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Yong EL, Wong BWX, Shen L, Hong EYT, Cheong CWZ, Kramer MS, Ng R. Prevalence and incidence of pelvic organ prolapse, bowel and urinary dysfunction in the Integrated Woman's Health Program. Maturitas 2024; 189:108106. [PMID: 39213930 DOI: 10.1016/j.maturitas.2024.108106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 07/02/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Despite its high prevalence, little information is available on the natural history of pelvic floor dysfunction. We aimed to determine the prevalence, incidence and persistence of pelvic organ prolapse (POP), bowel and urinary symptoms over 6-7 years and its associated factors. STUDY DESIGN Women from a midlife cohort in Asia completed baseline and 6-7-year follow-up assessments. Sociodemographic characteristics and health conditions were obtained at baseline using validated questionnaires. Body mass index (BMI) and physical performance were objectively measured. MAIN OUTCOME MEASURES POP, bowel, and urinary dysfunction were measured using the Pelvic Floor Distress Inventory Short Form 20 at both timepoints. Binary logistic regression was used to analyze independent associations between baseline risk factors and prevalent, new, and persistent symptoms. RESULTS Of the 1201 women enrolled at baseline, 62.3 % had symptoms in at least one domain of pelvic floor dysfunction. Poor sleep, poorer perceived health, and disability were associated with prevalent pelvic floor symptoms, while poor sleep doubled the adjusted risk of incident POP (adjusted odds ratio, aOR: 2.3, 95 % Confidence Interval: 1.4-3.9), bowel (aOR: 2.3, 1.4-3.7) and urinary (aOR: 1.7, 1.1-2.9) symptoms at the 6.6-year follow-up visit. Postmenopausal women had reduced risks of prevalent POP (aOR: 0.5, 0.3-0.7) and urinary symptoms (aOR: 0.4, 0.3-0.6), as well as a reduced risk of developing incident urinary symptoms (aOR: 0.4, 0.2-0.8). Good physical performance scores at baseline reduced the risk of incident bowel symptoms (aOR: 0.5, 0.2-0.9), whereas obesity increased the risks of persistent symptoms. CONCLUSION Poor sleep quality independently predicted incident pelvic floor dysfunction, while poor physical performance was associated with incident bowel symptoms.
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Affiliation(s)
- Eu-Leong Yong
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, 119228, Singapore.
| | - Beverly W X Wong
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, 119228, Singapore
| | - Liang Shen
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore
| | - Eliane Y T Hong
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, 119228, Singapore
| | - Clare W Z Cheong
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, 119228, Singapore
| | - Michael S Kramer
- Departments of Epidemiology and Biostatistics and of Pediatrics, McGill University Faculty of Medicine and Health Sciences, Montreal, QC H3G 2M1, Canada
| | - Roy Ng
- Department of Obstetrics and Gynecology, National University Hospital, National University of Singapore, 119228, Singapore
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Gao Q, Wang M, Zhang J, Qing Y, Yang Z, Wang X, Xu X, Ye Q, Zhang F. Pelvic floor dysfunction in postpartum women: A cross-sectional study. PLoS One 2024; 19:e0308563. [PMID: 39361594 PMCID: PMC11449369 DOI: 10.1371/journal.pone.0308563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 07/26/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Pelvic floor dysfunction (PFD) is a disease of weakened pelvic floor support tissues, leading to changes in the pelvic organ position and function of pelvic organs, with long-term effects on women. This study aimed to assess pelvic floor function using electrophysiology and clinical symptoms, exploring the risk factors for PFD one month postpartum. METHODS This cross-sectional study included 845 women from postpartum outpatient clinic of Nantong Affiliated Hospital from August 2019 to October 2021. Pelvic floor muscle strength was evaluated via pelvic floor surface electromyography. Clinical symptoms (urinary incontinence (UI) and pelvic organ prolapse) were diagnosed by gynecologists. Sociodemographic, pregnancy, and obstetrical data were obtained from self-reported questionnaires and electronic records. RESULTS The study identified maternal age, parity, immigrant status, and economic income as factors were related to PFD. Gestational constipation increased the risk of abnormal resting muscle strength (OR:1.553, 95%CI: 1.022-2.359). Cesarean delivery was associated with higher rates of abnormal resting muscle strength than vaginal delivery (post-resting stage: OR, 2.712; 95% CI, 1.189-6.185), but a decreased incidence of UI (OR: 0.302; 95% CI, 0.117-0.782). Increased gestational weight gain was correlated with a greater risk of developing UI (OR:1.030, 95%CI: 1.002-1.058). Women with vaginal inflammation faced a higher risk of abnormal fast-twitch muscle (OR: 2.311, 95%CI: 1.125-4.748). CONCLUSIONS In addition to uncontrollable factors like mode of delivery, age, and parity, interventions targeting weight gain and constipation during pregnancy and vaginal flora could mitigate the risks of PFD. Educational programs for pregnant women should emphasize a proper diet and lifestyle. For women with vaginal inflammation, clinical treatment should be carried out as soon as possible to avoid further aggravating the damage to the pelvic floor muscles.
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Affiliation(s)
- Qian Gao
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu Province, China
| | - Mingbo Wang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu Province, China
| | - Jie Zhang
- Medical school of Nantong University, Nantong, Jiangsu Province, China
| | - Yangzhe Qing
- Medical school of Nantong University, Nantong, Jiangsu Province, China
| | - Ziyi Yang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu Province, China
| | - Xin Wang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu Province, China
| | - Xujuan Xu
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Qing Ye
- Department of Nursing, Affiliated Hospital of Nantong University, Nantong, Jiangsu Province, China
| | - Feng Zhang
- School of Nursing and Rehabilitation, Nantong University, Nantong, Jiangsu Province, China
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Escobar AJ, Vasdev R, Gallo M, Softness K, Scott Wang HH, Rayala HJ. Self-adjusted Nitrous Oxide During Urodynamic Studies Reduces Patient Pain Without Compromising Study Quality: A Randomized Controlled Trial. EUR UROL SUPPL 2024; 68:25-31. [PMID: 39257621 PMCID: PMC11381832 DOI: 10.1016/j.euros.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 09/12/2024] Open
Abstract
Background and objective A urodynamic study (UDS) is a routine clinic procedure that can cause significant discomfort for certain patients, with no satisfactory analgesic alternatives currently available. Our aim was to evaluate the effectiveness of low-dose self-adjusted nitrous oxide (SANO), titrated to the patient's desired effect, on standard metrics for bladder function and on patient-reported pain and anxiety. Methods We conducted a single-institution, double-blind, randomized crossover trial in adults undergoing UDS. Each patient underwent two consecutive UDS runs, randomized to receive oxygen during the first run followed by SANO during the second run, or vice versa. UDS outcomes (capacity, detrusor strength, residual volume) and patient subjective outcomes (Visual Analog Scale for pain and anxiety, operator assessment of verbal feedback) were compared between the two runs. Secondary analyses were performed to compare outcomes during the first UDS run and adjust for treatment order. A paired Wilcoxon signed rank-sum test and McNemar's χ2 test were used to compare continuous and categorical variables, respectively. Adverse events were recorded. Key findings and limitations Nineteen patients were randomized (10 to oxygen for the first run, 9 to SANO for the first run). UDS outcomes did not differ between the two arms. Patients reported significantly less pain during the SANO run than during the oxygen run (p = 0.046). Verbal feedback was significantly better with SANO (p = 0.001). Most patients (15/19, 79%) stated that they would prefer to receive SANO during future UDS. There were no significant complications. Conclusions and clinical implications SANO oxide is a safe and effective means of preserving standard adult UDS metrics while significantly reducing patient-reported pain. Patient summary Urodynamic tests (UDS) for evaluation of lower urinary tract symptoms can cause discomfort and pain. Our study shows that nitrous oxide gas self-adjusted by patients had no effect on UDS test outcomes or on verbal feedback during the procedure, and reduced discomfort and pain in comparison to oxygen. Nitrous oxide may an attractive option for patients who are reluctant to undergo UDS.
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Affiliation(s)
- Abigail J Escobar
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Mary Gallo
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth Softness
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Heidi J Rayala
- Department of Surgery, Division of Urology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Ozden E, Iyigun E, Bedir S. The Effect of Different Education Methods Before Invasive Urodynamics on Patients' Anxiety, Pain, Readiness and Satisfaction Levels: Randomized Controlled Clinical Trial. Pain Manag Nurs 2024; 25:e346-e354. [PMID: 38969613 DOI: 10.1016/j.pmn.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/07/2024] [Accepted: 05/07/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Urodynamic testing is an invasive procedure that causes pain and anxiety. Patient education is an evidence-based nursing intervention that relieves pain and anxiety and increases patient satisfaction. AIMS This study was carried out to compare the effects of different education methods utilized before a urodynamic testing procedure on patients' pain, anxiety, readiness for the procedure, and satisfaction. METHODS The study is a randomized controlled clinical trial. Participants (n = 80) were randomly assigned to four groups. While patients in the control group were provided with routine clinical information, patients in the intervention group were given education with brochures, videos, and brochure-supported videos. The research data were collected by using a Data Collection Form with items about participants' descriptive characteristics, the Visual Analog Scale, and the State Anxiety Inventory. RESULTS It was determined that pain expectation before urodynamics and the severity of pain during urodynamics were lower in intervention groups than in the control group. Pain expectation before urodynamics was lower in the brochure-supported video education group than in the brochure education group. Anxiety levels were lower and satisfaction levels were higher in the video education and brochure-supported video education groups than in the control and brochure education groups. CONCLUSIONS Of the methods utilized, it was determined that the most effective one was brochure-supported video education as it affected all parameters positively.
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Affiliation(s)
- Esra Ozden
- Department of Surgical Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Türkiye.
| | - Emine Iyigun
- Department of Surgical Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Türkiye
| | - Selahattin Bedir
- Department of Urology, Gulhane Training and Research Hospital, University of Health Sciences Turkey, Ankara, Türkiye
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Li J, Deng G, Li X, Yin L, Yuan C, Shao W, Xia X, Yan J, Yao J. A wireless, battery-free device for electrical neuromodulation of bladder contractions. Mater Today Bio 2024; 28:101233. [PMID: 39318375 PMCID: PMC11420504 DOI: 10.1016/j.mtbio.2024.101233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 09/04/2024] [Accepted: 09/07/2024] [Indexed: 09/26/2024] Open
Abstract
Lower urinary tract dysfunction (LUTD) is a prevalent condition characterized by symptoms such as urinary frequency, urgency, incontinence, and difficulty in urination, which can significantly impair patient's quality of life and lead to severe physiological complications. Despite the availability of diverse treatment options, including pharmaceutical and behavioral therapies, these approaches are not without challenges. The objective of this study was to enhance treatment options for LUTD by developing a wireless, battery-free device for managing bladder contractions. We designed and validated a compact, fully implantable, battery-free pulse generator using the magnetic induction coupling mechanism of wireless power transmission. Weighing less than 0.2 g and with a volume of less than 0.1 cubic centimeters, this device enables precise stimulation of muscles or neurons at voltages ranging from 0 to 10 V. Wireless technology allows real-time adjustment of key stimulation parameters such as voltage, duration, frequency, pulse width, and pulse interval. Our findings demonstrate that the device effectively controlled bladder contractions in mice when used to stimulate the Major Pelvic Ganglion (MPG). Additionally, the device successfully managed micturition in mice with bilateral transection of the pudendal nerve. In conclusion, the development of this innovative wireless pulse generator provides a safer and more cost-effective alternative to conventional battery-powered neurostimulators for bladder control, addressing the limitations of such devices. We anticipate that this novel technology will play a pivotal role in the future of electrical stimulation therapies for voiding dysfunctions.
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Affiliation(s)
- Jun Li
- School of Physical Science and Technology, Guangxi University, Nanning, 530004, China
- Department of Urology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Guoxian Deng
- Department of Urology, PLA Naval Medical Center, Naval Medical University, Shanghai, 200052, China
| | - Xianping Li
- Department of Urology, PLA Naval Medical Center, Naval Medical University, Shanghai, 200052, China
| | - Lingxuan Yin
- Guangxi Key Laboratory of Special Biomedicine, School of Medicine, Guangxi University, Nanning, 530004, China
| | - Chunhui Yuan
- Department of Urology, PLA Naval Medical Center, Naval Medical University, Shanghai, 200052, China
| | - Wei Shao
- Guangxi Key Laboratory of Special Biomedicine, School of Medicine, Guangxi University, Nanning, 530004, China
| | - Xiaowen Xia
- Department of Urology, PLA Naval Medical Center, Naval Medical University, Shanghai, 200052, China
| | - Junan Yan
- School of Physical Science and Technology, Guangxi University, Nanning, 530004, China
- Department of Urology, PLA Naval Medical Center, Naval Medical University, Shanghai, 200052, China
- Department of Urology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Jiwei Yao
- Department of Urology, PLA Naval Medical Center, Naval Medical University, Shanghai, 200052, China
- Center for Neurointelligence, School of Medicine, Chongqing University, Chongqing, 400030, China
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Kurose H, Ueda K, Chikui K, Uemura K, Nishihara K, Nakiri M, Suekane S, Igawa T. Effects of long-term desmopressin treatment for nocturia in older people. Int J Urol 2024; 31:1114-1120. [PMID: 39007527 DOI: 10.1111/iju.15530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVES Desmopressin improves nocturia frequency; however, reports on its long-term efficacy and safety are few, and concerns regarding its effect on body composition exist. We thus investigated the efficacy and safety of long-term desmopressin administration and its effect on body composition. METHODS This retrospective study, conducted at Chikugo City Hospital between August 2020 and December 2022, involved 133 men (mean age, 77.7 years) with nocturnal and persistent nocturia, who were administered an initial dose of 50 μg desmopressin. Efficacy endpoints included nocturnal urinary frequency, nocturnal urinary volume, hours of undisturbed sleep, nocturnal polyuria index, initial nocturnal urinary volume, and daily urinary frequency in a frequency-volume chart (3 days), before treatment and at 1, 4, 12, 24, and 52 weeks after desmopressin administration. Additionally, the effects of desmopressin on body composition were examined, including blood-brain natriuretic peptide and a chest radiography, before and 52 weeks after administration. RESULTS Treatment improved most efficacy endpoint evaluation parameters. Around 87.6% of patients showed improved symptoms after 52 weeks compared with those before treatment (score ≤ 3). The blood-brain natriuretic peptide level rose; however, cardiothoracic ratio was unchanged. CONCLUSION Long-term administration of desmopressin is thus effective and safe in older people with nocturnal polyuria, with little effect on body composition.
