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Özden F, Tümtürk İ, Özkeskin M, Bakırhan S. The effect of pelvic floor muscle training on urinary incontinence in patients with stroke: a systematic review and meta-analysis. Ir J Med Sci 2022:10.1007/s11845-022-03083-x. [PMID: 35776264 DOI: 10.1007/s11845-022-03083-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: 06/10/2022] [Accepted: 06/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND No other systematic review presented the effectiveness of pelvic floor muscle training (PFMT) in individual with stroke. AIMS The purpose of this systematic review and meta-analysis was to demonstrate the effectiveness of PFMT for urinary incontinence in patients with stroke. METHODS "Web of Science (WoS), Cochrane Library, PubMed and Scopus" databases were searched. "Revised Cochrane risk-of-bias tool randomized trials (RoB 2)" and "PEDro" were used to assess the risk of bias and methodological quality of the studies. Narrative synthesis and meta-analysis were conducted to present the results. RESULTS A total of 8 articles were included in the review. Seven articles were classified as "good" level evidence. Four articles were considered to have "high risk" of bias for the overall score. Regarding two homogenous studies, PFMT-based rehabilitation was not superior standard urinary incontinence therapy on SF-36-Social Function score at 12-week follow-up (ES 0.47, 95% CI - 0.16-0.96). Data pooling of two studies did not provide an additional advantage of pelvic muscle training on 3 days voiding diary (night, total day) score at 12-week follow-up (ES 28, 95% CI - 0.61-0.48; ES 0.30, 95% CI - 0.23-0.95). On the other hand, low-quality evidence demonstrated that pelvic muscle training yielded better results on daytime voiding (ES 0.28, 95% CI 0.04-1.16). CONCLUSIONS The results demonstrated that PFMT had positive effects in terms of daytime urination frequency and incontinence. Although some studies have reported positive effects on symptoms, function, strength, and endurance, the generalizability of these results is controversial. Further studies should assess the quality-of-life and function with urinary incontinence and stroke-specific tools.
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Affiliation(s)
- Fatih Özden
- Department of Health Care Services, Köyceğiz Vocational School of Health Services, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - İsmet Tümtürk
- Department of Physiotherapy and Rehabilitation, Institute of Health Sciences, Ege University, İzmir, Turkey
| | - Mehmet Özkeskin
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ege University, İzmir, Turkey
| | - Serkan Bakırhan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ege University, İzmir, Turkey
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Mostafa MM, Patil N, Khalil M, Elgammal MA, Mahdy A. Is Holmium Laser Enucleation of Prostate equally effective in management of benign prostatic hyperplasia patients with either voiding or storage lower urinary tract symptoms? A comparative study. Arch Ital Urol Androl 2022; 94:174-179. [PMID: 35775342 DOI: 10.4081/aiua.2022.2.174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/14/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate and compare the effectiveness and safety of holmium laser enucleation of prostate (HoLEP) in relieving either voiding or storage lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia (BPH) patients. MATERIALS AND METHODS The charts of patients with BPH who underwent HoLEP for either predominant voiding or predominant storage LUTS at University of Cincinnati hospitals in the period between February 2015 and December 2020 were retrospectively reviewed and analyzed for changes in voiding symptomatology, storage symptomatology, hematuria, International Prostate Symptom Score (IPSS), peak flow rates (Qmax), presence of detrusor overactivity (DO), and post-voiding residual urine (PVR) from baseline to up to 6 months postoperatively. RESULTS A total of 132 patients were included in the analysis. Patients were divided into two groups: Group 1 included BPH patients with predominant voiding LUTS (68 Patients) while group 2 involved those with predominant storage LUTS (64 Patients). HoLEP was equally effective in management of both groups with significant improvement in urodynamics study (UDS) parameters, patient voiding and storage symptomatology, and IPSS from preoperatively to up to 6 months postoperatively with relatively low procedure complication rate and postoperative need for medication or procedure. CONCLUSIONS HoLEP is a safe, effective, and reliable minimally invasive surgical modality that can be relied on for BPH patients with either predominant voiding or predominant storage symptoms with relatively low procedure complicat.
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Affiliation(s)
- Mostafa M Mostafa
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati (US); Asiut University Hospitals, Asiut, Egypt.
| | - Nilesh Patil
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati.
| | | | | | - Ayman Mahdy
- Division of Urology, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati.
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Goldberg N, Tamam S, Weintraub AY. The association between overactive bladder and fibromyalgia: A systematic review and meta-analysis. Int J Gynaecol Obstet 2022; 159:630-641. [PMID: 35641437 DOI: 10.1002/ijgo.14290] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/09/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Overactive bladder is a common syndrome that significantly affects the quality of life. Fibromyalgia is characterized by widespread pain, impacting patients' lives. The exact mechanisms of the two syndromes remain unknown, but there is an overlap between the suspected pathophysiologies. OBJECTIVE To present an overview of the current research on the association between overactive bladder (OAB) and fibromyalgia. SEARCH STRATEGY A systematic search of four electronic databases was conducted. SEARCH STRATEGY Studies examining the correlation between OAB and fibromyalgia with female patients aged over 18 years were included. DATA COLLECTION AND ANALYSIS Two reviewers screened the studies for eligibility. Eligible studies were screened for quality. A meta-analysis was performed for eligible studies. MAIN RESULTS Seven studies were included in the final review, of which six presented a positive association between the syndromes. The studies demonstrated a positive association between fibromyalgia and the severity of OAB and an adverse effect on the quality of life related to OAB. A mean effect size of 1.96 (95% confidence interval 0.85-3.06) was calculated. CONCLUSION OAB and fibromyalgia are both complex and multifactorial syndromes. The study presents an association between them, but additional studies on the topic should be conducted for a more precise conclusion.
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Affiliation(s)
- Nitzan Goldberg
- Department of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Shai Tamam
- Library of Life Sciences and Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Y Weintraub
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Kender Erturk N, Tasgoz FN, Temur M. Effects of transobturator tape procedure on female sexual function at 2-year follow-up: A prospective cohort study with matched control group. Low Urin Tract Symptoms 2022; 14:358-365. [PMID: 35603770 DOI: 10.1111/luts.12445] [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: 03/03/2022] [Revised: 04/11/2022] [Accepted: 05/02/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We aimed to compare the effect of elapsed time on sexual function in women who underwent a transobturator tape (TOT) procedure for stress urinary incontinence (SUI) with continent controls. METHODS Urinary and sexual function of 70 females were assessed preoperatively at month 6 and postoperatively at month 24 in the study group. Forty-five patients without urinary incontinence and demographically matched with the study group were assessed for sexual function at first administration and 24 months later in the control group. The Female Sexual Function Index (FSFI) was used. RESULTS The baseline total FSFI score (23.4 ± 3.2 vs 27.0 ± 4.3, P < .001) was significantly lower in patients with SUI. There was a slight increase (24.0 ± 3.0, P = .167) in sexual function at the end of 2 years in the study group, whereas in the control group, the total FSFI score (25.0 ± 4.5, P < .001) decreased significantly within 2 years. The success of the incontinence surgery was associated with higher long-term sexual function scores. CONCLUSIONS Successful TOT surgery can improve sexual function in women with SUI. This improvement decreases less over time compared to healthy controls.
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Affiliation(s)
- Nergis Kender Erturk
- Department of Obstetrics and Gynecology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Fatma Nurgul Tasgoz
- Department of Obstetrics and Gynecology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Muzaffer Temur
- Department of Obstetrics and Gynecology, Yıldırım Doruk Special Hospital, Bursa, Turkey
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Ajay D, Kahokehr AA, Lentz AC, Peterson AC. Valsalva leak point pressure (VLPP) greater than 70 cm H 2O is an indicator for sling success: a success prediction model for the male transobturator sling. Int Urol Nephrol 2022; 54:1499-1503. [PMID: 35505169 DOI: 10.1007/s11255-022-03222-4] [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: 01/24/2022] [Accepted: 04/15/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Urodynamic studies are often performed in the evaluation of post-prostatectomy urinary incontinence (PPUI). The male transobturator sling (TOS) is a minimally invasive treatment for PPUI. Others have reported their results with a specific Valsalva leak point pressure (VLPP) that predicts a good outcome with the male TOS. Our objective was to determine the relationship of the pre-operative VLPP on the success rate of the male TOS in a high-volume, single center. We hypothesized that a higher pre-operative VLPP better predicts successful outcomes. METHODS We reviewed patients undergoing a male TOS placement from 2006 to 2012 at our institution. Patients who underwent TOS placement were identified using our patient data portal (DEDUCE). Demographic, urodynamic, and follow-up data were extracted by chart review. Post-operative success was defined by the use of 0 or 1 security pad, a negative stress test on exam, or pad weight of less than 8 g per 24 h. Cox and linear regression models were performed. RESULTS 290 patients were included. All patients underwent a radical prostatectomy for prostate cancer and presented with PPUI. Mean age at surgery was 66.3 (± 7.4) years and 84% were Caucasian. Median time to follow-up was 5 months (IQR 1-15). A linear regression model shows an inverse prediction curve for sling failure versus VLPP (p = 0.02). The hazard ratio for failure with a VLPP of ≤ 70 cm H2O compared with a VLPP of > 70 cm H2O, adjusted for pelvic radiation and 24-h pad weight was 0.5 (95% CI 0.2-0.98). CONCLUSION Patient selection is imperative in the success of the male TOS for patients with PPUI. In our cohort of patients with PPUI, those with a pre-procedural VLPP of > 70 cm H2O were 50% less likely to fail after TOS placement versus those with a VLPP ≤ 70 cm H2O. In our practice, we use these data to support the use of VLPP cut off of 70 cm H2O as an indicator for success to help in the evaluation and counseling of patients.
