Prevalence of stress urinary incontinence and intrinsic sphincter deficiency in patients with stage IV pelvic organ prolapse

AIM

To determine the prevalence of stress urinary incontinence (SUI) and intrinsic sphincter deficiency (ISD) in women with stage IV pelvic organ prolapse.

METHODS

Retrospective analysis of women with stage IV prolapse who underwent multichannel urodynamic testing. Abdominal leak point pressures (ALPP) and maximum urethral closure pressures (MUCP) were recorded. ISD was defined as ALPP ≤60 cm of water and/or MUCP ≤20 cm of water. Percentages were used to present the proportion of subjects diagnosed with SUI and ISD.

RESULTS

A total of 145 patients met inclusion criteria. Mean age was 69 years; most patients were Caucasian (56%). Eighty-two (56%) patients were found to have SUI on urodynamic testing. Thirty-six (44%) of these were asymptomatic and identified as having occult SUI. Sixteen (19.5%) patients were diagnosed with ISD using ALPP and/or MUCP. Six (37%) of the ISD patients had at least one MUCP value ≤20 cm of water and 12 (75%) had observed leakage with at least one ALPP value ≤60 cm of water. The number of patients with leakage at ALPP ≤60 cm of water increased with increasing bladder volumes. Five ISD patients (31%) had ALPP ≤60 cm of water at 200 mL, six (37.5%) had ALPP ≤60 cm of water at 300 mL and seven (43.8%) had ALPP ≤60 cm of water at 400 mL.

CONCLUSION

Greater than 50% of patients with stage IV pelvic organ prolapse had SUI on urodynamic testing, and 20% were found to have ISD. Of the patients diagnosed with SUI, 40% were asymptomatic. These findings may assist in counseling and preoperative planning for women with stage IV prolapse.

Good urodynamic practice: Pressure signal quality immediately after catheter insertion for cystometry with a water-filled pressure transducer system and its relevance for the ICS zero procedure

Aim

This study aims to evaluate the intracorporeal pressures immediately after the insertion of the catheters for urodynamic testing with a water‐filled urodynamic pressure transducer system to determine the relevance of the International Continence Society (ICS) zeroing principles.

Methods

Here, a retrospective analysis of a random series of urodynamic recordings is performed. The initial pressures, immediately after the insertion of the catheters, have been compared with the pressures after some milliliters of filling and flushing away of the gel, used with insertion, and/or the mucus and debris from the inserted catheters. Differences of initially recorded intravesical and intrarectal pressures from those after flushing and filling are analyzed and associated with the ICS standard practice of zeroing.

Results

Statistically and clinically significant differences between the initial pressures and the pressures after filling and flushing are observed, with nonphysiological initial pressures in 62% of the studies. Some filling (20 ml or more in the bladder) and flushing of the pressure channels resulted in the registration of physiological pressures and synchronous response from both lines on abdominal pressure increases.

Conclusions

The pressure signal quality of a water‐filled urodynamic system immediately after catheter insertion is low with inaccurately displayed pressure values, but it changes to normal after flushing the pressure channels and some filling. Rezeroing of the intracorporeal pressures immediately after catheter insertion for cystometry is the inappropriate correction procedure that misleadingly modifies the false initial pressures, resulting in ongoing unrealistic urodynamic study pressures.

Usefulness of Ospemifene in the treatment of urgency in menopausal patients affected by mixed urinary incontinence underwent mid-urethral slings surgery