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Affiliation(s)
- Hirofumi Kurose
- Department of Urology, Chikugo City Hospital, Chikugo, Fukoka, Japan
- Department of Urology, Kurume University School of Medicine, Kurume, Fukoka, Japan
| | - Kosuke Ueda
- Department of Urology, Kurume University School of Medicine, Kurume, Fukoka, Japan
| | - Katsuaki Chikui
- Department of Urology, Kurume University School of Medicine, Kurume, Fukoka, Japan
| | - Keiichiro Uemura
- Department of Urology, Kurume University School of Medicine, Kurume, Fukoka, Japan
| | - Kiyoaki Nishihara
- Department of Urology, Kurume University School of Medicine, Kurume, Fukoka, Japan
| | - Makoto Nakiri
- Department of Urology, Kurume University School of Medicine, Kurume, Fukoka, Japan
| | - Shigetaka Suekane
- Department of Urology, Kurume University School of Medicine, Kurume, Fukoka, Japan
| | - Tsukasa Igawa
- Department of Urology, Kurume University School of Medicine, Kurume, Fukoka, Japan
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Shimizu Y, Kawashiri SY, Noguchi Y, Sasaki N, Nakamichi S, Arima K, Nagata Y, Maeda T. Feeling of incomplete bladder emptying and angiogenesis-related polymorphism rs3025020 among older community-dwelling individuals. Geriatr Gerontol Int 2024; 24:1039-1044. [PMID: 39180314 DOI: 10.1111/ggi.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/30/2024] [Accepted: 08/12/2024] [Indexed: 08/26/2024]
Abstract
AIM To clarify the association between genetic factors related to angiogenesis and feeling of incomplete bladder emptying among older community-dwelling individuals. METHOD A cross-sectional study of 1762 (607 men and 1155 women) older Japanese individuals aged 60-79 years with data on rs3025020 was conducted, because vascular endothelial growth factor (VEGF), which contributes to the progression of angiogenesis, has been reported to be positively associated with the minor allele (T) of polymorphism rs3025020. RESULTS In the study population, 155 (103 men and 52 women) had feeling of incomplete bladder emptying. With rs3025020 (C/C) as the reference group, rs3025020 (T/T) was associated with a significantly higher odds ratio (OR) for feeling of incomplete bladder emptying. The adjusted ORs and 95% confidence intervals were 3.01(1.53, 5.93) in men and 2.48 (1.09, 5.66) in women, respectively. CONCLUSION VEGF polymorphism rs3025020 was associated with feeling of incomplete bladder emptying among older community-dwelling individuals. Development of angiogenesis could be associated with feeling of incomplete bladder emptying in older individuals. Geriatr Gerontol Int 2024; 24: 1039-1044.
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Affiliation(s)
- Yuji Shimizu
- Epidemiology Section, Division of Public Health, Osaka Institute of Public Health, Osaka, Japan
- Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Shin-Ya Kawashiri
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Leading Medical Research Core Unit, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yuko Noguchi
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Nagisa Sasaki
- Epidemiology Section, Division of Public Health, Osaka Institute of Public Health, Osaka, Japan
| | - Seiko Nakamichi
- Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Nagasaki University Health Center, Nagasaki, Japan
| | - Kazuhiko Arima
- Leading Medical Research Core Unit, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yasuhiro Nagata
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Leading Medical Research Core Unit, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takahiro Maeda
- Department of General Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Leading Medical Research Core Unit, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
- Department of Island and Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Chiung HK, Lo TS, Ayedh AA, Harun F, Jhang LS, Tan YL. Outcomes of bladder outlet obstruction following extensive vaginal pelvic reconstruction surgery on patient with advanced pelvic organ prolapse. Int J Gynaecol Obstet 2024; 167:206-213. [PMID: 38720419 DOI: 10.1002/ijgo.15569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/27/2024] [Accepted: 04/20/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVE To evaluate the impact of extensive vaginal pelvic reconstruction surgery (PRS) on advanced pelvic organ prolapse (POP) patients with bladder outlet obstruction (BOO). METHODS We conducted a single-center, retrospective analysis of women who received extensive vaginal pelvic reconstruction surgery for advanced POP (POP-Q ≥3) with BOO from January 2006 to January 2016. Data regarding preoperative evaluation, surgical procedure, and postoperative management were abstracted from medical records. Patients were considered to have BOO when detrusor pressure at maximum flow (Dmax) was ≥20 cm H2O and peak flow rate (Qmax) was ≤15 mL/s. Patients with postoperative value of Dmax lower than 20 cm H2O or Qmax higher than 15 mL/s were regarded as objectively cured. RESULTS A total of 1894 patients with POP stages III or IV were assessed. The incidence of BOO was 22.8% (431/1894) within this patient population of advanced POP. One year after the vaginal PRS, the objective cure rate of BOO was 98.1%. Urodynamic parameters showed a significant increase in Qmax (P < 0.001), while Dmax (P < 0.001) and postvoid residual urine (PVR) (P < 0.001) were significantly decreased. Previous POP surgery, native tissue repair (NTR), PVR ≥200 mL, and maximal cystometric capacity (MCC) ≥500 mL increase the likelihood of persistent BOO in patients. CONCLUSION Vaginal PRS demonstrated effectiveness in treating BOO in patients with advanced POP. Irrespective of the types of transvaginal mesh (TVM), using TVM achieved better outcome than did NTR. Previous POP surgery, preoperative PVR ≥200 mL, and MCC ≥500 mL were the risk factors predicting the failure of PRS in improving BOO.
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Affiliation(s)
- Huan-Ka Chiung
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei Medical Center, Taipei, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Aisha Ayash Ayedh
- Women Health Center, International Medical Center (IMC) Hospital, Jeddah, Saudi Arabia
| | - Fazlin Harun
- Department of Obstetrics and Gynecology, Women and Children Hospital (Hospital Tunku Azizah), Kuala Lumpur, Malaysia
| | - Lan-Sin Jhang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Tucheng, Medical Center, Taipei, Taiwan
| | - Yiap Loong Tan
- Department of Obstetrics and Gynecology, Kuching Specialist Hospital, Sarawak, Malaysia
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Takusagawa S, Treijtel N, Saito M, Michon I, Miyatake D, Osaki F, Guro S, Fadini T, Sekino H, Aarden-Bakker M, Kuroishi K, van Till JWO, Groenendaal-van de Meent D, de Vries M. Safety, Tolerability, Pharmacokinetics, and Pharmacodynamics of a Muscarinic M 3 Receptor-Positive Allosteric Modulator ASP8302 Following Single and Multiple Ascending Oral Doses in Healthy Volunteers. Clin Pharmacol Drug Dev 2024; 13:1130-1142. [PMID: 39120583 DOI: 10.1002/cpdd.1460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 07/15/2024] [Indexed: 08/10/2024]
Abstract
ASP8302 is an orally administered positive allosteric modulator of the muscarinic M3 receptor. Two Phase 1 studies were conducted, a first-in-human study in Europe and a Japanese phase 1 study. Both were randomized, participant- and investigator-blinded, placebo-controlled, single and multiple ascending oral doses, parallel group, clinical studies in healthy volunteers. Both studies evaluated safety and pharmacokinetics and also included salivary secretion and pupil diameter as pharmacodynamic assessments. There were no deaths, serious adverse events, or treatment-emergent adverse events reported leading to study discontinuation. There were no clinically relevant findings in any of the laboratory, vital signs, electrocardiogram assessments, or photosensitivity testing following multiple administration of up to 150 mg or up to 140 mg once daily for 14 days in the European first-in-human and Japanese Phase 1 study, respectively. The pharmacokinetics of ASP8302 were approximately linear over the dose range studied. There was no evidence of drug accumulation upon repeated dosing. In both studies, ASP8302 showed a dose-dependent pharmacodynamic effect on saliva production at doses from 100 mg onward, which was maintained during repeated dosing. No effect was observed on pupil diameter. These data supported progression of ASP8302 into Phase 2 clinical trials for further clinical development.
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Affiliation(s)
| | | | | | - Ingrid Michon
- Astellas Pharma Europe B.V., Leiden, The Netherlands
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Morizawa Y, Hori S, Gotoh D, Nakai Y, Torimoto K, Fujimoto K. Feasibility of approximate measurement of bladder volume in children using the Lilium α-200 portable bladder scanner. Int J Urol 2024; 31:1166-1167. [PMID: 38943357 DOI: 10.1111/iju.15526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/27/2024] [Accepted: 06/12/2024] [Indexed: 07/01/2024]
Affiliation(s)
- Yosuke Morizawa
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Shunta Hori
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, Kashihara, Nara, Japan
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Kitta T, Wada N, Shinohara S, Hayashi N, Yamamura H, Yamamoto T, Takagi H, Hatakeyama T, Nagabuchi M, Morishita S, Tsunekawa R, Ohtani M, Kobayashi S, Hori JI, Kakizaki H. Validation of the area under the Watts factor curve during the voiding cycle as a novel parameter for diagnosing detrusor underactivity in females. Int J Urol 2024; 31:1121-1127. [PMID: 38969345 DOI: 10.1111/iju.15531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/24/2024] [Indexed: 07/07/2024]
Abstract
OBJECTIVE Detrusor underactivity (DU) is a common cause of lower urinary tract symptoms (LUTS). To date, no consensus has been reached on the urodynamic criteria for defining DU. We previously proposed the area under the curve of the Watts factor (WF-AUC) as a new parameter for diagnosing DU. By comparing previously reported five criteria for DU and WF-AUC, we analyzed whether the WF-AUC could assess detrusor contraction in women with LUTS. METHODS Using urodynamic data of consecutive 77 women with LUTS, first, we classified DU based on previously reported five criteria. Second, we assessed the potential correlation between multiple parameters and WF-AUC. Third, receiver operating characteristic curve analysis was performed to determine the cutoff value of WF-AUC for diagnosing DU based on previously reported five criteria. Fourth, a linear regression analysis was conducted and compared using multiple criteria and female bladder outlet obstruction index (BOOIf). RESULTS WF-AUC was positively correlated with the maximum values of WF, bladder contractility index (BCI), and projected isovolumetric pressure 1 (PIP1) with correlation coefficients of 0.63, 0.57, and 0.34, respectively. AUC for diagnosing DU based on previously reported five criteria ranging from 0.773 to 0.896 with different cutoff values of AUC-WF. The Spearman's correlation test revealed that BOOIf was significantly correlated with BCI, but not Wmax, PIP1 and WF-AUC. CONCLUSIONS This study demonstrated the non-inferiority of the WF-AUC compared to previously reported criteria for defining DU. Depending on the cutoff value, the WF-AUC could appropriately evaluate women with DU, regardless of the presence of BOO.
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Affiliation(s)
- Takeya Kitta
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Satoshi Shinohara
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Nagisa Hayashi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hayato Yamamura
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Takayuki Yamamoto
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Haruka Takagi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Tsubasa Hatakeyama
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Masaya Nagabuchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Shun Morishita
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Ryouken Tsunekawa
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Miyu Ohtani
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Shin Kobayashi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Jun-Ichi Hori
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
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Aydın S, Çekiç SG. Novel Vaginal Cerclage Assisted Laparoscopic Cervico-Sacropexy Technique for Uterovaginal Prolapse. Surg Innov 2024; 31:453-459. [PMID: 39095326 DOI: 10.1177/15533506241273447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
AIM Laparoscopic hysteropexy is a complicated procedure that requires specialized surgical skills, including precise dissection and suturing. The aim is to describe the technical considerations for performing a new, feasible, and minimally invasive technique to correct apical and concurrent apical and anterior vaginal wall defects. METHOD A retrospective analysis was conducted on 70 consecutive women who underwent surgery for stage ≥3 uterovaginal prolapse. As a part of the technique, an anterior 2-cm long transverse incision was made at the anterior cervicovaginal junction, and the bladder was dissected through blunt and sharp dissection to the level of the isthmus. A posterior colpotomy was performed. A polypropylene tape was inserted into the cervical connective tissue, and the free arms of the tape were inserted into the peritoneum via the posterior colpotomy. Two arms of the tape were passed from the tunnel parallel and medial to a right sacrouterine fold, then fixed to the anterior longitudinal ligament via the laparoscopic route. RESULTS The tape can be inserted into the cervix in a median of 15 min, and the laparoscopy procedure can be completed in 24 min. No mesh erosion or long-term complications occurred. At a 1-year control, there were no cases of recurrence. CONCLUSIONS This novel cervico-sacrocolpopexy technique is a feasible and safe, minimally invasive way to correct apical or multicompartment defects, with a short operation time and an anatomical result that mimics the normal sacrouterine ligament.
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Affiliation(s)
- Serdar Aydın
- Department of Obstetrics and Gynecology, Koc University School of Medicine, Istanbul, Turkey
| | - Sebile Güler Çekiç
- Department of Obstetrics and Gynecology, Koc University Hospital, Istanbul, Turkey
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13
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Kohada Y, Kitano H, Tasaka R, Miyamoto S, Hatayama T, Shikuma H, Iwane K, Yukihiro K, Takemoto K, Naito M, Kobatake K, Sekino Y, Goto K, Goriki A, Hieda K, Hinata N. Clinical characteristics and predictors of long-term postoperative urinary incontinence in patients treated with robot-assisted radical prostatectomy: A propensity-matched analysis. Int J Urol 2024; 31:1145-1152. [PMID: 39016443 DOI: 10.1111/iju.15533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/30/2024] [Indexed: 07/18/2024]
Abstract
OBJECTIVES This study aimed to elucidate the clinical characteristics and predictors of long-term postoperative urinary incontinence (PUI) after robot-assisted radical prostatectomy (RARP). METHODS This study included patients who underwent RARP at our institution and were stratified into PUI (≥1 pad/day) and continence (0 pad/day) groups at 60 months after RARP. A propensity score-matched analysis with multiple preoperative urinary status (Expanded Prostate Cancer Index Composite urinary subdomains, total International Prostate Symptom Score (IPSS), and IPSS-quality of life scores) was performed to match preoperative urinary status in these groups. Serial changes in urinary status and treatment satisfaction preoperatively and until 60 months after RARP were compared, and predictors of long-term PUI were assessed using multivariate logistic regression analysis. RESULTS A total of 228 patients were included in the PUI and continence groups (114 patients each). Although no significant difference in preoperative urinary status was observed between the two groups, the postoperative urinary status significantly worsened overall in the PUI group than in the continence group. Treatment satisfaction was also significantly lower in the PUI group than in the continence group from 12 to 60 months postoperatively. Multivariate logistic regression analysis revealed that age (≥70 years) and biochemical recurrence (BCR) were significant predictors of the long-term PUI group (p < 0.05). CONCLUSIONS Patients with long-term PUI had poor overall postoperative urinary status and lower treatment satisfaction than the continence group. Considering the age and risk of BCR is important for predicting long-term PUI when performing RARP.
