urinary tract symptoms (LUTS). But first of all, a distinction must be made between use in male LUTS due to benign prostate syndrome (BPS) and use in cases of overactive bladder (OAB) alone. A differentiated diagnosis and treatment of male LUTS is therefore essential.
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Affiliation(s)
- Sandra Schönburg
- Universitätsklinik für Urologie und Nierentransplantation, Martin-Luther-Universität Halle/Saale, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland.
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Basin MF, Chadha P, Useva A, Ginzburg N, Ferry E. Investigation of intradetrusor onabotulinum toxin A efficacy and safety in older adults with urge urinary incontinence. Int Urol Nephrol 2024; 56:1559-1563. [PMID: 38071727 DOI: 10.1007/s11255-023-03891-9] [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: 09/29/2023] [Accepted: 11/14/2023] [Indexed: 04/09/2024]
Abstract
PURPOSE Intradetrusor onabotulinum toxin A (BTX-A) has been demonstrated to be an effective treatment option for overactive bladder (OAB). However, concerns about frailty and frequent injections may deter its use in the elderly. This study aims to assess the safety, efficacy, and treatment duration of BTX-A in managing OAB in elderly women. METHODS We retrospectively reviewed female patients aged 70 and above who were diagnosed with OAB with predominant urge urinary incontinence and underwent intravesical BTX-A treatment. We collected demographic and clinical data, with repeat BTX-A injections re-administered upon patient-reported symptom recurrence. RESULTS Twenty-one female patients, median age 77 (range 71-92), were included. The median time between the first and second injection was 185 (84-448) days, 186 (105-959) days between the second and third injection, and increased to 206.5 (84-256) days between the third and fourth injection. However, the median interval trended downward after the fourth injection (Fig. 1). Patients with four or more injections had a shorter median interval between injections, 154 days, compared to those with fewer injections, 210 days. Two patients (6.9%) experienced urinary retention after the initial treatment, with 1 (2.2%) among a total of 46 subsequent treatments (Table 3). There were ten (13.3%) episodes of UTIs within 2 weeks of treatment. Patients reported improvement in symptoms following 93.3% of the injections. CONCLUSION This real-world study demonstrates that BTX-A effectively controls OAB symptoms in elderly women, with just two injections annually. BTX-A appears safe and efficacious for treating OAB in elderly females.
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Affiliation(s)
- Michael F Basin
- Department of Urology, SUNY Upstate University Hospital, Syracuse, NY, USA.
| | - Priyal Chadha
- Department of Urology, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Anastasija Useva
- Department of Urology, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Natasha Ginzburg
- Department of Urology, SUNY Upstate University Hospital, Syracuse, NY, USA
| | - Elizabeth Ferry
- Department of Urology, SUNY Upstate University Hospital, Syracuse, NY, USA
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El-Sayed RF, Moqbel NM, Hussein AF, Abdelatty MA, Hanna SA, Azim MSA. Lax Uterosacral Ligament and Urge Urinary Incontinence: MRI Findings in Symptomatic Patients Versus Healthy Volunteers. Int Urogynecol J 2024; 35:793-801. [PMID: 38240800 PMCID: PMC11052867 DOI: 10.1007/s00192-023-05722-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/15/2023] [Indexed: 04/29/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to explore the association between urge urinary incontinence (UUI) and lax uterosacral ligaments (USL) using MRI. METHODS Sixty-seven female participants were recruited prospectively: 41 continent volunteers (control group) and 26 patients with UUI. Static proton density- and T2-weighted turbo spin echo sequences of MR images were used. A radiologist employed a standardized grid system to record structural observations of the USLs on sequentially numbered axial MR images and then applied a four-point grading scale to assess ligament visibility. MR images were interpreted by a radiologist and a urologist, and then validated by an expert radiologist. RESULTS The comparison between the mean length of uterosacral ligaments in the control and UUI groups was highly statistically significant (p < 0.001). The mean length of the right USL was 38 ± 11 mm, and the left USL was 35 ± 12 mm in the UUI group. In the control group, the mean length of the USL was 22 ± 9 mm on the right side and 18 ± 9 mm on the left side, along their craniocaudal extent. The highest inter-observer agreement was on the level of origin and insertion (image numbers), whereas the lowest agreement was on the anatomical site of origin and insertion of the USL in both the control and UUI groups. CONCLUSIONS The average length of USLs in patients with UUI is significantly longer than that in healthy continent women, indicating laxity. Our findings support the relationship between the laxity of the USL and UUI symptoms and have therapeutic implications.
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Affiliation(s)
- Rania F El-Sayed
- Department of Diagnostic and Interventional Radiology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
| | - Noha M Moqbel
- Department of Diagnostic and Interventional Radiology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
| | - Ahmed F Hussein
- Department of Urology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
| | - Mohamed A Abdelatty
- Department of Diagnostic and Interventional Radiology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt.
| | - Sameh A Hanna
- Department of Diagnostic and Interventional Radiology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
| | - Mohamed S Abdel Azim
- Department of Urology, Kasr Al-Ainy Hospital, Cairo University, Kasr Al-Ainy Street, Cairo, 11956, Egypt
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Chen KY, Jones MK, Zillioux JM, Rapp DE. Pilot Study of a Novel Online Comprehensive Pelvic Floor Program for Urinary Incontinence in Women. Int Urogynecol J 2024; 35:415-421. [PMID: 38175280 DOI: 10.1007/s00192-023-05695-y] [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: 09/19/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence (UI) is common in women and has a vast impact on quality of life (QOL), financial health, and work disability. Robust evidence demonstrates the efficacy of comprehensive conservative therapy (pelvic floor muscle training [PFMT], and behavioral and dietary modification) in the treatment of UI. However, numerous barriers impede access to this care, including limited specialized therapists, financial barriers, and scheduling obstacles. To address these barriers, we developed a novel comprehensive online pelvic floor program (oPFP). METHODS We performed a prospective study assessing continence and QOL outcomes in women with stress urinary incontinence (SUI), urge urinary incontinence (UUI), or mixed urinary incontinence (MUI) treated with oPFP between May 2019 and November 2022. Outcomes were assessed at baseline and following completion of the 2-month program using the validated International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms, Urgency Perception Scale (UPS), Incontinence Impact Questionnaire (IIQ-7) questionnaires, and 24-h bladder diary. Data were analyzed using linear, Poisson mixed models, or generalized estimating equations. RESULTS Twenty-eight women (2 SUI, 3 UUI, 23 MUI) were enrolled and 19 (2 SUI, 2 UUI, 15 MUI) completed the study. Following oPFP, participants showed significantly improved SUI domain scores (3.04 ± 0.19 vs 1.81 ± 0.23, p < 0.001), UPS reason score (2.52 ± 0.18 vs 2.05 ± 0.14, p = 0.003), IIQ-7 sum scores (5.16 ± 0.88 vs 3.07 ± 0.70, p = 0.038), and daily incontinence episodes (2.96 ± 0.60 vs 1.06 ± 0.29, p < 0.001). Mean patient-reported improvement was 5.4 ± 2.5 (ten-point Likert scale). Of respondents, 89% reported program satisfaction, ease of use, and would recommend the program to others. CONCLUSION The oPFP results in significant improvements to a variety of UI and QOL measures. This program provides an important UI treatment option and gives women greater access to effective conservative therapy.
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Affiliation(s)
- Katherina Y Chen
- Department of Urology, University of Virginia, Charlottesville, VA, USA.
| | - Marieke K Jones
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | | | - David E Rapp
- Department of Urology, University of Virginia, Charlottesville, VA, USA
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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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Arjmand M, Abbasi H, Behforouz A. The effect of vitamin D on urgent urinary incontinence in postmenopausal women. Int Urogynecol J 2023; 34:1955-1960. [PMID: 36826518 DOI: 10.1007/s00192-023-05486-5] [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: 10/27/2022] [Accepted: 01/24/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Conflicting results have been reported on the effect of vitamin D supplementation on urinary incontinence (UI). Therefore, the aim of this study was to evaluate the effect of consuming vitamin D oral supplements on improving urge UI (UUI) in postmenopausal women with vitamin D deficiency. METHODS This randomized clinical trial was conducted in 2019-2020 in postmenopausal women with UUI or nocturia more than once at night with vitamin D levels less than 30 ng/ml. After recording the severity of UI and its impact on the patient's daily life, patients were randomly divided into two groups of 45 patients: one taking vitamin D3 (50,000 IU) tablets and one taking placebo weekly for 8 weeks. RESULTS There was no significant difference between the two groups in terms of the severity of UI and the frequency of nocturia before treatment. However, after treatment, in the vitamin D group, the severity of UI and the frequency of nocturia significantly reduced. Before treatment, the impact of UI on patients' daily life was reported to be high in more than 70% of patients in both groups, which was not significantly different; however, after treatment, its impact was significantly reduced in the vitamin D group. CONCLUSIONS The findings of the present study showed that in postmenopausal women with UUI or nocturia, weekly use of vitamin D 50,000 IU tablets for 8 weeks can reduce the severity of UI and the frequency of nocturia, and reduce their impact on disruption in daily life.