The aim of this study was to assess the effectiveness and safety of Ospemifene in the improvement of urgency component in women affected by mixed urinary incontinence (MUI) who underwent surgery with mid-urethral sling (MUS). Eighty-one patients with MUI underwent surgical intervention with MUS were enrolled. After surgical intervention 38 patients received Ospemifene 60 mg one tablet daily per os for 12 weeks. Physical examination, 3-day voiding diary, urodynamic testing were performed at the start and the follow-up after 12 weeks in the Trans-Obturator-Tape (TOT)-Alone group and TOT-Ospemifene. Patients completed the Overactive Bladder Symptom and Health-Related Quality of Life Short-Form (OAB-Q SF), International Consultation on Incontinence Questionnaire (ICIQ-UI-SF), and King' s Health Questionnaire (KHQ). A significant difference between the two groups was observed in peak flow (ml/s), in first voiding desire (ml), in maximum cystometric capacity (ml), and in detrusor pressure at peak flow (cmH₂O) at urodynamic evaluation. A significative difference between the two groups at voiding diary was observed in the mean number of voids, urgent micturition episodes/24 h, urge urinary incontinence, and in nocturia events. The OAB-Q symptoms and OAB-Q (HRQL) scores after 12 weeks showed a significative difference between the two groups. Ospemifene is an effective potential therapy after MUSs in women with MUI improving urgency symptoms and quality of life.

Efficacy and tolerability of treatment with mirabegron compared with solifenacin in the management of overactive bladder syndrome: A retrospective analysis

AIM

The aim of this study was to compare the efficacy and tolerability of solifenacin and mirabegron in patients with overactive bladder (OAB) syndrome.

METHODS

We carried out a retrospective analysis in 342 women affected by OAB syndrome; 168 were treated with solifenacin 5 mg/daily and 174 with mirabegron 50 mg/daily. A clinical evaluation, 3-day voiding diary, and urodynamic testing was performed. Patients completed the Overactive Bladder Questionnaire - Short Form, the King's Health Questionnaire, and the Patient Global Impression of Improvement questionnaire. The adverse effects were evaluated. The two groups were compared at baseline and at 12 weeks.

RESULTS

After 12 weeks, a significant reduction in the mean number/24 h of voids and urgent micturition episodes/24 h was observed in both groups. Detrusor overactivity decreased from 58.3% to 13.1% in the solifenacin group and from 58% to 11% in the mirabegron group. Twenty (12%) and 18 (10.7%) patients taking solifenacin reported constipation and dry mouth, respectively, versus four (2.3%) and five (2.9%) patients taking mirabegron, respectively, but there was no difference between the groups in the change in vital signs. The Overactive Bladder Questionnaire - Short Form and King's Health Questionnaire scores did not demonstrate significant differences and the abandonment rates in the solifenacin and mirabegron groups were 25.5% and 20%, respectively.

CONCLUSION

Solifenacin and mirabegron showed the same efficacy in the treatment of OAB but solifenacin had more adverse effects.

Retrospective analysis in 46 women with vulvovaginal atrophy treated with ospemifene for 12 weeks: improvement in overactive bladder symptoms

AIMS

The aim of this study was to assess the effectiveness and safety of ospemifene in the improvement of overactive bladder (OAB) symptoms in postmenopausal women affected by vulvovaginal atrophy (VVA).

METHODS

Forty-six postmenopausal patients affected by VVA with OAB syndrome were enrolled for the study. All patients received Ospemifene 60 mg for 12 weeks. Clinical examination, 3-day voiding diary, urodynamic testing, ultrasound measurement of endometrial and bladder wall thickness (BWT) and the Vaginal Health Index (VHI) were performed at baseline and 12 weeks. Patients completed the OAB-Q SF and UDI-6.

RESULTS

After 12-weeks, the number of patients with detrusor overactivity decreased from 39% to 13% (p = 0.04). The reduction in the mean number in 24 h of voids (9.57 ± 2.12 vs. 6.63 ± 1.22, p < 0.0001), urgent micturition episodes/24 h (5.63 ± 1.46 vs. 1.44 ± 1.31, p < 0.0001), nocturia episodes (3.17 ± 0.85 vs. 1.11 ± 1.18, p < 0.0001), urinary incontinence episodes/24 h (0.85 ± 0.96 vs. 0.33 ± 0.64, p = 0.003) was observed. The UDI-6, OAB-Q symptoms, OAB-Q (HRQL) scores were 8.95 ± 0.91 vs. 5.56 ± 1.40, 62.60 ± 14.70 vs. 20.08 ± 10.83 and 18.71 ± 7.41 vs. 79.45 ± 14.47 (p < 0.001) before and after 12 weeks.