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Affiliation(s)
- Yuki Kohada
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Hiroyuki Kitano
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Ryo Tasaka
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Shunsuke Miyamoto
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Tomoya Hatayama
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Hiroyuki Shikuma
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kyohsuke Iwane
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kazuma Yukihiro
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kenshiro Takemoto
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Miki Naito
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Kohei Kobatake
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Yohei Sekino
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Keisuke Goto
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Akihiro Goriki
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Keisuke Hieda
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
| | - Nobuyuki Hinata
- Department of Urology, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan
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Aydin S, Yasli M. A Novel Sliding Knot Technique Without a Knot Pusher for Laparoscopic Pelvic Floor Surgery. Int Urogynecol J 2024:10.1007/s00192-024-05941-x. [PMID: 39352427 DOI: 10.1007/s00192-024-05941-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 08/23/2024] [Indexed: 10/03/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Challenges in intracorporeal knot tying can be addressed with extracorporeal slip knots, simplifying the process of tying and managing tissue tension using a knot pusher. However, existing extracorporeal knot techniques are difficult owing to their complexity, the finesse required with thin yarns, and extensive training needs. We developed a new laparoscopic extracorporeal slip knot technique that can be used with a conventional needle driver or standard clamps, offering the advantages of being cost-effective and easy to learn. METHODS The technique involves passing the active strand over another loop and securing it with the nondominant hand. A Kelly clamp is then wound around both loops three times in a tornado-like motion, passing the instrument over the active loop and under the passive one, and grasping the active strand. The passive strand is pulled to approximate the knot to the tissue and is tightened by the tension of the passive strand. RESULTS This method has proven effective in various laparoscopic procedures such as sacrocolpopexy, colposuspension, pectopexy, myomectomy, and hysterectomy, facilitating surgeries without complications. CONCLUSIONS The tornado knot technique is a feasible and safely locked sliding extracorporeal knot that can be easily learned, especially by surgeons who are accustomed to open surgery.
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Affiliation(s)
- Serdar Aydin
- Obstetrics and Gynecology Department, Koç University Hospital, Davutpaşa Cad. No:4 Zeytinburnu, Istanbul, Turkey.
- Koç University School of Medicine, Koç University, Istanbul, Turkey.
- Koc University Research Center for Translational Medicine, Istanbul, Turkey.
- Rahmi M. Koç Academy of Interventional Medicine, Education, and Simulation (RMK AIMES), Istanbul, Turkey.
| | - Mert Yasli
- Koç University School of Medicine, Koç University, Istanbul, Turkey
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Rotem R, Weintruab AY, Padoa A. Bridging present and future: A narrative review and visionary outlook on innovative solutions for the diagnosis and treatment of urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2024; 301:55-59. [PMID: 39094536 DOI: 10.1016/j.ejogrb.2024.07.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/29/2024] [Accepted: 07/30/2024] [Indexed: 08/04/2024]
Abstract
Urinary incontinence, characterized by the involuntary leakage of urine, significantly impacts millions globally, affecting their quality of life, social interactions, and psychological well-being. Traditional diagnostic methods and treatments often fall short, especially for refractory urinary incontinence, due to their invasive nature and limited scope for continuous, real-time assessment. This narrative review critically examines current approaches to diagnosing and managing urinary incontinence, highlights significant gaps in practice, and underscores the urgent need for innovative solutions. We explore the evolution of diagnostic and treatment modalities and introduce a preliminary method involving a conceptual catheter device that promises to shift toward non-invasive, real-time monitoring and management. This review synthesizes prevailing research and provides a visionary outlook on how emerging technologies could revolutionize urinary incontinence care, offering a future of personalized, patient-centered strategies. Our discussion extends to the limitations of conventional urodynamic studies, which are often uncomfortable and fail to capture the dynamic nature of urinary incontinence in everyday settings. The proposed preliminary method features an advanced, smart-device solution integrating sensors and artificial intelligence to offer precise, real-time insights into bladder activity. This device, still in the conceptual stages, has the potential to transform the landscape of urinary incontinence management by enhancing diagnostic accuracy and therapeutic efficacy. By bridging the gap between current limitations and future possibilities, this paper aims to inspire ongoing innovation and research in the field of urogynecology.
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Affiliation(s)
- Reut Rotem
- Department of Urogynaecology, Cork University Maternity Hospital, Cork, Ireland; Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel.
| | - Adi Y Weintruab
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Anna Padoa
- Department of Obstetrics and Gynecology, Yitzhak Shamir (Assaf Harofe) Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Khondker A, Ahmad I, Rajesh Z, Balkaran S, Al-Daqqaq Z, Kim JK, Brownrigg N, Varghese A, Chua M, Rickard M, Lorenzo AJ, Dos Santos J. The Role of Secondary Conservative Management Strategies in Bladder and Bowel Dysfunction: A Systematic Review and Meta-analysis. J Pediatr 2024; 273:114152. [PMID: 38906507 DOI: 10.1016/j.jpeds.2024.114152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/11/2024] [Accepted: 06/11/2024] [Indexed: 06/23/2024]
Abstract
OBJECTIVE We sought to determine the effect of secondary management strategies in addition to urotherapy on bowel bladder dysfunction outcomes. STUDY DESIGN The review protocol was prospectively registered (CRD42023422168). MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Scopus (database initiation until June 2023) were searched. Comparative studies of secondary management strategies vs conventional urotherapy alone were included. Two authors independently screened titles, abstracts, and reviewed full-text articles. Two authors extracted data related to study characteristics, methodology, subjects, and results. RESULTS In this systematic review and meta-analysis of 18 studies and 1228 children, secondary management strategies (home-based education, biofeedback, and physical therapy) were associated with reduced symptom burden, fewer recurrent urinary tract infections, and improved uroflowmetry findings than children treated solely with urotherapy for conservative management. CONCLUSIONS Although there is significant reporting heterogeneity, secondary conservative management strategies such as home education, biofeedback or cognitive behavioral therapy, and physiotherapy-based education are associated with less urinary incontinence, fewer infections, and fewer abnormal uroflowmetry findings.
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Affiliation(s)
- Adree Khondker
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Ihtisham Ahmad
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zwetlana Rajesh
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sabrina Balkaran
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zizo Al-Daqqaq
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jin K Kim
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Natasha Brownrigg
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Abby Varghese
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michael Chua
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mandy Rickard
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Armando J Lorenzo
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada; Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Joana Dos Santos
- Division of Urology, Department of Surgery, The Hospital for Sick Children, Toronto, ON, Canada.
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Di Bello F, Fraia A, Pezone G, Collà Ruvolo C, Di Mauro E, Cirillo L, Fusco GM, Morra S, Aprea S, La Rocca R, Califano G, Creta M, Longo N, Napolitano L. The role of lipidic balance on erectile dysfunction in prostate cancer patients undergoing robotic surgery. Int J Urol 2024; 31:1159-1164. [PMID: 38957091 DOI: 10.1111/iju.15516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/05/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE New indices of dyslipidemia, such as the Atherogenic Index of Plasma (AIP) or Castelli Risk Index I and II (CR-I/II), have been tested to predict erectile dysfunction (ED). The aim of this study was to assess the role of these lipidic scores in predicting severe ED and erectile function (EF) worsening in patients who underwent robot-assisted radical prostatectomy (RARP). METHODS Data from 1249 prostate cancer patients who underwent RARP at our single tertiary academic referral center from September 2021 to April 2023 were reviewed. RARP patients with a complete lipid panel were included in the final analysis. Two independent multivariable logistic regression models (LRMs) were fitted to identify predictors of ED severity and worsening in RARP patients. RESULTS Among the 357 RARP patients, the median age was 70 (interquartile range [IQR]: 65-74), and the median BMI was 28.4 (IQR: 26-30.4). According to the preoperative IIEF5, 115 (32.2%), 86 (24.5%), 26 (7.3%), and 40 (11.2%) were mild, mild-moderate, moderate, and severe ED patients, respectively. After multivariable LRMs predicting severe ED, only the nerve-sparing (NS) approach (odds ratio [OR]: 0.09) as well as the preoperative IIEF5 score (OR: 0.32) were independent predictors (p < 0.001). After LRMs predicting EF worsening, only preoperative IIEF5 was an independent predictor (OR: 1.42, p < 0.001). CONCLUSION The power of novel lipidic scores in predicting severe ED and EF worsening in RARP patients was low, and they should not be routinely applied as a screening method in this patient subgroup. Only preoperative IIEF5 and nerve-sparing approaches are relevant in EF prediction after RARP.
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Affiliation(s)
- Francesco Di Bello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Agostino Fraia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Gabriele Pezone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Claudia Collà Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Ernesto Di Mauro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Luigi Cirillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Giovanni Maria Fusco
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Simone Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Salvatore Aprea
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Luigi Napolitano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
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Elsaqa M, El Tayeb MM. The Role of Transurethral BPH Surgeries in Management of Urinary Symptoms in Prostate Cancer Patients, Narrative Review. Curr Urol Rep 2024; 26:7. [PMID: 39352587 PMCID: PMC11445351 DOI: 10.1007/s11934-024-01229-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2024] [Indexed: 10/04/2024]
Abstract
PURPOSE OF REVIEW Prostate cancer and benign prostate hyperplasia (BPH) are two ubiquitous pathologies that may coexist. A significant percentage of patients with different stages of prostate cancer suffer lower urinary tract symptoms (LUTS) due to associated BPH. We aimed to review the literature regarding the role of transurethral surgeries in the management of prostate cancer patients and the different available management options. RECENT FINDINGS The evidence in literature for the use of BPH surgeries in prostate cancer patients is based mainly on low-quality retrospective studies. In patients on active surveillance, BPH surgeries are beneficial in relieving LUTS without oncological risk and can eliminate the contribution of adenoma to PSA level. In patients with advanced prostate cancer, palliative BPH surgery can relieve LUTS and urinary retention with unclear oncological impact; however some reports depict that the need for BPH surgery in advanced prostate cancer is associated with poorer prognosis. In patients receiving radiotherapy, various studies showed that transurethral resection of prostate (TURP) is associated with increased radiotoxicity despite some recent reports encouraging the use of Holmium Laser Enucleation of the Prostate (HoLEP) to improve urinary symptom scores before radiotherapy. The most commonly reported techniques utilized are TURP, photoselective vaporization of prostate (PVP) and HoLEP. The use of BPH surgery is justified for relieving LUTS in selected prostate cancer patients on active surveillance or in advanced stages, however the use in the pre-radiotherapy settings remains controversial. Future prospective and randomized controlled trials are required for validating the benefits and assessing potential hazards.
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Affiliation(s)
- Mohamed Elsaqa
- Alexandria University Faculty of Medicine, Sultan Hussein Street, Alazarita, Alexandria, 21131, Egypt.
| | - Marawan M El Tayeb
- Division of Urology, Department of Surgery, Baylor Scott & White Health, Temple, TX, USA
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Aqeel J, Sawyer K, Zheng Y, Gupta P. Management Strategies for Patients with Non-Infectious Cystitis: A Review of the Literature. Curr Urol Rep 2024; 26:6. [PMID: 39347847 DOI: 10.1007/s11934-024-01236-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2024] [Indexed: 10/01/2024]
Abstract
PURPOSE OF REVIEW The management of noninfectious cystitis continues to evolve as new treatments continue to be developed and investigated. This review aims to synthesize the most recent data regarding management strategies for noninfectious cystitis focused on non-ulcerative, ulcerative, eosinophilic, and ketamine-induced cystitis. RECENT FINDINGS Several novel treatments have shown promise as management options including combination antihistamine therapy, phosphodiesterase 5 inhibitors, alpha lipoic acid supplements, and onabotulinumtoxin A. Recent studies have also found pentosan polysulfate sodium to have adverse ophthalmologic effects. For patients with ulcerative cystitis, recent research has shown that fulguration with or without triamcinolone injections should not be delayed. The treatment of noninfectious cystitis should be patient specific based on factors including etiology and symptom profile. Multimodal regimens are often the most effective. Treatment should be started with conservative options and escalated as necessary to oral treatments, intravesical options, or procedural management.
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Affiliation(s)
- Jawad Aqeel
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kathryn Sawyer
- Brigham and Women's Hospital, Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Yu Zheng
- Department of Urology, Division of Neurourology and Pelvic Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Priyanka Gupta
- Department of Urology, Division of Neurourology and Pelvic Reconstructive Surgery, University of Michigan, Ann Arbor, MI, USA.
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Gong H, Huang S. Associations of overactive bladder (OAB) with suicidal ideation incidence and all-cause mortality among the U.S. population. BMC Psychiatry 2024; 24:641. [PMID: 39350063 PMCID: PMC11443948 DOI: 10.1186/s12888-024-06107-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Accepted: 09/23/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Few studies have explored the correlation between overactive bladder (OAB) and suicidal ideation. This study aims to investigate the association between OAB and suicidal ideation, as well as the relationship between OAB and all-cause mortality among individuals with suicidal ideation. METHODS Data from the 2005-2018 National Health and Nutrition Examination Survey (NHANES) were analyzed using cross-sectional and cohort study designs. Weighted multivariable logistic regression models were used to examine the association between OAB and suicidal ideation. Kaplan-Meier curves and weighted multivariable Cox proportional hazards models assessed the relationship between OAB and all-cause mortality among those with suicidal ideation. Interaction analyses on subgroups were conducted to validate the findings. Mediation analysis was performed to examine the effect of depression on the relationship between OAB and suicidal ideation. RESULTS Among 33,426 participants aged ≥ 20 years, 1,290 (3.8%) reported suicidal ideation. After adjusting for potential confounders, participants with OAB were 2.57 times more likely to have suicidal ideation (P < 0.001). Over an average follow-up of 87 months, 197 participants with suicidal ideation died. The Cox model revealed that participants with OAB had a 3.08 times higher risk of death (P = 0.006). Kaplan-Meier curves indicated higher survival rates for non-OAB participants. Mediation analysis indicates that depression significantly mediates the relationship between OAB and suicidal ideation, with a mediation proportion of 75.25% (P < 0.001). CONCLUSIONS OAB is positively associated with the incidence of suicidal ideation and all-cause mortality among participants with suicidal ideation. Additionally, the association between OAB and suicidal ideation is mediated by depression.
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Affiliation(s)
- Hongyang Gong
- Department of Oncology Surgery, Fuzhou Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine, No.102 Gudong Road, Gulou District, Fuzhou City, 350001, Fujian Province, China
- Department of Physiology, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Shaoqun Huang
- Department of Oncology Surgery, Fuzhou Hospital of Traditional Chinese Medicine Affiliated to Fujian University of Traditional Chinese Medicine, No.102 Gudong Road, Gulou District, Fuzhou City, 350001, Fujian Province, China.