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Affiliation(s)
- Mahsa Arjmand
- Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Shoosh Square, Fadaeiyan Eslam Street, Shishehgar Khaneh Street, Tehran, Iran
| | - Hajar Abbasi
- Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Shoosh Square, Fadaeiyan Eslam Street, Shishehgar Khaneh Street, Tehran, Iran
| | - Athena Behforouz
- Clinical Research Development Center, Mahdiyeh Educational Hospital, Shahid Beheshti University of Medical Sciences, Shoosh Square, Fadaeiyan Eslam Street, Shishehgar Khaneh Street, Tehran, Iran.
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Kennady EH, Zillioux J, Ali M, Hutchison D, Farhi J, DeNovio A, Barquin D, Rapp DE. Longitudinal urgency outcomes following robotic-assisted laparoscopic prostatectomy. World J Urol 2023; 41:1885-1889. [PMID: 37296234 DOI: 10.1007/s00345-023-04458-0] [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: 02/13/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE Stress urinary incontinence (SUI) is a well-known adverse outcome following robotic-assisted laparoscopic prostatectomy (RALP). Although postoperative SUI has been extensively studied, little focus has been placed on understanding the natural history and impact of urgency symptoms following RALP. The UVA prostatectomy functional outcomes program (PFOP) was developed to comprehensively assess and optimize continence outcomes following RALP. The present study focuses on assessing urgency outcomes in this cohort. METHODS PFOP patients with a minimum of 6-months follow up following RALP were included. The PFOP includes prospectively assessed incontinence and quality of life outcomes utilizing ICIQ-MLUTS, Urgency Perception Score (UPS), and IIQ-7 questionnaires. The primary study outcome was urgency urinary incontinence (UUI) as determined by ICIQ-MLUTS UUI domain. Secondary outcomes included urgency (UPS score) and quality of life (IIQ-7). RESULTS Forty patients were included with median age 63.5 years. Fourteen (35%) patients reported UUI at baseline. UUI and QOL scores worsened compared to baseline at all time-points. Urgency worsened at 3-weeks and 3-months but returned to baseline by 6-months. Notably, 63% of patients without baseline UUI reported de-novo UUI at 6 months. Although QOL was lower in patients with versus without UUI (IIQ-7 score 3.0 vs 0.0, p = 0.009), severity of UUI was not associated with QOL when controlling for SUI severity. CONCLUSION Our data demonstrate significantly worsened UUI from baseline and a large incidence of de-novo UUI following RALP. Further study is needed to inform how urgency and UUI and its treatment affect health-related quality of life following RALP.
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Affiliation(s)
- Emmett H Kennady
- Department of Urology, University of Virginia, UVA Medical Center, 500 Ray C. Hunt Drive, Charlottesville, VA, USA
| | - Jacqueline Zillioux
- Department of Urology, University of Virginia, UVA Medical Center, 500 Ray C. Hunt Drive, Charlottesville, VA, USA
| | - Marwan Ali
- Department of Urology, University of Virginia, UVA Medical Center, 500 Ray C. Hunt Drive, Charlottesville, VA, USA
| | - Dylan Hutchison
- Department of Urology, University of Virginia, UVA Medical Center, 500 Ray C. Hunt Drive, Charlottesville, VA, USA
| | - Jacques Farhi
- Department of Urology, University of Virginia, UVA Medical Center, 500 Ray C. Hunt Drive, Charlottesville, VA, USA
| | - Anthony DeNovio
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - David Barquin
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - David E Rapp
- Department of Urology, University of Virginia, UVA Medical Center, 500 Ray C. Hunt Drive, Charlottesville, VA, USA.
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Dominguez AP, Isaza PG, Pantoja SN, Fusco I. Role of top flat magnetic stimulation for urinary incontinence as a debilitating condition of pelvic floor dysfunction: an observational evaluation of Latin American population. World J Urol 2023; 41:173-7. [PMID: 36513890 DOI: 10.1007/s00345-022-04233-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Urinary incontinence (UI) is a common dysfunction of the pelvic floor, affecting 10-20% of all women, and up to 70% in the elderly general prevalence of 17% 20-year-old women and 38% in women over 60 years. It is estimated that only 25% of patients seek treatment for this debilitating condition. AIM The aim of this study was to evaluate the efficacy of a device based on top flat magnetic stimulation to treat pelvic floor disorders especially female urinary incontinence. METHODS A total of 33 volunteer patients were divided into 5 groups according to the type of complaint. Subjects received 8 treatment sessions, with a frequency of twice a week with two different settings. Pelvic Floor Bother Questionnaire (PFBQ), Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) and Urinary Incontinence Short Form (ICIQ-UI-SF) were compiled by all patients at the beginning and after 3 months from the end of the last treatment (3MFU). RESULTS The patient's scores from validated Questionnaires significantly decreased (p < 0.01) from baseline up to 3MFU inside most of the groups. CONCLUSIONS The noninvasiveness and safety of device make this approach an interesting tool as alternative approach for pelvic floor dysfunctions .
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Osborne LA, Mair Whittall C, Emery S, Reed P. Change in depression predicts change in bladder symptoms for women with urinary incontinence undergoing pelvic-floor muscle training. Eur J Obstet Gynecol Reprod Biol 2023; 280:54-59. [PMID: 36402023 DOI: 10.1016/j.ejogrb.2022.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION To examine the relationship between depression and bladder symptoms, especially the impact of change in depression on changes in bladder symptoms, for women with urge and stress urinary incontinence undergoing a course of PFMT. METHOD 106 adult females with pelvic-floor dysfunction (PFD), consecutively referred to an outpatient pelvic-floor muscle training (PFMT) programme for either urge, stress, or mixed incontinence, participated in a prospective observational study. Participants reported subjective views of their pelvic floor problems (Queensland), and their levels of depression (HADS_D), and data relating to age and BMI were collected. The trial was registered on clinicaltrials.gov (NCT02549157). RESULTS There was a positive relationship between depression and bladder symptoms at intake. Levels of initial depression significantly predicted levels of bladder symptoms at completion of PFMT, and ability to complete the PFMT programme. Change in depression significantly predicted change in bladder symptoms, over and above intake patient characteristics and symptoms. DISCUSSION These data imply a multidisciplinary focus, including psychological input, for PFD may be a highly effective strategy for its management.
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Affiliation(s)
- Lisa A Osborne
- Swansea Bay University Health Board, UK; The Open University, UK
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Gacci M, Sakalis VI, Karavitakis M, Cornu JN, Gratzke C, Herrmann TRW, Kyriazis I, Malde S, Mamoulakis C, Rieken M, Schouten N, Smith EJ, Speakman MJ, Tikkinen KAO, Gravas S. European Association of Urology Guidelines on Male Urinary Incontinence. Eur Urol 2022; 82:387-398. [PMID: 35697561 DOI: 10.1016/j.eururo.2022.05.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 11/04/2022]
Abstract
CONTEXT Urinary incontinence (UI) is a common condition in elderly men causing a severe worsening of quality of life, and a significant cost for both patients and health systems. OBJECTIVE To report a practical, evidence-based, guideline on definitions, pathophysiology, diagnostic workup, and treatment options for men with different forms of UI. EVIDENCE ACQUISITION A comprehensive literature search, limited to studies representing high levels of evidence and published in the English language, was performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. A level of evidence and a grade of recommendation were assigned. EVIDENCE SYNTHESIS UI can be classified into stress urinary incontinence (SUI), urge urinary incontinence (UUI), and mixed urinary incontinence. A detailed description of the pathophysiology and diagnostic workup has been reported. Simple clinical interventions, behavioural and physical modifications, and pharmacological treatments comprise the initial management for all kinds of UI. Surgery for SUI includes bulking agents, male sling, and compression devices. Surgery for UUI includes bladder wall injection of botulinum toxin A, sacral nerve stimulation, and cystoplasty/urinary diversion. CONCLUSIONS This 2022 European Association of Urology guideline summary provides updated information on definition, pathophysiology, diagnosis, and treatment of male UI. PATIENT SUMMARY Male urinary incontinence comprises a broad subject area, much of which has been covered for the first time in the literature in a single manuscript. The European Association of Urology Non-neurogenic Male Lower Urinary Tract Symptoms Guideline Panel has released this new guidance, with the aim to provide updated information for urologists to be able to follow diagnostic and therapeutic indications for optimising patient care.