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Affiliation(s)
- Divya Ajay
- Department of Urology, University of Rochester Medical Center, 601 Elmwood Drive, Rochester, NY, 14602, USA.
| | - Arman A Kahokehr
- Department of Urology, The University of Adelaide, Adelaide, SA, Australia
| | - Aaron C Lentz
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Andrew C Peterson
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Vredeveld T, van Benten E, Beekmans REPM, Koops MP, Ket JCF, Mollema J, Ramaekers SPJ, Pool JJM, Coppieters MW, Pool-Goudzwaard AL. Reliability and validity of assessment methods available in primary care for bladder outlet obstruction and benign prostatic obstruction in men with lower urinary tract symptoms: a systematic review. BMJ Open 2022; 12:e056234. [PMID: 35487713 PMCID: PMC9058800 DOI: 10.1136/bmjopen-2021-056234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To systematically review the literature regarding the reliability and validity of assessment methods available in primary care for bladder outlet obstruction or benign prostatic obstruction in men with lower urinary tract symptoms (LUTS). DESIGN Systematic review with best evidence synthesis. SETTING Primary care. PARTICIPANTS Men with LUTS due to bladder outlet obstruction or benign prostatic obstruction. REVIEW METHODS PubMed, Ebsco/CINAHL and Embase databases were searched for studies on the validity and reliability of assessment methods for bladder outlet obstruction and benign prostatic obstruction in primary care. Methodological quality was assessed with the COSMIN checklist. Studies with poor methodology were excluded from the best evidence synthesis. RESULTS Of the 5644 studies identified, 61 were scored with the COSMIN checklist, 37 studies were included in the best evidence synthesis, 18 evaluated bladder outlet obstruction and 17 benign prostatic obstruction, 2 evaluated both. Overall, reliability was poorly evaluated. Transrectal and transabdominal ultrasound showed moderate to good validity to evaluate bladder outlet obstruction. Measured prostate volume with these ultrasound methods, to identify benign prostatic obstruction, showed moderate to good accuracy, supported by a moderate to high level of evidence. Uroflowmetry for bladder outlet obstruction showed poor to moderate diagnostic accuracy, depending on used cut-off values. Questionnaires were supported by high-quality evidence, although correlations and diagnostic accuracy were poor to moderate compared with criterion tests. Other methods were supported by low level evidence. CONCLUSION Clinicians in primary care can incorporate transabdominal and transrectal ultrasound or uroflowmetry in the evaluation of men with LUTS but should not solely rely on these methods as the diagnostic accuracy is insufficient and reliability remains insufficiently researched. Low-to-moderate levels of evidence for most assessment methods were due to methodological shortcomings and inconsistency in the studies. This highlights the need for better study designs in this domain.
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Affiliation(s)
- Tom Vredeveld
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Esther van Benten
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- HU University of Applied Sciences Utrecht, Institute of Movement Sciences, Utrecht, The Netherlands
| | | | - M Patrick Koops
- Physiotherapy Practice De Werfheegde, Haaksbergen, The Netherlands
| | - Johannes C F Ket
- Medical Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jurgen Mollema
- Medical Library, HU University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Stephan P J Ramaekers
- Centre of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Jan J M Pool
- HU University of Applied Sciences Utrecht, Institute of Movement Sciences, Utrecht, The Netherlands
| | - Michel W Coppieters
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Queensland, Australia
| | - Annelies L Pool-Goudzwaard
- Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- SOMT University of Physiotherapy, Amersfoort, The Netherlands
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Fluids affecting bladder urgency and lower urinary symptoms: results from a randomized controlled trial. Int Urogynecol J 2022; 33:1329-1345. [PMID: 35435467 DOI: 10.1007/s00192-022-05090-z] [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: 03/30/2021] [Accepted: 01/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Caffeinated, alcoholic, artificially sweetened, carbonated, and acidic beverages are pervasive and consumed in large quantities. Reputedly, these beverages are "irritating to the bladder" and result in heightened void frequency, but prior studies lack control for intake volume. We tested the null hypothesis that women recruited from the community who demonstrate overactive bladder symptoms will show no difference by groups in void frequency when one group is instructed to replace listed beverages by substituting non-irritants (emphasis on water or milk) and the other group is instructed in healthy eating. METHODS This was a parallel-group randomized controlled trial design with a three-period fixed sequence (baseline and 2 and 6 weeks post-baseline). We recruited 105 community women with overactive bladder symptoms. INCLUSION CRITERIA >7 voids per day or 2 voids per night, daily intake of ≥16 oz. (473 ml) of beverages containing the ingredients listed above, and ≥ 32 oz. (946 ml) of total fluid intake. Stratified randomization was conducted. The primary outcome was average daily void frequency on a 3-day diary. RESULTS Participants were 86% white, mean (SD) age was 46.6 (17.6) years, and baseline void frequency was 9.2 (2.9) voids per day. At 2 and 6 weeks, estimated average (SD) difference in void frequency between group 1 and group 2 was -0.46 (0.57) and -0.31 (0.57) voids per day (p > 0.05); the null hypothesis was not rejected. CONCLUSIONS Women who reduce potentially irritating beverages while maintaining total fluid volume intake is not predictive of void frequency. Further research on type and volume of beverage intake is recommended.
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Campagna G, Vacca L, Panico G, Vizzielli G, Caramazza D, Zaccoletti R, Marturano M, Granese R, Arcieri M, Cianci S, Scambia G, Ercoli A. Laparoscopic High Uterosacral Ligament Suspension vs. Laparoscopic Sacral Colpopexy for Pelvic Organ Prolapse: A Case-Control Study. Front Med (Lausanne) 2022; 9:853694. [PMID: 35308533 PMCID: PMC8930828 DOI: 10.3389/fmed.2022.853694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Laparoscopic sacral colpopexy is the gold standard technique for apical prolapse correction but it is a technically challenging procedure with rare but severe morbidity. Laparoscopic high uterosacral ligament suspension could be a valid technically easier alternative using native tissue. Material and Methods In the period from 2015 to 2018, 600 women were submitted to laparoscopic sacral colpopexy while 150 to laparoscopic high uterosacral ligament suspension in three Italian urogynecology referral centers. We enrolled women with apical prolapse stage ≥2 alone or multicompartment descensus. To reduce allocation bias, we performed a propensity matched analysis. Women undergoing laparoscopic high uterosacral ligament suspension surgery were matched 1:2 to women undergoing laparoscopic sacral colpopexy. The cumulative proportion of relapse-free women in time was analyzed by the Kaplan–Meier method. The primary objective of this multicenter case-control retrospective study was to compare the recurrence rate while the secondary objectives were to compare feasibility, safety, and efficacy of laparoscopic sacral colpopexy and laparoscopic high uterosacral ligament suspension in surgical treatment of pelvic organ prolapse. Results Three hundred and nine women were enrolled (103 laparoscopic high uterosacral ligament suspension; 206 laparoscopic sacral colpopexy). Median operatory time was significantly shorter in the laparoscopic high uterosacral ligament suspension group (P = 0.0001). No statistically significative difference was found in terms of estimated blood loss, admission time, intraoperative, and major early postoperative complications, postoperative pelvic pain, dyspareunia and de novo stress urinary incontinence. Surgical approach was the only independent risk factor for prolapse recurrence (RR = 6.013 [2.965–12.193], P = 0.0001). The objective cure rate was higher in the laparoscopic sacral colpopexy group (93.7 vs. 68%, 193/206 vs. 70/103, P = 0.0001) with a highly reduced risk of recurrence (RR = 5.430 [1.660–17.765]). Median follow up was 22 months. Conclusion Both techniques are safe, feasible, and effective. Laparoscopic sacral colpopexy remains the best choice in treatment of multicompartment and advanced pelvic organ prolapse while laparoscopic high uterosacral ligament suspension could be appropriate for moderate and isolated apical prolapse when laparoscopic sacral colpopexy is not suitable for the patient or to prevent prolapse in women at high risk at the time of the hysterectomy.
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Affiliation(s)
- Giuseppe Campagna
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Lorenzo Vacca
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Giovanni Panico
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- *Correspondence: Giovanni Panico
| | - Giuseppe Vizzielli
- Department of Medicinal Area (DAME) Clinic of Obstetrics and Gynecology, Santa Maria della Misericordia Hospital, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Daniela Caramazza
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Riccardo Zaccoletti
- Obstetrics and Gynecology Unit, P. Pederzoli Hospital, Peschiera del Garda, Verona, Italy
| | - Monia Marturano
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
| | - Roberta Granese
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, Messina, Italy
| | - Martina Arcieri
- Department of Biomedical, Dental, Morphological and Functional Imaging Science, University of Messina, Messina, Italy
| | - Stefano Cianci
- Department of Human Pathology in Adult and Childhood “G. Barresi, ” University of Messina, Messina, Italy
| | - Giovanni Scambia
- Department of Woman, Child, and Public Health, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy
- Department of Woman, Child and Public Health, Catholic University of Sacred Heart, Rome, Italy
| | - Alfredo Ercoli
- Department of Human Pathology in Adult and Childhood “G. Barresi, ” University of Messina, Messina, Italy
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Diagnostic Value of the Maximum Urethral Closing Pressure in Women With Overactive Bladder Symptoms and Functional Bladder Outlet Obstruction. Int Neurourol J 2022; 26:S1-7. [PMID: 35236047 PMCID: PMC8896775 DOI: 10.5213/inj.2040482.241] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/13/2021] [Indexed: 11/08/2022] Open
Abstract
Purpose Overactive bladder (OAB) is observed in women with functional bladder outlet obstruction (FBOO), as are lower urinary tract symptoms (LUTS). Therefore, we evaluated the urodynamic characteristics of women with storage LUTS and FBOO diagnosed by urodynamic studies (UDS). Methods Women (n=108) with storage LUTS and FBOO diagnosed by UDS were included in this study. The urodynamic characteristics of women with FBOO were compared with those of women with OAB (n=34) and stress urinary incontinence (SUI, n=78). FBOO was defined as a maximum flow rate (Qmax) < 15 mL/sec, combined with detrusor pressure at a Qmax (PdetQmax) > 20 cm H2O in a pressure-flow study. The UDS included uroflowmetry, postvoid residual volume determination, a cystometrogram, and a pressure-flow study. Results Women with FBOO who had storage symptoms showed a higher PdetQmax and maximum urethral closing pressure (MUCP) than women with OAB and SUI. Interstitial cystitis/bladder pain syndrome (IC/BPS) was observed in 17.6% of women with FBOO. MUCP was significantly higher in women with BOO than in women with BOO and IC/BPS (115.6±27.4 and 96.6±14.1 cm H2O, P=0.00). The receiver operating characteristic curve analysis showed that the cutoff values of MUCP in women with FBOO compared to women with OAB and SUI were 87 cm H2O (sensitivity=81.5%, specificity=73.5%) and 36 cm H2O (sensitivity=92.6%, specificity=84.4%), respectively. The cutoff value of MUCP in women with FBOO compared to women with FBOO and IC/BPS was 92 cm H2O (sensitivity=85.4%, specificity=78.9%). Conclusions MUCP could have predictive value for identifying FBOO in women with complex LUTS.