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Dey A, Georgiadis G, Umezurike J, Yuan Y, Farag F, N'Dow J, Omar MI, Mamoulakis C. Mirabegron Versus Placebo and Other Therapeutic Modalities in the Treatment of Patients with Overactive Bladder Syndrome-A Systematic Review. Eur Urol Focus 2024:S2405-4569(24)00181-0. [PMID: 39343691 DOI: 10.1016/j.euf.2024.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Accepted: 09/17/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND AND OBJECTIVE The prevalence of overactive bladder (OAB) increases with age. Mirabegron and other drugs are used for the management of patients with OAB. To evaluate mirabegron versus other treatments for overactive bladder syndrome (OAB). METHODS This randomised controlled trial (RCT)-based systematic review (CRD42020200394) was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses statement, with standards reported in the Cochrane Handbook for Systematic Reviews of Interventions. KEY FINDINGS AND LIMITATIONS We included 28 RCTs (n = 27 481 adults), comparing the following: mirabegron 25 mg versus placebo (n = 8798; six RCTs): significant changes in urgency urinary incontinence (mean difference [MD] -0.41, 95% confidence interval [CI] -0.56 to -0.26), total incontinence (MD -0.47, 95% CI -0.63 to -0.30), and nocturia (MD -0.10, 95% CI -0.17 to -0.02), and mirabegron 50 mg versus placebo (n = 14 933; 12 RCTs): significant changes in urgency urinary incontinence (MD -0.41, 95% CI -0.52 to -0.31), urgency (MD -0.49, 95% CI -0.64 to -0.33), total incontinence (MD -0.44, 95% CI -0.55 to -0.33), favouring mirabegron 25/50 mg; mirabegron 50 mg versus tolterodine 4 mg (n = 8008; five RCTs): significant changes in micturition (MD -0.16, 95% CI -0.31 to -0.02) and overall adverse events (AEs; odds ratio [OR] 0.71, 95% CI 0.59-0.86), favouring mirabegron 50 mg; mirabegron 50 mg versus solifenacin 5 mg (n = 8911; four RCTs): significant changes in voided volume/micturition in millilitres (MD -7.77, 95% CI -12.93 to -2.61), favouring mirabegron 50 mg; and mirabegron 50 mg versus oxybutynin 73.5 mg (n = 302; one RCT): significant changes in overall AEs (OR 0.02, 95% CI 0.00-0.16), favouring mirabegron 50 mg. CONCLUSIONS AND CLINICAL IMPLICATIONS Mirabegron is effective, safe, and well tolerated. Coadministration with anticholinergics provides an advantageous additive effect without a higher occurrence of side effects. PATIENT SUMMARY Mirabegron is effective, safe, and well tolerated for treating overactive bladder. When used in conjunction with anticholinergic medications, it provides extra benefits without causing more side effects.
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Affiliation(s)
- Anirban Dey
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Georgios Georgiadis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | | | - Yuhong Yuan
- Department of Medicine, London Health Science Centre, London, Ontario, Canada
| | - Fawzy Farag
- Department of Urology, Sohag University Hospital, Sohag, Egypt
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Muhammad Imran Omar
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Guidelines Office, European Association of Urology, Arnhem, The Netherlands.
| | - Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
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22
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Zhang D, Zhou M, Zhang M, Zhang Y, Wu D, Weng R, Tang M, Munemo ZPR, Zhang H. Development and external validation of clinical predictive model for stress urinary incontinence in Chinese women : a multicenter retrospective study. BMC Womens Health 2024; 24:532. [PMID: 39334141 PMCID: PMC11430263 DOI: 10.1186/s12905-024-03363-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Accepted: 09/06/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Stress urinary incontinence (SUI), the prevalent form of urinary incontinence, significantly impairs women's quality of life. This study aims to create a visual nomogram to estimate the risk of SUI within one year postpartum for early intervention in high-risk Chinese women. METHODS We recruited 1,531 postpartum women who gave birth at two hospitals in Kunshan City from 2021 to 2022. Delivery details were meticulously extracted from the hospitals' medical records system, while one-year postpartum follow-ups were conducted via phone surveys specifically designed to ascertain SUI status. Utilizing data from one hospital as the training set, logistic regression analysis was performed to pinpoint significant factors and subsequently construct the nomogram. To ensure robustness, an independent dataset sourced from the second hospital served as the external validation cohort. The model's performance was rigorously evaluated using calibration plots, ROC curves, AUC values, and DCA curves. RESULTS The study population was 1,125 women. The SUI incidence within one year postpartum was 26% (293/1125). According to the regression analysis, height, pre-pregnancy BMI, method of induction, mode of delivery, perineal condition, neonatal weight, SUI during pregnancy, and SUI during the first pregnancy were incorporated into the nomogram. The AUC of the nomogram was 0.829 (95% CI 0.790-0.867), and the external validation set was 0.746 (95% CI 0.689-0.804). Subgroup analysis based on parity showed good discrimination. The calibration curve indicated concordance. The DCA curve showed a significant net benefit. CONCLUSION Drawing from real-world data, we have successfully developed an SUI predictive model tailored for postpartum Chinese women. Upon successful external validation, this model holds immense potential as an effective screening tool for SUI, enabling timely interventions and ultimately may improve women's quality of life.
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Affiliation(s)
- Dan Zhang
- Department of Obstetrics and Gynecology, Dianshan Lake People's Hospital of Kunshan, No.1288 Xinle Road, Kunshan, Jiangsu, 215300, China
| | - Min Zhou
- Department of Urology, Dianshan Lake People's Hospital of Kunshan, No.1288 Xinle Road, Kunshan, Jiangsu, 215300, China
| | - Mingya Zhang
- State key Laboratory for Novel Software Technology, Nanjing University, No. 163 Xianlin Road,Qixia District, Nanjing, Jiangsu, 210029, China
| | - Youfang Zhang
- Department of Obstetrics and Gynecology, Bacheng People's Hospital of Kunshan, No.2139 Zhuchongzhi Road, Kunshan, Jiangsu, 215300, China
| | - Donghui Wu
- Department of Obstetrics and Gynecology, Dianshan Lake People's Hospital of Kunshan, No.1288 Xinle Road, Kunshan, Jiangsu, 215300, China
| | - Ruijuan Weng
- Department of Obstetrics and Gynecology, Bacheng People's Hospital of Kunshan, No.2139 Zhuchongzhi Road, Kunshan, Jiangsu, 215300, China
| | - Min Tang
- Department of Urology, the First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Zvikomborero Panashe Rejoice Munemo
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Hongxiu Zhang
- Department of Obstetrics and Gynecology, the First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
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Minagawa T. Recent developments in diagnostic ultrasound for lower urinary tract function. J Med Ultrason (2001) 2024:10.1007/s10396-024-01494-0. [PMID: 39327335 DOI: 10.1007/s10396-024-01494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 08/05/2024] [Indexed: 09/28/2024]
Abstract
Ultrasonography (US) is an essential tool in the clinical management of lower urinary tract dysfunction (LUTD), including lower urinary tract symptoms, overactive bladder, and benign prostatic hyperplasia, in which prostatic volume and post-void residual volume are routinely used to evaluate the pathophysiological characteristics of afflicted patients. US can also be employed to diagnose hydronephrosis and bladder calculus as complications of severe LUTD. Moreover, US is essential for identifying pathophysiological characteristics and surgical indications, predicting disease development and drug efficacy, and monitoring bladder function improvement by means of such parameters as bladder wall thickness, prostatic urethral length, intravesical prostatic protrusion, and prostatic urethral angulation/angle. Herein, I narratively review the recent advances in US approaches for the management of LUTD, especially in adult males.
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Affiliation(s)
- Tomonori Minagawa
- Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
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24
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Xu G, Dai G, Huang Z, Guan Q, Du C, Xu X. The Etiology and Pathogenesis of Benign Prostatic Hyperplasia: The Roles of Sex Hormones and Anatomy. Res Rep Urol 2024; 16:205-214. [PMID: 39345801 PMCID: PMC11430843 DOI: 10.2147/rru.s477396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 09/09/2024] [Indexed: 10/01/2024] Open
Abstract
Benign prostatic hyperplasia (BPH) mainly causes lower urinary tract symptoms in ageing men, but its exact etiology and pathogenesis have not been established. The objective of this review was to design an update on the advances of human BPH research. We undertook a literature search for identifying studies of the roles of sex hormones (androgens and estrogens) in the onset and development of human BPH using the Pubmed database. In literature, many studies have indicated that ageing and obesity are the factors for preceding the onset of BPH. No evidence for the role of testosterone (T) or dihydrotestosterone (DHT) is found in BPH initiation. Since BPH exclusively occurs in the transitional zone (TZ) surrounding the urethra, it is postulated that years of exposure to uncharacterized urinary toxins could disrupt the homeostasis of the stroma and/or epithelium of this prostatic zone that are typically occurring in ageing men. After cellular damage and subsequent inflammation generated, the intraprostatic DHT produced mainly from T by 5α-reductase promotes BPH development. Further, estrogens could take part in the nodular proliferation of stromal cells in some BPH patients. The confounding of BPH may attenuate the development of prostate tumor in the TZ. In conclusion, evidence in literature suggests that androgens are not etiological factors for BPH, and intraprostatic DHT along with chronic inflammation are mainly responsible for nodular proliferation of stromal and/or epithelial cells in prostatic TZ. The urinary factors for the etiology of BPH and BPH as a prediction of PCa progression still need further investigation.
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Affiliation(s)
- Ganzhe Xu
- Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
| | - Guoyu Dai
- Department of Biomedical Engineering, Guoke Ningbo Life Science and Health Industry Research Institute, Ningbo, Zhejiang, People’s Republic of China
| | - Zhongli Huang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Qiunong Guan
- Department of Biomedical Engineering, Guoke Ningbo Life Science and Health Industry Research Institute, Ningbo, Zhejiang, People’s Republic of China
| | - Caigan Du
- Department of Biomedical Engineering, Guoke Ningbo Life Science and Health Industry Research Institute, Ningbo, Zhejiang, People’s Republic of China
| | - Xiaoming Xu
- Department of Urology, Ningbo No. 2 Hospital, Ningbo, Zhejiang, People’s Republic of China
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25
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Li M, Zhang J, Ding J, Gao Z. Association between dietary mineral intakes and urine flow rate: data from the 2009-2018 National Health and Nutrition Examination Survey. Front Nutr 2024; 11:1424651. [PMID: 39360285 PMCID: PMC11444966 DOI: 10.3389/fnut.2024.1424651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 09/09/2024] [Indexed: 10/04/2024] Open
Abstract
Background Minerals play an important role in human health, but their effect on urinary function remains controversial. The aim of this study was to assess the association between dietary intake of minerals (Ca, P, Mg, Fe, Zn, Cu, Na, K, Se) and urine flow rate (UFR). Methods We conducted a cross-sectional study using the National Health and Nutrition Examination Survey (NHANES, 2009-2018) database. Multivariate regression and smooth curve fitting were used to investigate the association between dietary mineral intakes and UFR. Subgroup analyses and interaction tests were used to investigate whether this association was stable in the population. Results Our study involving 10,229 representative adult NHANES participants showed an association between Mg intake and UFR in a linear regression model for continuous variables. And in the model analysis of tertile categorical variables, we observed a positive association between six mineral intakes (Ca, Mg, Zn, Cu, Na, and K) and UFR. Smoothed curve fitting and threshold effect analysis further support the nonlinear relationship between mineral intakes and UFR. Subgroup analyses and interaction tests ensured the reliability and robustness of the findings. Conclusion This study examined the effects of nine dietary minerals on UFR and found that intake of Ca, Mg, Zn, Cu, Na, and K were positively correlated with UFR, suggesting that these minerals may have a positive effect on improving urinary function. In particular, Mg showed a more significant positive correlation with UFR in women, while Na showed a stronger positive correlation in diabetics. However, P, Fe and Se did not show significant correlations. In summary, although these findings provide a preliminary understanding of the relationship between dietary minerals and urinary function, further prospective studies are still necessary to validate these relationships and explore the physiologic mechanisms underlying them.
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Affiliation(s)
- Ming Li
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jiqian Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jiasen Ding
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhan Gao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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26
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Hao X, Liu G, Li D. Association of healthy eating index-2015 and overactive bladder: a cross-sectional study. Front Nutr 2024; 11:1400398. [PMID: 39355559 PMCID: PMC11442424 DOI: 10.3389/fnut.2024.1400398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 09/09/2024] [Indexed: 10/03/2024] Open
Abstract
Objective The aim of this cross-sectional study was to investigate the association of HEI-2015 and overactive bladder (OAB) in a large population. Methods Data were retrieved from the National Health and Nutrition Examination Survey (NHANES) 2005-2020 datasets. Univariate and multivariate logistic regression were performed to evaluate the association between HEI-2015 and OAB. The restricted cubic spline (RCS) model was conducted to investigate the dose-response relationship. Results Totally, this study included 29,206 participants with 6,184 OAB patients among them. The higher continuous HEI-2015 value was independently associated with lower OAB incidence (OR: 0.87; 95%CI: 0.78, 0.98). Similarly, the highest quartile categorical HEI-2015 was significantly associated with a lower OAB odds (OR: 0.72; 95%CI: 0.52, 0.99) when compared with the lowest quartile. The RCS curve also showed a favorable non-linear dose-response relationship between HEI-2015 and OAB. Conclusion A higher HEI-2015 had a favorable association with OAB and there was a non-linear dose-response relationship between them. We suggest adherence to the United States diet recommendation as a potential behavioral prevention of OAB. Large-scale long term prospective cohort studies across various regions are needed to verify the findings of this paper.
