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Smith AL, Kolon TF, Canning DA, Weissbart SJ. Partially Obstructed Longitudinal Vaginal Septum Presenting in Adulthood With Complaint of Urinary Incontinence. Urology 2018; 124:302-305. [PMID: 30471368 DOI: 10.1016/j.urology.2018.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/05/2018] [Accepted: 11/13/2018] [Indexed: 11/26/2022]
Abstract
A longitudinal vaginal septum can be obstructive or nonobstructive. We report on an adult woman who presented with involuntary fluid loss per vagina and had a partially obstructive longitudinal vaginal septum. A 36-year-old nulliparous female presented with malodorous, clear, leakage per vagina that she described as "urinary incontinence." Examination revealed a fluid-filled fluctuant anterior vaginal wall with a draining sinus. Imaging revealed a solitary right kidney with duplicated ectopic fluid-filled ureters inserting into a partially obstructed left hemivagina with a longitudinal vaginal septum. A longitudinal vaginal septum may present in adulthood with the complaint of urinary incontinence.
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Affiliation(s)
- Ariana L Smith
- University of Pennsylvania, Division of Urology, Philadelphia, PA.
| | - Thomas F Kolon
- University of Pennsylvania, Division of Urology, Philadelphia, PA
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Stahl EP, Dickert NW, Smith AL, Cole RT, Vega JD, Nguyen D, Gupta D. P5117Disparities in decisional regret among left ventricular assist device patient and caregiver recipients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E P Stahl
- Emory University School of Medicine, Department of Medicine, Atlanta, United States of America
| | - N W Dickert
- Emory University School of Medicine, Division of Cardiology, Atlanta, United States of America
| | - A L Smith
- Emory University School of Medicine, Center for Heart Failure Therapy and Transplantation, Atlanta, United States of America
| | - R T Cole
- Emory University School of Medicine, Center for Heart Failure Therapy and Transplantation, Atlanta, United States of America
| | - J D Vega
- Emory University School of Medicine, Center for Heart Failure Therapy and Transplantation, Atlanta, United States of America
| | - D Nguyen
- Emory University School of Medicine, Center for Heart Failure Therapy and Transplantation, Atlanta, United States of America
| | - D Gupta
- Emory University School of Medicine, Center for Heart Failure Therapy and Transplantation, Atlanta, United States of America
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Smith AL, Brown J, Wyman JF, Berry A, Newman DK, Stapleton AE. Treatment and Prevention of Recurrent Lower Urinary Tract Infections in Women: A Rapid Review with Practice Recommendations. J Urol 2018; 200:1174-1191. [PMID: 29940246 DOI: 10.1016/j.juro.2018.04.088] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2018] [Indexed: 01/08/2023]
Abstract
PURPOSE Recurrent lower urinary tract infections in women are a highly prevalent and burdensome condition for which best practice guidelines for treatment and prevention that minimize harm and optimize well-being are greatly needed. To inform development of practice recommendations, a rapid literature review of original research, systematic reviews, meta-analyses and practice guidelines was conducted. MATERIALS AND METHODS PubMed®, Embase®, Opus, Scopus®, Google Scholar, The Cochrane Library and the U.S. National Guideline Clearinghouse electronic databases were searched from inception to September 22, 2017. Articles and practice guidelines were included if they were in English, were peer reviewed, included women, involved treatment or prevention strategies for recurrent urinary tract infection and reported an outcome related to recurrence rates of urinary tract infection. Critical appraisal of original studies was conducted using the Cochrane risk of bias tool, and of systematic reviews using the AMSTAR 2 tool. RESULTS Of 1,582 citations identified 74 met our study inclusion criteria. These comprised 49 randomized controlled trials, 23 systematic reviews (16 with meta-analyses) and 2 practice guidelines. No study reported a multi-targeted treatment approach. There was a lack of high quality studies and systematic reviews evaluating prevention strategies for recurrent urinary tract infection. CONCLUSIONS We recommend an algorithmic approach to care that includes education on lifestyle and behavioral modifications, and addresses specific populations of women with antimicrobial based and nonantibiotic alternatives. This approach includes the use of vaginal estrogen with or without lactobacillus containing probiotics in postmenopausal women, low dose post-coital antibiotics for recurrent urinary tract infection associated with sexual activity in premenopausal women, low dose daily antibiotic prophylaxis in premenopausal women with infections unrelated to sexual activity, and methenamine hippurate and/or lactobacillus containing probiotics as nonantibiotic alternatives. Future research should involve consistent use of terminology, validated instruments to assess response to interventions and patient perspectives on care. Our treatment algorithm is based on the best available evidence, and fills a gap in the literature and practice regarding effective strategies to prevent recurrent urinary tract infection in women.
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Affiliation(s)
- Ariana L Smith
- Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jason Brown
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jean F Wyman
- School of Nursing, University of Minnesota, Minneapolis, Minnesota
| | - Amanda Berry
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Diane K Newman
- Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann E Stapleton
- Division of Allergy and Infectious Disease, University of Washington, Seattle, Washington
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Lukacz ES, Bavendam TG, Berry A, Fok CS, Gahagan S, Goode PS, Hardacker CT, Hebert-Beirne J, Lewis CE, Lewis J, Low LK, Lowder JL, Palmer MH, Smith AL, Brady SS. A Novel Research Definition of Bladder Health in Women and Girls: Implications for Research and Public Health Promotion. J Womens Health (Larchmt) 2018; 27:974-981. [PMID: 29792542 DOI: 10.1089/jwh.2017.6786] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Bladder health in women and girls is poorly understood, in part, due to absence of a definition for clinical or research purposes. This article describes the process used by a National Institutes of Health funded transdisciplinary research team (The Prevention of Lower Urinary Tract Symptoms [PLUS] Consortium) to develop a definition of bladder health. METHODS The PLUS Consortium identified currently accepted lower urinary tract symptoms (LUTS) and outlined elements of storage and emptying functions of the bladder. Consistent with the World Health Organization's definition of health, PLUS concluded that absence of LUTS was insufficient and emphasizes the bladder's ability to adapt to short-term physical, psychosocial, and environmental challenges for the final definition. Definitions for subjective experiences and objective measures of bladder dysfunction and health were drafted. An additional bioregulatory function to protect against infection, neoplasia, chemical, or biologic threats was proposed. RESULTS PLUS proposes that bladder health be defined as: "A complete state of physical, mental, and social well-being related to bladder function and not merely the absence of LUTS. Healthy bladder function permits daily activities, adapts to short-term physical or environmental stressors, and allows optimal well-being (e.g., travel, exercise, social, occupational, or other activities)." Definitions for each element of bladder function are reported with suggested subjective and objective measures. CONCLUSIONS PLUS used a comprehensive transdisciplinary process to develop a bladder health definition. This will inform instrument development for evaluation of bladder health promotion and prevention of LUTS in research and public health initiatives.
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Affiliation(s)
- Emily S Lukacz
- 1 Division of Female Pelvic Medicine and Reconstructive Surgery, University of California San Diego , San Diego, California
| | - Tamara G Bavendam
- 2 National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health , Bethesda, Maryland
| | - Amanda Berry
- 3 Division of Urology, Children's Hospital of Philadelphia , Philadelphia, Pennsylvania
| | - Cynthia S Fok
- 4 Department of Urology, University of Minnesota , Minneapolis, Minnesota
| | - Sheila Gahagan
- 5 Division of Academic General Pediatrics, University of California San Diego , San Diego, California
| | - Patricia S Goode
- 6 Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham , Birmingham, Alabama.,7 Birmingham/Atlanta Veterans Affairs Geriatric Research, Education, and Clinical Center , Birmingham, Alabama
| | - Cecilia T Hardacker
- 8 Howard Brown Health, Rush University College of Nursing , Chicago, Illinois
| | - Jeni Hebert-Beirne
- 9 Division of Community Health Sciences, University of Illinois at Chicago , School of Public Health, Chicago, Illinois
| | - Cora E Lewis
- 10 Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham , Birmingham, Alabama
| | - Jessica Lewis
- 11 Yale School of Public Health , New Haven, Connecticut
| | - Lisa Kane Low
- 12 University of Michigan School of Nursing , Ann Arbor, Michigan
| | - Jerry L Lowder
- 13 Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine , St. Louis, Missouri
| | - Mary H Palmer
- 14 School of Nursing, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina
| | - Ariana L Smith
- 15 Division of Urology, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Sonya S Brady
- 16 Division of Epidemiology and Community Health, University of Minnesota School of Public Health , Minneapolis, Minnesota
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Smith AL, Delfelder CJ, Stark CR, Evans CE, Yoder AD, Paulk CB, Beyer RS, Jones CK. 493 Effects of Monesin Sodium and Xylanase on Broiler Growth Performance. J Anim Sci 2018. [DOI: 10.1093/jas/sky073.490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A L Smith
- Kansas State University, Manhattan, KS
| | | | - C R Stark
- Kansas State University, Manhattan, KS
| | - C E Evans
- Kansas State University, Manhattan, KS
| | - A D Yoder
- Kansas State University, Manhattan, KS
| | - C B Paulk
- Kansas State University, Manhattan, KS
| | - R S Beyer
- Kansas State University, Manhattan, KS
| | - C K Jones
- Kansas State University, Manhattan, KS
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Weissbart SJ, Bhavsar R, Rao H, Wein AJ, Detre JA, Arya LA, Smith AL. Specific Changes in Brain Activity during Urgency in Women with Overactive Bladder after Successful Sacral Neuromodulation: A Functional Magnetic Resonance Imaging Study. J Urol 2018; 200:382-388. [PMID: 29630979 DOI: 10.1016/j.juro.2018.03.129] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE The mechanism of sacral neuromodulation is poorly understood. We compared brain activity during urgency before and after sacral neuromodulation in women with overactive bladder and according to the response to treatment. MATERIALS AND METHODS Women with refractory overactive bladder who elected sacral neuromodulation were invited to undergo functional magnetic resonance imaging before and after treatment. During imaging the bladder was filled until urgency was experienced. Regions of interest were identified a priori and brain activity in these regions of interest was compared before and after treatment as well as according to the treatment response. Whole brain exploratory analysis with an uncorrected voxel level threshold of p <0.001 was also performed to identify additional brain regions which changed after sacral neuromodulation. RESULTS Of the 12 women who underwent a pretreatment functional magnetic resonance imaging examination 7 were successfully treated with sacral neuromodulation and underwent a posttreatment examination. After sacral neuromodulation brain activity decreased in the left anterior cingulate cortex, the bilateral insula, the left dorsolateral prefrontal cortex and the bilateral orbitofrontal cortex (each p <0.05). No new brain regions showed increased activity after sacral neuromodulation. Pretreatment brain activity levels in the bilateral anterior cingulate cortex, the right insula, the bilateral dorsolateral prefrontal cortex, the right orbitofrontal cortex, the right supplementary motor area and the right sensorimotor cortex were higher in women who underwent successful treatment (each p <0.05). CONCLUSIONS Brain activity during urgency changes after successful sacral neuromodulation. Sacral neuromodulation may be more effective in women with higher levels of pretreatment brain activity during urgency.