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Affiliation(s)
- Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Vasileios I Sakalis
- Department of Urology, Agios Pavlos General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
| | - Christian Gratzke
- Department of Urology, University Hospital Freiburg, Freiburg, Germany
| | | | - Iason Kyriazis
- Department of Urology, General University Hospital of Patras, Patras, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | | | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Emma J Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Mark J Speakman
- Department of Urology, Taunton & Somerset Hospital, Taunton, UK
| | - Kari A O Tikkinen
- Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Surgery, South Karelia Central Hospital, Lappeenranta, Finland
| | - Stavros Gravas
- Department of Urology, Medical School, University of Cyprus, Nicosia, Cyprus
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11
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Zhong H, Liu E, Kohli P, Perez L, Edgerton VR, Ginsberg D, Gad P, Kreydin E. Noninvasive spinal neuromodulation mitigates symptoms of idiopathic overactive bladder. Bioelectron Med 2022; 8:5. [PMID: 35317851 PMCID: PMC8941742 DOI: 10.1186/s42234-022-00087-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/28/2022] [Indexed: 11/14/2022] Open
Abstract
Background Overactive bladder (OAB) affects 12 to 30% of the world’s population. The accompanying urinary urgency, frequency and incontinence can have a profound effect on quality of life, leading to depression, social isolation, avoidance of sexual activity and loss of productivity. Conservative measures such as lifestyle modification and pelvic floor physical therapy are the first line of treatment for overactive bladder. Patients who fail these may go on to take medications, undergo neuromodulation or receive injection of botulinum toxin into the bladder wall. While effective, medications have side effects and suffer from poor adherence. Neuromodulation and botulinum toxin injection are also effective but are invasive and not acceptable to some patients. Methods We have developed a novel transcutaneous spinal cord neuromodulator (SCONE™,) that delivers multifrequency electrical stimulation to the spinal cord without the need for insertion or implantation of stimulating electrodes. Previously, multifrequency transcutaneous stimulation has been demonstrated to penetrate to the spinal cord and lead to motor activation of detrusor and external urethral sphincter muscles. Here, we report on eight patients with idiopathic overactive bladder, who underwent 12 weeks of SCONE™ therapy. Results All patients reported statistically significant clinical improvement in multiple symptoms of overactive bladder, such as urinary urgency, frequency and urge incontinence. In addition, patients reported significant symptomatic improvements as captured by validated clinical surveys. Conclusion SCONE™ therapy represents the first of its kind therapy to treat symptoms of urgency, frequency and urge urinary incontinence in patients with OAB. Trial registration The study was listed on clinicaltrials.gov (NCT03753750).
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Affiliation(s)
- Hui Zhong
- Department of Neurobiology, University of California, Los Angeles, CA, 90095, USA.,Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA
| | - Emilie Liu
- Department of Neurobiology, University of California, Los Angeles, CA, 90095, USA.,Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA.,SpineX Inc., 19509 Astor Pl, Northridge, Los Angeles, CA, 91324, USA
| | - Priya Kohli
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA.,Institute of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
| | - Laura Perez
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA.,Institute of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
| | - V Reggie Edgerton
- Department of Neurobiology, University of California, Los Angeles, CA, 90095, USA.,Department of Neurosurgery, University of California, Los Angeles, CA, 90095, USA.,Brain Research Institute, University of California, Los Angeles, CA, 90095, USA.,Institut Guttmann, Hospital de Neurorehabilitació, Institut Universitari adscrit a la Universitat Autònoma de Barcelona, 08916, Badalona, Barcelona, Spain
| | - David Ginsberg
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA.,Institute of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
| | - Parag Gad
- Department of Neurobiology, University of California, Los Angeles, CA, 90095, USA. .,Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA. .,SpineX Inc., 19509 Astor Pl, Northridge, Los Angeles, CA, 91324, USA.
| | - Evgeniy Kreydin
- Rancho Research Institute, Rancho Los Amigos National Rehabilitation Center, Downey, CA, 90242, USA.,Institute of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA, 90033, USA
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12
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Steenstrup B, Lopes F, Cornu JN, Gilliaux M. Cognitive-behavioral therapy and urge urinary incontinence in women. A systematic review. Int Urogynecol J 2021; 33:1091-1101. [PMID: 34716765 DOI: 10.1007/s00192-021-04989-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/24/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS UUI co-exists with numerous health conditions, having a substantial negative impact on health-related quality of life and mental health. Cognitive-behavioral therapy (CBT) could help patients manage these problems by changing the way they think and behave. METHODS We carried out a systematic review of the literature assessing the modalities and effects of CBT as a stand-alone strategy, without adding PFMT, on symptoms and clinical signs, in women with UUI. Our secondary objective was to report modalities and effects of CBT on health-related quality of life, psychological symptoms and patient-reported satisfaction. The PRISMA methodology was used to carry out this systematic review. A literature search was conducted in PubMed, PEDro, Web of Science and Cochrane Library databases from inception to December 2020. The PICO approach was used to determine the eligibility criteria. RESULTS Twelve papers were included in the present review which showed beneficial effects on both symptom severity (p < 0.05) and more subjective areas such as quality of life, psychological symptoms or patient satisfaction level (p < 0.05), respectively). However, results on the effectiveness of CBT on clinical signs remains conflicting. CONCLUSION Based on the available literature, this review suggested a high level of evidence for the effectiveness of CBT on symptom severity and a moderate level of evidence for the effectiveness of CBT on quality of life, psychological symptoms and patient satisfaction. However, we highlighted no evidence for the effects of CBT on clinical signs.
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Affiliation(s)
| | - Floriane Lopes
- La Musse Physiotherapy Training Institute, Saint-Sébastien-de-Morsent, France
| | | | - Maxime Gilliaux
- Clinical Research Department, La Musse Hospital, Saint-Sébastien-de-Morsent, France.,CETAPS Laboratory, Rouen University, EA, 3882, Rouen, France
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13
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Okuyama Y, Okamoto T, Sasaki D, Ozaki K, Songee J, Hatakeyama S, Mikami T, Ohyama C. The influence of gut microbiome on progression of overactive bladder symptoms: a community-based 3-year longitudinal study in Aomori, Japan. Int Urol Nephrol 2021; 54:9-16. [PMID: 34714460 DOI: 10.1007/s11255-021-03044-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess the influence of gut microbiome on overactive bladder (OAB) symptoms progression. METHODS This was a 3-year longitudinal study, Hirosaki in Japan. We assessed OAB symptoms and reviewed the medication records of each subject in 2016. We extracted 16S rRNA genes from fecal samples and analyzed gut microbiomes via next-generation sequencing. We evaluated the changes in urinary urgency (UU) and/or urgent urinary incontinence (UUI) from 2016 to 2019. We defined UU/UUI-progression as exacerbation of UU and/or UUI. We compared the clinical backgrounds and microbiota structure between UU/UUI-progression subjects and non-progression (controls). We assessed the impact of gut microbiome on the UU/UUI-progression via multivariate logistic regression analyses. RESULTS Of 669 subjects, 126 were UU/UUI-progression subjects. These subjects had a higher age and prevalence of proton pump inhibitor (PPI) use (14% vs. 5.4%, P = 0.003), irritable bowel syndrome, sleep disturbance, and metabolic syndrome than those without. We found the different microbiota structures between subjects with UU/UUI-progression and those without. A higher relative abundance of genus Streptococcus (harmful bacterial genus for human health) appeared in UU/UUI-progression subjects (3.8% vs. 2.3%, P < 0.001). Multivariate analysis revealed that age ≥ 65 years, current smoking, sleep disturbance, metabolic syndrome, and genus Streptococcus (Odds ratio: 1.05, P = 0.029) were independent risk factors for UU/UUI-progression. PPI use turned to be a significant risk factor on a multivariate analysis without including genus Streptococcus. CONCLUSIONS Gut microbiome might be associated with a risk for OAB symptoms progression. PPI use might cause gut dysbiosis and increase this risk.