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Affiliation(s)
- Xuanyu Hao
- Department of Gastroenterology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Gang Liu
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Dongyang Li
- Department of Urology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
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27
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Amous Y, Isefan S, Hamarsheh K, Hijaz H, Amer R, Shawahna R. Lower urinary tract symptoms among normal-weight, overweight, and obese palestinians: a study of prevalence and impact on the quality of life. BMC Urol 2024; 24:199. [PMID: 39272085 PMCID: PMC11396118 DOI: 10.1186/s12894-024-01587-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 09/03/2024] [Indexed: 09/15/2024] Open
Abstract
BACKGROUND This study was conducted to assess the prevalence of lower urinary tract symptoms (LUTS) among non-obese and obese Palestinians. The study also aimed to assess the effects of LUTS on the quality of life of obese and non-obese Palestinians. METHODS This was a cross-sectional study that was conducted among normal-weight, overweight, and obese Palestinians using the King Health Questionnaire. The data collected from participants were entered and analyzed using SPSS (version 22). RESULTS In this study, data were collected from 378 participants. The median age of the participants was 42.0 [30.0, 55.0] years, and the median body mass index was 27.1 [24.0, 30.8] kg/m2. Of the participants, 149 (39.4%) were overweight and 112 (29.6%) were obese. The prevalence of urinary hesitancy, incomplete emptying, urgency, nocturia, urgency, urge incontinence, stress incontinence, nocturnal enuresis, intercourse incontinence, bladder pain, number of urinations/24 h, and number of urinations/night was significantly higher among obese participants. Similarly, role limitations, physical/social limitation, personal relationships, emotions, and sleep/energy were affected significantly higher in obese compared to nonobese participants. CONCLUSION Higher prevalence of LUTS among obese patients compared to nonobese patients was observed among the Palestinians. Obese patients reported significantly higher deterioration of the quality of life as a result of LUTS compared to nonobese patients. Urologists, nutritionists, public health specialists, and other healthcare providers should consider measures to reduce LUTS among obese patients and improve their quality of life.
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Affiliation(s)
- Yazeed Amous
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Sabreen Isefan
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Kholoud Hamarsheh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Hatim Hijaz
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
- An-Najah National University Hospital, Nablus, Palestine.
| | - Riad Amer
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- An-Najah National University Hospital, Nablus, Palestine
| | - Ramzi Shawahna
- Department of Physiology, Pharmacology, and Toxicology, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, Palestine.
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Rickey LM, Mueller ER, Newman DK, Markland AD, Falke C, Rudser K, Smith AL, Mueller MG, Lowder JL, Lukacz ES. Reliability of Uroflowmetry Pattern Interpretation in Adult Women. Neurourol Urodyn 2024. [PMID: 39264028 DOI: 10.1002/nau.25584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/03/2024] [Accepted: 08/10/2024] [Indexed: 09/13/2024]
Abstract
INTRODUCTION Uroflowmetry is often used to assess lower urinary tract symptoms (LUTS). Criteria for characterization of flow patterns are not well established, and subjective interpretation is the most common approach for flow curve classification. We assessed the reliability of uroflowmetry curve interpretation in adult women. MATERIALS AND METHODS Uroflowmetry studies were obtained in 296 women who participated in an observational cohort study. Four investigators with expertise in female LUTS and urodynamics reviewed and categorized each tracing for interrater reliability. A random subset of 50 tracings was re-reviewed by each investigator for intrarater reliability. The uroflowmetry tracings were rated using categories of continuous, continuous fluctuating, interrupted, and prolonged. Other parameters included flow rate, voided volume, time to maximum flow, and voiding time. Agreement between raters is summarized with kappa (k) statistics and percentage where at least three raters agreed. RESULTS The mean age of participants was 44.8 ± 18.3 years. Participant age categories were 18-24 years: 20%; 25-34 years: 17%; 35-64 years: 42%; 65+ years: 18%. Nine percent described their race as Asian, 31% Black, 62% White, and 89% were of non-Hispanic ethnicity. The interrater reliability was highest for the continuous flow category (k = 0.65), 0.47 for prolonged, 0.41 for continuous fluctuating, and 0.39 for interrupted flow curves. Agreement among at least three raters occurred in 74.3% of uroflow curves (69% for continuous, 33% for continuous fluctuating, 23% for interrupted, and 25% for prolonged). For intrarater reliability, the mean k was 0.72 with a range of 0.57-0.85. CONCLUSIONS Currently accepted uroflowmetry pattern categories have fair to moderate interrater reliability, which is lower for flow curves that do not meet "continuous" criteria. Given the subjective nature of interpreting uroflowmetry data, more consistent and clear parameters may enhance reliability for use in research and as a screening tool for LUTS and voiding dysfunction. TRIAL REGISTRATION Parent trial: Validation of Bladder Health Instrument for Evaluation in Women (VIEW); ClinicalTrials.gov ID: NCT04016298.
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Affiliation(s)
- Leslie M Rickey
- Department of Urology & Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elizabeth R Mueller
- Department of Obstetrics and Gynecology, Loyola University Chicago, Chicago, Illinois, USA
| | - Diane K Newman
- Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alayne D Markland
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Chloe Falke
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kyle Rudser
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ariana L Smith
- Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Margaret G Mueller
- Department of Obstetrics and Gynecology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Emily S Lukacz
- Division of Female Pelvic Medicine & Reconstructive Surgery, UC San Diego, San Diego, California, USA
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Sokol ER, Tu LM, Thomas SL, Erickson TB, Roovers JPWR. Transvaginal Mesh Versus Native Tissue Repair for Anterior and Apical Pelvic Organ Prolapse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102658. [PMID: 39260621 DOI: 10.1016/j.jogc.2024.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 08/16/2024] [Accepted: 08/18/2024] [Indexed: 09/13/2024]
Abstract
OBJECTIVES This prospective comparative cohort study aims to evaluate the safety and efficacy of transvaginal mesh compared to native tissue repair (NTR) in the surgical correction of anterior and apical compartment pelvic organ prolapse (POP) over a 36-month follow-up period. METHODS Prospective comparative cohort study to prove superiority for efficacy and non-inferiority for serious adverse events (SAEs). The setting was 49 sites across the United States, Canada, Europe, and Australia. Women with bothersome POP symptoms indicated for vaginal surgery with pelvic organ prolapse quantification (POP-Q) scores of Ba ≥0 and C ≥ -1/2 total vaginal length were included. Interventions included vaginal NTR or single-incision transvaginal mesh based on shared decision-making. POP recurrence, the primary efficacy endpoint, was defined as anatomical prolapse beyond the hymenal ring, subjective perception of protrusion or bulge, or retreatment in the target compartment. The primary safety endpoint consisted of the proportion of device and/or procedure-related SAEs in the target compartment. Secondary endpoints included surgical parameters, quality of life, postoperative pain, and sexual function. RESULTS POP recurrence rate at 12 months was 13.1% in the Mesh-arm and 11.5% in the NTR-arm (P = 0.44). The primary safety endpoint was met, with the Mesh-arm demonstrating statistically non-inferior outcomes compared to the NTR-arm in the incidence of device and/or procedure-related SAEs in the target compartment through 12 months (P < 0.01). At 36 months, the surgical POP recurrence rate was 26.7% in the Mesh-arm and 27.0% in the NTR-arm. CONCLUSIONS At 12- and 36-month follow-up, transvaginal mesh was not superior, but non-inferior in terms of efficacy and safety when compared to NTR for patients with combined anterior and apical compartment prolapse.
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Affiliation(s)
- Eric R Sokol
- Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA
| | - Le Mai Tu
- Division of Urology, Department of Surgery, University of Sherbrooke, Sherbrooke, QC
| | - Sherry L Thomas
- Department of Family Medicine, University of Southern California, Los Angeles, CA
| | - Ty B Erickson
- Division of Urogynecology, Kirk Kevorkian School of Medicine, Las Vegas, NV
| | - Jan-Paul W R Roovers
- Amsterdam UMC, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
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Yu WR, Jhang JF, Jiang YH, Kuo HC. The Pathomechanism and Current Treatments for Chronic Interstitial Cystitis and Bladder Pain Syndrome. Biomedicines 2024; 12:2051. [PMID: 39335564 PMCID: PMC11428245 DOI: 10.3390/biomedicines12092051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/14/2024] [Accepted: 09/02/2024] [Indexed: 09/30/2024] Open
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic and debilitating condition characterized by symptoms such as bladder pain, frequent urination, and nocturia. Pain is typically perceived in the lower abdomen, pelvic floor, or urethra, causing significant discomfort and impacting quality of life. Due to the similarity of its symptoms with those of overactive bladder and acute bacterial cystitis, patients often face misdiagnosis and delayed appropriate treatment. Hunner's (HIC) and non-Hunner's IC (NHIC), each with distinct clinical presentations, urothelial dysfunction, chronic inflammation, and central sensitization and thus multimodal symptomatic treatment approaches, may be the most common pathogeneses of IC/BPS. Treatment of IC/BPS should involve identifying the different clinical phenotypes and underlying pathophysiology causing clinical symptoms and developing strategies tailored to the patient's needs. This review discusses the roles of urine biomarkers, bladder inflammation, and glycosaminoglycans in the pathogenesis of IC/BPS. Various bladder treatment modalities are explored, including glycosaminoglycan replenishment, botulinum toxin A injection, platelet-rich plasma injection, low-energy shock waves, immunosuppression, and low-dose oral prednisolone. Pelvic floor muscle physiotherapy and bladder therapy combined with psychiatric consultation can help alleviate psychological stress and enhance the quality of life of patients with IC/BPS. Elucidating the pathological mechanisms and exploring diverse treatment options would help advance the care of individuals suffering from this challenging bladder condition.
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Affiliation(s)
- Wan-Ru Yu
- Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien 970, Taiwan
- Institute of Medical Science, Tzu Chi University, Hualien 970, Taiwan
| | - Jia-Fong Jhang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien 970, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien 970, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, Hualien 970, Taiwan
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Bashi T, Margalioth J, Savin Z, Marom R, Dekalo S, Fahoum I, Naamneh R, Mano R, Yossepowitch O. The Association between Specimen Neuromuscular Characteristics and Urinary Incontinence after Robotic-Assisted Radical Prostatectomy. Diagnostics (Basel) 2024; 14:2001. [PMID: 39335681 PMCID: PMC11431029 DOI: 10.3390/diagnostics14182001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2024] [Revised: 09/03/2024] [Accepted: 09/07/2024] [Indexed: 09/30/2024] Open
Abstract
Urinary incontinence after robotic-assisted radical prostatectomy (RARP) has been associated with older age, a longer operative time, a higher BMI, a short membranous urethral length and preoperative erectile function. The authors sought to assess the association between the neuromuscular characteristics and postoperative urinary incontinence. METHODS RARP specimens from 29 men who underwent bilateral nerve sparing were reanalyzed. Urinary incontinence was evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) at 6 weeks post surgery and last follow-up. Linear and logistic regression analyses were performed to assess neuromuscular characteristics and incontinence. RESULTS At the 1-year follow-up, 11 patients (38%) reported severe incontinence (>12 ICIQ-SF score). The median number of peripheral nerves observed at the base and apex in the specimens was 52 (IQR 13-139) and 59 (IQR: 28-129), respectively. Ganglia were present in 19 patients (65%) at the base and 12 patients (41%) at the apex. Additionally, the median proportional area of detrusor smooth muscle fibers at the base was 0.54 (IQR 0.31-1), while the median proportional area of striated muscle fibers at the apex was 0.13 (IQR 0.08-0.24). No statistically significant associations were found. CONCLUSIONS Histologic neuromuscular characteristics were not associated with postoperative urinary incontinence. Enhanced intraoperative evaluation and larger-scale studies may prove useful for the prediction of postprostatectomy incontinence.
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Affiliation(s)
- Tomer Bashi
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Jonathan Margalioth
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Ziv Savin
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Ron Marom
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Snir Dekalo
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Ibrahim Fahoum
- Pathology Department, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Rabab Naamneh
- Pathology Department, Rabin Medical Center, Petah Tikva 4941492, Israel
| | - Roy Mano
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
| | - Ofer Yossepowitch
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel
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Alves BB, Gabrich P, Favorito LA. Prospective results of the minimally invasive laser enucleation of the prostate (MiLEP). Prostate 2024. [PMID: 39245857 DOI: 10.1002/pros.24790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 08/16/2024] [Accepted: 08/28/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND The objective of the present study is to prospectively analyze the prostate enucleation procedure with Holmium Laser using the minimally invasive technique (MiLEP), comparing the outcomes and their variables pre- and postoperatively. METHODS We studied men aged 40 years or over, with prostate volumes greater than or equal to 35 cm³ with lower urinary tract symptoms due to BPH. We performed flowmetry and administered the IPSS questionnaire before and 6 months after the MiLEP procedure. The patients were operated on with a 60 W Holmium Laser (Cyber-Ho Quanta System®) using 54 W of power (energy 1.8 J and frequency of 30 Hz). Enucleation was performed using the en bloc technique with early sphincter release. After enucleation, the tissue was morcellated using a 22 Fr morcescope (RZ-Medizintechnik GmbH, Tuttlingen, Germany) and Piranha (Richard Wolf) morcellator. The final Hemostasis after morcelation was made using laser with 30wW power, energy at 1,0 joules and frequency at 30 Hertz. Student's T test and Man-Whitney was used to statistical analysis (p < 0.05). RESULTS After selection we submitted 73 patients (mean age= 68.2 years) to MiLEP procedure with a follow up of 6 months. The prostate volume presented an average of 94.53 cm³ (65 to 112 cm³, SD = 5.363) preoperatively. The urinary continence rate after the procedure was greater than 95% after 1 week and 99% in the 1st month. All patients were continent after 6 months. The IPSS questionnaire before (mean = 21.18 points/SD = 6.557) and after (mean = 7.92 points/SD = 2.408) the MiLEP had statistical significance (p < 0.001). The flowmetry(ml/s) before (9.02/SD = 2.842) and after (21.07/SD = 6.228) the MiLEP had statistical significance (p < 0.001). The average time of the procedure was 78.5 min and the bladder catheter was removed after 18 h in mean. In 4 patients (5.8%) we observed hematuria and in 1 case (1.47%) the patient needs urinary catheterization. CONCLUSION MiLEP is a safe and effective procedure, with significant improvement in urinary flow and symptoms in the short term. Although the results of this study were satisfactory and the urinary incontinence rate was lower compared to HoLEP data found in the literature, multicenter studies with longer follow-up are needed to confirm these findings.