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Affiliation(s)
- Steven J Weissbart
- Department of Urology, Stony Brook University School of Medicine, Stony Brook, New York.
| | - Rupal Bhavsar
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Hengyi Rao
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Alan J Wein
- Division of Urology, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - John A Detre
- Department of Neurology, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Lily A Arya
- Department of Obstetrics and Gynecology, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ariana L Smith
- Division of Urology, Perelman School of Medicine, Philadelphia, Pennsylvania
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Weissbart SJ, Wang M, Wein AJ, Arya LA, Newman DK, Smith AL, Bavaria T. Accuracy of a Portable Bladder Scanner to Measure Post-Void Residual Urine Volume in Women with Pelvic Organ Prolapse. Urology Practice 2018. [DOI: 10.1016/j.urpr.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Steven J. Weissbart
- Department of Urology, Stony Brook University, Stony Brook, New York
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Wang
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alan J. Wein
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lily A. Arya
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diane K. Newman
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ariana L. Smith
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas Bavaria
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Wattrang E, Magnusson SE, Näslund K, Thebo P, Hagström Å, Smith AL, Lundén A. Expression of perforin, granzyme A and Fas ligand mRNA in caecal tissues upon Eimeria tenella infection of naïve and immune chickens. Parasite Immunol 2017; 38:419-30. [PMID: 27136454 DOI: 10.1111/pim.12329] [Citation(s) in RCA: 7] [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: 02/10/2016] [Accepted: 04/22/2016] [Indexed: 01/10/2023]
Abstract
Cytotoxic cells of the immune system may kill infected or transformed host cells via the perforin/granzyme or the Fas ligand (FasL) pathways. The purpose of this study was to determine mRNA expression of perforin, granzyme A and FasL in Eimeria tenella-infected tissues at primary infection and infection of immune chickens as an indirect measure of cytotoxic cell activity. Chickens were rendered immune by repeated E. tenella infections, which were manifested as an absence of clinical signs or pathological lesions and significantly reduced oocyst production upon challenge infection. During primary E. tenella infection, perforin, granzyme A and FasL mRNA expression in caecal tissue was significantly increased at 10 days after infection, compared to uninfected birds. In contrast, at infection of immune birds, perforin and granzyme A mRNA expression in caecal tissue was significantly increased during the early stages of E. tenella challenge infection, days 1-4, which coincided with a substantial reduction of parasite replication in these birds. These results indicate the activation of cytotoxic pathways in immune birds and support a role for cytotoxic T cells in the protection against Eimeria infections.
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Affiliation(s)
- E Wattrang
- Department of Microbiology, National Veterinary Institute, Uppsala, Sweden
| | - S E Magnusson
- Department of Microbiology, National Veterinary Institute, Uppsala, Sweden
| | - K Näslund
- Department of Microbiology, National Veterinary Institute, Uppsala, Sweden
| | - P Thebo
- Department of Microbiology, National Veterinary Institute, Uppsala, Sweden
| | - Å Hagström
- Department of Microbiology, National Veterinary Institute, Uppsala, Sweden
| | - A L Smith
- Department of Zoology, University of Oxford, Oxford, UK
| | - A Lundén
- Department of Microbiology, National Veterinary Institute, Uppsala, Sweden
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Huybregts MAJM, de Vroege R, Christiaans HMT, Smith AL, Paulus RCE. The use of a mini bypass system (Cobe Synergy) without venous and cardiotomy reservoir in a mitral valve repair: a case report. Perfusion 2017; 20:121-4. [PMID: 15918450 DOI: 10.1191/0267659105pf794cr] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The use of mini cardiopulmonary bypass circuits is an emerging technology. The venous and cardiotomy reservoir have been excluded from the circuit. This results in a reduction of the blood contact surface area and of the priming volume. Entrainment of venous air, however, remains a drawback in the widespread acceptance of using these mini circuits. The technique described resolves this problem by automatic removal of venous air, and explains how this mini cardiopulmonary bypass circuit was utilized on a 64-year-old female presented for a mitral valve repair. In the absence of a cardiotomy reservoir, an autotrans-fusion cell separator was used to process shed blood and, after CPB, the residual pump blood. This mini bypass circuit, with the safety feature to remove automatically venous air, provided an additional degree of protection. In our experience, mini bypass circuits allow us safely to perform cardiopulmonary bypass during valve procedures.
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Affiliation(s)
- M A J M Huybregts
- Department of Cardiothoracic Surgery, Vrije Universiteit Medisch Centrum, Amsterdam, The Netherlands.
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Sterling ME, Hartigan SM, Wein AJ, Smith AL. A standardized surgical technique for removal of the Interstim tined lead. Can J Urol 2016; 23:8471-8475. [PMID: 27705733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Explantation of the Interstim sacral neuromodulation (SNM) device is occasionally necessary. Removing the tined lead can put strain on the lead, resulting in a possible break and retained fragments. The Food and Drug Administration (FDA) released a notification regarding health consequences related to retained lead fragments. We describe a novel and safe surgical technique for removing the Interstim device and permanent lead. MATERIALS AND METHODS We searched the Manufacturer and User Facility Device Experience (MAUDE) database for complications related to tined lead removal and searched the database of a single surgeon at our institution. Our standardized technique for tined lead removal is as follows. An incision is made over the previous lead insertion site and the lead is isolated and externalized. The fibrous encapsulation is dissected off the lead to expose the tines and ensure the lead is free from adhesions. The lead is removed by wrapping it around a curved hemostat and turning it under tension. If the lead breaks, the incision is extended and dissection is carried down to the sacral body to remove all fragments. RESULTS Twenty-eight patients had their tined lead removed between 2009 and 2015 after being in place a median of 2.00 years (IQR 1.32-3.32 years). One lead broke (3.6%) during removal over the 6 years using our standardized approach. CONCLUSION Permanent tined leads can break on removal and retained fragments can pose significant health consequences. Our technique standardizes the approach for removal and is safe and effective in our series.
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Affiliation(s)
- Matthew E Sterling
- Division of Urology, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
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Sung VW, Borello-France D, Dunivan G, Gantz M, Lukacz ES, Moalli P, Newman DK, Richter HE, Ridgeway B, Smith AL, Weidner AC, Meikle S. Methods for a multicenter randomized trial for mixed urinary incontinence: rationale and patient-centeredness of the ESTEEM trial. Int Urogynecol J 2016; 27:1479-90. [PMID: 27287818 DOI: 10.1007/s00192-016-3031-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Mixed urinary incontinence (MUI) can be a challenging condition to manage. We describe the protocol design and rationale for the Effects of Surgical Treatment Enhanced with Exercise for Mixed Urinary Incontinence (ESTEEM) trial, designed to compare a combined conservative and surgical treatment approach versus surgery alone for improving patient-centered MUI outcomes at 12 months. METHODS ESTEEM is a multisite, prospective, randomized trial of female participants with MUI randomized to a standardized perioperative behavioral/pelvic floor exercise intervention plus midurethral sling versus midurethral sling alone. We describe our methods and four challenges encountered during the design phase: defining the study population, selecting relevant patient-centered outcomes, determining sample size estimates using a patient-reported outcome measure, and designing an analysis plan that accommodates MUI failure rates. A central theme in the design was patient centeredness, which guided many key decisions. Our primary outcome is patient-reported MUI symptoms measured using the Urogenital Distress Inventory (UDI) score at 12 months. Secondary outcomes include quality of life, sexual function, cost-effectiveness, time to failure, and need for additional treatment. RESULTS The final study design was implemented in November 2013 across eight clinical sites in the Pelvic Floor Disorders Network. As of 27 February 2016, 433 total/472 targeted participants had been randomized. CONCLUSIONS We describe the ESTEEM protocol and our methods for reaching consensus for methodological challenges in designing a trial for MUI by maintaining the patient perspective at the core of key decisions. This trial will provide information that can directly impact patient care and clinical decision making.
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Affiliation(s)
- Vivian W Sung
- The Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI, USA. .,Women and Infants Hospital of Rhode Island Division of Urogynecology and Reconstructive Pelvic Surgery, Warren Alpert Medical School of Brown University, 101 Plain Street 5th floor, Providence, RI, 02903, USA.
| | - Diane Borello-France
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA
| | - Gena Dunivan
- The Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM, USA
| | - Marie Gantz
- Social, Statistical, & Environmental Sciences, RTI International, Research Triangle Park, NC, USA
| | - Emily S Lukacz
- The Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Reproductive Medicine, UC San Diego Health System, San Diego, CA, USA
| | - Pamela Moalli
- Women's Center for Bladder and Pelvic Health, Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Urogynecology and Reconstructive Pelvic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Diane K Newman
- The Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Holly E Richter
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Beri Ridgeway
- Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ariana L Smith
- The Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Alison C Weidner
- Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Susan Meikle
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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Chu CM, Harvie HS, Smith AL, Arya LA, Andy UU. The Impact of Treatment of Overactive Bladder on Physical Activity Limitations. J Womens Health (Larchmt) 2016; 25:801-5. [PMID: 27135856 DOI: 10.1089/jwh.2015.5643] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To determine if treatment of overactive bladder (OAB) can improve self-reported limitations in physical activity in women. MATERIALS AND METHODS This is a prospective study of women with OAB treated with flexible-dose fesoterodine therapy and standardized behavioral counseling. Subjects were evaluated at baseline and 8 weeks post-treatment. Physical activity scores were assigned using two questions of the Short Form 12 (SF-12) and categorized into three levels of physical activity (no limitations, moderate limitations, severe limitations). Response of urinary symptoms to treatment at 8 weeks was measured using the Patient Global Impression of Improvement. Physical activity limitations at baseline and 8 weeks were compared. RESULTS We recruited 137 women. At baseline, 71 (52%) women had no limitations, 34 (25%) had moderate, and 32 (23%) had severe physical limitations. Eight weeks after treatment, the proportion of women reporting severe limitations in physical activity was significantly lower with 71 (52%) women reporting no limitations, 50 (36%) reporting moderate, and 16 (12%) reporting severe limitations in physical activity (p = 0.001). At 8 weeks, the proportion of women with no limitations in physical activity was higher in responders than nonresponders (52% vs. 33%), and the proportion of women with severe restriction was lower in responders (13% vs. 17%), although there was no significant difference between the groups (p = 0.24), which both showed overall improvement in physical activity limitations. CONCLUSION Treatment of OAB is associated with a decrease in perceived physical activity limitations; however, this is not directly associated with improvement in urinary symptoms.