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Affiliation(s)
- Yoshiharu Okuyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan.
| | - Daichi Sasaki
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Kai Ozaki
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Jung Songee
- Department of Digital Nutrition, Graduate School of Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Tatsuya Mikami
- Innovation Center for Health Promotion, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifu-chou, Hirosaki, 036-8562, Japan.,Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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14
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Brandt F, Solomayer EF, Sklavounos P. Psychometric properties of the German-language questionnaire for urinary incontinence diagnosis (QUID) in women with urinary incontinence. Arch Gynecol Obstet 2021; 304:1233-1242. [PMID: 34357447 PMCID: PMC8342980 DOI: 10.1007/s00404-021-06167-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/27/2021] [Indexed: 12/02/2022]
Abstract
Purpose The aim of this study was to translate the questionnaire for urinary incontinence diagnosis (QUID) into German and to assess its psychometric properties in German-speaking women with urinary incontinence (UI). The QUID contains two subscales to measure symptom severity of stress urinary incontinence (SUI) and urge urinary incontinence (UUI) and to distinguish between both forms. Methods A total of 161 women with UI completed the QUID and the King’s Health Questionnaire (KHQ), each in the German version. To examine construct validity Spearman’s correlation coefficients between both questionnaires were computed. Furthermore, the internal consistency (Cronbach’s alpha) of the QUID and its criterion validity were examined. Looking at criterion validity, sensitivity, specificity, ROC curves, and Youden-indexes were computed for both subscales. Results The QUID showed good construct validity by strong correlations with related domains of the KHQ. Cronbach’s alpha values were good for both subscales of the QUID (SUI-subscale: 0.76; UUI-subscale: 0.86). Sensitivity and specificity were 83% (95% CI, 0.72–0.9) and 45% (95% CI, 0.25–0.67) for the SUI-subscale and 83% (95% CI, 0.7–0.91) and 56% (95% CI, 0.4–0.72) for the UUI-subscale. Youden-index was 0.28 for the SUI-subscale and 0.39 for the UUI-subscale at the given cut-off values. Conclusion Psychometric properties of the German-language QUID are principally good and support its use in the German-speaking area. However, the modest specificity when distinguishing between SUI and UUI should be taken into account. Trial registration number: DRKS00018777 (date of registration: 16-January-2020).
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Affiliation(s)
- Florian Brandt
- Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital and Medical Faculty of Saarland University, Homburg, Germany.
- Saarland University, Saarbrücken, Germany.
| | - Erich-Franz Solomayer
- Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital and Medical Faculty of Saarland University, Homburg, Germany
| | - Panagiotis Sklavounos
- Clinic for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital and Medical Faculty of Saarland University, Homburg, Germany
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15
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Schiavi MC, Zullo MA, Luffarelli P, Di Pinto A, Oliva C, Palazzetti P. Urogynecological survey in a group of Italian women treated for overactive bladder: Symptoms and quality of life analysis during the Covid-19 period. Taiwan J Obstet Gynecol 2021; 60:674-678. [PMID: 34247805 PMCID: PMC8266265 DOI: 10.1016/j.tjog.2021.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives The aim of this study is to assess the impact of life change and social distancing measures, during the Covid-19 outbreak, on the OAB symptoms and quality of life in women underwent different types of treatment. Materials and methods Observational survey analysis in OAB treated patients was performed. The women showed a greater than 50% improvement during specific therapy for OAB. Population had previously completed bladder diary, OAB-Q symptom, OAB HRQL scale, SF-36 and PGI-I questionnaires. Four weeks after the introduction of the restrictive measures, these women were invited to complete the same questionnaires by e-mail for new evaluation during Covid-19 outbreak. Primary endpoint was changes in number of voids/24h, urgent micturitions/24h, urinary incontinence events/24h, nocturia events. Secondary endpoints were the assessment of the change in the OAB-SF, SF-36 questionnaires and PGI-I satisfaction. Results Six hundred seventy-three patients were considered. The mean age was 63.21 ± 10.24 years. Four weeks after the start of the social distancing measures, the increase in mean number of voids/24h (7.13 ± 1.08 vs 9.76 ± 2.12, p < 0.0001), urgent micturition episodes/24h (2.65 ± 1.11 vs 4.57 ± 1.28, p < 0.0001), nocturia episodes (1.19 ± 1.21 vs 2.83 ± 0.94, p < 0.0001) was observed. The OAB symptom scores (32.67 ± 12.88 vs 51.23 ± 12.11, p < 0.0001), OAB-HRQL (75.45 ± 12.76 vs 48.23 ± 10.34, p < 0.0001), and SF-36 (82.15 ± 11.78 vs 69.39 ± 10.85, p < 0.0001) changed significantly. The satisfaction decreased significantly at the PGI-I during the Covid-19 period 79.8% vs 45% (p < 0.0001). Conclusions The Covid-19 outbreak and the restrictive social distancing measures have negatively influenced the OAB symptoms and quality of life in women underwent different types of treatment.
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Affiliation(s)
| | - Marzio Angelo Zullo
- Department of Surgery-Week Surgery, Campus Biomedico University, Rome, Italy
| | - Paolo Luffarelli
- Department of Surgery-Week Surgery, Campus Biomedico University, Rome, Italy
| | - Anna Di Pinto
- Department of Gynecological and Obstetric Sciences, and Urological Sciences, University of Rome "Sapienza", Umberto I Hospital, Rome, Italy
| | - Cosimo Oliva
- Department of Gynecological and Obstetric, San Filippo Neri Hospital, Rome, Italy
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16
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Dietz HP, Subramaniam N. Is coital incontinence a manifestation of urodynamic stress incontinence or detrusor overactivity? Int Urogynecol J 2021; 33:1175-1178. [PMID: 33938964 DOI: 10.1007/s00192-021-04809-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Coital incontinence (CI) is an underreported symptom among sexually active women. It has been assumed that incontinence at penetration (CIAP) is due to urodynamic stress incontinence (USI), while coital incontinence at orgasm (CIAO) is thought to be due to detrusor overactivity (DO). METHODS To evaluate demographic and urodynamic findings associated with coital incontinence (CI) and to confirm the hypotheses 'CIAP is associated with USI' and 'CIAO is associated with DO we performed a retrospective study of 661 sexually active women attending a tertiary clinic between January 2017 and December 2019 for pelvic floor dysfunction. All patients filled in a standardized questionnaire and had a clinical examination and multichannel urodynamic testing. Women were asked if they experienced urine leakage during intercourse and the timing of such leakage. RESULTS Of 661 sexually active women, one third (n = 220) reported coital incontinence. While 121 (18%) women experienced CIAP, 172 (26%) had CIAO and 76 (11.5%) suffered both. For women with pure USI, the prevalence of CIAP (61.7%) and CIAO (69.5%) was significantly higher than for women with pure DO, where only 12.3% had CIAP and 8.6% had CIAO. Factors significantly associated with CI were body mass index, mid-urethral closure pressure (MUCP) and abdominal leak point pressure (ALPP). When only women with pure USI or DO were included, USI remained associated with CI while DO was not. CONCLUSIONS CI is clearly associated with SUI and USI and is likely to share etio-pathogenetic mechanisms. CI seems to be a manifestation of USI, even when it occurs during orgasm.
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Affiliation(s)
- Hans Peter Dietz
- University of Sydney, Penrith, Australia. .,, 193 Burns Rd, Springwood, NSW 2777, Australia.