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Affiliation(s)
- Breno Barros Alves
- Urogenital Research Unit of the Department of Anatomy of State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | - Pedro Gabrich
- Urogenital Research Unit of the Department of Anatomy of State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
| | - Luciano A Favorito
- Urogenital Research Unit of the Department of Anatomy of State University of Rio de Janeiro - UERJ, Rio de Janeiro, Brazil
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Yang D, Sun Q, Li W, Wang Y, Qian H, Li D. Efficiency of HoLEP in patients with detrusor underactivity and renal dysfunction secondary to BPO. World J Urol 2024; 42:509. [PMID: 39240342 PMCID: PMC11379783 DOI: 10.1007/s00345-024-05208-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 08/05/2024] [Indexed: 09/07/2024] Open
Abstract
PURPOSE The purpose of this study was to assess the bladder and renal functional outcomes of holmium laser enucleation of the prostate (HoLEP) in patients with benign prostatic obstruction (BPO) complicated by detrusor underactivity (DU) and secondary renal dysfunction. METHODS Thirty-one patients were included in this prospective study. Eligible patients had urinary retention, a bladder outlet obstruction index (BOOI) greater than 40, a bladder contractility index (BCI) less than 100, abnormal renal function at the initial diagnosis (serum creatinine > 132 µmol/L) and a renal pelvis anteroposterior diameter (PRAPD) > 1.5 cm bilaterally. All patients underwent HoLEP in a routine manner and were evaluated preoperatively and at 1, 3 and 6 months after surgery. The baseline characteristics of the patients, perioperative data, postoperative outcomes and complications were assessed. RESULTS Significant improvement was observed in the international prostate symptom score (IPSS), quality of life (QoL) score, maximal urinary flow rate (Qmax), post-void residual volume (PVR), Scr and RPAPD at the 6-month follow-up. Bladder wall thickness (BWT) exhibited a decreasing trend but did not significantly differ from the preoperative values. No grade 3 or higher adverse events occurred, and grade 3 and lower complications were treated conservatively. Three patients required reinsertion of indwelling catheters, and they were able to void spontaneously after two weeks of catheterisation training and medication treatment. CONCLUSION HoLEP is an effective treatment for men with BPO accompanied by DU and consequent renal function impairment. Patients are able to regain spontaneous voiding. Both bladder and renal functions were preserved and improved.
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Affiliation(s)
- Dengke Yang
- Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Rd, Shanghai, China
| | - Qian Sun
- Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Rd, Shanghai, China
| | - Weiyuan Li
- Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Rd, Shanghai, China
| | - Yibin Wang
- Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Rd, Shanghai, China
| | - Haining Qian
- Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Rd, Shanghai, China
| | - Dong Li
- Department of Urology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, No. 1111 Xianxia Rd, Shanghai, China.
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Li C, Li K. Effect of pelvic floor muscle exercise combined with infrared physiotherapy on postpartum urinary incontinence. Technol Health Care 2024:THC240831. [PMID: 39302396 DOI: 10.3233/thc-240831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
BACKGROUND Scientific treatments for postpartum urinary incontinence, including pelvic floor muscle exercises (such as Kegel exercises) and infrared therapy, can effectively improve pelvic floor and urethral function, thus enhancing quality of life. However, clinical research on the combined use of these interventions for postpartum urinary incontinence is limited. OBJECTIVE To investigate the combining efficacy of pelvic floor muscle exercises with infrared physiotherapy on postpartum urinary incontinence. METHODS Clinical information of 102 patients with postpartum urinary incontinence (June 2021-June 2022) were collected and analyzed. Patients were randomly divided into control (conventional intervention) and observation (pelvic floor muscle exercises combined with infrared physiotherapy) groups, with 52 and 50 cases respectively. We compared pelvic floor muscle strength, urodynamic indicators, leakage volume, quality of life, and overall clinical efficacy between the two groups. RESULTS Before intervention, both groups had similar pelvic floor function scores and urodynamic indicators. Post-intervention, the pelvic floor function scores in the observation group were significantly lower than control. The urodynamic indicator levels of the observation group were markedly higher than control after 2 months of intervention. Leakage volume was similar before intervention, while the observation group had significantly lower volumes after 1 and 2 months of intervention. Quality of life scores were similar initially, but after 2 months, the observation group scored higher. The observation group showed notably better pelvic floor rehabilitation at 2 months post-intervention. CONCLUSION Combining pelvic floor muscle exercise with infrared physiotherapy has been shown to be a highly effective approach in enhancing pelvic floor muscle strength and improving the quality of life for postpartum women experiencing urinary incontinence. This combined therapy also demonstrates positive effects on urodynamic indicators, reducing leakage volume, and facilitating pelvic floor rehabilitation.
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Yang CC, Jiang YH, Kuo HC. Predictive Factors for the Successful Outcome of Urethral Sphincter Injections of Botulinum Toxin A for Non-Neurogenic Dysfunctional Voiding in Women. Toxins (Basel) 2024; 16:386. [PMID: 39330844 PMCID: PMC11435777 DOI: 10.3390/toxins16090386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 08/25/2024] [Accepted: 08/27/2024] [Indexed: 09/28/2024] Open
Abstract
PURPOSE Dysfunctional voiding (DV) is not uncommon in women with non-neurogenic voiding dysfunction. Because of its unknown pathophysiology, effective and durable treatment is lacking. This study aimed to analyze the results of treatment and predictive factors for a successful outcome of botulinum toxin A (BoNT-A) treatment in female patients with DV. METHODS In total, 66 women with DV confirmed by a videourodynamic study (VUDS) were treated with a BoNT-A injection into the urethral sphincter once (n = 33) or several times (n = 33). VUDS was performed before (baseline) and after the BoNT-A treatment. Patients with a global response assessment of the voiding condition of 2 or 3 and a voiding efficiency (VE) of >20% than baseline were considered to have a successful outcome. The baseline demographics, VUDS parameters, and VUDS DV subtypes were compared between the successful and failed groups. Predictive factors for a successful outcome were investigated by logistic regression analyses. RESULTS Successful and failed outcomes were achieved in 27 (40.9%) and 39 (59.1%) women, respectively. After BoNT-A injections, the maximum flow rate (Qmax), voided volume, and VE all significantly increased, and the postvoid residual (PVR) was slightly improved. No significant difference in the number of injections and medical comorbidity was found between the groups. However, the successful group had a higher incidence of previous pelvic surgery. No significant difference in the treatment outcome was found among patients with different urethral obstruction sites. Significant improvements in Qmax, voided volume, PVR, VE, and the bladder outlet obstruction (BOO) index were noted in the successful group. A lower VE at baseline and a history of surgery were identified as predictive factors for a successful outcome of BoNT-A injections for treating DV. CONCLUSION BoNT-A injections into the urethral sphincter can effectively improve VE in 40.9% of women with DV. Women with higher BOO grades and previous pelvic surgery are predicted to have a successful treatment outcome.
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Affiliation(s)
| | | | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien 970, Taiwan; (C.-C.Y.); (Y.-H.J.)
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Hui Z, Zewu Z, Yang L, Yu C. Association between weight-adjusted waist index and overactive bladder: a cross-sectional study based on 2009-2018 NHANES. Front Nutr 2024; 11:1423148. [PMID: 39296511 PMCID: PMC11408301 DOI: 10.3389/fnut.2024.1423148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 08/19/2024] [Indexed: 09/21/2024] Open
Abstract
Background The weight-adjusted waist index (WWI) is a novel obesity indicator that appears to outperform the body mass index (BMI) and waist circumference (WC) in assessing both overweight and obesity. Studies have demonstrated the relationship between obesity and overactive bladder (OAB). The purpose of this study is to examine the correlation between WWI and OAB. Methods This research utilizes data from the National Health and Nutrition Examination Survey (NHANES) collected between 2009 and 2018. Each participant's WWI was calculated as their WC in centimeters by the square root of weight in kilograms. The Overactive Bladder Symptom Score (OABSS) questionnaire is used to determine whether a participant has OAB. Multivariate logistic regression and generalized additive model analysis were employed to investigate the relationship between WWI and OAB. We used smoothing curve fitting to explore non-linear relationships. Additionally, subgroup analysis and interaction tests are conducted. Results In this cross-sectional study involving 35,950 subjects, we found that individuals with a higher WWI have a higher risk of OAB (OR = 1.41, 95% CI: 1.02-1.74). Subgroup analysis and interaction testing showed that the relationship between WWI and OAB is consistent across various population characteristics. Smoothing curve fitting reveals a positive non-linear relationship between WWI and OAB. Furthermore, the association between WWI and OAB is stronger than that of other obesity-related indicators. Conclusion Weight-adjusted waist index may be able to predict the incidence of OAB and that WWI-based obesity management may help to reduce the risk of OAB.
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Affiliation(s)
- Zeng Hui
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhu Zewu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li Yang
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Cui Yu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
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Piao J, Shin D, Moon M, Kim S, Bae W. Effectiveness of Electrical Stimulation Combined with Pelvic Floor Muscle Training on Female Sexual Dysfunction with Overactive Bladder: A Randomized Controlled Clinical Trial. J Pers Med 2024; 14:938. [PMID: 39338192 PMCID: PMC11432904 DOI: 10.3390/jpm14090938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Revised: 08/02/2024] [Accepted: 08/27/2024] [Indexed: 09/30/2024] Open
Abstract
(1) Background: Female sexual dysfunction (FSD) and overactive bladder (OAB) are prevalent disorders that significantly impair women's quality of life. While pelvic floor muscle training (PFMT) is a well-established treatment for OAB, its effectiveness for FSD remains uncertain. Recent studies suggest that intravaginal electrical stimulation (IVES) may enhance the effects of PFMT. Therefore, this study aimed to evaluate the efficacy of combining IVES with PFMT to improve sexual function and bladder control in women with OAB and FSD. (2) Methods: A total of 40 women with FSD and OAB as determined by the Female Sexual Function Index (FSFI) and Overactive Bladder Symptom Score (OABSS) were randomized into two groups: group 1, the intravaginal electrical stimulation group (IVESG) (n = 20), and group 2, the placebo control group (CG) (n = 20). Patients in both groups received PFMT during the trial, and the IVESG underwent 10 weeks of electrical stimulation. The primary outcome was the change in the FSFI score from baseline to week 4 and week 10. The secondary outcome was a comparison of the OABSS values at week 4 and week 10 of the trial. (3) Results: After treatment, the IVESG scores for the total FSFI, sexual arousal and orgasm, increased significantly (p < 0.05). After 10 weeks of treatment, the OABSS values for IVESG were significantly lower (p < 0.01). After 10 weeks of treatment, the percentage of patients with mild OAB in the IVESG and CG increased by 53.33% and 60%, respectively, while the percentage of patients with both moderate and severe OAB decreased, especially in the IVESG, where patients with severe OAB were non-existent after 10 weeks of treatment. (4) Conclusions: IVES combined with PFMT improved objective and subjective measures of FSD and OAB. There was a significant improvement in FSD (including arousal and orgasmic domain scores). This study concludes that IVES is an effective conservative treatment.
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Affiliation(s)
- JunJie Piao
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul 03083, Republic of Korea; (J.P.); (D.S.); (S.K.)
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Dongho Shin
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul 03083, Republic of Korea; (J.P.); (D.S.); (S.K.)
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - MyeongKeon Moon
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - SaeWoong Kim
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul 03083, Republic of Korea; (J.P.); (D.S.); (S.K.)
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Green Medicine Co., Ltd., Busan 48307, Republic of Korea
- China-Korea Joint Research Center for Male Reproductive and Sexual Medicine, Institute of Urology, Tianjin Medical University, Tianjin 301700, China
| | - WoongJin Bae
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul 03083, Republic of Korea; (J.P.); (D.S.); (S.K.)
- Catholic Integrative Medicine Research Institute, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Green Medicine Co., Ltd., Busan 48307, Republic of Korea
- China-Korea Joint Research Center for Male Reproductive and Sexual Medicine, Institute of Urology, Tianjin Medical University, Tianjin 301700, China
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Hawks-Ladds N, Cook R, Babar M, Zhu M, Schulz A, Loloi J, Masoud Z, Singh J, Jamil H, Sayed R, Ines M, Ciatto M. Four years of real-world sexual function outcomes after Rezum therapy in men with and without baseline erectile dysfunction. J Sex Med 2024; 21:777-786. [PMID: 39084676 DOI: 10.1093/jsxmed/qdae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 05/28/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Rezum alleviates lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH) while preserving sexual function, but long-term sexual function outcomes are lacking in patients with baseline erectile dysfunction (ED). AIM The study sought to analyze 4 years of real-world sexual function outcomes of Rezum using the International Index of Erectile Function (IIEF) questionnaire, stratified by baseline ED status. METHODS Participants included multiethnic Rezum-treated patients from a single outpatient office. IIEF domains and BPH medication usage were compared at baseline and 6, 12, and 48 months using t tests, Mann-Whitney U tests, chi-square tests, and Wilcoxon signed rank tests. OUTCOMES Primary outcomes over 4 years included the IIEF functional domains (erectile function [EF], orgasmic function [OF], sexual desire [SD], intercourse satisfaction [IS], overall satisfaction [OS]) and BPH medication usage. RESULTS A total of 91 patients were included: 40 (44%) in the ED cohort and 51 (56%) in the no ED cohort. History of diabetes was more prevalent in the ED cohort (35% vs 15.7%; P = .048). Baseline scores in the EF, OF, IS, and OS domains were lower in the ED cohort. Compared with baseline, there were no significant changes in any IIEF domains in either cohort at 6 months. At 12 months, the ED cohort had significant percent decreases in OF (-25%; P = .02), SD (-22.2%; P = .04), and OS (-33.3%; P = .004); the no ED cohort had a significant percent increase in EF (5%; P = .04). At 48 months, the no ED cohort had no significant changes in any IIEF domains, while the ED cohort had significant percent increases in EF (30%; P = .01), SD (22.5%; P = .02), IS (20%; P = .01), and OS (58.3%; P = .008). Both cohorts significantly discontinued BPH medications at all follow-ups. At 48 months, there were no cases of de novo ED in the no ED cohort. CLINICAL IMPLICATIONS As modern BPH therapies continue to demonstrate efficacy in alleviating lower urinary tract symptoms, the preservation or improvement of sexual function emerges as an increasingly important consideration for patients, with our study suggesting Rezum as a compelling option. STRENGTHS AND LIMITATIONS Our study has the strength of long-term Rezum outcomes in an ethnically diverse patient population, stratified by the presence of baseline ED, but is limited by retrospective design, single-center nature, and small sample sizes at long-term follow-ups. CONCLUSION Rezum preserved long-term sexual function in patients without baseline ED and improved sexual function in those with baseline ED; however, individuals with ED may experience temporary decreases in sexual function at 12 months.