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Affiliation(s)
- Christine M Chu
- 1 Division of Urogynecology, Department of Obstetrics & Gynecology, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Heidi S Harvie
- 1 Division of Urogynecology, Department of Obstetrics & Gynecology, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Ariana L Smith
- 2 Department of Urology, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Lily A Arya
- 1 Division of Urogynecology, Department of Obstetrics & Gynecology, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania
| | - Uduak U Andy
- 1 Division of Urogynecology, Department of Obstetrics & Gynecology, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania
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Strother MC, Weissbart S, Brooks JS, Smith AL. Subpubic Cartilaginous Cyst--A Rare Periurethral Lesion With Implications for Surgical Approach. Urology 2016; 90:16-8. [PMID: 26826588 DOI: 10.1016/j.urology.2015.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 11/11/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Affiliation(s)
| | - Steven Weissbart
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - John S Brooks
- Department of Pathology, Pennsylvania Hospital, Philadelphia, PA
| | - Ariana L Smith
- Division of Urology, University of Pennsylvania, Philadelphia, PA
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Eckstrand CD, Hillman C, Smith AL, Sparger EE, Murphy BG. Viral Reservoirs in Lymph Nodes of FIV-Infected Progressor and Long-Term Non-Progressor Cats during the Asymptomatic Phase. PLoS One 2016; 11:e0146285. [PMID: 26741651 PMCID: PMC4704817 DOI: 10.1371/journal.pone.0146285] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 12/15/2015] [Indexed: 12/20/2022] Open
Abstract
Background Examination of a cohort of cats experimentally infected with feline immunodeficiency virus (FIV) for 5.75 years revealed detectable proviral DNA in peripheral blood mononuclear cells (PBMCs) harvested during the asymptomatic phase, undetectable plasma viral RNA (FIV gag), and rarely detectable cell-associated viral RNA. Despite apparent viral latency in peripheral CD4+ T cells, circulating CD4+ T cell numbers progressively declined in progressor animals. The aim of this study was to explore this dichotomy of peripheral blood viral latency in the face of progressive immunopathology. The viral replication status, cellular immunophenotypes, and histopathologic features were compared between popliteal lymph nodes (PLNs) and peripheral blood. Also, we identified and further characterized one of the FIV-infected cats identified as a long-term non-progressor (LTNP). Results PLN-derived leukocytes from FIV-infected cats during the chronic asymptomatic phase demonstrated active viral gag transcription and FIV protein translation as determined by real-time RT-PCR, Western blot and in situ immunohistochemistry, whereas viral RNA in blood leukocytes was either undetectable or intermittently detectable and viral protein was not detected. Active transcription of viral RNA was detectable in PLN-derived CD4+ and CD21+ leukocytes. Replication competent provirus was reactivated ex vivo from PLN-derived leukocytes from three of four FIV-infected cats. Progressor cats showed a persistent and dramatically decreased proportion and absolute count of CD4+ T cells in blood, and a decreased proportion of CD4+ T cells in PLNs. A single long-term non-progressor (LTNP) cat persistently demonstrated an absolute peripheral blood CD4+ T cell count indistinguishable from uninfected animals, a lower proviral load in unfractionated blood and PLN leukocytes, and very low amounts of viral RNA in the PLN. Conclusion Collectively our data indicates that PLNs harbor important reservoirs of ongoing viral replication during the asymptomatic phase of infection, in spite of undetectable viral activity in peripheral blood. A thorough understanding of tissue-based lentiviral reservoirs is fundamental to medical interventions to eliminate virus or prolong the asymptomatic phase of FIV infection.
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Affiliation(s)
- C D Eckstrand
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
| | - C Hillman
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
| | - A L Smith
- Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California, Davis, California, United States of America
| | - E E Sparger
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California, United States of America
| | - B G Murphy
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, California, United States of America
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Weissbart SJ, Pechersky D, Malykhina A, Bavaria T, Parrillo L, Arya LA, Bilello M, Wein AJ, Smith AL. The impact of pontine disease on lower urinary tract symptoms in patients with multiple sclerosis. Neurourol Urodyn 2016; 36:453-456. [PMID: 26741487 DOI: 10.1002/nau.22953] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/14/2015] [Indexed: 01/23/2023]
Abstract
AIMS To investigate the relationship between pontine lesion characteristics on MRI and lower urinary tract symptoms (LUTS) in patients with multiple sclerosis (MS). METHODS We performed a prospective cohort study of patients with MS and LUTS who were undergoing brain/spine MRI. Patients were administered the American Urological Association Symptom Score (AUA-SS), Medical, Epidemiologic, and Social Aspects of Aging questionnaire (MESA), and Urogenital Distress Inventory questionnaire (UDI-6), underwent Kurtzke Expanded Disability Status Scale (EDSS) scoring by a neurologist, and had their MRIs reviewed by a neuroradiologist. The relationships between symptom scores and lesion number, size, and location were analyzed. RESULTS There were 42 patients that completed the study and 20 (48%) had one or more pontine lesions. Total AUA-SS and UDI-6 were related to multiple Short Form Health Survey (SF-36) scales and not EDSS scoring. Weak urinary stream measured on the AUA-SS (P = 0.028), and urgency incontinence measured on the MESA questionnaire (P = 0.034) were related to pontine lesion diameter. There was no difference in urinary symptoms according to the presence or absence of a pontine lesion, or according to lesion location within the pons. CONCLUSIONS Pontine lesion size appears to be related to lower urinary tract symptoms (weak stream and urgency incontinence) in patients with MS. Therefore, CNS lesion characteristics may be able to phenotype voiding symptoms in patients with MS. Neurourol. Urodynam. 36:453-456, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Steven J Weissbart
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dasha Pechersky
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anna Malykhina
- Division of Urology, Department of Surgery, University of Colorado, Aurora, Colorado
| | - Thomas Bavaria
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lisa Parrillo
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lily A Arya
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michel Bilello
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alan J Wein
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Weissbart SJ, Lewis R, Smith AL, Harvie HS, Miller JM, Arya LA. Impact of Dry Mouth on Fluid Intake and Overactive Bladder Symptoms in Women taking Fesoterodine. J Urol 2015; 195:1517-1522. [PMID: 26682757 DOI: 10.1016/j.juro.2015.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE We investigated the long-term relationships between dry mouth, fluid intake and overactive bladder symptoms in women undergoing treatment with fesoterodine. We hypothesized that women who experienced dry mouth would increase their fluid intake and worsen their urinary symptoms. MATERIALS AND METHODS We conducted a prospective ancillary study to a 9-month open-label trial of fesoterodine for women with urgency urinary incontinence. Fluid intake was measured and compared according to reported dry mouth. Multivariable analysis was used to study the interaction between dry mouth, fluid intake and urinary symptoms. RESULTS During the study 407 women without dry mouth significantly reduced their fluid intake (mean decrease 172.1 ml, median 118.3 ml, p = 0.02), while 91 women with dry mouth did not (mean decrease 95.8 ml, median 118.3 ml, p = 0.54). On univariable analysis a greater proportion of women who experienced dry mouth reported improvement in their urinary symptoms compared to women without dry mouth (60.5% vs 47.2%, p = 0.03). On multivariable analysis black women were less likely to report dry mouth (OR 0.4, 95% CI 0.2-0.9, p = 0.03) and older women were less likely to report improvement in urinary symptoms (OR 0.98, 95% CI 0.96-0.99, p = 0.003). Factors not associated with improvement in urinary symptoms on multiple regression were dry mouth, baseline fluid intake volume, change in fluid intake volume and caffeine intake volume. CONCLUSIONS In women with overactive bladder receiving fesoterodine dry mouth may prevent restriction of fluid intake but does not diminish treatment efficacy.
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Affiliation(s)
- Steven J Weissbart
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Rusell Lewis
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Heidi S Harvie
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Janis M Miller
- Department of Health Behavior and Biological Sciences, School of Nursing, and Department of Obstetrics and Gynecology, School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lily A Arya
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
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Pearce MM, Zilliox MJ, Rosenfeld AB, Thomas-White KJ, Richter HE, Nager CW, Visco AG, Nygaard IE, Barber MD, Schaffer J, Moalli P, Sung VW, Smith AL, Rogers R, Nolen TL, Wallace D, Meikle SF, Gai X, Wolfe AJ, Brubaker L. The female urinary microbiome in urgency urinary incontinence. Am J Obstet Gynecol 2015; 213:347.e1-11. [PMID: 26210757 PMCID: PMC4556587 DOI: 10.1016/j.ajog.2015.07.009] [Citation(s) in RCA: 185] [Impact Index Per Article: 20.6] [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: 05/08/2015] [Revised: 06/15/2015] [Accepted: 07/11/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to characterize the urinary microbiota in women who are planning treatment for urgency urinary incontinence and to describe clinical associations with urinary symptoms, urinary tract infection, and treatment outcomes. STUDY DESIGN Catheterized urine samples were collected from multisite randomized trial participants who had no clinical evidence of urinary tract infection; 16S ribosomal RNA gene sequencing was used to dichotomize participants as either DNA sequence-positive or sequence-negative. Associations with demographics, urinary symptoms, urinary tract infection risk, and treatment outcomes were determined. In sequence-positive samples, microbiotas were characterized on the basis of their dominant microorganisms. RESULTS More than one-half (51.1%; 93/182) of the participants' urine samples were sequence-positive. Sequence-positive participants were younger (55.8 vs 61.3 years old; P = .0007), had a higher body mass index (33.7 vs 30.1 kg/m(2); P = .0009), had a higher mean baseline daily urgency urinary incontinence episodes (5.7 vs 4.2 episodes; P < .0001), responded better to treatment (decrease in urgency urinary incontinence episodes, -4.4 vs -3.3; P = .0013), and were less likely to experience urinary tract infection (9% vs 27%; P = .0011). In sequence-positive samples, 8 major bacterial clusters were identified; 7 clusters were dominated not only by a single genus, most commonly Lactobacillus (45%) or Gardnerella (17%), but also by other taxa (25%). The remaining cluster had no dominant genus (13%). CONCLUSION DNA sequencing confirmed urinary bacterial DNA in many women with urgency urinary incontinence who had no signs of infection. Sequence status was associated with baseline urgency urinary incontinence episodes, treatment response, and posttreatment urinary tract infection risk.