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17
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Akin MN, Sivaslioglu AA, Edgunlu T, Kasap B, Celik SK. SMAD2, SMAD3 and TGF-β GENE expressions in women suffering from urge urinary incontinence and pelvic organ prolapse. Mol Biol Rep 2021; 48:1401-1407. [PMID: 33599951 DOI: 10.1007/s11033-021-06220-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/06/2021] [Indexed: 11/24/2022]
Abstract
We evaluated the changes in the levels of TGF-β and SMAD gene and protein expression in the uterosacral ligament (USL) of patients with concomitant pelvic organ prolapse (POP) and urgency urinary incontinence (UUI) to illuminate the pathophysiology of UUI. The TGF-β pathway is involved in collagen synthesis and degradation. The Transforming Growth Family-β (TGF-β) superfamily has essential intracellular signaling components, such as newly identified SMAD family members. We evaluated the changes in the levels of TGF-β and SMAD gene and protein expression in the USL of patients with concomitant pelvic organ prolapse (POP) and UUI. This study included 10 patients who had been diagnosed with POP and UUI in the study group and 14 asymptomatic women without complaints of POP and UUI in the control group. Biopsy samples were collected from bilateral USL tissues during vaginal or abdominal hysterectomy. Total RNA was extracted from USL tissue and analyzed by qPCR. The protein expression levels were also analyzed with ELISA. In UUI patients, SMAD3 and TGF-ß1 gene expression levels significantly decreased compared to the control patients (p = 0.008 and p = 0.006, respectively). SMAD2 mRNA levels did not differ between the study and control groups (p = 0.139). No differences was found in the levels of SMAD2, SMAD3, and TGF-ß1 protein expression between the two groups. The reduction in the gene and protein expression levels of SMAD3 and TGF-ß1 in women with UUI and lax uterosacral ligaments may indicate a causal link.Clinical trial registration: NCT04525105.
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Affiliation(s)
- Melike Nur Akin
- Department of Obstetrics and Gynecology, School of Medicine, Mugla Sitki Kocman University, 48000, Mugla, Turkey.
| | - Ahmet Akin Sivaslioglu
- Department of Obstetrics and Gynecology, School of Medicine, Mugla Sitki Kocman University, 48000, Mugla, Turkey
| | - Tuba Edgunlu
- Department of Medical Biology, School of Medicine, Mugla Sitki Kocman University, 48000, Mugla, Turkey
| | - Burcu Kasap
- Department of Obstetrics and Gynecology, School of Medicine, Mugla Sitki Kocman University, 48000, Mugla, Turkey
| | - Sevim Karakas Celik
- Department of Medical Genetic, School of Medicine, Bulent Ecevit University, Zonguldak, Turkey
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18
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Fuentes-Angulo I, Jiménez Vílchez AJ, Rodríguez Torronteras A, Olmo Carmona MV. [Percutaneous tibial nerve stimulation in urge urinary incontinence: A prospective study]. Rehabilitacion (Madr) 2020; 54:236-43. [PMID: 32441267 DOI: 10.1016/j.rh.2020.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/10/2020] [Accepted: 02/12/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the efficacy of percutaneous tibial nerve stimulation and its effectiveness over time in urge urinary incontinence. MATERIALS AND METHODS We performed a longitudinal, observational, prospective study without a control group that included patients diagnosed with urge urinary incontinence who met the inclusion/exclusion criteria. Patients were treated with 12 sessions of percutaneous tibial nerve stimulation by electroacupuncture. Baseline and post-treatment data were collected from medical records. Patients were assessed by a telephone interview after the treatment. The variables studied were sociodemographic variables, time until interview, the Sandvick and ICIQ-SF questionnaires, daytime urinary frequency, night-time urinary frequency, use of absorbent material and drug treatment. A descriptive analysis of the variables was performed and patient outcomes were analysed with generalised linear mixed models by SPSS v. 25 statistics software. RESULTS A total of 32 women were included (mean age 58.69±8.96). All variables significantly improved after treatment: Sandvick by 4.38 points (95% CI: 2.68-6.08, P<.001), ICIQ-SF by 8.55 points (95% CI: 5.89-11.22, P<.001), daytime urinary frequency by 2.10 points (95% CI: 1.04-3.16, P<.001) and night-time urinary frequency by 1.31 points (95%CI: 0.58-2.04, P<.001). However, 16.34±9.72 months after treatment, these improvements diminished but without reaching baseline levels. CONCLUSIONS Percutaneous tibial nerve stimulation by electroacupuncture is effective for the treatment of urge urinary incontinence. Although its effect diminishes over time, the improvement over the baseline situation is maintained during the follow-up period.
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19
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Kissane LM, Martin KD, Meyer I, Richter HE. Effect of darifenacin on fecal incontinence in women with double incontinence. Int Urogynecol J 2020; 32:2357-2363. [PMID: 32542466 DOI: 10.1007/s00192-020-04369-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 05/26/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS To evaluate change in fecal incontinence symptom severity after 8 weeks of darifenacin therapy in patients with double incontinence-urgency urinary incontinence (UUI) and fecal incontinence. Important secondary outcomes included fecal incontinence symptom distress and impact on quality of life, fecal incontinence episodes, global impression of improvement and overactive bladder symptom distress and impact. METHODS Prospective open-label cohort study of women presenting primarily with UUI, diagnosed with double incontinence and electing antimuscarinic therapy for UUI. Women ≥ 18 years with moderate or greater bothersome UUI and fecal incontinence of liquid/solid stool with St. Marks (Vaizey) score ≥ 12 were included. Subjects were treated with darifenacin 15 mg daily for 8 weeks. The primary outcome was change in fecal incontinence symptom severity using the St. Marks (Vaizey) score after 8 weeks. Sample size was based on the minimally important difference of the St. Marks, -5, and standard deviation, ± 8.5; 30 subjects provided 80% power and type I error of 0.05, including a 15% attrition rate. RESULTS Thirty-two women were consented with mean baseline St. Marks (Vaizey) score of 18.0 ± 3.0. Mean age was 66.5 ± 10.3 years. Twenty-eight subjects (29/32, 87.5%) completed assessments. St. Marks (Vaizey) score significantly improved from 18.0 to 11.0 [mean difference - 7.0, 95% confidence interval (CI): -8.7, -5.3], and 19 subjects (19/32,67.9%) met the minimally important difference. Statistically significant improvements were also noted in fecal incontinence frequency, quality of life, and overactive bladder symptom bother and quality of life (all p < 0.01). CONCLUSIONS Darifenacin can be considered a highly effective early intervention in women suffering from double incontinence. CLINICAL TRIAL REGISTRATION Bladder Antimuscarinic Medication and Accidental Bowel Leakage (BAMA), https://clinicaltrials.gov/ct2/show/NCT03543566 , NCT03543566.
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Affiliation(s)
- Lindsay M Kissane
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, 1700 6th Ave S.WIC Rm 10382, Birmingham, AL, 35233, USA.
| | - Kimberly D Martin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Isuzu Meyer
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, 1700 6th Ave S.WIC Rm 10382, Birmingham, AL, 35233, USA
| | - Holly E Richter
- Division of Urogynecology and Pelvic Reconstructive Surgery, University of Alabama at Birmingham, 1700 6th Ave S.WIC Rm 10382, Birmingham, AL, 35233, USA
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20
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Illiano E, Finazzi Agrò E, Natale F, Balsamo R, Costantini E. Italian real-life clinical setting: the persistence and adherence with mirabegron in women with overactive bladder. Int Urol Nephrol 2020; 52:1035-42. [PMID: 32086713 DOI: 10.1007/s11255-020-02412-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/12/2020] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aims of this study were to evaluate the persistence, the adherence on treatment with mirabegron, the reasons for the interruption in patients with overactive bladder syndrome (OAB) and their satisfaction. METHODS This was an Italian multicentre prospective study. Four tertiary urological centers were involved. We included women with no neurogenic OAB symptoms already in therapy with once-daily mirabegron 50 mg for 1 month. They were followed up at 1, 3 and 6 months post-treatment with uroflowmetry with voiding diary for 3 days and post-void residual measurement. They completed self-administered Overactive Bladder questionnaire short form (OABq), Morisky Medication Adherence Scale-4 short form (MMAS), Patient Global Impression-Improvement questionnaire. Patients were divided in OAB wet and OAB dry groups, and in treatment-naive and treatment-experienced groups. RESULTS Between January 2018 and July 2018, 80 patients with OAB were included. Fifteen (18.7%) patients continued the treatment for 6 months; 17.5% interrupted the therapy before 1 month: 30% within the third month, while, 33.7% after 1 month. The median time to discontinuation with mirabegron was 62.5 days. The mean adherence was 0.42 ± 0.33, median MMAS was 2 (0-4). The adherence was significantly greater in treatment-naïve (22.4%) than treatment-experienced (6.5%) patients, without statistically significant differences in the different OAB form. The cost is the main cause of interruption of therapy (50% of cases).There was an improvement of OABqSF score and PGI-I score. CONCLUSION In Italy, the cost compromises adherence and persistence of therapy with mirabegron despite the good functional outcomes.