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Affiliation(s)
- Noah Hawks-Ladds
- Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Ryan Cook
- Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Mustufa Babar
- Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Michael Zhu
- Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Alison Schulz
- Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Justin Loloi
- Department of Urology, Montefiore Medical Center, Bronx, NY 10467, United States
| | - Zaki Masoud
- Department of Medicine, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, United States
| | | | - Hasan Jamil
- School of Public Health, St. Luke International University, Tokyo 104-8560, Japan
| | - Rahman Sayed
- Albert Einstein College of Medicine, Bronx, NY 10461, United States
| | - Matthew Ines
- DSS Urology, Queens Village, NY 11427, United States
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Neri DA, Venturini BA, Massuqueto E, Estevam de Abreu G, Portugal MM, Costa J, Velame Souza Santos MK, de Araújo Rosier C, Monteiro G, Barroso U. Agreement between two uroflowmetry tests in children with lower urinary tract symptoms. J Pediatr Urol 2024:S1477-5131(24)00450-9. [PMID: 39358126 DOI: 10.1016/j.jpurol.2024.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 08/26/2024] [Accepted: 08/31/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Uroflowmetry is a non-invasive examination considered as a first-line assessment for children with lower urinary tract symptoms (LUTS). Currently, the performance of two uroflowmetry tests is recommended by ICCS for all patients with LUTS. This study aims to evaluate the differences between two uroflowmetry tests in children with lower urinary tract symptoms and their impact on the patient's diagnostic workup and clinical outcome. METHODS Forty patients with LUTS, aged 4-17 years, were evaluated prospectively with two consecutive uroflowmetry tests and ultrasonography. They were classified based on the ICCS criteria for curve pattern and divided into two groups based on the SPU classification of fractionated (staccato and intermittent) and smooth (bell, tower and plateau). They were also separated into three groups based on estimated bladder capacity (voided volume + post-void residual on ultrasound): high (>115%), low (<60%) or normal capacity. RESULTS The mean age was 8 (IQR 6.0-10.0) years and 25 (62.5%) patients were female. There was an increase in nonbell-shaped curves from the first (32.5%) to the second test (52.5%). The curve shape between the uroflowmetries based on ICCS classification showed a Kappa value of 0.349 (fair). Classifying curves as fractionated or smooth yielded a Kappa value of 0.714 (substantial) (table). The Bland-Altman test showed disagreement in the parameter of time to Qmax. There was a significant difference in categorizing bladder capacity as high, low, or normal: it was concordant in 63.6% for high, 68.4% for normal and 50% for low capacity (p = 0.001). DISCUSSION Despite the disagreement found classifying the curves based on the ICCS pattern, also demonstrated in other studies, there was a substantial agreement using the SPU criteria. It reinforces the greater reliability of the SPU system and it may be the key to reduce the subjectivity of uroflowmetry. Even though this classification being associated with a higher agreement in interpretation of the curves, repeating uroflowmetry does not present a clinically significant divergence that changes the patient's diagnostic workup. Our study is limited by the lack of EMG and larger sample. CONCLUSION Considering the flow curve pattern, the agreement between two uroflowmetries was substantial according to the SPU and only reasonable by the ICCS classification. Regardless of some differences found between the flows, a second uroflowmetry test might not have clinical relevance that justifies its recommendation for all patients.
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Affiliation(s)
| | | | - Eliakim Massuqueto
- Center for Childhood Urinary Disorders (CEDIMI), Salvador, Bahia, Brazil
| | | | | | - Juliana Costa
- Center for Childhood Urinary Disorders (CEDIMI), Salvador, Bahia, Brazil
| | | | | | - Gabriel Monteiro
- Center for Childhood Urinary Disorders (CEDIMI), Salvador, Bahia, Brazil
| | - Ubirajara Barroso
- Center for Childhood Urinary Disorders (CEDIMI), Salvador, Bahia, Brazil.
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Silvinato A, Floriano I, Bernardo WM. Photoselective vaporization with green laser versus monopolar transurethral resection for benign prostatic hyperplasia. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024D708. [PMID: 39230154 PMCID: PMC11370748 DOI: 10.1590/1806-9282.2024d708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 06/12/2024] [Indexed: 09/05/2024]
Affiliation(s)
- Antonio Silvinato
- Brazilian Medical Association, Evidence-Based Medicine – São Paulo (SP), Brazil
| | - Idevaldo Floriano
- Brazilian Medical Association, Evidence-Based Medicine – São Paulo (SP), Brazil
| | - Wanderley Marques Bernardo
- Brazilian Medical Association, Evidence-Based Medicine – São Paulo (SP), Brazil
- Universidade de São Paulo, Faculty of Medicine – São Paulo (SP), Brazil
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Clark S, Johnson T, Runkel K, Wallace J. Update on Therapies in Older Adults. Med Clin North Am 2024; 108:895-910. [PMID: 39084840 DOI: 10.1016/j.mcna.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Memory loss and dementia are among older adults' greatest health fears. This article provides insight into new developments to help delay the onset of dementia, to treat dementia in its earliest stages, and to manage behavioral problems that occur in persons with dementia. Urinary incontinence (UI) is another common problem in older adults that has a major impact on quality of life. This article evaluates newer medications for reducing urinary urge/UI and provides perspective in their role for managing UI.
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Affiliation(s)
- Sophie Clark
- Division of Geriatric Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Box B179, Aurora, CO 80045, USA
| | - Thomas Johnson
- Division of Geriatric Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Box B179, Aurora, CO 80045, USA. https://twitter.com/TMJohnsonMD
| | - Katherine Runkel
- Division of Geriatric Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Box B179, Aurora, CO 80045, USA
| | - Jeffrey Wallace
- Division of Geriatric Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Box B179, Aurora, CO 80045, USA.
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Baboudjian M, Hashim H, Bhatt N, Creta M, De Nunzio C, Gacci M, Herrmann T, Karavitakis M, Malde S, Moris L, Netsch C, Rieken M, Sakalis V, Schouten N, Tutolo M, Cornu JN. Summary Paper on Underactive Bladder from the European Association of Urology Guidelines on Non-neurogenic Male Lower Urinary Tract Symptoms. Eur Urol 2024; 86:213-220. [PMID: 38644139 DOI: 10.1016/j.eururo.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 02/29/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND AND OBJECTIVE The European Association of Urology (EAU) Guidelines Panel on non-neurogenic male lower urinary tract symptoms (LUTS) aimed to develop a new subchapter on underactive bladder (UAB) in non-neurogenic men to inform health care providers of current best evidence and practice. Here, we present a summary of the UAB subchapter that is incorporated into the 2024 version of the EAU guidelines on non-neurogenic male LUTS. METHODS A systematic literature search was conducted from 2002 to 2022, and articles with the highest certainty evidence were selected. A strength rating has been provided for each recommendation according to the EAU Guideline Office methodology. KEY FINDINGS AND LIMITATIONS Detrusor underactivity (DU) is a urodynamic diagnosis defined as a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or failure to achieve complete bladder emptying within a normal time span. UAB is a terminology that should be reserved for describing symptoms and clinical features related to DU. Invasive urodynamics is the only widely accepted method for diagnosing DU. In patients with persistently elevated postvoid residual (ie, >300 ml), intermittent catheterization is indicated and preferred to indwelling catheters. Alpha-adrenergic blockers are recommended before more invasive techniques, but the level of evidence is low. In men with DU and concomitant benign prostatic obstruction (BPO), benign prostatic surgery should be considered only after appropriate counseling. In men with DU and no BPO, a test phase of sacral neuromodulation may be considered. CONCLUSIONS AND CLINICAL IMPLICATIONS The current text represents a summary of the new subchapter on UAB. For more detailed information, refer to the full-text version available on the EAU website (https://uroweb.org/guidelines/management-of-non-neurogenic-male-luts).
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Affiliation(s)
- Michael Baboudjian
- Department of Urology, APHM, North Academic Hospital, Marseille, France; Department of Urology, APHM, La Conception Hospital, Marseille, France; Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain; Department of Urology, La Croix, Quint Fonsegrives, France.
| | | | - Nikita Bhatt
- Department of Urology, East of England Deanery, Cambridge, UK
| | | | - Cosimo De Nunzio
- Department of Urology, Sapienza University, Ospedale Sant'Andrea, Rome, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Thomas Herrmann
- Department of Urology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Markos Karavitakis
- Department of Urology, University General Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | | | | | - Vasileios Sakalis
- Department of Urology, Hippokrateion General Hospital, Thessaloniki, Greece
| | - Natasha Schouten
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Manuela Tutolo
- Department of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jean-Nicolas Cornu
- Department of Urology, CHU Hôpitaux de Rouen - Hôpital Charles Nicolle, Rouen, France
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Yang F, Hashim R, Philippou J. Tamsulosin and Dutasteride Combination Therapy for Asian Men With Moderate-to-Severe Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A Systematic Review of Clinical Considerations That Influence the Prescription. J Clin Med Res 2024; 16:385-397. [PMID: 39346571 PMCID: PMC11426169 DOI: 10.14740/jocmr5255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 08/23/2024] [Indexed: 10/01/2024] Open
Abstract
The goal of combination therapy for moderate-to-severe lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH) is to ease both the dynamic and static symptoms by using agents that have complementary mechanisms of action. Similar to prescribing other drugs, LUTS/BPH combination therapy has been affected by multiple factors. Previous qualitative research discussed the individual perspectives that influenced combination therapy administration. Yet, until recently, there has been limited interest in clinical reasons that physicians have to consider before prescribing LUTS/BPH combination treatment. This systematic review aimed to identify the clinical considerations that influence the decision to prescribe combination therapy of tamsulosin 0.4 mg + dutasteride 0.5 mg for Asian men with LUTS/BPH. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic search was performed in databases Medline, CINAHL, the Cochrane Library, and Embase from inception until January 2024 using Medical Subject Headings (MeSH) terms and keywords with truncation for alternative acronyms. A citation search was performed to gather works of literature on LUTS/BPH combination treatment in addition to the "PICO" framework for search terms. Five English-language primary randomized controlled trials (RCTs) were included in the narrative analysis using the Critical Appraisal Skills Program (CASP) checklist after critical appraisal. Several dosages of tamsulosin (0.2 mg and 0.4 mg) have been administered in LUTS/BPH combination treatment over the last few decades despite 0.2 mg tamsulosin being standardized as an effective regime in Asian countries. A remarkable correlation between prostate volume (PV) and prostate-specific antigen (PSA) was found in Asian men, which requires higher PSA secretion to enlarge each prostate unit and causes an increased risk of moderate-to-severe LUTS. Additionally, BPH baseline variables may lead to a different response to combination therapy, especially the PV and PSA differences. In conclusion, compared with Caucasian men, a significantly higher risk of moderate-to-severe LUTS was found in Asian men. Initiation of combination therapy, especially dutasteride, depends on a larger PV (≥ 30 mL); it is possible, therefore, that earlier PV and PSA examinations and baseline variables assessments ought to be performed by physicians before the combination therapy prescription. Alternative treatment options may be considered for a patient who prefers an active pattern of sexual activity during their BPH combined pharmacotherapy. These clinical considerations may influence the prescription of tamsulosin 0.4 mg + dutasteride 0.5 mg combination therapy for Asian men with moderate-to-severe LUTS/BPH. This study was registered on PROSPERO (CRD42024575528).
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Affiliation(s)
- Fan Yang
- Department of Urology, Singapore General Hospital, Singapore, Singapore
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, England, UK
| | - Rahab Hashim
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, England, UK
| | - Julia Philippou
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King’s College London, London, England, UK
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Doersch KM, Hines L, Campbell TD, Jain RK, Quarrier SO. Predictors of Postoperative Urinary Incontinence After Holmium Laser Enucleation of the Prostate (HoLEP) for Surgeons Early in Their Experience. Low Urin Tract Symptoms 2024; 16:e12533. [PMID: 39267354 DOI: 10.1111/luts.12533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 08/15/2024] [Accepted: 08/29/2024] [Indexed: 09/17/2024]
Abstract
OBJECTIVES To evaluate factors impacting continence recovery following holmium laser enucleation of the prostate (HoLEP) for surgeons early in their HoLEP experience. METHODS Predefined factors were evaluated from a prospectively maintained database for their impact on the recovery of continence after HoLEP. Both surgeons had performed fewer than 150 HoLEPs as attending physicians. Inclusion criteria were subjects with at least 6 months of incontinence data or documented recovery of continence. One or fewer pads per day was defined as continence. Statistical analyses were performed using R and Prism and included Spearman correlations, linear modeling, and Mantel-Cox log-rank testing as appropriate. RESULTS From December 2020 to May 2023, 152 subjects met inclusion criteria with a median age of 70 (range: 51-93). The median case number was 56 (1-146). Within the study period, 144/152 (94.7%) recovered continence at a median of 1.6 months postoperatively. Linear modeling demonstrated that younger age (p = 0.01) and shorter enucleation time (p = 0.001) predicted recovery. Enucleation time less than 100 min predicted earlier continence recovery based on Mantel-Cox testing (p = 0.0004). CONCLUSIONS During the surgeons' HoLEP learning curve, age, and enucleation time were predictive of the recovery of continence. Enucleation time under 100 min predicted a faster rate of continence recovery. The relationship between enucleation time and continence recovery may be demonstrative of case difficulty or may be a result of pressure on the external urethral sphincter during enucleation. These findings further our understanding of HoLEP outcomes early in a surgeon's learning curve.
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Affiliation(s)
- Karen M Doersch
- University of Rochester Medical Center, Rochester, New York, USA
| | - Laena Hines
- University of Rochester Medical Center, Rochester, New York, USA
| | | | - Rajat K Jain
- University of Rochester Medical Center, Rochester, New York, USA
| | - Scott O Quarrier
- University of Rochester Medical Center, Rochester, New York, USA
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Chastek B, Carrera A, Landis C, Snyder D, Abedinzadeh L, Bancroft T, Nesheim J, Kennelly M, Staskin D. Comparative analysis of real-world adherence and persistence patterns with vibegron, mirabegron, and anticholinergics in patients with overactive bladder: A retrospective claims study. Neurourol Urodyn 2024; 43:1504-1513. [PMID: 38720543 DOI: 10.1002/nau.25478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 08/22/2024]
Abstract
INTRODUCTION Vibegron is a selective β3-adrenergic receptor agonist that was approved by the US Food and Drug Administration in December 2020 for the treatment of overactive bladder in adults. This retrospective study assessed US pharmacy claims data to evaluate the real-world adherence and persistence of vibegron compared with mirabegron and with anticholinergics. MATERIALS AND METHODS This analysis used the Optum Research Database to identify adults with ≥1 pharmacy claim for vibegron, mirabegron, or an anticholinergic from April 1, 2021, to August 31, 2022. Patients had ≥ 90 days of continuous commercial or Medicare medical and pharmacy coverage preindex and ≥ 60 days of continuous pharmacy coverage postindex. Two independent propensity-score models matched patients treated with (1) vibegron versus mirabegron and (2) vibegron versus anticholinergics on key variables such as demographics and clinical characteristics, index copay, days' supply, and time of entry into analysis (index quarter). Adherence was measured by proportion of days covered (PDC) from index to the end of follow-up and was defined as PDC ≥ 80%. Persistence was defined as days to discontinuation of index medication (first 30-day gap) or end of follow-up. RESULTS The matched vibegron and mirabegron cohorts included 4921 and 9842 patients, respectively, and the matched vibegron and anticholinergic cohorts included 4676 and 9352 patients, respectively. Patients receiving vibegron had greater mean PDC versus patients receiving mirabegron (0.67 vs. 0.64, respectively; p < 0.001) or anticholinergics (0.67 vs. 0.58; p < 0.001). A greater percentage of patients receiving vibegron were adherent versus those receiving mirabegron (49.0% vs. 45.1%, respectively; p < 0.001) or anticholinergics (49.1% vs. 38.5%; p < 0.001). Persistence was longer with vibegron compared with both mirabegron (median [95% CI], 171 [159-182] vs. 128 [122-137] days, respectively; p < 0.001) and anticholinergics (172 [159-183] vs. 91 [91] days; p < 0.001). CONCLUSION In this retrospective analysis of pharmacy claims data, patients receiving vibegron exhibited significantly higher adherence and demonstrated longer persistence in comparison to matched patient cohorts receiving either mirabegron or anticholinergics.