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Affiliation(s)
- Meghan M Pearce
- Departments of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Michael J Zilliox
- Department of Molecular Pharmacology and Therapeutics, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Amy B Rosenfeld
- Microbiology and Immunology Department, Hammer Health Sciences, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Krystal J Thomas-White
- Departments of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Charles W Nager
- Department of Reproductive Medicine, UC San Diego Health System, San Diego, CA
| | - Anthony G Visco
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
| | - Ingrid E Nygaard
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, Salt Lake City, UT
| | - Matthew D Barber
- Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH
| | - Joseph Schaffer
- Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Pamela Moalli
- Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA
| | - Vivian W Sung
- Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, RI
| | - Ariana L Smith
- Department of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rebecca Rogers
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM
| | | | | | - Susan F Meikle
- Contraception and Reproductive Health Branch, Center for Population Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Xiaowu Gai
- Department of Molecular Pharmacology and Therapeutics, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Alan J Wolfe
- Departments of Microbiology and Immunology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - Linda Brubaker
- Departments of Obstetrics and Gynecology and Urology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL.
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Andy UU, Arya LA, Smith AL, Propert KJ, Bogner HR, Colavita K, Harvie HS. Is self-reported adherence associated with clinical outcomes in women treated with anticholinergic medication for overactive bladder? Neurourol Urodyn 2015; 35:738-42. [PMID: 25995132 DOI: 10.1002/nau.22798] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/22/2015] [Indexed: 11/08/2022]
Abstract
AIM To determine the association between self-reported adherence to anticholinergic medication and clinical outcomes in women with overactive bladder (OAB). METHODS A prospective study of women with OAB treated with fesoterodine for 8 weeks. Adherence to medication was measured using the Medication Adherence Self-report Inventory (MASRI). A self reported adherence rate of ≥80% was considered adherent. The association between self-reported adherence and clinical outcomes (Global Index of Improvement, Global impression of Severity, urinary symptom and quality of life scores) was examined. We hypothesized that adherent women would have greater improvement in urinary symptoms and quality of life than non-adherent women. RESULTS Based on the MASRI, 115 (62.5%) women were adherent and 69 (37.5%) were non-adherent to anticholinergic medication at 8weeks. Adherent women were more likely to report overall improvement in their symptoms compared to non-adherent women (84% vs. 24%, P < 0.001). Significantly more non-adherent women described their bladder symptoms as "moderate" or "severe" at 8 weeks compared to adherent women (74% vs. 44%, P = 0.03). At 8 weeks, adherent women reported significantly greater improvement (change) in urinary symptoms from baseline to 8 weeks than non-adherent women (-13.3 ± 25.8 vs. 2.5 ± 14.4, P = 0.04). Similarly, adherent women reported greater improvement in quality of life scores than non-adherent women (- 7.9 ± 24.0 vs. -1.8 ± 11.9, P = 0.003). CONCLUSION Self-reported non-adherence, as measured by the MASRI, is associated with clinically meaningful outcomes in women with OAB. This further validates the MASRI as a clinically useful tool for measuring adherence to anticholinergic medications in women with OAB. Neurourol. Urodynam. 35:738-742, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Lily A Arya
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Kathleen J Propert
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Hillary R Bogner
- Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Kristen Colavita
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Heidi S Harvie
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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Smith AL, Bascuñana C, Hall A, Salman A, Andrei AZ, Volenik A, Rothenmund H, Ferland D, Lamoussenery D, Kamath AS, Amre R, Caglar D, Gao ZH, Haegert DG, Kanber Y, Michel RP, Omeroglu-Altinel G, Asselah J, Bouganim N, Kavan P, Arena G, Barkun J, Chaudhury P, Gallinger S, Foulkes WD, Omeroglu A, Metrakos P, Zogopoulos G. Establishing a clinic-based pancreatic cancer and periampullary tumour research registry in Quebec. ACTA ACUST UNITED AC 2015; 22:113-21. [PMID: 25908910 DOI: 10.3747/co.22.2300] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Enrolling patients in studies of pancreatic ductal adenocarcinoma (pdac) is challenging because of the high fatality of the disease. We hypothesized that a prospective clinic-based study with rapid ascertainment would result in high participation rates. Using that strategy, we established the Quebec Pancreas Cancer Study (qpcs) to investigate the genetics and causes of pdac and other periampullary tumours (pats) that are also rare and underrepresented in research studies. METHODS Patients diagnosed with pdac or pat were introduced to the study at their initial clinical encounter, with a strategy to enrol participants within 2 weeks of diagnosis. Patient self-referrals and referrals of unaffected individuals with an increased risk of pdac were also accepted. Family histories, epidemiologic and clinical data, and biospecimens were collected. Additional relatives were enrolled in families at increased genetic risk. RESULTS The first 346 completed referrals led to 306 probands being enrolled, including 190 probands affected with pdac, who represent the population focus of the qpcs. Participation rates were 88.4% for all referrals and 89.2% for pdac referrals. Family history, epidemiologic and clinical data, and biospecimens were ascertained from 91.9%, 54.6%, and 97.5% respectively of patients with pdac. Although demographics and trends in risk factors in our patients were consistent with published statistics for patients with pdac, the qpcs is enriched for families with French-Canadian ancestry (37.4%), a population with recurrent germ-line mutations in hereditary diseases. CONCLUSIONS Using rapid ascertainment, a pdac and pat research registry with high participation rates can be established. The qpcs is a valuable research resource and its enrichment with patients of French-Canadian ancestry provides a unique opportunity for studies of heredity in these diseases.
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Affiliation(s)
- A L Smith
- The Research Institute of the McGill University Health Centre, Montreal, QC. ; The Goodman Cancer Research Centre, McGill University, Montreal, QC
| | - C Bascuñana
- The Research Institute of the McGill University Health Centre, Montreal, QC. ; The Goodman Cancer Research Centre, McGill University, Montreal, QC
| | - A Hall
- The Research Institute of the McGill University Health Centre, Montreal, QC. ; The Goodman Cancer Research Centre, McGill University, Montreal, QC
| | - A Salman
- The Research Institute of the McGill University Health Centre, Montreal, QC. ; Hepato-Pancreato-Biliary and Transplant Surgery, McGill University Health Centre, Montreal, QC
| | - A Z Andrei
- The Research Institute of the McGill University Health Centre, Montreal, QC. ; The Goodman Cancer Research Centre, McGill University, Montreal, QC
| | - A Volenik
- The Research Institute of the McGill University Health Centre, Montreal, QC. ; The Goodman Cancer Research Centre, McGill University, Montreal, QC. ; Program in Cancer Genetics, Department of Oncology and Human Genetics, McGill University, Montreal, QC
| | - H Rothenmund
- The Research Institute of the McGill University Health Centre, Montreal, QC. ; The Goodman Cancer Research Centre, McGill University, Montreal, QC. ; Program in Cancer Genetics, Department of Oncology and Human Genetics, McGill University, Montreal, QC
| | - D Ferland
- The Research Institute of the McGill University Health Centre, Montreal, QC. ; Hepato-Pancreato-Biliary and Transplant Surgery, McGill University Health Centre, Montreal, QC
| | - D Lamoussenery
- Hepato-Pancreato-Biliary and Transplant Surgery, McGill University Health Centre, Montreal, QC. ; Hepato-Pancreato-Biliary Oncology, McGill University Health Centre, Montreal, QC
| | - A S Kamath
- Hepato-Pancreato-Biliary and Transplant Surgery, McGill University Health Centre, Montreal, QC
| | - R Amre
- Department of Pathology, McGill University Health Centre, Montreal, QC
| | - D Caglar
- Department of Pathology, McGill University Health Centre, Montreal, QC
| | - Z H Gao
- Department of Pathology, McGill University Health Centre, Montreal, QC
| | - D G Haegert
- Department of Pathology, McGill University Health Centre, Montreal, QC
| | - Y Kanber
- Department of Pathology, McGill University Health Centre, Montreal, QC
| | - R P Michel
- Department of Pathology, McGill University Health Centre, Montreal, QC
| | | | - J Asselah
- Hepato-Pancreato-Biliary Oncology, McGill University Health Centre, Montreal, QC
| | - N Bouganim
- Hepato-Pancreato-Biliary Oncology, McGill University Health Centre, Montreal, QC
| | - P Kavan
- Hepato-Pancreato-Biliary Oncology, McGill University Health Centre, Montreal, QC
| | - G Arena
- Hepato-Pancreato-Biliary and Transplant Surgery, McGill University Health Centre, Montreal, QC
| | - J Barkun
- Hepato-Pancreato-Biliary and Transplant Surgery, McGill University Health Centre, Montreal, QC
| | - P Chaudhury
- Hepato-Pancreato-Biliary and Transplant Surgery, McGill University Health Centre, Montreal, QC
| | - S Gallinger
- The Research Institute of the McGill University Health Centre, Montreal, QC
| | - W D Foulkes
- The Research Institute of the McGill University Health Centre, Montreal, QC. ; Program in Cancer Genetics, Department of Oncology and Human Genetics, McGill University, Montreal, QC
| | - A Omeroglu
- Department of Pathology, McGill University Health Centre, Montreal, QC
| | - P Metrakos
- The Research Institute of the McGill University Health Centre, Montreal, QC. ; Hepato-Pancreato-Biliary and Transplant Surgery, McGill University Health Centre, Montreal, QC
| | - G Zogopoulos
- The Research Institute of the McGill University Health Centre, Montreal, QC. ; The Goodman Cancer Research Centre, McGill University, Montreal, QC. ; Hepato-Pancreato-Biliary and Transplant Surgery, McGill University Health Centre, Montreal, QC. ; Program in Cancer Genetics, Department of Oncology and Human Genetics, McGill University, Montreal, QC
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Affiliation(s)
- V C Liu
- Division of Infectious Disease, Children's Hospital and Medical Center, Seattle, Wash
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Wensrich CM, Kisi EH, Luzin V, Garbe U, Kirstein O, Smith AL, Zhang JF. Force chains in monodisperse spherical particle assemblies: three-dimensional measurements using neutrons. Phys Rev E Stat Nonlin Soft Matter Phys 2014; 90:042203. [PMID: 25375485 DOI: 10.1103/physreve.90.042203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Indexed: 06/04/2023]
Abstract
The full triaxial stress state within individual particles in a monodisperse spherical granular assembly has been measured. This was made possible by neutron imaging and computed tomography combined with neutron diffraction strain measurement techniques and associated stress reconstruction. The assembly in question consists of 549 precision steel ball bearings under an applied axial load of 85 MPa in a cylindrical die. Clear evidence of force chains was observed in terms of both the shape of the probability distribution function for normal stresses and the network formed by highly loaded particles. An extensive analysis of the source and magnitude of uncertainty in these measurements is also presented.