CONCLUSION

Ospemifene is an effective potential therapy for postmenopausal women with VVA improving OAB symptoms and quality of life.

Effective treatment of ketamine-associated cystitis with botulinum toxin type a injection combined with bladder hydrodistention

Objective Ketamine-associated cystitis (KAC) has been described in a few case reports, but its treatment in a relatively large number of patients has not been documented. This study aimed to describe our experience of treatment of 36 patients with KAC. Methods Thirty-six patients (30 males and 6 females, aged 19-38 years) with KAC, who had previously taken a muscarinic receptor blocker and/or antibiotics, but without symptomatic relief, were treated with botulinum toxin A injection combined with bladder hydrodistention. Urodynamic testing, and the O'Leary-Sant interstitial cystitis symptom index (ICSI) and problem index (ICPI) were used to evaluate baseline values and improvement before and after the treatment. Results One month post-treatment, all patients achieved marked relief of symptoms. The nocturia time was markedly reduced, while bladder capacity, the interval between micturition, the void volume, and the maximum flow rate were remarkably increased at 1 month. Additionally, the ICSI and ICPI were significantly improved. Conclusion Botulinum toxin A injection along with bladder hydrodistention is effective for managing KAC.

Overactive bladder in women

Overactive bladder in women is a common chronic condition of urinary storage, affecting a significant proportion of the population. It is defined as a symptom diagnosis that indicates lower urinary tract dysfunction, in which patients experience urinary urgency, with or without urge incontinence, usually accompanied by frequency and nocturia. The diagnosis and treatment of overactive bladder are straightforward and systematic in line with national and international guidelines. However, women are required to disclose their bladder symptoms, and be motivated to make changes to their lifestyle to see improvements. This article focuses specifically on idiopathic detrusor overactivity; its diagnosis, treatment and psychological effects on women. Healthcare professionals require an understanding of the pathophysiology and treatment rationale for the condition to ensure appropriate management strategies for patients presenting to primary and secondary care are implemented.

Trends in surgical management and pre-operative urodynamics in female medicare beneficiaries with mixed incontinence

OBJECTIVE

We sought to examine the surgical trends and utilization of treatment for mixed urinary incontinence among female Medicare beneficiaries.

METHODS

Data was obtained from a 5% national random sample of outpatient and carrier claims from 2000 to 2011. Included were female patients 65 and older, diagnosed with mixed urinary incontinence, who underwent surgical treatment identified by Current Procedural Terminology, Fourth Edition (CPT-4) codes. Urodynamics (UDS) before initial and secondary procedure were also identified using CPT-4 codes. Procedural trends and utilization of UDS were analyzed.

RESULTS

Utilization of UDS increased during the study period, from 38.4% to 74.0% prior to initial surgical intervention, and from 28.6% to 62.5% preceding re-intervention. Sling surgery (63.0%) and injectable bulking agents (28.0%) were the most common surgical treatments adopted, followed by sacral nerve stimulation (SNS) (4.8%) and Burch (4.0%) procedures. Re-intervention was performed in 4.0% of patients initially treated with sling procedures and 21.3% of patients treated with bulking agents, the majority of whom (51.7% and 76.3%, respectively) underwent injection of a bulking agent. Risk of re-intervention was not different among those who did or did not receive urodynamic tests prior to the initial procedure (8.5% vs. 9.3%) CONCLUSIONS: Sling and bulk agents are the most common treatment for MUI. Preoperative urodynamic testing was not related to risk of re-intervention following surgery for mixed urinary incontinence in this cohort. Neurourol. Urodynam. 36:422-425, 2017. © 2015 Wiley Periodicals, Inc.

Impact of preoperative urodynamic testing for urinary incontinence and pelvic organ prolapse on clinical management in Chinese women

AIM

To assess the impact of preoperative urodynamic testing on the clinical management of urinary incontinence and pelvic organ prolapse.

METHODS

Urodynamic testing was performed prior to surgery in 307 patients with pelvic organ prolapse or urinary incontinence. The resulting changes to planned treatment were recorded and retrospectively assessed.