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Affiliation(s)
| | - Adam Carrera
- Sumitomo Pharma America, Inc. (formerly Urovant Sciences, Inc.), Marlborough, Massachusetts, USA
| | | | - Daniel Snyder
- Sumitomo Pharma America, Inc. (formerly Urovant Sciences, Inc.), Marlborough, Massachusetts, USA
| | - Laleh Abedinzadeh
- Sumitomo Pharma America, Inc. (formerly Urovant Sciences, Inc.), Marlborough, Massachusetts, USA
| | | | - Jeffrey Nesheim
- Sumitomo Pharma America, Inc. (formerly Urovant Sciences, Inc.), Marlborough, Massachusetts, USA
| | | | - David Staskin
- Tufts University School of Medicine, Boston, Massachusetts, USA
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Vanli S, Kurtoglu F, Alan BS, Akcakavak G, Ozdemir O. Investigation of the effects of Theranekron and Sorafenib treatments on carcinogenesis, apoptosis and biochemical profile in hepatocellular carcinoma in rats. Toxicol Mech Methods 2024; 34:750-760. [PMID: 38577837 DOI: 10.1080/15376516.2024.2332909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/15/2024] [Indexed: 04/06/2024]
Abstract
This study aimed to investigate the effects of Tarantula cubensis alcohol extract (TCAE, Theranekron) and Sorafenib (S) treatments on carcinogenesis, apoptosis and biochemical profile of rats with experimentally induced hepatocellular carcinoma (HCC). In the presented study, 58 male rats were divided into 7 groups; Negative Control (NC, n = 6), NC + TCAE (NCT, n = 6), NC + Sorafenib (NCS, n = 6), Positive Control (PC, n = 10), Positive Control + TCAE (PCT, n = 10), Positive Control + Sorafenib (PCS, n = 10), Positive Control + TCAE + Sorafenib (PCTS, n = 10). The active ingredients Diethylnitrosamine (DEN, 120 mg/kg, single dose) and Nitrosomorpholine (NMOR, 50 ppm, 21 weeks orally) were used to induce HCC in rats. At the end of the experiment, the animals were euthanized under appropriate conditions and samples were collected for biochemical and pathological investigations. In the PC group, alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transpeptidase (GGT) levels were higher (p < 0.001) and urea levels were lower (p < 0.001) compared to all other groups. Treatment groups reorganized the relevant markers (ALT, AST, GGT, and urea). A significant increase was detected in Caspase-10, Caspase-3 and Granzyme-B (GrzB) (p < 0.001) in blood and Caspase-10 and GrzB (p < 0.05) in liver tissue in PCT, PCS and PCTS groups compared to the PC group. Histopathological examination revealed that the PC group showed cancer morphology, and the treatment groups caused a decrease in tumor incidence and size. Our current findings suggest that the mechanism of action of TCAE in HCC is through the NKs/CTLs-GrzB-Casp10-Casp3 signaling pathway and can be used in combination with chemotherapy drugs for the development of future drug designs.
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Affiliation(s)
- Serdar Vanli
- Ministry of Agriculture and Forestry, Ilgin District Directorate of Agriculture and Forestry, Konya, Turkey
| | - Firuze Kurtoglu
- Department of Biochemistry, Faculty of Veterinary Sciences, Selcuk University, Konya, Turkey
| | - Beyza S Alan
- Department of Biochemistry, Faculty of Veterinary Sciences, Selcuk University, Konya, Turkey
| | - Gokhan Akcakavak
- Department of Pathology, Faculty of Veterinary Sciences, Yozgat Bozok University, Yozgat, Turkey
| | - Ozgur Ozdemir
- Department of Pathology, Faculty of Veterinary Sciences, Selcuk University, Konya, Turkey
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Park HJ, Kim EJ, Kim JY. Serious Games as a Therapeutic Tool in Pediatric Urology: A Review of Current Applications and Future Directions. Int Neurourol J 2024; 28:185-195. [PMID: 39363409 DOI: 10.5213/inj.2448322.161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Accepted: 09/10/2024] [Indexed: 10/05/2024] Open
Abstract
This paper examines the use of serious games that integrate engaging gameplay with educational and therapeutic benefits with a particular focus on their application in urology. The study reviews both domestic and international cases to evaluate the current practices and implications of these digital therapies. While serious games have been widely utilized in the treatment of pediatric cancer and psychiatric disorders-areas that require long-term care and management-their application in urology, in particular pediatric urology, has been limited. Although digital therapies like serious games are still emerging in the field of urology, they hold promise as effective supplements to traditional treatments while offering new options for managing a range of urological conditions. Pediatric conditions such as bedwetting, urinary incontinence, and dysuria, which often benefit from long-term training and habit formation, are particularly well-suited to this approach. By helping pediatric patients better understand and manage their symptoms, serious games can play a supportive role in the treatment process and have shown positive medical outcomes. This paper reviews the definitions and therapeutic effects of serious games, analyzes their current use in the medical field, and argues for their increased application in treating pediatric urinary conditions.
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Affiliation(s)
- Hyung Jun Park
- Department of Game and Interactive Media, Graduate School, Gachon University, Seongnam, Korea
| | - Eun Joung Kim
- Department of Game Contents, College of Smart Content, Kyungil University, Gyeongsan, Korea
| | - Jung Yoon Kim
- Department of Game Media, College of IT Convergence, Gachon University, Seongnam, Korea
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Lo TS, Harun F, Zakaria HB, Tan YL, Hsieh WC, Ayedh Al-Zabidi AA. What maximal urethral closure pressure threshold predicts failure of mid-urethral sling surgery? Taiwan J Obstet Gynecol 2024; 63:692-699. [PMID: 39266150 DOI: 10.1016/j.tjog.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 09/14/2024] Open
Abstract
OBJECTIVE Low Maximal Urethral Closure Pressure (MUCP) is linked to unfavourable outcome of anti-incontinence surgery, however the cut-off value varied within studies. This study aimed to predict the cut-off value of MUCP that contributes to poor outcome of Mid-Urethral Sling (MUS) surgery in Urinary Stress Incontinence (USI) patients. MATERIALS AND METHODS Records of 729 women underwent MUS procedure from January 2004 to April 2017 reviewed. Patients were divided into four MUCP groups, which were <20 cmH2O (≥20 and < 40) cmH2O (≥40 and ≤ 60) cmH2O and >60 cmH2O. Objective evaluation comprising 72-h voiding diary, multichannel urodynamic study (UDS) and post-operative bladder neck angle measurement. Subjective evaluation through validated urinary symptoms questionnaires. Primary outcome was objective cure rate of negative urine leak on provocative filling cystometry and 1-h pad test weight <2 g, and subjective cure rate was negative response to question 3 of UDI-6. Secondary outcome was identifying risk factors of cure failure for MUS in low MUCP groups. To identify the risk factors of cure failure, MUCP groups were narrowed down into <40 cmH2O or ≥40 cmH2O. RESULTS Total of 688 women evaluated. Overall objective cure rate was 88.2% with subjective cure rate of 85.9%. Objective and subjective cure rates were lower in groups with low MUCP <40 cmH2O. Failure of MUS correlate significantly in patients with low MUCP <40 cmH20, bladder neck angle <30° and Functional urethral length (FUL) < 2 cm. CONCLUSION Women with MUCP <40cmH2O, bladder neck angle <30° and FUL < 2 cm are more likely to have unfavorable outcome following MUS surgery. We proposed the cut-off low MUCP <40cmH2O as predictor for fail MUS surgery in SUI patients.
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Affiliation(s)
- Tsia-Shu Lo
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei, Medical Center, Taipei, Taiwan, Republic of China; Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China.
| | - Fazlin Harun
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Department of Obstetrics and Gynecology, Women and Children Hospital (Hospital Tunku Azizah), Kuala Lumpur, Malaysia
| | - Hateeza Binti Zakaria
- Department of Obstetrics and Gynecology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Yiap Loong Tan
- Kuching Specialist Hospital, KPJ Healthcare Group, Kuching, Sarawak, Malaysia
| | - Wu-Chiao Hsieh
- Division of Urogynecology, Department of Obstetrics and Gynecology, Linkou, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China
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Gallego-Gómez C, Rodríguez-Gutiérrez E, Torres-Costoso A, Martínez-Vizcaíno V, Martínez-Bustelo S, Quezada-Bascuñán CA, Ferri-Morales A. Urinary incontinence increases risk of postpartum depression: systematic review and meta-analysis. Am J Obstet Gynecol 2024; 231:296-307.e11. [PMID: 38437894 DOI: 10.1016/j.ajog.2024.02.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/22/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Postpartum depression is one of the most common complications after childbearing. Urinary incontinence is a frequent symptom during pregnancy and the postnatal period, often being the first time that women experience it. This systematic review and meta-analysis aimed to synthesize the evidence on the association between urinary incontinence and postpartum depression and to assess whether this association becomes weaker at 6 months after childbirth. DATA SOURCES MEDLINE, Embase, Cochrane Library, Web of Science, and PsycINFO were searched from inception to December 26, 2023. STUDY ELIGIBILITY CRITERIA Cross-sectional and cohort studies addressing the association between urinary incontinence and postpartum depression were included. METHODS Pooled odds ratios and their 95% confidence intervals, and 95% prediction intervals were estimated using a DerSimonian and Laird random-effects model for the association between urinary incontinence and postpartum depression. Subgroup analyses were conducted on the basis of time after delivery (<6 or ≥6 months). The risk of bias was assessed with the National Institutes of Health Quality Assessment Tool for Observational Cohort Studies. RESULTS Eleven published studies were included in the systematic review and meta-analysis. Overall, the odds ratio for the association between urinary incontinence and postpartum depression was 1.45 (95% confidence interval, 1.11-1.79; 95% prediction interval, 0.49-2.40; I2=65.9%; P=.001). For the 7 cohort studies, the odds ratio was 1.63 (95% confidence interval, 1.35-1.91; 95% prediction interval, 1.14-2.13; I2=11.1%; P=.345). For the 4 cross-sectional studies, the odds ratio was 1.05 (95% confidence interval, 1.04-1.05; 95% prediction interval, 1.04-1.06; I2=0.0%; P=.413). According to the time after delivery, the odds ratio estimates for cohort studies with a postpartum period <6 months were 1.44 (95% confidence interval, 1.07-1.81; prediction interval, 0.63-2.25; I2=0.0%; P=.603) and 1.53 (95% confidence interval, 1.16-1.89; prediction interval, 0.41-2.65; I2=50.7%; P=.087) for those with a postpartum period ≥6 months. CONCLUSION This systematic review and meta-analysis suggests that urinary incontinence may be a potential predictor of postpartum depression. Thus, it is important that health care professionals offer support and treatment options to women who experience these conditions.
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Affiliation(s)
- Cristina Gallego-Gómez
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain; Physiotherapy Unit, Health Center of Camarena, Toledo, Spain; Toledo Physiotherapy Research Group (GIFTO), University of Castilla-La Mancha, Toledo, Spain
| | | | - Ana Torres-Costoso
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain; Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile
| | - Sandra Martínez-Bustelo
- Psychosocial Intervention and Functional Rehabilitation Research Group, Faculty of Physiotherapy, University of A Coruña, A Coruña, Spain
| | | | - Asunción Ferri-Morales
- Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain; Health and Social Research Center, University of Castilla-La Mancha, Cuenca, Spain
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50
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Padmanabhan P, Roberts LH, Chancellor MB, Peters KM, Zwaans BMM. Prospective follow-up of overactive bladder symptoms in patients with prior SARS-CoV-2 infection. Neurourol Urodyn 2024; 43:1514-1522. [PMID: 38828830 DOI: 10.1002/nau.25509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/21/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Abstract
PURPOSE SARS-CoV-2 infection can result in genitourinary symptoms, such as frequency, urgency, nocturia, and pain/pressure. In this study, we followed the progression of overactive bladder (OAB) symptoms in patients that reported new or worsening OAB symptoms after coronavirus disease-19 (COVID-19) diagnosis. MATERIALS AND METHODS Individuals from a COVID-19 serology study were invited to participate in a follow-up study. Respondents were divided into three groups based on prior COVID-19 testing. Patients scored symptoms retrospectively before the pandemic, at study onset, and prospectively during 12-month follow-up. Genitourinary symptoms were assessed using international consultation on incontinence questionaire for OAB (ICIQ-OAB). Change in ICIQ-OAB scores from baseline were calculated. The minimal important difference of one on ICIQ-OAB is considered a significant change. RESULTS 26.0% of participants previously had positive COVID polymerase chain reaction (PCR) test (PCR+), 5.6% a positive serology test only (Ser+), and 65.5% were COVID naïve (COVID-). 23.8% of participants reported a significant increase in ICIQ-OAB score at study onset compared to prepandemic. ICIQ-OAB scores were similar at prepandemic but significantly higher at study start (p < 0.001) in PCR+ group. During follow-up, change in ICIQ-OAB scores from baseline remained unchanged for COVID- group, but gradually reduced for PCR+, reaching similar levels as COVID- group by 12 months. By 12 months, 71.4% of PCR+, 42.9% of Ser+, and 68.8% of COVID- participants still reported significant increase in ICIQ-OAB scores. CONCLUSIONS Most COVID-19 patients experienced return of symptoms to baseline, indicative of the potential resolution of COVID-associated cystitis. A subset of cases did not, raising questions about the underlying factors contributing to this outcome. Additional research is needed to assess long COVID on urological health.
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Affiliation(s)
- Priya Padmanabhan
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Ly Hoang Roberts
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Michael B Chancellor
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Kenneth M Peters
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Bernadette M M Zwaans
- Department of Urology, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
- Department of Urology, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
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