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Affiliation(s)
- C M Wensrich
- The University of Newcastle, University Drive, Callaghan NSW 2308, Australia
| | - E H Kisi
- The University of Newcastle, University Drive, Callaghan NSW 2308, Australia
| | - V Luzin
- Bragg Institute, Australian Nuclear Science and Technology Organisation, Locked Bag 2001, Kirrawee NSW 2232, Australia
| | - U Garbe
- Bragg Institute, Australian Nuclear Science and Technology Organisation, Locked Bag 2001, Kirrawee NSW 2232, Australia
| | - O Kirstein
- The University of Newcastle, University Drive, Callaghan NSW 2308, Australia and European Spallation Source, Box 176, S-221 00 Lund, Sweden
| | - A L Smith
- The University of Newcastle, University Drive, Callaghan NSW 2308, Australia
| | - J F Zhang
- The University of Newcastle, University Drive, Callaghan NSW 2308, Australia
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Smith AL, Whitten MMA, Hirschle L, Pope EC, Wootton EC, Vogan CL, Rowley AF. Bacterial septicaemia in prerecruit edible crabs, Cancer pagurus L. J Fish Dis 2014; 37:729-737. [PMID: 23962351 DOI: 10.1111/jfd.12163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 07/12/2013] [Accepted: 07/12/2013] [Indexed: 06/02/2023]
Abstract
Juvenile edible crabs, Cancer pagurus L., were surveyed from Mumbles Head and Oxwich Bay in South Wales, UK, and the number of heterotrophic bacteria and vibrios in the hemolymph was determined. The percentage of crabs with hemolymph containing bacteria was variable over the survey with higher numbers of animals affected in summer than in winter. Post-moult crabs contained significantly higher numbers of heterotrophic bacteria in the hemolymph than pre- and intermoult animals. Crabs with cuticular damage to the gills also had significantly higher numbers of bacteria in the hemolymph. Crabs were found to have a high prevalence of infection by the dinoflagellate, Hematodinium. Such animals had significantly fewer bacteria in the blood in comparison with Hematodinium-free animals. Of the 463 crabs surveyed, only 3 individuals had hemolymph containing 2000 + CFU mL(-1). Based on 16S rRNA gene sequences, two of these crabs contained a Vibrio pectenicida-like isolate, while the other had a mixed assemblage of vibrios. Although 59% of the crabs surveyed had culturable bacteria in the hemolymph, the majority only had small numbers (<2000 CFU mL(-1) ), suggesting that such infections may be of limited importance to the sustainability of the crab fishery in this region.
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Affiliation(s)
- A L Smith
- Department of Biosciences, College of Science, Swansea University, Singleton Park, Swansea, UK
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McMillan MT, Pan XQ, Smith AL, Newman DK, Weiss SR, Ruggieri MR, Malykhina AP. Coronavirus-induced demyelination of neural pathways triggers neurogenic bladder overactivity in a mouse model of multiple sclerosis. Am J Physiol Renal Physiol 2014; 307:F612-22. [PMID: 25007876 DOI: 10.1152/ajprenal.00151.2014] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In the present study, we aimed to determine whether mice with coronavirus-induced encephalomyelitis (CIE) develop neurogenic bladder dysfunction that is comparable with the neurogenic detrusor overactivity observed in patients with multiple sclerosis. Adult mice (C57BL/6J, 8 wk of age, n = 146) were inoculated with a neurotropic strain of mouse hepatitis virus (A59 strain) and followed for 4 wk. Inoculation with the virus caused a significant neural deficit in mice with an average clinical symptom score of 2.6 ± 0.5 at 2 wk. These changes were accompanied by 25 ± 5% weight loss at 1 and 2 wk postinoculation (P ≤ 0.001 vs. baseline) followed by a recovery phase. Histological analysis of spinal cord sections revealed multifocal sites of demyelinated lesions. Assessment of micturition patterns by filter paper assay determined an increase in the number of small and large urine spots in CIE mice starting from the second week after inoculation. Cystometric recordings in unrestrained awake animals confirmed neurogenic bladder overactivity at 4 wk postinoculation. One week after inoculation with the A59 strain of mouse hepatitis virus, mice became increasingly sensitive to von Frey filament testing with responses enhanced by 45% (n = 8, P ≤ 0.05 vs. baseline at 4 g); however, this initial increase in sensitivity was followed by gradual and significant diminution of abdominal sensitivity to mechanical stimulation by 4 wk postinoculation. Our results provide direct evidence showing that coronavirus-induced demyelination of the central nervous system causes the development of a neurogenic bladder that is comparable with neurogenic detrusor overactivity observed in patients with multiple sclerosis.
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Affiliation(s)
- Matthew T McMillan
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Glenolden, Pennsylvania
| | - Xiao-Qing Pan
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Glenolden, Pennsylvania
| | - Ariana L Smith
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Glenolden, Pennsylvania
| | - Diane K Newman
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Glenolden, Pennsylvania
| | - Susan R Weiss
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Michael R Ruggieri
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Anna P Malykhina
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
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77
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Abstract
Intrinsic sphincter deficiency (ISD) is a pathologic condition that is diagnosed by using urodynamics to measure Valsalva leak point pressure and maximal urethral closure pressure. The diagnosis can be difficult to reach given natural discrepancies in these values in women of different age groups and with varying degrees of incontinence. By standardizing urodynamic methodologies and interpretations to better diagnosis women with ISD, it may be possible to improve preoperative planning and outcomes for these patients treated surgically with synthetic midurethral slings.
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Affiliation(s)
- Lisa M Parrillo
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Parvati Ramchandani
- Division of Urology, Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA; Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, Perelman School of Medicine, 800 Walnut Street, Floor 19, Philadelphia, PA 19104, USA.
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Freeman SM, Walum H, Inoue K, Smith AL, Goodman MM, Bales KL, Young LJ. Neuroanatomical distribution of oxytocin and vasopressin 1a receptors in the socially monogamous coppery titi monkey (Callicebus cupreus). Neuroscience 2014; 273:12-23. [PMID: 24814726 DOI: 10.1016/j.neuroscience.2014.04.055] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 04/04/2014] [Accepted: 04/24/2014] [Indexed: 11/29/2022]
Abstract
The coppery titi monkey (Callicebus cupreus) is a socially monogamous New World primate that has been studied in the field and the laboratory to investigate the behavioral neuroendocrinology of primate pair bonding and parental care. Arginine vasopressin has been shown to influence male titi monkey pair-bonding behavior, and studies are currently underway to examine the effects of oxytocin on titi monkey behavior and physiology. Here, we use receptor autoradiography to identify the distribution of arginine vasopressin 1a receptor (AVPR1a) and oxytocin receptors (OXTR) in hemispheres of titi monkey brain (n=5). AVPR1a are diffuse and widespread throughout the brain, but the OXTR distribution is much more limited, with the densest binding being in the hippocampal formation (dentate gyrus, CA1 field) and the presubiculum (layers I and III). Moderate OXTR binding was detected in the nucleus basalis of Meynert, pulvinar, superior colliculus, layer 4C of primary visual cortex, periaqueductal gray (PAG), pontine gray, nucleus prepositus, and spinal trigeminal nucleus. OXTR mRNA overlapped with OXTR radioligand binding, confirming that the radioligand was detecting OXTR protein. AVPR1a binding is present throughout the cortex, especially in cingulate, insular, and occipital cortices, as well as in the caudate, putamen, nucleus accumbens, central amygdala, endopiriform nucleus, hippocampus (CA4 field), globus pallidus, lateral geniculate nucleus, infundibulum, habenula, PAG, substantia nigra, olivary nucleus, hypoglossal nucleus, and cerebellum. Furthermore, we show that, in the titi monkey brain, the OXTR antagonist ALS-II-69 is highly selective for OXTR and that the AVPR1a antagonist SR49059 is highly selective for AVPR1a. Based on these results and the fact that both ALS-II-69 and SR49059 are non-peptide, small-molecule antagonists that should be capable of crossing the blood-brain barrier, these two compounds emerge as excellent candidates for the pharmacological manipulation of OXTR and AVPR1a in future behavioral experiments in titi monkeys and other primate species.