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Male Lower Urinary Tract Dysfunction: An Underrepresented Endpoint in Toxicology Research. TOXICS 2022; 10:toxics10020089. [PMID: 35202275 PMCID: PMC8880407 DOI: 10.3390/toxics10020089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 02/04/2023]
Abstract
Lower urinary tract dysfunction (LUTD) is nearly ubiquitous in men of advancing age and exerts substantial physical, mental, social, and financial costs to society. While a large body of research is focused on the molecular, genetic, and epigenetic underpinnings of the disease, little research has been dedicated to the influence of environmental chemicals on disease initiation, progression, or severity. Despite a few recent studies indicating a potential developmental origin of male LUTD linked to chemical exposures in the womb, it remains a grossly understudied endpoint in toxicology research. Therefore, we direct this review to toxicologists who are considering male LUTD as a new aspect of chemical toxicity studies. We focus on the LUTD disease process in men, as well as in the male mouse as a leading research model. To introduce the disease process, we describe the physiology of the male lower urinary tract and the cellular composition of lower urinary tract tissues. We discuss known and suspected mechanisms of male LUTD and examples of environmental chemicals acting through these mechanisms to contribute to LUTD. We also describe mouse models of LUTD and endpoints to diagnose, characterize, and quantify LUTD in men and mice.
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Liu J, Zhou L, Zhao F, Zhou C, Yang T, Xu Z, Wang X, Xu L, Xu Z, Ge Y, Wu R, Jia R. Therapeutic effect of adipose stromal vascular fraction spheroids for partial bladder outlet obstruction induced underactive bladder. Stem Cell Res Ther 2022; 13:68. [PMID: 35139904 PMCID: PMC8826668 DOI: 10.1186/s13287-022-02739-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/23/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Underactive bladder (UAB) is a common clinical problem but related research is rarely explored. As there are currently no effective therapies, the administration of adipose stromal vascular fraction (ad-SVF) provides a new potential method to treat underactive bladder. METHODS Male Sprague-Dawley rats were induced by partial bladder outlet obstruction (PBOO) for four weeks and randomly divided into three groups: rats treated with PBS (Sham group); rats administrated with ad-SVF (ad-SVF group) and rats performed with ad-SVF spheroids (ad-SVFsp group). After four weeks, urodynamic studies were performed to evaluate bladder functions and all rats were sacrificed for further studies. RESULTS We observed that the bladder functions and symptoms of UAB were significantly improved in the ad-SVFsp group than that in the Sham group and ad-SVF group. Meanwhile, our data showed that ad-SVF spheroids could remarkably promote angiogenesis, suppress cell apoptosis and stimulate cell proliferation in bladder tissue than that in the other two groups. Moreover, ad-SVF spheroids increased the expression levels of bFGF, HGF and VEGF-A than ad-SVF. IVIS Spectrum small-animal in vivo imaging system revealed that ad-SVF spheroids could increase the retention rate of transplanted cells in bladder tissue. CONCLUSIONS Ad-SVF spheroids improved functions and symptoms of bladder induced by PBOO, which contributes to promote angiogenesis, suppress cell apoptosis and stimulate cell proliferation. Ad-SVF spheroids provide a potential treatment for the future patients with UAB.
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Affiliation(s)
- Jingyu Liu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Liuhua Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Feng Zhao
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Changcheng Zhou
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Tianli Yang
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Zhongle Xu
- Department of Urology, Hefei Hospital Affiliated to Anhui Medical University (The Second People's Hospital of Hefei), Hefei, Anhui, People's Republic of China
| | - Xinning Wang
- Department of Urology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, People's Republic of China
| | - Luwei Xu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Zheng Xu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Yuzheng Ge
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Ran Wu
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China
| | - Ruipeng Jia
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing, 210006, Jiangsu, People's Republic of China.
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The effectiveness of different electrical nerve stimulation protocols for treating adults with non-neurogenic overactive bladder: a systematic review and meta-analysis. Int Urogynecol J 2022; 33:1045-1058. [PMID: 35119495 DOI: 10.1007/s00192-022-05088-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Electrical nerve stimulation is a widely used treatment for overactive bladder but there is no consensus regarding the best placement of electrodes or protocols. We hypothesised that some non-implanted neurostimulation protocols would be more effective compared to others for treating urinary symptoms and improving quality of life among adults diagnosed with non-neurogenic overactive bladder. METHODS A systematic review and meta-analyses of randomized clinical trials were performed in five electronic databases: PubMed/MEDLINE, Lilacs, CINAHL, Web of Science, and PEDro. The main outcome was urinary symptoms-frequency, nocturia, and urgency-and the secondary outcome quality of life. Some protocol characteristics were extracted, e.g., frequency, pulse width, intensity, intervention time, and electrode placement. RESULTS Nine randomized controlled trials were included. Tibial neurostimulation showed better results than sacral neurostimulation for urge incontinence (mean difference = 1.25 episodes, 95% CI, 0.12-2.38, n = 73). On the pooled analysis, the different neurostimulation protocols-intravaginal, percutaneous tibial, and transcutaneous tibial nerve stimulation-demonstrated similar results for urinary frequency, nocturia, and urgency as well as quality of life. In general, effect sizes from meta-analyses were low to moderate. The best reported parameters for percutaneous tibial nerve stimulation were 20-Hz frequency and 200-μs width, once a week. CONCLUSIONS There was evidence that tibial neurostimulation is more effective than sacral neurostimulation for urge incontinence symptoms among patients with non-neurogenic overactive bladder. Overall, there was no superiority of an electrical nerve stimulation electrode placement and protocol over others considering urinary symptoms and quality of life. Further studies with three-arm trials are necessary. This study was registered at PROSPERO: CRD4201810071.
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Fernandes A, Sacomani CAR, Averbeck M, Prezotti JA, Ferreira RS, Moser D, Gajewski JB. Tradução para o português An International Continence Society (ICS) report on the terminology for adult neurogenic lower urinary tract dysfunction (ANLUTD). EINSTEIN-SAO PAULO 2022; 20:eAE5680. [PMID: 35195159 PMCID: PMC8815336 DOI: 10.31744/einstein_journal/2022ae5680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/15/2020] [Indexed: 11/05/2022] Open
Abstract
Introdução A terminologia para disfunção neurogênica do trato urinário inferior em adultos (DNTUIA) deve ser definida e organizada com base clínica em um relatório de consenso. Métodos Este relatório foi criado por um Grupo de Trabalho sob o endosso e diretrizes do Standardization Steering Committee (SSC) da International Continence Society (ICS), auxiliado em intervalos por julgadores externos. Todas as definições relevantes para DNTUIA foram atualizadas com base em pesquisas nos últimos 14 anos. Um extenso processo de 18 rodadas de revisão interna e externa foi realizado para examinar exaustivamente cada definição, com tomada de decisão pela opinião coletiva (consenso). Resultados O Relatório de Terminologia para a DNTUIA, englobando 97 definições (42 novas e oito modificadas), foi desenvolvido. Este relatório é clinicamente baseado nos diagnósticos definidos mais comuns. Clareza e facilidade de uso têm sido os principais objetivos para torná-lo interpretável por profissionais e pessoas em treinamento em todos os diferentes grupos envolvidos não só na disfunção do trato urinário inferior, mas também em muitas outras especialidades médicas. Conclusão Baseado no consenso, o Relatório de Terminologia para a DNTUIA foi produzido para auxiliar na pesquisa e na prática clínica.
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Sinsomboon O, Noppakulsatit P, Tassanarong A, Tungsukruthai P, Sriyakul K. A Comparison of Effectiveness of Thai Traditional Massage and Tamsulosin in Lower Urinary Tract Symptoms: A Randomized Controlled Trial. J Evid Based Integr Med 2022; 27:2515690X211068825. [PMID: 35001668 PMCID: PMC8753073 DOI: 10.1177/2515690x211068825] [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] [Indexed: 11/27/2022] Open
Abstract
The prospective clinical, non-inferiority study aimed to investigate the effectiveness of Thai traditional massage on lower urinary tract symptoms (LUTS) compared with Tamsulosin in Thai men. It was conducted on men aged 50 to 75 years old with LUTS (N = 45). Participants were blocked four randomly assigned into 2 groups. The control group (n = 25) was received 0.4 mg Tamsulosin daily and the study group (n = 20) was given Thai traditional massage for 4 weeks. The efficacy evaluation was performed by the International Prostate Symptoms Score (IPSS), a Thai version of the World Health Organization Quality of Life Questionnaire (WHO-QoL Brief), Uroflowmetry, and Post-void residual urine (PVR) at baseline and end of study. The background characteristics of participants were not significantly different between groups. Both interventions relieved LUTS in the total IPSS and the quality of life score associated with urination were decreased, described as symptoms and quality of life due to urination improvement after 4 weeks of intervention. Interestingly, the Thai traditional massage has significant improvement in total IPSS and voiding score (p < .05). Additionally, the time to peak flow rate, peak flow rate (Qmax), average flow rate (Qave) and voided volume of both interventions were improved with no statistical significance. PVR was decreased in both interventions. The WHO-QoL brief score was improved the total score. There was no significant difference in terms of uroflowmetry, PVR, and WHO-QoL brief scores compared between groups. The result suggests that Thai traditional massage has the potential to be an alternative treatment for LUTS.