RESULTS

Results of urodynamic testing prompted changes to the treatment plan in 136 cases (44.2%), including 86 cases of no or slight-stress urinary incontinence, 28 cases of bladder outlet obstruction, 12 cases of occult stress urinary incontinence and 10 cases of detrusor overactivity and urge urinary incontinence. Urodynamic testing excluded disadvantageous factors in 69 cases (22.4%), including 46 cases of overactive bladder and 23 cases of voiding dysfunction. The information provided to patients when seeking informed consent was augmented by the results of urodynamic testing in 63 cases (20.5%). Urodynamic testing was of no value in 39 cases (12.7%).

CONCLUSIONS

Preoperative urodynamic testing for urinary incontinence and pelvic organ prolapse can result in changes to treatment plans, exclusion of disadvantageous factors, and augmentation of information provided to patients when seeking informed consent.

Renal tract ultrasonography for routine surveillance in spinal cord injury patients

OBJECTIVES

To report the efficacy of a urinary tract surveillance regime based on annual renal tract ultrasound without routine use of urodynamic testing (UDS) in our population of spinal cord injury (SCI) patients managed with clean intermittent catheterization (CIC).

METHODS

Data was gathered retrospectively from the records of 48 SCI patients (40 males and 8 females). After establishing a safe system with initial urodynamics, renal ultrasonography was done annually for surveillance. UDS was repeated only when patients presented with new symptoms. The primary endpoint was the report of ultrasound findings at last follow-up. Findings of dilatation, calculi, scarring, and reflux were noted.

RESULTS

Mean follow-up was 6.8 years. By final follow-up, pelvicaliectasis was present in 4 (8%) subjects. Mild-moderate hydronephrosis was present in 3 (6%) subjects: 1 stable and 2 (4%) new compared to initial assessment. No severe cases of hydronephrosis were noted. Six (13%) subjects had renal/ureteral calculi. No new cases of renal cortical scarring or thinning were noted. One (2%) subject had high-grade reflux on UDS secondary to a double J stent.

CONCLUSIONS

Data relating to the efficacy of sequential surveillance studies in SCI patients are scarce, thus there is great variability in urologic surveillance methods worldwide. Upper tract abnormalities detected in our patients were early consequences of acute obstruction rather than late manifestations of detrusor changes and could not have been prevented with more regular urodyamic testing. These results suggest that annual ultrasound monitoring without routine urodynamic testing is an effective surveillance strategy in SCI patients managed with CIC.

Can urodynamic studies identify patients at risk for voiding difficulty after pubovaginal sling? The "voiding quality index"

OBJECTIVE

The value of urodynamics (UDS) as a predictor of voiding dysfunction after pubovaginal sling is controversial. We sought to determine whether individual urodynamic parameters or a "Voiding Quality Index" (VQI) can predict prolonged catheter time after sling.

METHODS

Individual voiding parameters for the 75 patients who had preoperative urodynamics included maximum detrusor pressure (Pdet), voiding time (VT), maximum uroflow (Qmax), post-void residual (PVR), and abdominal straining. Each parameter was scored 1 if normal and 0 if abnormal; these urodynamic scores were added to calculate the VQI (range 0-5). Each patient had a suprapubic catheter and maintained a voiding diary. Individual voiding parameters and the VQI were compared statistically between groups who required a catheter for more than 14 days and those who did not. Informed consent was obtained from all patients and the study was conducted with Ochsner Institutional Review Board approval.

RESULTS

Average catheter time for the 66 patients who completed the study was 11.1 days. Fifty patients voided within 14 days and were defined as being in the non-retention group (NR). Sixteen patients were catheter dependent at 14 days and were considered in the retention group (R). When each voiding parameter was individually analyzed between groups with respect to catheter time, the mean values in each group were not significantly different and offered no predictive value. When the VQI was analyzed between groups, the VQI was significantly lower for patients developing voiding difficulty (VQI-R = 3.81) than those who did not (VQI-NR = 2.31) p = .001.

CONCLUSION

No single urodynamic voiding parameter accurately predicts prolonged catheter time following sling. A combination of voiding parameters, the "Voiding Quality Index," may predict patients at risk for prolonged catheter time following sling.