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Affiliation(s)
- S M Freeman
- Silvio O. Conte Center for Oxytocin and Social Cognition, Center for Translational Social Neuroscience, Department of Psychiatry and Behavioral Sciences, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road, Atlanta, GA 30329, USA.
| | - H Walum
- Silvio O. Conte Center for Oxytocin and Social Cognition, Center for Translational Social Neuroscience, Department of Psychiatry and Behavioral Sciences, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road, Atlanta, GA 30329, USA
| | - K Inoue
- Silvio O. Conte Center for Oxytocin and Social Cognition, Center for Translational Social Neuroscience, Department of Psychiatry and Behavioral Sciences, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road, Atlanta, GA 30329, USA
| | - A L Smith
- Silvio O. Conte Center for Oxytocin and Social Cognition, Center for Translational Social Neuroscience, Department of Psychiatry and Behavioral Sciences, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road, Atlanta, GA 30329, USA; Department of Radiology, Emory University, 954 Gatewood Road, Atlanta, GA 30329, USA
| | - M M Goodman
- Silvio O. Conte Center for Oxytocin and Social Cognition, Center for Translational Social Neuroscience, Department of Psychiatry and Behavioral Sciences, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road, Atlanta, GA 30329, USA; Department of Radiology, Emory University, 954 Gatewood Road, Atlanta, GA 30329, USA
| | - K L Bales
- California National Primate Research Center, One Shields Avenue, University of California-Davis, Davis, CA 95616, USA; Department of Psychology, 135 Young Hall, University of California-Davis, Davis, CA 95616, USA
| | - L J Young
- Silvio O. Conte Center for Oxytocin and Social Cognition, Center for Translational Social Neuroscience, Department of Psychiatry and Behavioral Sciences, Yerkes National Primate Research Center, Emory University, 954 Gatewood Road, Atlanta, GA 30329, USA
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79
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Andy UU, Harvie HS, Smith AL, Propert KJ, Bogner HR, Arya LA. Validation of a self-administered instrument to measure adherence to anticholinergic drugs in women with overactive bladder. Neurourol Urodyn 2014; 34:424-8. [PMID: 24719232 DOI: 10.1002/nau.22605] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/14/2014] [Indexed: 11/11/2022]
Abstract
AIM To validate a self-administered instrument, the Medication Adherence Self-Report Inventory (MASRI) for measuring adherence to anti-cholinergic medication for overactive bladder (OAB). METHODS Prospective study in 131 women with OAB treated with fesoterodine. Adherence was measured at 8 and 12 weeks using an interviewer administered brief medication questionnaire (BMQ) that assesses barriers to adherence (criterion standard), the MASRI, and pill count. Construct, concurrent and discriminant validity of the MASRI was assessed. We hypothesized that women who were non-adherent as measured by the MASRI would be more likely to have a belief barrier than women who were adherent to medication. RESULTS Women diagnosed as non-adherent by the MASRI were more likely to report a belief barrier to taking medication as compared to adherent women at 8 weeks (80% vs. 38%, P < 0.001) and at 12 weeks (70% vs. 40%, P = 0.003). Significant correlations were noted between adherence rates measured by the MASRI and the BMQ at 8 weeks (r = 0.87, P < 0.001) and 12 weeks (r = 0.90, P < 0.001). Moderate correlation was noted between the adherence rate as measured by the MASRI and pill count at 8 weeks (r = 0.49, P = 0.02) but not at 12 weeks (r = 0.05, P = 0.87). The MASRI correctly identified 93% and 96% of non-adherent women at 8 and 12 weeks, respectively. Sensitivity, specificity, and positive likelihood ratio of the MASRI for predicting non-adherence was 91%, 82%, and 5.1 at 8 weeks and 90%, 85% and 6.1 at 12 weeks. CONCLUSIONS The MASRI is a valid self-administered tool for measuring adherence to anti-cholinergic medication in women with OAB.
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Affiliation(s)
- Uduak U Andy
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Heidi S Harvie
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Kathleen J Propert
- Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Hillary R Bogner
- Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Lily A Arya
- Division of Urogynecology, Department of Obstetrics and Gynecology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
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80
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Morrisroe SN, Rodriguez LV, Wang PC, Smith AL, Trejo L, Sarkisian CA. Correlates of 1-year incidence of urinary incontinence in older Latino adults enrolled in a community-based physical activity trial. J Am Geriatr Soc 2014; 62:740-6. [PMID: 24618012 DOI: 10.1111/jgs.12729] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The prevalence of urinary incontinence (UI) among older urban Latinos is high. Insight into etiologies of and contributing factors to the development of this condition is needed. This longitudinal cohort study identified correlates of 1-year incidence of UI in older community-dwelling Latino adults participating in a senior center-based physical activity trial in Los Angeles, California. Three hundred twenty-eight Latinos aged 60 to 93 participating in Caminemos, a randomized trial to increase walking, were studied. Participants completed an in-person survey and physical performance measures at baseline and 1 year. UI was measured using the International Consultation on Incontinence item: "How often do you leak urine?" Potential correlates of 1-year incidence of UI included sociodemographic, behavioral, medical, physical, and psychosocial characteristics. The overall incidence of UI at 1 year was 17.4%. Incident UI was associated with age, baseline activity of daily living impairment, health-related quality of life (HRQoL), mean steps per day, and depressive symptoms. Multivariate logistic regression models revealed that improvement in physical performance score (odds ratio (OR) = 0.69, 95% confidence interval (CI) = 0.50-0.95) and high baseline physical (OR = 0.60, 95% CI = 0.40-0.89) and mental (OR = 0.62, 95% CI = 0.43-0.91) HRQoL were independently associated with lower rates of 1-year incident UI. An increase in depressive symptoms at 1 year (OR = 4.48, 95% CI = 1.02-19.68) was independently associated with a higher rate of incident UI. One-year UI incidence in this population of older urban Latino adults participating in a walking trial was high but was lower in those who improved their physical performance. Interventions aimed at improving physical performance may help prevent UI in older Latino adults.
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Affiliation(s)
- Shelby N Morrisroe
- Department of Urology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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81
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Malykhina AP, Lei Q, Chang S, Pan XQ, Villamor AN, Smith AL, Seftel AD. Bladder outlet obstruction triggers neural plasticity in sensory pathways and contributes to impaired sensitivity in erectile dysfunction. Am J Physiol Regul Integr Comp Physiol 2013; 304:R837-45. [PMID: 23535456 DOI: 10.1152/ajpregu.00558.2012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) are common problems in aging males worldwide. The objective of this work was to evaluate the effects of bladder neck nerve damage induced by partial bladder outlet obstruction (PBOO) on sensory innervation of the corpus cavernosum (CC) and CC smooth muscle (CCSM) using a rat model of PBOO induced by a partial ligation of the bladder neck. Retrograde labeling technique was used to label dorsal root ganglion (DRG) neurons that innervate the urinary bladder and CC. Contractility and relaxation of the CCSM was studied in vitro, and expression of nitric oxide synthase (NOS) was evaluated by Western blotting. Concentration of the sensory neuropeptides substance P (SP) and calcitonin gene-related peptide was measured by ELISA. Partial obstruction of the bladder neck caused a significant hypertrophy of the urinary bladders (2.5-fold increase at 2 wk). Analysis of L6-S2 DRG sections determined that sensory ganglia received input from both the urinary bladder and CC with 5-7% of all neurons double labeled from both organs. The contractile responses of CC muscle strips to KCl and phenylephrine were decreased after PBOO, followed by a reduced relaxation response to nitroprusside. A significant decrease in neuronal NOS expression, but not in endothelial NOS or protein kinase G (PKG-1), was detected in the CCSM of the obstructed animals. Additionally, PBOO caused some impairment to sensory nerves as evidenced by a fivefold downregulation of SP in the CC (P ≤ 0.001). Our results provide evidence that PBOO leads to the impairment of bladder neck afferent innervation followed by a decrease in CCSM relaxation, downregulation of nNOS expression, and reduced content of sensory neuropeptides in the CC smooth muscle. These results suggest that nerve damage in PBOO may contribute to LUTS-ED comorbidity and trigger secondary changes in the contraction/relaxation mechanisms of CCSM.
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Affiliation(s)
- Anna P Malykhina
- Division of Urology, Department of Surgery, University of Pennsylvania, Glenolden, PA, USA.
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82
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Abstract
Currently, there is no consensus on the use of mesh in transvaginal surgical repairs for the treatment of pelvic organ prolapse. This review recapitulates and assesses the recent U. S. Food and Drug Administration (FDA) warnings about the use of surgical mesh in transvaginal pelvic organ prolapse repair and summarizes the responses of the national organizations that represent the health care providers most invested in treating patients with transvaginal surgical mesh. Mesh exposure or extrusion through the vaginal wall, true mesh erosion into viscera, and infection are the major complications that are currently used to define the safety of synthetic mesh use. Other potential adverse postsurgical outcomes that can affect quality of life, sexual function, and patient satisfaction include dyspareunia, "hispareunia" (ie, complaints of a sexual partner), prosthetic contraction or prominence, vaginal shortening, pelvic pain, urinary dysfunction, and failure of the repair. These outcomes are frequently attributed to mesh use, and can result in expense, frustration, and the need for further medical and surgical interventions for patients undergoing treatment for pelvic floor disorders. Information regarding the FDA's reports on the use of surgical mesh in pelvic organ prolapse repair should be made available to patients at the time of surgical planning and should be used as an adjunct in the process of obtaining informed consent.
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Affiliation(s)
- Lindsey C Menchen
- Division of Urology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, 19104, USA.
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Anger JT, Le TX, Nissim HA, Rogo-Gupta L, Rashid R, Behniwal A, Smith AL, Litwin MS, Rodriguez LV, Wein AJ, Maliski SL. How dry is "OAB-dry"? Perspectives from patients and physician experts. J Urol 2012; 188:1811-5. [PMID: 22999694 DOI: 10.1016/j.juro.2012.07.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE Overactive bladder is subtyped into overactive bladder-wet and overactive bladder-dry, based on the presence or absence, respectively, of urgency incontinence. To better understand patient and physician perspectives on symptoms among women with overactive bladder-wet and overactive bladder-dry, we performed patient focus groups and interviews with experts in urinary incontinence. MATERIALS AND METHODS Five focus groups totaling 33 patients with overactive bladder symptoms, including 3 groups of overactive bladder-wet and 2 groups of overactive bladder-dry patients, were conducted. Topics addressed patient perceptions of overactive bladder symptoms, treatments and outcomes. A total of 12 expert interviews were then done in which experts were asked to describe their views on overactive bladder-wet and overactive bladder-dry. Focus groups and expert interviews were transcribed verbatim. Qualitative data analysis was performed using grounded theory methodology, as described by Charmaz. RESULTS During the focus groups sessions, women screened as overactive bladder-dry shared the knowledge that they would probably leak if no toilet were available. This knowledge was based on a history of leakage episodes in the past. Those few patients with no history of leakage had a clinical picture more consistent with painful bladder syndrome than overactive bladder. Physician expert interviews revealed the belief that many patients labeled as overactive bladder-dry may actually be mild overactive bladder-wet. CONCLUSIONS Qualitative data from focus groups and interviews with experts suggest that a spectrum exists between very mild overactive bladder-wet and severe overactive bladder-wet. Scientific investigations are needed to determine whether urgency without fear of leakage constitutes a unique clinical entity.