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Affiliation(s)
- Ongart Sinsomboon
- Integrative medicine department, Chulabhorn International College of Medicine, 37698Thammasat University, Thailand
| | - Patranuch Noppakulsatit
- Division of Urology, Surgery department, Faculty of Medicine, 37698Thammasat University, Thailand
| | - Adis Tassanarong
- Integrative medicine department, Chulabhorn International College of Medicine, 37698Thammasat University, Thailand
| | - Parunkul Tungsukruthai
- Integrative medicine department, Chulabhorn International College of Medicine, 37698Thammasat University, Thailand
| | - Kusuma Sriyakul
- Integrative medicine department, Chulabhorn International College of Medicine, 37698Thammasat University, Thailand
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Veronese N, Smith L, Pizzol D, Soysal P, Maggi S, Ilie PC, Dominguez LJ, Barbagallo M. URINARY INCONTINENCE AND QUALITY OF LIFE: A LONGITUDINAL ANALYSIS FROM THE ENGLISH LONGITUDINAL STUDY OF AGEING. Maturitas 2022; 160:11-15. [PMID: 35550703 DOI: 10.1016/j.maturitas.2022.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/28/2021] [Accepted: 01/19/2022] [Indexed: 12/12/2022]
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Chan K, Charles L, Triscott J, Dobbs B. Common Problems of the Elderly. Fam Med 2022. [DOI: 10.1007/978-3-030-54441-6_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kim J, De Hoedt A, Wiggins E, Haywood K, Jin P, Greenwood B, Narain NR, Tolstikov V, Bussberg V, Barbour KE, Kiebish MA, Freedland S, Anger JT. Diagnostic Utility of Serum and Urinary Metabolite Analysis in Patients with Interstitial Cystitis/Painful Bladder Syndrome. Urology 2021; 157:85-92. [PMID: 34010675 PMCID: PMC10461181 DOI: 10.1016/j.urology.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To identify the potential biomarkers of interstitial cystitis/painful bladder syndrome (IC), a chronic syndrome of bladder-centric pain with unknown etiology that has an adverse impact on quality of life, we analyzed the urine and serum metabolomes of a cohort of IC patients and non-disease controls (NC). METHODS Home collection of serum and urine samples was obtained from 19 IC and 20 NC females in the Veterans Affairs (VA) Health Care System. IC was diagnosed independently by thorough review of medical records using established criteria. Biostatistics and bioinformatics analyses, including univariate analysis, unsupervised clustering, random forest analysis, and metabolite set enrichment analysis (MSEA), were then utilized to identify potential IC biomarkers. RESULTS Metabolomics profiling revealed distinct expression patterns between NC and IC. Random forest analysis of urine samples suggested discriminators specific to IC; these include phenylalanine, purine, 5-oxoproline, and 5-hydroxyindoleacetic acid. When these urinary metabolomics-based analytes were combined into a single model, the AUC was 0.92, suggesting strong potential clinical value as a diagnostic signature. Serum-based metabolomics did not provide potential IC discriminators. CONCLUSION Analysis of serum and urine revealed that women with IC have distinct metabolomes, highlighting key metabolic pathways that may provide insight into the pathophysiology of IC. The findings from this pilot study suggest that integrated analyses of urinary metabolites, purine, phenylalanine, 5-oxoproline, and 5-HIAA, can lead to promising IC biomarkers for pathophysiology of IC. Validation of these results using a larger dataset is currently underway.
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Affiliation(s)
- Jayoung Kim
- Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | | | - Peng Jin
- Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | | | | | - Kamil E. Barbour
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, GA
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Hellman KM, Oladosu FA, Garrison EF, Roth GE, Dillane KE, Tu FF. Circulating sex steroids and bladder pain sensitivity in dysmenorrhea. Mol Pain 2021; 17:17448069211035217. [PMID: 34689649 DOI: 10.1177/17448069211035217] [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: 11/16/2022] Open
Abstract
Although elevated estradiol levels facilitate chronic pelvic pain in animal models, it remains to be determined whether sex steroid levels are altered in a cross-section of women with chronic pelvic pain (CPP) and those at-risk for developing CPP. We sought to determine if sex steroid levels are increased in women with menstrual pain and whether those changes were more extreme in two groups of women with worsened pelvic pain profiles: a) dysmenorrhea plus evidence of bladder pain sensitivity and b) bladder pain syndrome. Serum samples were collected during the mid-luteal phase to measure estradiol, progesterone, testosterone, and sex hormone-binding globulin. We also compared quantitative sensory testing profiles to evaluate how sex steroid differences influence proposed pain sensitivity mechanisms. Women with combined dysmenorrhea and bladder sensitivity had higher estradiol concentrations than controls (487 [IQR 390 - 641] vs 404 [336 - 467] pmol/L, p = 0.042). Bladder pain syndrome participants had greater sex hormone-binding globulin than controls (83 [71 - 108] vs 55 [42 - 76 nmol/L; p = 0.027). Levels of pain sensitivity and mood were different across the groups, but the only significant relationship to sex steroids was that sex hormone-binding globulin was correlated to somatic symptoms (r = 0.26, p = 0.03). These findings show women potentially at-risk for CPP and women with diagnosed CPP exhibit altered circulating levels of sex steroids. Because these hormonal differences appear to be independent of mood or pain sensitivity, the role of sex steroids in the emergence of CPP may be via sensitization of visceral afferents.
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Affiliation(s)
- Kevin M Hellman
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Folabomi A Oladosu
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Ellen F Garrison
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, USA
| | - Genevieve E Roth
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, USA
| | - Katlyn E Dillane
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, USA
| | - Frank F Tu
- Department of Obstetrics & Gynecology, Northshore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
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Te Dorsthorst M, van Balken M, Janssen D, Heesakkers J, Martens F. Real-life patient experiences of TTNS in the treatment of overactive bladder syndrome. Ther Adv Urol 2021; 13:17562872211041470. [PMID: 34484428 PMCID: PMC8411642 DOI: 10.1177/17562872211041470] [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: 05/18/2021] [Accepted: 08/04/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction and objectives: Overactive bladder syndrome (OAB) is defined as urinary urgency, with or without urgent
urinary incontinence; it is often associated with urinary frequency and nocturia, in the
absence of any pathological or metabolic conditions that may cause or mimic OAB. The aim
of this study was to evaluate the long-term real-life adherence of transcutaneous tibial
nerve stimulation (TTNS) in the treatment of OAB, patient satisfaction of the treatment,
and reasons for quitting therapy. Materials and methods: In this single center study, all patients who had a positive effect on percutaneous
tibial nerve stimulation (PTNS) and continued to receive home-based treatment with TTNS
since 2012 were included for analysis. Patients were retrospectively asked to fill out a
questionnaire regarding satisfaction, reasons for quitting, and additional or next line
of therapy. Results: We included 42 patients for this study, 81% of these patients were female
(n = 34). The median age was 67 years (range 36–86). Most of the
patients (64%, n = 27) were diagnosed with OAB wet. The median TTNS
treatment persistence was 16 months (range 1–112 months). Reasons and percentages for
stopping therapy were: 55% stopped treatment due to loss of effect, and 24% stopped
because of preferring other type of neuromodulation. The mean satisfaction score (scale
1–10) in patients who continued TTNS was 6.2 (n = 9, SD 1.30)
versus 5.4 (n = 29, SD 2.24) for patients who quit
therapy. We did not find a statistically significant difference between the two groups
(p = 0.174). Conclusion: TTNS, although effective in the short-term, is not effective in the long-term. In
combination with a low satisfaction rate among patients, there is a need for improvement
in terms of OAB treatment modalities.
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Affiliation(s)
| | | | | | - John Heesakkers
- Maastricht University Medical Centre, Maastricht, Netherlands
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Abrar S, Razzak L, Mohsin R. The practice of Burch Colposuspension versus Mid Urethral Slings for the treatment of Stress Urinary Incontinence in developing country. Pak J Med Sci 2021; 37:1359-1364. [PMID: 34475912 PMCID: PMC8377912 DOI: 10.12669/pjms.37.5.4017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/24/2021] [Accepted: 05/02/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To compare the effectiveness and complications of Burch colposuspension and Mid Urethral Slings (MUS) for the treatment of Stress Urinary Incontinence (SUI). METHODS We conducted a cross-sectional study of 162 patients who underwent surgery for SUI with Burch colposuspension (n=40), tension free vaginal tape (TVT) (n= 59) or transobturator tape (TOT) (n=63), from 2006 to 2014 at the Aga Khan University Hospital- Karachi. All three groups were assessed in terms of demographics, cure rates, intraoperative and postoperative complications at one and five years using incontinence impact questionnaire-short form-7 (IIQ-7) and urogenital distress inventory -short form-6 (UDI-6). RESULTS Mean age of the participants in Burch, TVT and TOT group was 44.1 ± 7.4, 48.3 ± 8.9, 53.0 ± 9.4 respectively. Majority of patients in TVT group were premenopausal (59.3%) and postmenopausal in TOT group (53.9%). Most abdominal hysterectomies were done in Burch group (40) while vaginal hysterectomies and anterior and posterior colporrhaphy in TOT group (55). All the procedures had both subjective and objective cure rate of more than 82% at one year, with TVT having the highest success rate of 96.61%. The objective cure rate in Burch, TVT and TOT group at five years was 74.19%, 90.30% and 81.25% respectively. Intraoperative complications included hemorrhage in one patient during Burch procedure and bladder perforation in two cases of TVT, with no significant difference in short or long-term complications with either procedure. CONCLUSIONS All the three procedures have equal efficacy and complication rates. Even though TVT is the new gold standard but in view of current debate regarding mesh related complications, there is a need to readdress Burch colposuspension for treatment of SUI.
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Affiliation(s)
- Saida Abrar
- Dr. Saida Abrar Clinical Fellow Urogynecology and Pelvic Reconstructive Surgery, Department of OBGYN, Aga Khan University Hospital Karachi, Karachi, Pakistan
| | - Lubna Razzak
- Dr. Lubna Razzak Clinical Fellow Urogynecology and Pelvic Reconstructive Surgery, Department of OBGYN, Aga Khan University Hospital Karachi, Karachi, Pakistan
| | - Raheela Mohsin
- Dr. Raheela Mohsin Rizvi Associate Professor Urogynecology, Department of OBGYN, Aga Khan University Hospital Karachi, Karachi, Pakistan
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Taidi Z, Zhou T, Moore KH, Mansfield KJ, Liu L. P2X7 Receptor Blockade Protects Against Acrolein-Induced Bladder Damage: A Potential New Therapeutic Approach for the Treatment of Bladder Inflammatory Diseases. Front Pharmacol 2021; 12:682520. [PMID: 34456718 PMCID: PMC8397461 DOI: 10.3389/fphar.2021.682520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/12/2021] [Indexed: 01/28/2023] Open
Abstract
Inflammatory conditions of the urinary bladder have been shown to be associated with urothelial damage and loss of function. The purinergic P2X7 receptor has been implicated in several inflammatory conditions. The aim of this study was to investigate the role of the P2X7 receptor in acrolein-induced inflammatory damage using the porcine urinary bladder. For this purpose, an ex-vivo model of porcine urothelial damage induced by direct instillation of acrolein into the whole bladder lumen was used. To determine the role of the P2X7 receptor, the bladders were pre-incubated with a selective P2X7 receptor antagonist, A804598 (10 μM), for 1 h. The effects of the acrolein-induced urothelial damage on the bladder’s function were assessed by examining the bladder wall contractile response, structure changes, apoptosis, and oxidative stress in the bladder tissues. The acrolein treatment led to significant damage to the urothelium histology, tight junction expression, and contractile responses. Acrolein also induced apoptosis in the mucosa layer. All these acrolein-induced responses were attenuated by pre-treatment with the P2X7 receptor antagonist A804598. Acrolein also significantly induced DNA oxidation in the submucosal layer; however, the P2X7 receptor antagonism did not show any protective effect towards the acrolein-induced oxidative stress. These findings suggested that the P2X7 receptor is involved in the acrolein-induced damage to the urothelium; therefore, the P2X7 receptor antagonists may be a new therapeutic option for the treatment of bladder inflammation.