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21
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Bascur-Castillo C, Araneda-Gatica V, Castro-Arias H, Carrasco-Portiño M, Ruiz-Cantero MT. Determinants in the process of seeking help for urinary incontinence in the Chilean health system. Int J Gynaecol Obstet 2018; 144:103-111. [PMID: 30267534 DOI: 10.1002/ijgo.12685] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/24/2018] [Accepted: 09/27/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To analyze via the Andersen model what leads women with urinary incontinence (UI) to seek help and remain in the healthcare system. METHODS An interpretative phenomenologic study enrolling women aged 18 years or older who were diagnosed with UI at a tertiary care hospital in Chile between January and March 2016. Data were collected by semi-structured interview. The categories explored experience with UI and reasons for seeking health care, and included the dimensions of the Andersen model. RESULTS Ten women were enrolled. Characteristics that eased or hindered healthcare seeking were identified to come from the women (frequency and quantity of symptoms, coping strategies, and beliefs about its causes) and from their environment (reaction of partner, family, or coworkers to her condition). Some were associated with primary care (human and/or technical resources) and some with secondary care (pelvic floor units). CONCLUSION The results reflect the complexities of asking for health care for women with UI, especially in a country such as Chile with different healthcare levels. Raising awareness of this complexity and developing an approach that includes all stakeholders (institution, community, and family) is crucial for professionals who want to offer both medical therapy and wellness-focused healthcare.
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Affiliation(s)
- Carolina Bascur-Castillo
- Department of Obstetrics and Puericulture, Faculty of Medicine, University of Concepción, Concepción, Chile.,Pelvic Floor Unit, Dr. Guillermo Grant Benavente Hospital, Concepción, Chile
| | | | - Henry Castro-Arias
- Pelvic Floor Unit, Dr. Guillermo Grant Benavente Hospital, Concepción, Chile.,Department of Obstetrics and Gynecology, Faculty of Medicine, University of Concepción, Concepción, Chile
| | - Mercedes Carrasco-Portiño
- Department of Obstetrics and Puericulture, Faculty of Medicine, University of Concepción, Concepción, Chile.,Research Group on Public Health, University of Alicante, Alicante, Spain
| | - María Teresa Ruiz-Cantero
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Concepción, Concepción, Chile.,CIBER de Epidemiología y Salud Púbica, Madrid, Spain
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Al-Azzawi IS, Al-Tamimi MAJ. The first Iraqi experience in sacral neuromodulation for patients with lower urinary tract dysfunction. Arab J Urol 2018; 16:391-396. [PMID: 30534437 PMCID: PMC6277263 DOI: 10.1016/j.aju.2018.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/17/2018] [Accepted: 05/03/2018] [Indexed: 11/27/2022] Open
Abstract
Objectives To present our experience, in Iraq, with sacral neuromodulation (SNM) in patients with refractory lower urinary tract dysfunction, with discussion of the factors that affect the response rate. Patients and methods In this prospective, clinical, interventional study, 24 patients were evaluated and treated by a team comprised of a Urologist and a Neurosurgeon with SNM over a 1.5-year period. The gender, age, pathology, and clinical presentation, were all studied and evaluated. Successful clinical response was defined as achieving a ≥50% improvement in voiding diary variables. Results The mean age of those that responded to SNM was 28 years, with females responding better than males (10 of 14 vs four of 10). The SNM response rate according to presentation was six of 10 in those with overactive bladder/urge urinary incontinence, six of nine of those with urinary retention, and two of five in those with a mixed presentation. The response rate in idiopathic voiding dysfunctions was 11 of 13, whilst for neurogenic dysfunctions it was three of 11. Other benefits such as in bowel motion, erectile function, menstruation, power of lower limbs, and quality of life (QoL), were also recorded. The complications were reasonable for this minimally invasive procedure. Conclusion SNM offers a good and durable solution for some functional bladder problems, if patients are well selected. There may also be additional extra-urinary benefits that contribute to improvements in QoL. SNM was well tolerated by our patients with an encouraging response rate, especially in psychologically stable patients with idiopathic dysfunctions.
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Abstract
BACKGROUND Little is known regarding the effect of bariatric surgery on urinary incontinence. METHODS Between September 2008 and November 2014, 240 female patients underwent bariatric surgery. RESULTS The prevalence of urinary incontinence preoperatively was 45 % (108). Eighty-two (76 %) completed urinary function questionnaires pre-operatively and post-operatively. Fifty-seven (70 %) underwent laparoscopic gastric bypass, twenty-four (29 %) underwent sleeve gastrectomy and one underwent a banding procedure. Thirty-one (38 %) reported leaking on sneezing or coughing-stress urinary incontinence (SUI). Thirteen (16 %) complained of leaking before reaching the toilet-overactive bladder syndrome (OAB). The remaining thirty-eight (46 %) reported mixed symptoms. The mean pre-operative weight and BMI were 133 (18) kg and 50 (SD = 6.2) kg/m(2) respectively. The mean post-operative BMI drop was 16 (SD = 5.2) kg/m(2). Preoperatively, 61 (75 %) reported moderate to very severe urinary incontinence compared to 30 (37 %) post-operatively (χ (2) = 3.24.67, p = 0.050). Twenty-seven (33 %) patients reported complete resolution of their urinary incontinence. Fifty-one (62 %) patients required incontinence pads on a daily basis pre-operatively, compared to 35 (43 %) post-operatively (χ (2) = 22.211.6, p = 0.00). The mean International Consultation on Incontinence Questionnaire- Urinary Incontinence short form (ICIQ-UI SF) score was 9.3 (SD = 4.4) pre-operatively compared to 4.9 (SD = 5.3) post-operatively (t = 7.2, p = 0.000). The improvement score post-operatively was 8 (SD = 3). A significant difference in the ICIQ-UI SF was identified between OAB and SUI groups when adjusting for age, number of children, type of delivery and pre-op BMI (t = 1.98, p = 0.05). CONCLUSION Bariatric surgery results in a clinically significant improvement in urinary incontinence. However, this is not proportional to pre-operative BMI, weight loss, age, parity and mode of delivery.
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Abstract
Urinary incontinence (UI) is an international problem, affecting a high percentage of geriatric women. Nurses caring for geriatric women of all ages should be aware of the problem of UI and familiarize themselves with the potential treatment options for these patients. This article focuses on the prevalence, burden, clinical application, and management recommendations for the different types of UI.
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Affiliation(s)
- Jessica A R Searcy
- Women's Health Nurse Practitioner Program, Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
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Tijnagel MJ, Scheepe JR, Blok BFM. Real life persistence rate with antimuscarinic treatment in patients with idiopathic or neurogenic overactive bladder: a prospective cohort study with solifenacin. BMC Urol 2017; 17:30. [PMID: 28403849 PMCID: PMC5390358 DOI: 10.1186/s12894-017-0216-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/24/2017] [Indexed: 12/03/2022] Open
Abstract
Background Several studies have shown that the antimuscarinic treatment of overactive bladder is characterized by low long-term persistence rates. We have investigated the persistence of solifenacin in real life by means of telephonic interviews in a prospective cohort. We included both patients with idiopathic overactive bladder as well as neurogenic overactive bladder. Methods From June 2009 until July 2012 patients with idiopathic or neurogenic overactive bladder who were newly prescribed solifenacin were included. In total 123 subjects were followed prospectively during one year by means of four telephonic interviews, which included questions about medication use and adverse events. Results After one year 40% of all patients included was still using solifenacin, 50% discontinued and 10% was lost to follow-up. In the neurogenic group 58% was still using solifenacin versus 32% in the idiopathic group after one year (p < 0,05). The main reasons to stop solifenacin were lack of efficacy, side effects and a combination of both. Conclusions This prospective cohort study showed a real life continuation rate of 40% after 12 months. This continuation rate is higher than found in most other studies. The use of regular telephonic evaluation might have improved medication persistence. The findings of this study also suggest that patients with neurogenic overactive bladder have a better persistence with this method of evaluation compared to patients with idiopathic overactive bladder. Trial registration This study was retrospectively registered on march 17, 2017 at the ISRCTN registry with study ID ISRCTN13129226. Electronic supplementary material The online version of this article (doi:10.1186/s12894-017-0216-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marloes J Tijnagel
- Department of Urology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Jeroen R Scheepe
- Department of Urology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Bertil F M Blok
- Department of Urology, Erasmus University Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Demir O, Sen V, Irer B, Bozkurt O, Esen A. Prevalence and Possible Risk Factors for Urinary Incontinence: A Cohort Study in the City of Izmir. Urol Int 2017; 99:84-90. [PMID: 28329752 DOI: 10.1159/000466705] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 02/28/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aimed to evaluate the prevalence and possible risk factors of urinary incontinence (UI) among women aged 18 or older living in the city of Izmir, located in the Aegean coast of Turkey. METHODS A questionnaire and the validated International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) were filled by urologists (O.D., V.S., A.E., O.B., and B.I.) with face-to-face interview. The participants with urge UI (UUI) and stress UI (SUI) were compared in terms of risk factors, quality of life (QoL) scores, severity of incontinence, status of doctor consultation, and total ICIQ-SF scores. RESULTS A total of 719 women were included and the prevalence of UI was 50.3% in our study. The key risk factors for UUI were hypertension and diabetes mellitus; the key risk factors for SUI were hypertension, multiparity, body mass index, and lower education level. Average QoL (ICIQ-SF 5) score for UUI was worse than SUI (3.8 ± 2.5 vs. 3.3 ± 2.4; p = 0.042) and seeking treatment for UI was significantly higher in participants with UUI when compared to those with SUI (45.1 vs. 24%; p ≤ 0.001). CONCLUSIONS Physicians should be aware that risk factors may differ according to specific UI subtypes when evaluating patients with UI.