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Affiliation(s)
- Jennifer T Anger
- Division of Urology, Cedars-Sinai Medical Center, Beverly Hills, California 90211, USA.
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Paigen B, Svenson KL, Von Smith R, Marion MA, Stearns T, Peters LL, Smith AL. Physiological effects of housing density on C57BL/6J mice over a 9-month period. J Anim Sci 2012; 90:5182-92. [PMID: 22952366 DOI: 10.2527/jas.2012-5417] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The NRC has consistently recommended floor space for animals used in science and agriculture. For mice, the recommended floor space is 77.4 cm(2) (12 in(2)) for a 15- to 25-g mouse. The NRC noted that its recommendations were based on "best professional judgment" and encouraged alternatives that were data driven. As part of a continual effort of The Jackson Laboratory to ensure the health and well-being of production and research mice, while promoting cost-effective, state-of-the-art research, several density-driven studies have been conducted by lab researchers. The objectives of this study were to determine the effect of housing density on variables related to mouse physiology and air quality in cages and assess the value of specific measured variables in such studies. In the present study, we monitored C57BL/6J mice in individually ventilated cages from weaning until 9 mo of age. Housing densities were equivalent to 66.4 or 36.8 cm(2) per mouse (10.3 or 5.7 in(2)). Clinical physiological variables representing general health and well-being were measured. Hematological traits, plasma lipids, and glucose, growth, bone mineral density, and percent body fat did not differ between housing densities. In the more densely housed mice, however, adrenal glands were significantly smaller, heart rates were significantly less, and food consumption was less. Cage air microenvironment was evaluated for ammonia, carbon dioxide, temperature, and humidity in cages changed weekly or every 2 wk. The cage microenvironment remained within acceptable limits at the higher density of mice at both cage-changing frequencies. The results suggest that mice housed for as long as 9 mo at up to twice the density currently recommended by NRC show no measurable adverse effects. Continued re-evaluation of the recommendation by measuring additional relevant variables of health and general well-being, and studying additional strains of mice is warranted.
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Affiliation(s)
- B Paigen
- The Jackson Laboratory, Bar Harbor, ME 04609, USA
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85
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Abstract
The majority of women with pelvic organ prolapse and stress urinary incontinence report more than one symptom that affects urinary, bowel, or sexual function. Most research studies on outcomes following surgery for pelvic organ prolapse and stress incontinence focus on anatomic outcomes and relief of symptoms specific to prolapse and/or stress incontinence. Pelvic symptoms related to voiding function such as de novo urgency or incontinence, bowel function, and sexual function are clinically important outcomes but are infrequently reported. Deterioration of pelvic symptoms postoperatively is associated with decreased patient satisfaction, which underscores the importance of effectively assessing functional and anatomic treatment outcomes. Future studies of reconstructive pelvic surgery should routinely include multiple domain functional outcomes specifically addressing voiding, defecatory, and sexual function.
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Affiliation(s)
- Saya Segal
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 1000 Courtyard, Ravdin, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Lily A. Arya
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 1000 Courtyard, Ravdin, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Ariana L. Smith
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, 299 South 8th Street, Philadelphia, PA 19104, USA
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Smith AL, Wein AJ. Predicting the future of urodynamics. Transl Androl Urol 2012; 1:76-7. [PMID: 26816691 PMCID: PMC4708210 DOI: 10.3978/j.issn.2223-4683.2012.06.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ariana L Smith
- Division of Urology, University of Pennsylvania, Philadelphia, PA 19106, USA
| | - Alan J Wein
- Division of Urology, University of Pennsylvania, Philadelphia, PA 19106, USA
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Garcia CB, Shaffer CM, Alfaro MP, Smith AL, Sun J, Zhao Z, Young PP, VanSaun MN, Eid JE. Reprogramming of mesenchymal stem cells by the synovial sarcoma-associated oncogene SYT-SSX2. Oncogene 2012; 31:2323-34. [PMID: 21996728 PMCID: PMC3752676 DOI: 10.1038/onc.2011.418] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Revised: 08/15/2011] [Accepted: 08/15/2011] [Indexed: 11/09/2022]
Abstract
Cell identity is determined by its gene expression programs. The ability of a cell to change its identity and produce cell types outside its lineage is achieved by the activity of transcription controllers capable of reprogramming differentiation gene networks. The synovial sarcoma (SS)-associated protein, SYT-SSX2, reprograms myogenic progenitors and human bone marrow-derived mesenchymal stem cells (BMMSCs) by dictating their commitment to a pro-neural lineage. It fulfills this function by directly targeting an extensive array of neural-specific genes as well as genes of developmental pathway mediators. Concomitantly, the ability of both myoblasts and BMMSCs to differentiate into their normal myogenic and adipogenic lineages was compromised. SS is believed to arise in mesenchymal stem cells where formation of the t(X/18) translocation product, SYT-SSX, constitutes the primary event in the cancer. SYT-SSX is therefore believed to initiate tumorigenesis in its target stem cell. The data presented here allow a glimpse at the initial events that likely occur when SYT-SSX2 is first expressed, and its dominant function in subverting the nuclear program of the stem cell, leading to its aberrant differentiation, as a first step toward transformation. In addition, we identified the fibroblast growth factor receptor gene, Fgfr2, as one occupied and upregulated by SYT-SSX2. Knockdown of FGFR2 in both BMMSCs and SS cells abrogated their growth and attenuated their neural phenotype. These results support the notion that the SYT-SSX2 nuclear function and differentiation effects are conserved throughout sarcoma development and are required for its maintenance beyond the initial phase. They also provide the stem cell regulator, FGFR2, as a promising candidate target for future SS therapy.
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Affiliation(s)
- CB Garcia
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - CM Shaffer
- Center for Human Genetics Research, Vanderbilt University, Nashville, TN, USA
| | - MP Alfaro
- Department of Pathology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - AL Smith
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - J Sun
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Z Zhao
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - PP Young
- Department of Pathology, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Veterans Affairs Medical Center, Nashville, TN, USA
| | - MN VanSaun
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - JE Eid
- Department of Cancer Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
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Sievert KD, Amend B, Toomey PA, Robinson D, Milsom I, Koelbl H, Abrams P, Cardozo L, Wein A, Smith AL, Newman DK. Can we prevent incontinence?: ICI-RS 2011. Neurourol Urodyn 2012; 31:390-9. [DOI: 10.1002/nau.22225] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Accepted: 01/13/2012] [Indexed: 01/31/2023]
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Smith AL, Iwanaga R, Drasin DJ, Micalizzi DS, Vartuli RL, Tan AC, Ford HL. The miR-106b-25 cluster targets Smad7, activates TGF-β signaling, and induces EMT and tumor initiating cell characteristics downstream of Six1 in human breast cancer. Oncogene 2012; 31:5162-71. [PMID: 22286770 PMCID: PMC3342483 DOI: 10.1038/onc.2012.11] [Citation(s) in RCA: 241] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The role of TGF-β signaling in tumorigenesis is paradoxical: it can be tumor suppressive or tumor promotional, depending on context. The metastatic regulator, Six1, was recently shown to mediate this switch, providing a novel means to explain this elusive “TGF-β paradox”. Herein, we identify a mechanism by which Six1 activates the tumor promotional arm of TGF-β signaling, via its ability to upregulate the miR-106b-25 microRNA cluster, and further identify a novel function for this cluster of microRNAs. While expression of the miR-106b-25 cluster is known to overcome TGF-β-mediated growth suppression via targeting p21 and BIM, we demonstrate for the first time that this same cluster can additionally target the inhibitory Smad7 protein, resulting in increased levels of the TGF-β type I receptor (TβRI) and downstream activation of TGF-β signaling. We further show that the miR-106b-25 cluster is sufficient to induce an epithelial to mesenchymal transition and a tumor initiating cell phenotype, and that it is required downstream of Six1 to induce these phenotypes. Finally, we demonstrate a significant correlation between miR-106b, Six1, and activated TGF-β signaling in human breast cancers, and further show that high levels of miR-106b and miR-93 in breast tumors significantly predicts shortened time to relapse. These findings expand the spectrum of oncogenic functions of miR-106b-25, and may provide a novel molecular explanation, through the Six1 regulated miR-106b-25 cluster, by which TGF-β signaling shifts from tumor suppressive to tumor promoting.
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Affiliation(s)
- A L Smith
- Program in Molecular Biology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Greer JA, Smith AL, Arya LA. Pelvic floor muscle training for urgency urinary incontinence in women: a systematic review. Int Urogynecol J 2012; 23:687-97. [PMID: 22246576 DOI: 10.1007/s00192-011-1651-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 12/24/2011] [Indexed: 12/19/2022]
Abstract
The objective of this study is to evaluate the effectiveness of existing physiotherapy modalities for the treatment of urge urinary incontinence (UUI). A systematic review was performed for primary studies of physiotherapy techniques for UUI published in English between 1996 and August 2010 in major electronic databases. Only randomized clinical trials that reported outcomes separately for women with UUI were included. Outcomes assessed were reduction in UUI, urinary frequency, and nocturia. Data from 13 full-text trials including the modalities of pelvic floor muscles exercises with or without biofeedback, vaginal electrical stimulation, magnetic stimulation, and vaginal cones were analyzed. The methodologic quality of these trials was fair. Significant improvement in UUI was reported for all physiotherapy techniques except vaginal cone therapy. There are insufficient data to determine if pelvic physiotherapy improves urinary frequency or nocturia. Evidence suggests that physiotherapy techniques may be beneficial for the treatment of UUI.
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Affiliation(s)
- Joy A Greer
- Hospital of the University of Pennsylvania, Division of Urogynecology, Department of OB-GYN, University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
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Smith AL, Jaffe WI, Wang M, Wein AJ. Detrusor overactivity leak point pressure in women with urgency incontinence. Int Urogynecol J 2011; 23:443-6. [PMID: 22008739 DOI: 10.1007/s00192-011-1587-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 10/06/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS When incontinence accompanies detrusor overactivity (DO), the pressure at which it occurs may have important predictive value and should be termed DO leak point pressure (DOLPP). METHODS A retrospective review of our video urodynamics database (n = 222) including validated questionnaires was performed. DOLPP was defined as detrusor pressure the moment DO incontinence occurred. Statistical analysis was performed using Student's t-test. RESULTS Women with DO leakage (47) and with DO without leakage (15) were analyzed. Urgency and urgency incontinence (UUI) were greater among patients with DO leakage. A link between sphincter deficiency and greater severity of UUI was noted. Among patients with DO leakage, those with subjective mixed incontinence had a lower mean DOLPP than those with pure UUI (p = 0.004). The detrusor pressure at peak flow was lower in the DO leakage group (versus DO alone, p = 0.05) likely reflecting a measure of outlet resistance. CONCLUSION DOLPP has predictive meaning in women and should be further studied for possible inclusion in standard urodynamic terminology.