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Affiliation(s)
- Zhinoos Taidi
- School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia
| | - Tommy Zhou
- School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia
| | - Kate H Moore
- St George Hospital, UNSW Sydney, Kogarah, NSW, Australia
| | - Kylie J Mansfield
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Lu Liu
- School of Medical Sciences, UNSW Sydney, Sydney, NSW, Australia
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Abstract
Numerous systematic reviews and meta-analyses have reported the effect of electrical nerve stimulation (ENS) on overactive bladder (OAB). However, these results are contradictory. We conducted an umbrella review to summarize the evidence and evaluate the effectiveness of ENS for OAB by using an umbrella review methodology from multiple perspectives with sufficient methodological quality. We searched the PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL and PsycINFO databases and two Chinese databases (CNKI and CBM) to identify articles written in English or Chinese that were published up to 15 February 2021. Two authors of this review independently selected the studies, assessed their quality, and extracted the data from all the included studies. We performed a quality assessment of eligible reviews using the AMSTAR 2.0 tool and estimated the summary effect size, 95% confidence intervals, 95% prediction intervals and heterogeneity. Ten systematic reviews and meta-analyses covering 89 randomized controlled trials and 16 prospective cohort studies with a total population of 5004 participants that investigated the effect of ENS for OAB in terms of 17 different outcomes were identified. ENS seems effective and safety for OAB, with our results showing weak evidence of clinical efficacy and no evidence of side effects. To recommend ENS as a practical treatment option for OAB, however, more high-quality research is needed.
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Cornwell LB, Ewing E, Algra J, Chiang GJ. Acute urinary retention in pediatric cerebral palsy: Is there an optimal management strategy? J Pediatr Urol 2021; 17:527.e1-527.e7. [PMID: 34162517 DOI: 10.1016/j.jpurol.2021.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVE Cerebral palsy (CP) patients commonly have lower urinary tract dysfunction. Urinary retention (UR), which has been associated with dysfunctional voiding in CP can correlate to chronic upper tract dysfunction. We sought to provide insight into the pediatric presentation of acute UR in patients with CP and subsequent outcomes in this at-risk population. STUDY DESIGN All children with perinatally acquired CP presenting to a regional health network were identified from 2009 to 2019. Retrospective analysis of a hospitalized subset concurrently diagnosed with a first episode of acute UR was performed. Factors associated with new-onset UR are described, as well as management. Using follow-up data, we also assessed the risk for recurrent UR and/or abnormal renal imaging after an initial UR presentation. RESULTS 3404 CP patients were analyzed with only 33 fulfilling inclusion criteria. Median age was 10(IQR 7.5-16; range 1-22) years, 87.9% were GMFCS-V. 39.4% had a reported history of decreased urinary frequency. At presentation, median maximal time without void prior to catheterization was 13 h, and catheterized volume was a median 120% expected capacity-for-age. 84.8% of presentations were associated with a known transient/reversible etiology. 51.5% were post-anesthesia at median 3.5 days, 33.3% had associated constipation, 30.3% had received exacerbating medications. 11/33 were taught clean intermittent catheterization (CIC) after the initial presentation (all pro re nata [PRN] except one). At a median follow-up of 37 months: 50% of those without a CIC PRN no void plan had a repeat episode, at a median of 10.8 months later. Of the patients who had follow-up renal imaging at a median 22.0 months after presentation, 45% had abnormalities: 7 with debris or suspected stones and 2 with collecting system dilation. No factors associated with the initial UR presentation were found to be significantly predictive of recurrence or abnormal follow-up imaging. DISCUSSION Patients with CP presenting with acute UR are often those with the most severe limitations and have a history of decreased urinary frequency. They usually have transient or reversible factors associated with UR presentation, however UR recurrence and abnormal imaging in this population subset is common. CONCLUSIONS Pediatric patients with CP who present with acute UR usually present in the context of recent anesthesia and in the setting of exacerbating factors. They are at risk for recurrence and may be best managed with caretaker education of CIC PRN no void to address recurrent episodes. Providers should consider surveillance of these patients for the development of abnormal renal imaging.
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Affiliation(s)
- Laura B Cornwell
- Department of Urology, University of California San Diego, 200 West Arbor Drive MC 7897, San Diego, CA 92103, USA; Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA.
| | - Emily Ewing
- Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA
| | - Jeffrey Algra
- Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA
| | - George J Chiang
- Department of Urology, University of California San Diego, 200 West Arbor Drive MC 7897, San Diego, CA 92103, USA; Rady Children's Hospital - San Diego, 3020 Childrens Way MC 5120, San Diego, CA 92123, USA
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Lamerton TJ, Mielke GI, Brown WJ. Urinary incontinence, body mass index, and physical activity in young women. Am J Obstet Gynecol 2021; 225:164.e1-164.e13. [PMID: 33652055 DOI: 10.1016/j.ajog.2021.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Current evidence suggests that excess weight and obesity are important risk factors for urinary incontinence in women. However, limited data exist regarding the relationships among body mass index, physical activity, and urinary incontinence in women in their 20s. OBJECTIVE This study aimed to (1) compare prevalence rates of urinary incontinence and high body mass index in 2 cohorts of young women, (2) explore associations between changes in body mass index and urinary incontinence using analysis of combined data from the 2 cohorts, and (3) explore the associations between physical activity and urinary incontinence, with adjustment for body mass index. STUDY DESIGN Data were collected from 2 cohorts of young women in the Australian Longitudinal Study of Women's Health (n=16,065), born 17 years apart: 1973-1978 (cohort 1) and 1989-1995 (cohort 2). The women in both cohorts completed the surveys at age 18 to 23 years (T1), with follow-up 4 years later (age, 22-27 years; T2). Self-reported urinary incontinence and body mass index were assessed in both surveys. As physical activity was measured using different questions in cohort 1 at T1, self-reported physical activity data were from T2 only. A total of 9 body mass index transition categories (based on body mass index status at baseline and follow-up) and 4 physical activity categories were created to assess multivariate-adjusted prevalence ratios for urinary incontinence at T2, using Poisson regression. RESULTS Rates of obesity increased in both cohorts over 4 years, from 6.6%% (95% confidence interval, 6.1-7.2) to 10.4% (95% confidence interval, 9.7-11.0) in cohort 1 and from 11.7% (95% confidence interval, 11.0-12.4) to 19.6% (95% confidence interval, 18.7-20.5) in cohort 2. Compared with women who maintained normal body mass index at T1 and T2, the prevalence ratio for urinary incontinence among those with body mass index >30 at age 22 to 27 years was higher, regardless of body mass index category at age 18 to 23 years (prevalence ratio at T1: 1.39 for normal body mass index [95% confidence interval, 1.1-1.76]; 1.44 for overweight [95% confidence interval, 1.27-1.63]; and 1.51 for obese [95% confidence interval, 1.36-1.67]). In cohort 1, there was no relationship between physical activity and urinary incontinence. However, in cohort 2 there was an inverse dose-response relationship between physical activity and urinary incontinence. CONCLUSION The strong association between obesity and urinary incontinence in young women is a public health concern, given that obesity rates are likely to increase further with age and parity. The potential mitigating effects of physical activity on the obesity-incontinence relationship merit further investigation.
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Affiliation(s)
- Tayla J Lamerton
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia.
| | - Gregore I Mielke
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
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Harmonizing outcomes for menopause research-a path forward. ACTA ACUST UNITED AC 2021; 28:845-846. [PMID: 34260479 DOI: 10.1097/gme.0000000000001824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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76
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Donskov AO, Vinge L, Axelsen SM, Andersen H. Overactive bladder in patients with myasthenia gravis-A cross-sectional population-based study. Acta Neurol Scand 2021; 144:76-80. [PMID: 33772766 DOI: 10.1111/ane.13419] [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: 12/15/2020] [Revised: 02/15/2021] [Accepted: 03/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In myasthenia gravis (MG), first-line treatment for MG is acetylcholinesterase inhibitors which alleviates symptoms, but concomitantly may cause autonomic adverse effects. AIMS OF THE STUDY In this study, we evaluated if symptoms of overactive bladder (OAB) are more frequent among MG patients than healthy controls. METHODS Eighty-three MG patients and 50 healthy sex- and age-matched controls were included and answered the questionnaire "International Consultation on Incontinence Questionnaire Overactive Bladder Module" (ICIQ-OAB), including questions about polyuria, nocturia, urgency, and stress incontinence. Clinical severity of MG was determined based on three standardized clinical evaluations. RESULTS Compared to control subjects, MG patients had a higher total OAB score (median 5 [range 0-12] versus 3 [0; 7]) (p < 0.005) with higher scores concerning all four items. Also, MG patients had a higher bother score (10 [0-40] versus 5 [0-40]) (p < 0.05). Patients receiving a daily dose of pyridostigmine of more than 300 mg had a higher OAB score than other patients. CONCLUSIONS Myasthenia gravis patients have more bothering symptoms of OAB than healthy controls, related to the daily dose of pyridostigmine. To minimize adverse effects in patients with symptoms of OAB, the pyridostigmine dose should be as low as possible.