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Affiliation(s)
- Omer Demir
- Department of Urology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Baekelandt F, Van Oyen P, Ghysel C, Van der Aa F, Ampe J. Long-term functional results after unilateral mid-urethral sling transection for voiding dysfunction. Eur J Obstet Gynecol Reprod Biol 2016; 207:89-93. [PMID: 27833061 DOI: 10.1016/j.ejogrb.2016.10.020] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/25/2016] [Accepted: 10/18/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the long-term outcomes of unilateral mid-urethral sling transection to treat voiding dysfunction after synthetic mid-urethral sling placement for stress urinary incontinence. STUDY DESIGN Twenty-three patients who underwent an unilateral sling transection were analyzed retrospectively. Patient records were analyzed for subjective outcome, and pre- and postoperative flow patterns were used as objective outcome parameters. RESULTS At the first postoperative follow-up, 77.3% of the patients remained dry. After a mean follow-up of 42 months, 73.9% of patients were continent. The flow pattern after lateral sling transection was significantly better than pre-operatively, with higher maximum flow rate (24.2ml/s, p=0.001), higher mean flow rate (10.4ml/s, p=0.001), higher voided volume (308.5ml, p=0.002) and lower residual volume (28.7ml, p=0.003). At final postoperative follow-up, eight patients (34.8%) reported urgency and six patients (26.1%) were incontinent; four of these patients (17.4%) mainly had urge incontinence. CONCLUSIONS Unilateral mid-urethral sling transection is a safe, effective technique to treat voiding symptoms with good preservation of continence. The technique repairs the obstructive flow effectively. Urgency and urge incontinence after mid-urethral sling placement are difficult to treat with transection alone.
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Affiliation(s)
- F Baekelandt
- Department of Urology, Saint-John's Hospital, Brugge, Belgium; Department of Urology, University Hospitals, Leuven, Belgium.
| | - P Van Oyen
- Department of Urology, Saint-John's Hospital, Brugge, Belgium
| | - C Ghysel
- Department of Urology, Saint-John's Hospital, Brugge, Belgium
| | - F Van der Aa
- Department of Urology, University Hospitals, Leuven, Belgium
| | - J Ampe
- Department of Urology, Saint-John's Hospital, Brugge, Belgium
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Kim MS, Lee GH, Na ED, Jang JH, Kim HC. The association of pelvic organ prolapse severity and improvement in overactive bladder symptoms after surgery for pelvic organ prolapse. Obstet Gynecol Sci 2016; 59:214-9. [PMID: 27200312 DOI: 10.5468/ogs.2016.59.3.214] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 11/22/2022] Open
Abstract
Objective The purpose of this study was to evaluate the impact of pelvic organ prolapse (POP) repair on overactive bladder (OAB) symptoms in women with POP and the effect of baseline POP severity on improvement in OAB after surgical repair of POP. And we also tried to identify any preoperative factors for persistent postoperative OAB symptoms. Methods A total of 87 patients with coexisting POP and OAB who underwent surgical correction of POP were included and retrospectively analyzed and postoperative data was obtained by telephone interview. OAB was defined as an affirmative response to item no. 15 (urinary frequency) and item no. 16 (urge incontinence) of the Pelvic Floor Distress Inventory. POP severity was dichotomized by Pelvic Organ Prolapse Quantification stage 1 to 2 (n=22) versus stage 3 to 4 (n=65). Results OAB symptoms were significantly improved after surgical treatment (P<0.001). But there was no significant differences in postoperative improvement of frequency and urge incontinence between stage 1 to 2 group versus stage 3 to 4 group. Preoperative demographic factors (age, parity, and POP stage) were not significantly related to persistent postoperative OAB symptoms. Conclusion Women with coexisting POP and OAB who undergo surgical repair experience significant improvement in OAB symptoms after surgery, but severity of POP had no significant difference in improvement of OAB symptoms. Postoperative persistent OAB symptoms were not related to age, parity, body mass index, and POP stage.
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Angulo J, Brenes F, Lizarraga I, Rejas J, Trillo S, Ochayta D, Arumi D. Impact of daily number of urgency urinary incontinence episodes on overactive bladder patient reported outcomes. Actas Urol Esp 2016; 40:173-82. [PMID: 26811022 DOI: 10.1016/j.acuro.2015.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Revised: 10/23/2015] [Accepted: 10/25/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the impact of urgency urinary incontinence (UUI) on well-being in non-institutionalized patients with overactive bladder (OAB) in a community sample. METHODS A cross-sectional web-based study was conducted in the general population, including males and females, >18 years of age. Patients with probable OAB were identified using a validated algorithm together with a score ≥8 on the OAB-V8 scale. Presence of coping behavior was considered determinant for the clinical diagnosis of OAB. Individual well-being was determined through a battery of patient-reported outcomes (PRO) measurements including assessment of health-related quality of life (EQ-5D), sleep disturbances (MOS Sleep), and life satisfaction (LISAT-8). Patients were grouped according to the number of daily UUI episodes (UUI severity): 0 (dry OAB),1, 2-3, or ≥4. Multivariate analysis to evaluate factors independently affecting quality of life was undertaken. RESULTS A total of 396 patients (52.5% women, mean age: 55.3 [11.1] years, OAB-V8 mean score: 14.5 [7.9]) out of 2035 subjects participating from the general population met the criteria for OAB: 203 (51.3%) with 0episodes, 119 (30.1%) with 1, 52 (13.1%) with 2 or 3, and 22 (5.6%) with ≥4 episodes. A statistically significant linear adjusted association was found between number of UUI episodes and PRO scores. Participants with more episodes had poorer health profiles and self-evaluated quality of life, worse life satisfaction, and more sleep disturbances and fewer hours of sleep per night. Number of incontinence episodes was independent factor to affect quality of life using both LISAT-8 and MOS questionnaires. CONCLUSION Severity of UUI was significantly associated with poorer individual well-being in subjects with OAB in a community sample in Spain.
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Chu CM, Arya LA, Andy UU. Impact of urinary incontinence on female sexual health in women during midlife. Womens Midlife Health 2015; 1:6. [PMID: 30766693 PMCID: PMC6214215 DOI: 10.1186/s40695-015-0007-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/07/2015] [Indexed: 11/10/2022] Open
Abstract
Sexual health is important to the self worth, emotional well being, and overall quality of life of women in midlife. However, urinary incontinence, which is prevalent in this population, has a negative impact on sexual function. The purpose of this article is to review the impact of urinary incontinence on female sexual dysfunction and discuss the impact of urinary incontinence treatment on sexual function. We carried out a literature review on the effect of stress urinary incontinence and urgency urinary incontinence on sexual health and physiological response, including coital incontinence, satisfaction, desire, orgasm, frequency, and partner relationships. We examined the literature regarding changes in sexual function related to non-surgical and surgical interventions for incontinence. Overall, though studies are lacking and of poor quality, treatment of incontinence has been shown to improve sexual function. Both pelvic muscle training and midurethral slings have been shown to improve sexual function in those with stress urinary incontinence. In urgency urinary incontinence, evidence indicates improvement in sexual function after treatment with anti-muscarinic medications. Coital incontinence commonly improves with treatment of the underlying incontinence subtype. Although problems related to sexual health are complex and involve both psychological and physical factors, it is important to consider treatment of urinary incontinence as part of management of sexual dysfunction.