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Affiliation(s)
- Ariana L Smith
- Department of Surgery, Division of Urology, University of Pennsylvania School of Medicine, Perelman Center for Advanced Medicine, Philadelphia, PA 19104, USA.
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94
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Smith AL, Leung J, Kun S, Zhang R, Karagiannides I, Raz S, Lee U, Glovatscka V, Pothoulakis C, Bradesi S, Mayer EA, Rodríguez LV. The effects of acute and chronic psychological stress on bladder function in a rodent model. Urology 2011; 78:967.e1-7. [PMID: 21868072 DOI: 10.1016/j.urology.2011.06.041] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 06/15/2011] [Accepted: 06/24/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Psychological stress plays a role in the exacerbation of functional lower urinary tract disorders, such as painful bladder syndrome and overactive bladder. To better understand the mechanism underlying this relationship, we characterized changes in micturition, anxiety-related behavior, and bladder pathology in rats exposed to repeated water avoidance (WA) stress. METHODS Twenty-four Wistar rats were subjected to WA stress or sham. Immediately after acute (day 1) and chronic (day 10) stress or sham, rats were placed in a metabolic cage for a 2-hour voiding behavior assessment. Voiding parameters were compared with baseline values obtained before stress. Four animals from each group were sacrificed on day 10 and bladders harvested for histologic and gene expression studies. The remaining 8 animals per group underwent repeated voiding assessment every 3 days for 1 month followed by 10 days of repeat WA stress or sham. Bladder histology and gene expression were studied. RESULTS Rats exposed to WA stress developed a significant increase in micturition frequency and decrease in latency to void, voiding interval, and volume of first void compared with sham and baseline. Alterations in micturition persisted for approximately 1 month. Stressed rats showed increased fecal pellet excretion and anxiety-like behavior. In addition, bladder specimens from stressed animals revealed increased angiogenesis, and increased total and activated mast cells. CONCLUSION In rats, repeated psychological stress results in lasting alterations in micturition frequency, interval, and volume. This rodent model may represent a valid tool for studying syndromes characterized by increased urinary frequency.
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Affiliation(s)
- Ariana L Smith
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA.
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95
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Smith AL, Ferlise VJ, Wein AJ, Ramchandani P, Rovner ES. Effect of A 7-F Transurethral Catheter on Abdominal Leak Point Pressure Measurement in Men With Post-prostatectomy Incontinence. Urology 2011; 77:1188-93. [DOI: 10.1016/j.urology.2010.07.478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 07/15/2010] [Accepted: 07/19/2010] [Indexed: 10/18/2022]
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Anger JT, Nissim HA, Le TX, Smith AL, Lee U, Sarkisian C, Litwin MS, Raz S, Rodriguez LV, Maliski SL. Women's experience with severe overactive bladder symptoms and treatment: insight revealed from patient focus groups. Neurourol Urodyn 2011; 30:1295-9. [PMID: 21538495 DOI: 10.1002/nau.21004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 08/16/2010] [Indexed: 11/08/2022]
Abstract
AIMS Research has focused on treatment of overactive bladder (OAB) symptoms in women with the goal of cure. The objective of this study was to assess women's perceptions of their OAB symptoms, treatment experience, and outcomes by conducting patient focus groups. METHODS Women seen in our academic center female urology referral clinics were identified by ICD-9 codes for OAB symptoms and recruited to participate in one of five focus groups, totaling 33 patients. Non-clinician moderators conducted the focus group sessions incorporating topics related to patients' perceptions of OAB symptoms, treatments, and outcomes. Data analysis was performed using grounded theory methodology. RESULTS Qualitative analysis yielded several preliminary themes: impact of OAB on quality of life, strategies to control wetness, medications and side effects, and triggers. The majority of focus group participants reported only a partial response to medication and other physician-recommended treatments for OAB. Therefore, they developed self-reliant personalized strategies to improve their quality of life. These strategies included fluid restriction, preventive toileting, and, most importantly, the use of incontinence pads. CONCLUSIONS The majority of the women who participated in the focus groups reported only a partial response to medical and other treatments for OAB. As a result, they developed personalized self-management strategies to improve their quality of life. Although most studies addressing the treatment of OAB aim at curing the condition, such a strategy may be unrealistic. Applying a chronic care model that uses a patient-centered symptom-management approach to OAB may optimize patient outcomes and improve quality of life.
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Affiliation(s)
- Jennifer T Anger
- Cedars-Sinai Medical Center, Los Angeles, California 90211, USA.
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Smith AL, Wein AJ. Outcomes of pharmacological management of nocturia with non-antidiuretic agents: does statistically significant equal clinically significant? BJU Int 2011; 107:1550-4. [DOI: 10.1111/j.1464-410x.2010.09972.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Toscano MJ, Sait L, Jørgensen F, Nicol CJ, Powers C, Smith AL, Bailey M, Humphrey TJ. Sub-clinical infection with Salmonella in chickens differentially affects behaviour and welfare in three inbred strains. Br Poult Sci 2011; 51:703-13. [PMID: 21161776 DOI: 10.1080/00071668.2010.528748] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
1. Much evidence exists detailing how animals respond to pathogen challenge, yet information explaining how the various behavioural, immunological, and physiological systems in chickens interplay during such challenges remains limited. 2. To gain an understanding of this interplay while controlling for genetic variation, the current study collected a variety of behavioural, physiological and immunological measures from three inbred lines (P, O and N) of laying hens before and after a sub-clinical infection with Salmonella enterica Typhimurium at 56 d of age. For comparison, an equal number of control birds were inoculated with a Salmonella-free broth. To identify an underlying profile, which might result in reduced susceptibility to infection, data were also collected in the pre-infection period. Post-infection blood and faeces were collected at 1-d post infection (dpi) and faeces again at 8 dpi. Animals were killed 15 d after infection and faeces, caecal contents, and spleen were examined for the presence of Salmonella. 3. Statistical analysis was performed to identify pre- and post-infection differences between genetic lines, changes in bird behavioural patterns between the two periods, and associations between a positive test for Salmonella and the various response measures. 4. Tissues from Line P birds were more often negative for Salmonella than those from birds of other lines, though this was inconsistent and tissue-dependent. The P line was also characterised by relatively greater serum concentrations of immunoglobulins at 1 dpi and α(1)-acid glycoprotein at 15 dpi. In addition, P line birds were more timid and their growth was reduced during the pre-infection period suggesting the possibility of a profile with reduced susceptibility to the bacterial challenge. 5. The current work has identified correlations between attributes of chicken strains and improved clearance. Future work using hypothesis-based testing will be required to determine whether the identified correlations are causally related.
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Affiliation(s)
- M J Toscano
- Animal Behaviour and Welfare Group, University of Bristol, Langford, Bristol, BS40 5DU, UK.
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Smith AL, Nissim HA, Le TX, Khan A, Maliski SL, Litwin MS, Sarkisian CA, Raz S, Rodríguez LV, Anger JT. Misconceptions and miscommunication among aging women with overactive bladder symptoms. Urology 2011; 77:55-9. [PMID: 20970839 PMCID: PMC3014400 DOI: 10.1016/j.urology.2010.07.460] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 06/30/2010] [Accepted: 07/09/2010] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To better understand aging women's experience with overactive bladder (OAB) symptoms and the care they receive, with the ultimate goal of improving the quality of care provided to aging women with overactive bladder. METHODS Women seen in outpatient female urology clinics were identified by ICD-9 codes for OAB and recruited. Patients with painful bladder syndrome, mixed stress and urge incontinence, prolapse, or recent pelvic surgery were excluded. Patient focus groups were conducted by trained nonclinician moderators incorporating topics related to patients' perceptions of OAB physiology, symptoms, diagnostic evaluation, treatments, and outcomes. Qualitative data analysis was performed using grounded theory methodology. RESULTS Five focus groups totaling 33 women with OAB were conducted. Average patient age was 67 years (range, 39-91). Older women with OAB lacked knowledge about the physiology of their disease and had poor understanding regarding the rationale for many diagnostic tests, including urodynamics and cystoscopy. The results of diagnostic studies often were not understood by older patients. Many women were dissatisfied with the care they had received. This lack of knowledge and understanding was more apparent among the elderly women in the group. CONCLUSIONS Findings demonstrated a poor understanding of the physiology of overactive bladder and the rationale for various diagnostic modalities and treatments. This was associated with dissatisfaction with care. There is a need for better communication with older women experiencing OAB symptoms about the physiology of the condition.
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Affiliation(s)
- Ariana L Smith
- Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19106, USA.
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Abstract
The impact of incontinence is felt by millions of people worldwide, with tremendous decrement in quality of life and enormous cost reaching billions of dollars. Urinary incontinence is defined as 'involuntary leakage of urine' and is categorized into two main types: urgency urinary incontinence (UUI) and stress urinary incontinence (SUI). Behavioral modifications and pharmacologic therapies, primarily antimuscarinic agents, are the mainstay of treatment for UUI. These drugs are moderately efficacious but have troublesome side-effects, the combination resulting in poor compliance and persistence with therapy. There are several agents on the market today, each with some variation in pharmacologic properties. Whether these translate into meaningful differences in clinical efficacy and tolerability remains a matter of debate. Treatment of SUI has seen little success with pharmacologic therapy. In Europe, duloxetine is approved for treatment of SUI with marginal success rates; this drug, although available in the United States for treatment of depression, is not approved for SUI. The search for newer and better pharmacologic options and novel therapies is on-going, fueled primarily by the high prevalence of bothersome incontinence and the tremendous number of health care dollars spent on current therapy. This review addresses pharmacologic options for treatment of urinary incontinence.
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Affiliation(s)
- Ariana L Smith
- University of Pennsylvania School of Medicine, Division of Urology, Philadelphia, USA.
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