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Affiliation(s)
| | - Lotte Vinge
- Department of Neurology Aarhus University Hospital Aarhus N Denmark
| | | | - Henning Andersen
- Department of Neurology Aarhus University Hospital Aarhus N Denmark
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Affiliation(s)
- Ann Yates
- Director of Continence Services, Cardiff and Vale University Health Board
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Sharifiaghdas F, Khoiniha MR, Basiri A, Bonakdar Hashemi M, Borumandnia N, Dadpour M. Benign prostatic hyperplasia: Who will benefit from surgical intervention? A single center experience. Urologia 2021; 89:371-377. [PMID: 34034581 DOI: 10.1177/03915603211019987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To evaluate the pre-operative factors affecting clinical response to prostate surgery in men with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS In this prospective cohort study, 172 patients who underwent surgical intervention for BPH (either as open prostatectomy (n = 78) or monopolar-trans-urethral resection of prostate (n = 94) from February 2017 to October 2019 were consecutively enrolled. Pre-operative conventional three-lumen urodynamic study and transabdominal sonography were performed for all patients to determine peak flow rate (Qmax), detrusor pressure at the peak flow rate (PdetQmax), post-void residual volume (PVR), presence of detrusor overactivity (DO), prostate volume and median lobe size, and bladder wall thickness with empty and full bladder. Uroflowmetry and cystoscopy were performed during follow-up, whenever indicated. Successful surgical outcome was defined as subjective satisfaction of the patient and a Qmax of more than 15 ml/s on post-operative uroflowmetry. RESULTS At 1-year follow-up, complete resolution of lower urinary tract syndrome (LUTS) was detected in 138 (80.2%) patients; however, 21 (12.2%) still had pure obstructive LUTS, 9 (5.2%) had pure storage LUTS, and 4 (2.3%) were still suffering from both storage and obstructive LUTS. After performing multivariable analysis, shorter duration of pre-operative medical treatment and higher pre-operative bladder contractility index (BCI) were found to be independent predictors of successful surgery (p = 0.012 and p < 0.001, respectively). Results of the ROC curve analysis showed that a preoperative BCI level more than 90.95 and pre-surgical medical treatment duration less than 14.45 months have the most specificity and sensitivity to predict the success of surgical outcome. We also observed that the probability of recovery decreased considerably over time following surgery. CONCLUSION Shorter duration of pre-operative medical treatment and increased pre-operative BCI can independently predict favorable outcome of BPH surgery. These factors could be used for better patient management and appropriate planning and consultation before BPH surgery.
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Affiliation(s)
- Farzaneh Sharifiaghdas
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Khoiniha
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Basiri
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Milad Bonakdar Hashemi
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasrin Borumandnia
- Urology and Nephrology Research Centre, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Dadpour
- Urology and Nephrology Research Center, Shahid Labbafinejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Jang M, Kim HJ, Kim A, Jeon B. Urinary Symptoms and Urodynamic Findings in Patients with Spinocerebellar Ataxia. THE CEREBELLUM 2021; 19:483-486. [PMID: 32193855 DOI: 10.1007/s12311-020-01126-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Urinary dysfunctions are not considered symptoms of spinocerebellar ataxias (SCAs). However, given that a patient with SCAs without a family history might be misdiagnosed as MSA-C when having urinary dysfunctions, characterization of urinary dysfunctions in SCAs is needed not only to understand SCAs but also to correctly diagnosis patients with ataxia. We retrospectively reviewed medical records of 143 patients with genetically confirmed SCA1, 2, 3, 6, 7, 17, and DRPLA. Twenty-two patients (men n = 9; age 62.1 ± 10.9; disease duration 8.2 ± 2.9 years) who had lower urinary track symptoms (LUTS) were included in this study. Six patients underwent urodynamic study (UDS), and 2 underwent uroflowmetry. LUTS was present in 1 of 11 patients with SCA1, in 4 of 51 with SCA2, in 2 of 26 with SCA3, in 3 of 20 with SCA6, in 2 of 4 with SCA7, in 8 of 26 with SCA17, and in 2 of 5 with DRPLA. Overall, urinary frequency was the most common symptom (16 patients, 72.7%) followed by voiding difficulty. In three of the 6 patients with UDS, post-micturition residuals were > 100 ml. Detrusor overactivity was noted in three patients. Detrusor areflexia was observed in one. Four patients were diagnosed with a neurogenic bladder, 3 with a storage problem, and 1 with both storage and voiding problems. Fifteen percent of the patients with SCAs had LUTS, and LUTS occurred in various types of SCAs. Our results indicate that SCAs should be considered in patients with progressive cerebellar ataxia and urinary dysfunctions.
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Affiliation(s)
- Mihee Jang
- Department of Neurology, Eulji University Hospital, Daejeon, South Korea
| | - Han-Joon Kim
- Department of Neurology, Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.
| | - Aryun Kim
- Department of Neurology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Beomseok Jeon
- Department of Neurology, Movement Disorder Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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Machado LDS, Marques Cerentini T, Laganà AS, Viana da Rosa P, Fichera M, Telles da Rosa LH. Pelvic floor evaluation in CrossFit® athletes and urinary incontinence: a cross-sectional observational study. Women Health 2021; 61:490-499. [PMID: 33993850 DOI: 10.1080/03630242.2021.1927288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Athletic urinary incontinence is characterized by urinary loss during sports practice. This condition occurs in the case of CrossFit®, a modality based on high intensity training and functional movements, it can also be considered as having a high impact on the pelvic floor. This study aimed to compare the force and the contraction capacity of the pelvic floor musculature and urinary incontinence between female CrossFit® practitioners (AG) and non-practitioners (CG). We performed a cross-sectional observational study in the period from December 2018 and May 2019. Complaints of urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF); the functional evaluation of the pelvic floor was performed by digital palpation; resting tone, maximum voluntary contraction, fast contractions and sustained contraction of the pelvic floor muscles was tested by electromyography. The prevalence of urinary incontinence was significantly higher in AG compared with CG (p < .001). Nevertheless, we did not find significant differences between the two groups for functional assessment and electromyographic parameters. The AG presented a prevalence 60% of UI, while CG only 9,5 (p < 0,001). Considering this point, tailored prevention strategies seem mandatory in this population, in order to allow early identification and management of urinary incontinence.
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Affiliation(s)
- Lisandra da Silva Machado
- Postgraduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Taís Marques Cerentini
- Postgraduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Patrícia Viana da Rosa
- Physiotherapy Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Michele Fichera
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Luís Henrique Telles da Rosa
- Postgraduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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Risk Factors Predicting Upper Urinary Tract Damage in Patients With Myelodysplasia: Data Analysis of 637 Cases From a Single Center. Int Neurourol J 2021; 26:S22-29. [PMID: 34044484 PMCID: PMC8896779 DOI: 10.5213/inj.2040468.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To determine the risk factors predicting upper urinary tract (UUT) damage using a grading system for upper urinary tract dilation (UUTD) and a descriptive system for all urinary tract dysfunction (AUTD) in patients with myelodysplasia. Methods Six hundred thirty-seven patients with myelodysplasia were evaluated at our center from January 2008 to November 2019. Clinical data, ultrasonography, magnetic resonance urography, and video-urodynamics (VUDS) parameters were collected. Univariate and multivariate analyses were used to determine the risk factors predicting UUT damage. Results Three hundred eighty-three males and 254 females were included. The average course of lower urinary tract symptoms (LUTS) was 14.08±7.07 years (range, 3–31 years). The urodynamic diagnoses of all patients were as follows: detrusor overactivity, 26.8%; detrusor underactivity, 6.44%; and acontractile detrusor, 66.72%. UUT damage was determined in 66.56% of the patients. Of the patients, 28.73 % had vesicoureteral reflux (VUR) during filling (bilateral, n=50; unilateral, n=133) on fluoroscopy during VUDS testing. Two hundred thirty-four patients had UUTD (bilateral, n=203; unilateral, n=31). The occurrence of hydronephrosis based on ultrasonography was closely related to ipsilateral VUR (P<0.05). Absent of bladder sensation, long-term course of LUTS, decreased maximum cystometric capacity (MCC) and bladder compliance (BC), and increased postvoid residual urine (PVR) were shown to be independent risk factors in logistic regression analysis. Conclusions This retrospective study using UUTD and AUTD systems indicated that patients with myelodysplasia have a high incidence of UUT damage. Absence of bladder sensation, long-term course of LUTS, decreased MCC and BC, and increased PVR were independent risk factors predicting UUT damage.
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Abstract
Women who develop bladder pain syndrome (BPS), irritable bowel syndrome, or dyspareunia frequently have an antecedent history of dysmenorrhea. Despite the high prevalence of menstrual pain, its role in chronic pelvic pain emergence remains understudied. We systematically characterized bladder, body, and vaginal mechanical sensitivity with quantitative sensory testing in women with dysmenorrhea (DYS, n = 147), healthy controls (HCs) (n = 37), and women with BPS (n = 25). Previously, we have shown that a noninvasive, bladder-filling task identified a subset of women with both dysmenorrhea and silent bladder pain hypersensitivity, and we repeated this to subtype dysmenorrhea sufferers in this study (DYSB; n = 49). DYS, DYSB, and BPS participants had lower vaginal mechanical thresholds and reported more pain to a cold stimulus during a conditioned pain modulation task and greater pelvic examination after-pain than HCs (P's < 0.05). DYSB participants also had reduced body mechanical thresholds and less conditioned pain modulation compared to HCs and DYS participants (P's < 0.05). Comparing quantitative sensory testing results among the DYS and HC groups only, provoked bladder pain was the only significant predictor of self-reported menstrual pain (r = 0.26), bladder pain (r = 0.57), dyspareunia (r = 0.39), and bowel pain (r = 0.45). Our findings of widespread sensory sensitivity in women with dysmenorrhea and provoked bladder pain, much like that observed in chronic pain, suggest a need to study the trajectory of altered mechanisms of pain processing in preclinical silent visceral pain phenotypes to understand which features convey inexorable vs modifiable risk.