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Affiliation(s)
- Christine M Chu
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, 3400 Spruce St., 1000 Courtyard Building, Philadelphia, PA 19104 USA
| | - Lily A Arya
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, 3400 Spruce St., 1000 Courtyard Building, Philadelphia, PA 19104 USA
| | - Uduak U Andy
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, 3400 Spruce St., 1000 Courtyard Building, Philadelphia, PA 19104 USA
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MacLachlan LS, Rovner ES. New treatments for incontinence. Adv Chronic Kidney Dis 2015; 22:279-88. [PMID: 26088072 DOI: 10.1053/j.ackd.2015.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/03/2015] [Accepted: 03/06/2015] [Indexed: 11/11/2022]
Abstract
Urinary incontinence (UI) is a common, yet underdetected and under-reported, health problem that can significantly affect quality of life. UI may also have serious medical and economic ramifications for untreated or undertreated patients, including perineal dermatitis, worsening of pressure ulcers, urinary tract infections, and falls. To prevent incontinence, the urethral sphincter must maintain adequate closure to resist the flow of urine from the bladder at all times until voluntary voiding is initiated and the bladder must accommodate increasing volumes of urine at a low pressure. UI can be categorized as a result of urethral underactivity (stress UI), bladder overactivity (urge UI), a combination of the 2 (mixed incontinence), or urethral overactivity/bladder underactivity (overflow incontinence). The main goal of therapy for the management of UI is to reduce the number of UI episodes, prevent complications, and, if possible, restore continence. This review highlights the existing treatment of stress, urge, mixed, and overflow UI in adult men and women and discusses many of the novel treatments including potential future or emerging therapies.
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Ostle Z. Vaginal oestrogen for overactive bladder in post-menopausal women. Br J Nurs 2015; 24:582-585. [PMID: 26067792 DOI: 10.12968/bjon.2015.24.11.582] [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: 06/04/2023]
Abstract
This article asks the question 'Should nurses recommend vaginal oestrogen for overactive bladder in post-menopausal women?' The article will review the evidence for use of vaginal oestrogen and consider the potential side-effects and risks. The main finding is that vaginal oestrogen is effective for treatment of overactive bladder in post-menopausal women with vaginal atrophy. However, vaginal atrophy is undertreated. This article identifies some of the barriers that may prevent diagnosis and treatment, and suggests changes in practice. Nurses should take the initiative and ask post-menopausal women about symptoms. Nurses should be trained to examine women, diagnose vaginal atrophy and discuss treatment.
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Affiliation(s)
- Zoe Ostle
- Continence Specialist Nurse, County Durham and Darlington NHS Foundation Trust Continence Service
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Chapple C, Oelke M, Kaplan SA, Scholfield D, Arumi D, Wagg AS. Fesoterodine clinical efficacy and safety for the treatment of overactive bladder in relation to patient profiles: a systematic review. Curr Med Res Opin 2015; 31:1201-43. [PMID: 25798911 DOI: 10.1185/03007995.2015.1032917] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To summarize published evidence on the pharmacology, efficacy, and safety of fesoterodine for the treatment of overactive bladder (OAB) symptoms in relation to patient clinical and demographic profiles. METHODS A systematic review of published articles on fesoterodine was conducted via a PubMed search. Articles were identified using the search term fesoterodine, with limits of human species and abstract available. Review and meta-analysis articles, validation studies, articles focused on treatment compliance/adherence, meeting abstracts, and articles not focused on oral fesoterodine administration in human subjects were excluded. Data from retained articles were summarized descriptively. RESULTS Of 137 articles identified, 61 (15 articles on the pharmacology and 46 articles on the efficacy and/or safety of fesoterodine) met inclusion criteria. Superiority trials demonstrated the additional efficacy of fesoterodine 8 mg versus fesoterodine 4 mg and tolterodine extended release 4 mg in treating OAB. Prospective trials in specific patient populations indicated beneficial effects of fesoterodine in elderly patients, vulnerable elderly patients, patients dissatisfied with or with a suboptimal response to previous antimuscarinic therapy, patients with urge urinary incontinence (UUI) or nocturnal urgency, and men with persistent LUTS during alpha-blocker treatment. With two effective doses, the fesoterodine dose can be adjusted to achieve optimal efficacy and tolerability in individual patients. The most common adverse events during fesoterodine treatment are dry mouth and constipation. CONCLUSIONS Extensive evidence demonstrates the efficacy and safety of fesoterodine in relieving OAB symptoms, including urgency, urinary frequency, UUI, and nocturnal urgency, in patients with various clinical and demographic profiles. Trial results provide valuable information on fesoterodine treatment in specific patient populations, including both elderly and vulnerable elderly patients. Potential limitations of this review are that only English language articles in PubMed were searched and included.
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Cipullo LMA, Cosimato C, Filippelli A, Conti V, Izzo V, Zullo F, Guida M. Pharmacological approach to overactive bladder and urge urinary incontinence in women: an overview. Eur J Obstet Gynecol Reprod Biol 2013; 174:27-34. [PMID: 24411952 DOI: 10.1016/j.ejogrb.2013.12.024] [Citation(s) in RCA: 13] [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: 06/10/2013] [Revised: 09/21/2013] [Accepted: 12/16/2013] [Indexed: 01/21/2023]
Abstract
Besides life-style changes, electrical stimulation or surgery, pharmacological treatment is becoming the first-choice approach in women suffering from lower urinary tract symptoms (LUTS), including urge urinary incontinence (UUI) and overactive bladder (OAB). Several drugs for the treatment of bladder storage and voiding disorders are currently available and, in the near future, novel compounds with higher specificity for the lower urinary tract receptors will be accessible. This will bring optimization of therapy, reducing side effects and increasing compliance, especially in patients with comorbidities and in women. The purpose of this paper is to give an overview on the pharmacotherapy of two common inter-correlated urological conditions, UUI and OAB. The study was conducted by analyzing and comparing the data of the recent international literature on this topic. Advances in the discovery of pharmacological options have dramatically improved the quality of life of patients affected by incontinence, but further studies are needed to increase the effectiveness and safety of the therapies used in this field.
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Affiliation(s)
- Lucio M A Cipullo
- Department of Gynecology and Obstetrics of San Giovanni di Dio and Ruggi d'Aragona Hospital, University of Salerno, SA, Italy.
| | - Cosimo Cosimato
- Department of Medicine and Surgery, University of Salerno, SA, Italy
| | - Amelia Filippelli
- Department of Medicine and Surgery, University of Salerno, SA, Italy
| | - Valeria Conti
- Department of Medicine and Surgery, University of Salerno, SA, Italy
| | - Viviana Izzo
- Department of Medicine and Surgery, University of Salerno, SA, Italy
| | - Fulvio Zullo
- Department of Gynecology and Obstetrics of San Giovanni di Dio and Ruggi d'Aragona Hospital, University of Salerno, SA, Italy
| | - Maurizio Guida
- Department of Gynecology and Obstetrics of San Giovanni di Dio and Ruggi d'Aragona Hospital, University of Salerno, SA, Italy
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Lucas MG, Bosch RJ, Burkhard FC, Cruz F, Madden TB, Nambiar AK, Neisius A, de Ridder DJ, Tubaro A, Turner WH, Pickard RS; European Association of Urology. EAU guidelines on surgical treatment of urinary incontinence. Actas Urol Esp 2013; 37:459-72. [PMID: 23835037 DOI: 10.1016/j.acuro.2013.02.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/12/2013] [Indexed: 11/22/2022]
Abstract
CONTEXT The European Association of Urology (EAU) guidelines on urinary incontinence published in March 2012 have been rewritten based on an independent systematic review carried out by the EAU guidelines panel using a sustainable methodology. OBJECTIVE We present a short version here of the full guidelines on the surgical treatment of patients with urinary incontinence, with the aim of dissemination to a wider audience. EVIDENCE ACQUISITION Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches based on Population, Intervention, Comparator, Outcome (PICO) questions. The appraisal of papers was carried out by an international panel of experts, who also collaborated in a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system. EVIDENCE SUMMARY The full version of the guidance is available online (www.uroweb.org/guidelines/online-guidelines/). The guidance includes algorithms that refer the reader back to the supporting evidence and have greater accessibility in daily clinical practice. Two original meta-analyses were carried out specifically for these guidelines and are included in this report. CONCLUSIONS These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where high-level evidence is lacking, they present a consensus of expert panel opinion.
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