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83
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Zhuang G, Wen Y, Briggs M, Shao Q, Tran D, Wang H, Chen B. Secretomes of human pluripotent stem cell-derived smooth muscle cell progenitors upregulate extracellular matrix metabolism in the lower urinary tract and vagina. Stem Cell Res Ther 2021; 12:228. [PMID: 33823931 PMCID: PMC8025391 DOI: 10.1186/s13287-021-02292-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 03/17/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adult mesenchymal stem cells (MSCs) have been studied extensively for regenerative medicine; however, they have limited proliferation in vitro, and the long culture time induces cell senescence. MSCs also contribute to tissue repair through their paracrine function. In this study, we sought to examine the paracrine effects of human smooth muscle cell progenitors (pSMC) on the urethra and adjacent vagina of stress urinary incontinence rodents. We use human pluripotent stem cell (PSC) lines to derive pSMCs to overcome the issue of decreased proliferation in tissue culture and to obtain a homogenous cell population. METHOD Three human PSC lines were differentiated into pSMCs. The conditioned medium (CM) from pSMC culture, which contain pSMC secretomes, was harvested. To examine the effect of the CM on the extracellular matrix of the lower urinary tract, human bladder smooth muscle cells (bSMCs) and vaginal fibroblasts were treated with pSMC-CM in vitro. Stress urinary incontinence (SUI) was induced in rats by surgical injury of the urethra and adjacent vagina. SUI rats were treated with pSMC-CM and monitored for 5 weeks. Urethral pressure testing was performed prior to euthanasia, and tissues were harvested for PCR, Western blot, and histological staining. Kruskal-Wallis one-way ANOVA test and Student t test were used for statistical comparisons. RESULTS pSMC-CM upregulated MMP-2, TIMP-2, collagen, and elastin gene expression, and MMP-9 activity in the human bladder and vaginal cells consistent with elastin metabolism modulation. pSMC-CM treatment in the SUI rat improved urethral pressure (increase in leak point pressure compared to intact controls, p < 0.05) and increased collagen and elastin expression in the urethra and the adjacent vagina. CONCLUSION Conditioned media from smooth muscle cell progenitors derived from human pluripotent stem cells improved urethral leak point pressure and collagen and elastin content in the SUI rat. These findings suggest a novel therapeutic potential for PSC-based treatments for SUI and pelvic floor disorders where tissues are affected by collagen, elastin, and smooth muscle loss.
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Affiliation(s)
- Guobing Zhuang
- Department of Obstetrics/Gynecology, Stanford University School of Medicine, 300 Pasteur Drive HH-333, Stanford, CA 94305 USA
- Department of Obstetrics/Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Yan Wen
- Department of Obstetrics/Gynecology, Stanford University School of Medicine, 300 Pasteur Drive HH-333, Stanford, CA 94305 USA
| | - Mason Briggs
- Department of Obstetrics/Gynecology, Stanford University School of Medicine, 300 Pasteur Drive HH-333, Stanford, CA 94305 USA
| | - Qingchun Shao
- Department of Obstetrics/Gynecology, Stanford University School of Medicine, 300 Pasteur Drive HH-333, Stanford, CA 94305 USA
- Department of Obstetrics/Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Darlene Tran
- Department of Obstetrics/Gynecology, Stanford University School of Medicine, 300 Pasteur Drive HH-333, Stanford, CA 94305 USA
| | - Hongbo Wang
- Department of Obstetrics/Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Bertha Chen
- Department of Obstetrics/Gynecology, Stanford University School of Medicine, 300 Pasteur Drive HH-333, Stanford, CA 94305 USA
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Review of the rechargeable sacral neuromodulation system to treat refractory overactive bladder. Ther Deliv 2021; 12:353-362. [PMID: 33821666 DOI: 10.4155/tde-2021-0007] [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: 11/17/2022] Open
Abstract
Overactive bladder is a medical condition that requires management. If left untreated, it may severely affect quality of life. When first- and second-line treatments fail, sacral neuromodulation can be a safe and effective option for patients with refractory overactive bladder. This article reviews the rechargeable sacral neuromodulation (Axonics).
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Sousa-Fraguas M, Lastra-Barreira D, Blanco-Díaz M. Peripheral neuromodulation in women with overactive bladder syndrome: a systematic review. Actas Urol Esp 2021; 45:177-187. [PMID: 33353738 DOI: 10.1016/j.acuro.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/01/2020] [Accepted: 10/26/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Overactive bladder syndrome (OBS) is a urological disorder characterized by urinary urgency, increased frequency, nocturia, and may be associated with urge urinary incontinence. Posterior tibial nerve peripheral neuromodulation (PTNS) is globally recognized within the treatment options available, although an optimal protocol has not been tested. The objective of this review is to collect the evidence available on the most widely used protocol of the PTNS technique in obtaining good results in the treatment for women with OBS. EVIDENCE ACQUISITION A systematic review of the scientific literature was carried out in PubMed, Embase, WoS and Scopus databases. A total of 222 results were obtained, with 58 duplicates, of which 8 studies met the established inclusion criteria, all of them randomized clinical trials. EVIDENCE SYNTHESIS The included works show that the most widely used PTNS technique with beneficial results in women with OBS is the percutaneous route with a needle placed 5-6cm proximal to the tibial malleolus, posterior to the edge of the tibia, with the following parameters: 1 weekly session of 30minutes duration for 12 weeks, the use of pulse widths of 200μs with frequency of 20Hz. CONCLUSION PTNS may have beneficial and safe short-term effects in women with OBS. Despite showing statistically significant improvements in clinical symptoms, further research is needed to obtain clear scientific evidence on the optimal protocol for treating women with OBS.
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Ziegelmüller B, Bauer RM, Sommer A. [Urinary incontinence in men: causes, diagnostic steps and treatment options]. MMW Fortschr Med 2021; 163:62-69. [PMID: 33710573 DOI: 10.1007/s15006-021-9631-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Brigitte Ziegelmüller
- Urologische Klinik und Poliklinik,, Klinikum der Ludwig-Maximilians-Universität (LMU) München, Marchioninistr. 15, 81377, München, Germany
| | - Ricarda M Bauer
- Urologische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Germany
| | - Anne Sommer
- Urologische Klinik und Poliklinik,, Klinikum der Ludwig-Maximilians-Universität (LMU) München, Marchioninistr. 15, 81377, München, Germany
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Jiang YH, Kuo HC. High percentage of neurologic deficits in the electrophysiology study of the lower urinary tract in patients with detrusor underactivity and chronic urinary retention. Neurourol Urodyn 2021; 40:883-890. [PMID: 33645850 DOI: 10.1002/nau.24644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/21/2021] [Accepted: 02/09/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Both detrusor underactivity (DU) and bladder outlet obstruction are the common causes of chronic urinary retention. Some novel treatment approaches focus on modulating micturition reflex and external urethral sphincter (EUS) function. This study used electrophysiologic (EP) studies to investigate the micturition reflex and EUS conditions of chronic urinary retention patients. METHODS Sixty patients with urodynamic DU and chronic urinary retention were studied using (1) bulbocavernous reflex (BCR) by electric stimulation, (2) electromyography (EMG) of the EUS, and (3) nerve conduction velocity (NCV) studies of the pudendal nerve. The EP findings were analyzed in DU patients with different etiologies. RESULTS The BCR was positive in 41.7% of patients. In EMG studies, denervation, reinnervation, and reduced recruitment of the EUS were observed in 21.7%, 71.7%, and 88.3% patients, respectively. Decreased amplitude of pudendal nerve conduction in NCV studies was noted in 73.3% of patients. Patients with sacral neuropathy had a lower BCR positive rate (p = 0.001), a nonsignificant but higher denervation rate (p = 0.059) in EMG studies, and a higher rate of decreased amplitude in NCV (p = 0.011) than those without sacral neuropathy. Excluding patients with sacral neuropathy or diabetes mellitus, a high percentage of neurologic deficits was still detected in EP studies. CONCLUSIONS Chronic urinary retention patients with urodynamic DU not only have bladder dysfunction, but also potential neuropathy in the sacral reflexes, pudendal nerve, or urethral sphincter innervation. The neurologic deficits explored in EP studies may affect the decision-making around the therapy to restore the voiding function in DU.
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Affiliation(s)
- Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Deger M, Surmelioglu O, Kuleci S, Izol V, Akdogan N, Onan E, Tanrisever I, Aridogan IA. Risk factors associated with nocturia in patients with obstructive sleep apnea syndrome. Int J Clin Pract 2021; 75:e13724. [PMID: 32959453 DOI: 10.1111/ijcp.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022] Open
Abstract
AIM To evaluate the risk factors associated with nocturia in patients with obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS Patients aged over 18 years who had been diagnosed with OSAS using polysomnography (PSG) from January to December 2019 were evaluated. The number of nocturia episodes had been assessed in a 3-day bladder diary. We analysed the age, sex, body mass index (BMI) score, apnea-hypopn ea index (AHI) score and severity, hypertension, diabetes mellitus, smoking and heart diseases in all patients. RESULTS A total of 124 patients with a mean age of 49.9 ± 11.6 years (range: 25-81 years) were included in the study. Ninety-two (75.8%) patients had nocturia. The mean number of nocturia episodes of patients with nocturia was 2.4 ± 1.3. To determine factors affecting the risk of nocturia, the logistic regression analysis was performed. Patient age and BMI scores were found as the most effective risk factors determining nocturia (P < .05). The odds of patient age were 1.06 (odds ratio: 1.12; 95% confidence interval: 1.01-1.11; P = .010) times higher for patients with nocturia. Every 1-unit increase in the BMI score increased the risk of nocturia 1.12 times. In the study period, 48 patients with nocturia had undergone the continuous positive airway pressure (CPAP) therapy or surgical treatment. The mean number of nocturia episodes of these patients was 2.3 ± 1.4 before treatment and 1.7 ± 2.2 after treatment, showing a significant decrease (P = .032). Although the total daily urine volume increased significantly with the treatment, the total night-time urine volume decreased significantly at night (P = .016 and P = .024, respectively). CONCLUSION The age and BMI score were the risk factors associated with nocturia in patients with OSAS.
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Affiliation(s)
- Mutlu Deger
- Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ozgur Surmelioglu
- Department of Otorhinolaryngology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sedat Kuleci
- Department of Chest Diseases, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Volkan Izol
- Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Nebil Akdogan
- Department of Urology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Elvan Onan
- Department of Otorhinolaryngology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Ilda Tanrisever
- Department of Otorhinolaryngology, Faculty of Medicine, Çukurova University, Adana, Turkey
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89
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Goh J, Romanzi L, Elneil S, Haylen B, Chen G, Ghoniem G, Ijaiya M, Kwon S, Lee J, Mourad S, Ramanah R, Regmi M, Mohsin Rivzi R, Rogers R, Sharp J, Sung V. An International Continence Society (ICS) report on the terminology for female pelvic floor fistulas. Neurourol Urodyn 2021; 39:2040-2071. [PMID: 33068487 DOI: 10.1002/nau.24508] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The terminology for female pelvic floor fistulas (PFF) needs to be defined and organized in a clinically based consensus Report. METHODS This Report combines the input of members of the International Continence Society (ICS) assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give a coding to definitions. An extensive process of 19 rounds of internal and external review was involved to examine each definition, with decision-making by collective opinion (consensus). RESULTS A terminology report for female PFF, encompassing 416 (188 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in different specialty groups involved in female pelvic floor dysfunction and PFF. Female-specific imaging (ultrasound, radiology, and magnetic resonance imaging) and conservative and surgical PFF managements as well as appropriate figures have been included to supplement and clarify the text. Interval (5-10 years) review is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION A consensus-based terminology report for female PFF has been produced to aid clinical practice and research.
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Affiliation(s)
- Judith Goh
- Department of Gynecology, Griffith University, Gold Coast, Queensland, Australia
| | - Lauri Romanzi
- Department of Global Health and Global Medicine, Harvard Medical School, New York, New York, USA
| | - Sohier Elneil
- Department of Urogynecology, University College, London Hospitals, London, UK
| | - Bernard Haylen
- Department of Gynecology, University of New South Wales, Sydney, New South Wales, Australia
| | - Grace Chen
- Department of Gynecology, John Hopkins University, Baltimore, Maryland, USA
| | - Gamal Ghoniem
- Division of Female Urology, UC Irvine Health, Irvine, California, USA
| | - Munir'deen Ijaiya
- Department of Obstetrics and Gynecology, University of IIorin, IIorin, Kwara, Nigeria
| | - Soo Kwon
- Department of Gynecology, Zucker School of Medicine, New York, New York, USA
| | - Joseph Lee
- Department of Gynecology, University of New South Wales, Sydney, New South Wales, Australia
| | - Sherif Mourad
- Department of Gynecology, Ain Shams University, Cairo, Egypt
| | | | - Mohan Regmi
- Department of Obstetrics and Gynecology, BP Koirala Institute, Dharan, Nepal
| | | | - Rebecca Rogers
- Department of Obstetrics and Gynecology, University of Texas, Austin, Texas, USA
| | - Jonothan Sharp
- Department of Women's Health, Fenwek Hospital, Bomet, Kenya
| | - Vivian Sung
- Division of Urogynecology, Woman & Infants Hospital, Providence, Rhode Island, USA
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90
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Enache T, Bratila E, Abendstein B. Chronic pelvic pain of unknown origin may be caused by loose uterosacral ligaments failing to support pelvic nerve plexuses - a critical review. Cent European J Urol 2021; 73:506-513. [PMID: 33552577 PMCID: PMC7848843 DOI: 10.5173/ceju.2020.0280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 12/05/2022] Open
Abstract
Introduction Chronic pelvic pain of unknown origin (CPPU) affects the quality of life (QoL) of up to 20% of women. The 2005 Cochrane Review, based on randomized controlled trials (RCTs), stated that the pathogenesis of CPPU is poorly understood and its treatment is empirical and ineffective. Totally ignored were the high cure rates from uterosacral ligament (USL) repair, the principal subject of this review. Material and methods We carried out a review of literature on USL causation, diagnosis, and treatment of CPPU, selecting only the literature relevant to USL. Results The first mention of CPPU being caused by lax USLs was in the pre-WWII German literature by Heinrich Martius. In 1993, CPPU was described as one of the 4 pillars of the posterior fornix syndrome (PFS- CPPU, urgency, nocturia, abnormal bladder emptying). Cure/improvement of CPPU was reported by widely geographically separated surgical groups using squatting-based pelvic floor exercises and by shortening and reinforcing USLs with tension tapes, literally a reverse transvaginal tape. Patients can potentially be cured either by native tissue ligament repair or in older women a posterior sling can be tested using a speculum test or even menstrual tampons. Conclusions This technology, based on USL pathogenesis, which can be tested for potential cure, non-surgical or surgical, offers hope for women for a condition previously considered incurable. Chronic pelvic pain, bladder and bowel incontinence occur in predictable symptom groupings, which are associated with apical prolapse. USL repair, whether native tissue or (preferably) using a posterior sling has the potential to improve clinical practice, QoL for women and open new research directions.
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Affiliation(s)
- Traian Enache
- 'Prof. Dr. Panait Sirbu' Clinical Hospital of Obstetrics and Gynecology, Bucharest, Romania
| | - Elvira Bratila
- 'Prof. Dr. Panait Sirbu' Clinical Hospital of Obstetrics and Gynecology, Bucharest, Romania
| | - Burghard Abendstein
- State Hospital Feldkirch, Department of Obstetrics and Gynecology, Feldkirch, Austria
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91
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The Prevalence of Overactive Bladder Symptoms in Women in Algeria, Egypt, Jordan and Lebanon: A Cross-Sectional Population-Based Survey. Adv Ther 2021; 38:1155-1167. [PMID: 33354738 PMCID: PMC7889545 DOI: 10.1007/s12325-020-01588-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/28/2020] [Indexed: 01/10/2023]
Abstract
Aims Estimate the prevalence of symptoms suggestive of overactive bladder (OAB) in women living in the Middle East to describe their demographic characteristics and explore treatment-seeking behavior. Methods Cross-sectional, population-based survey of women aged ≥ 40 years resident in Algeria, Jordan, Lebanon or Egypt. Respondents were recruited using computer-assisted telephone interview over approximately 4 months. Eligible respondents were asked to complete the OAB-V8, a validated questionnaire that explores the extent of bother from the key symptoms of OAB without clinical investigations. In addition, information regarding demographics, comorbidities and treatment behavior was collected, and respondents were stratified by age. Results A total of 2297 eligible women agreed to participate. Mean age was 54 ± 10 years; over half (59.3%) were aged 40–55 years. Overall, 53.8% of eligible women had symptoms suggestive of OAB (Jordan 58.5%; Egypt 57.5%; Algeria 49.9%; Lebanon 49.0%), with over 90% also reporting symptoms of urinary incontinence. Only 13.0% of women with symptoms suggestive of OAB were currently receiving treatment, while most (74.3%) had never been treated; these data were consistent across country and age categories. Among the untreated subgroup, almost half (48.7%) reported they were ‘not bothered by symptoms,’ while 8.4% considered OAB to be ‘part of normal aging’ and 4.7% did not know it was treatable. Conclusion A high prevalence of symptoms suggestive of OAB was observed, and the majority had symptoms of urinary incontinence. Despite the high prevalence, most women had never received treatment. Considering the potential significant impact of OAB symptoms on health, quality of life and productivity, these findings highlight an unmet medical need in the population studied. Strategies to improve treatment-seeking behavior (e.g., through education and tackling the stigma associated with OAB symptoms) may improve the diagnosis, management and health outcomes of women with OAB in the Middle East. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-020-01588-4.
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92
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Wróbel A, Serefko A, Szopa A, Poleszak E. Asiatic Acid, a Natural Compound that Exerts Beneficial Effects on the Cystometric and Biochemical Parameters in the Retinyl Acetate-Induced Model of Detrusor Overactivity. Front Pharmacol 2021; 11:574108. [PMID: 33584259 PMCID: PMC7878531 DOI: 10.3389/fphar.2020.574108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022] Open
Abstract
Scientists have been constantly looking for new synthetic and natural compounds that could have beneficial effects in bladder overactivity. Our attention was drawn by asiatic acid that influences a number of molecules and signaling pathways relevant for the proper functioning of the urinary tracts in humans. In the present project we wanted to check whether asiatic acid would have positive effects in the confirmed animal model of detrusor overactivity (DO) and whether it would affect the bladder blood flow, urothelium thickness, inflammatory and oxidative stress markers, neurotrophic and growth factors, and other parameters important for the activity of the urinary bladder. The outcomes of our study showed that a 14-day administration of asiatic acid (30 mg/kg/day) by oral gavage normalizes the cystometric parameters corresponding to DO and reduces the accompanying oxidative stress (measured by the levels of malondialdehyde–61,344 ± 24,908 pg/ml vs. 33,668 ± 5,071 pg/ml, 3-nitrotyrosine–64,615 ± 25,433 pg/ml vs. 6,563 ± 1,736 pg/ml, and NOS2–2,506 ± 411.7 vs. 3,824 ± 470.1 pg/ml). Moreover, it decreases the urinary secretion of neurotrophins (BDNF–304.4 ± 33.21 pg/ml vs. 119.3 ± 11.49 pg/ml and NGF–205.5 ± 18.50 vs. 109.7 ± 15.94 pg/ml) and prevents the changes in a range of biomarkers indicating the dysfunction of the urinary bladder, CGRP (421.1 ± 56.64 vs. 108.1 ± 11.73 pg/ml), E-Cadherin (773.5 ± 177.5 pg/ml vs. 1,560 ± 154.5 pg/ml), OCT3 (3,943 ± 814.6 vs. 1,018 ± 97.07 pg/ml), SNAP-23 (6,763 ± 808.9 pg/ml vs. 3,455 ± 554.5 pg/ml), SNAP-25 (2,038 ± 162.7 pg/ml vs. 833.3 ± 65.48), substance P (171.7 ± 16.86 pg/ml vs. 65.07 ± 8.250 pg/ml), SV2A (1,927 ± 175.3 pg/ml vs. 1,154 ± 254.9 pg/ml), tight junction protein 1 (360.1 ± 95.05 pg/ml vs. 563.4 ± 65.43 pg/ml), VAChT (16,470 ± 2,419 pg/ml vs. 7,072 ± 1,339 pg/ml), VEGFA (318.3 ± 37.89 pg/ml vs. 201.5 ± 22.91 pg/ml). The mentioned parameters are associated with smooth muscle contractions, urothelial barrier, transportation and release of transmitters, or bladder compensation. Thus, the presented findings allow to suggest a possible future role of asiatic acid in the prevention of conditions accompanied by DO, such as overactive bladder.
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Affiliation(s)
- Andrzej Wróbel
- Second Department of Gynecology, Medical University of Lublin, Lublin, Poland
| | - Anna Serefko
- Chair and Department of Applied and Social Pharmacy, Laboratory of Preclinical Testing, Medical University of Lublin, Lublin, Poland
| | - Aleksandra Szopa
- Chair and Department of Applied and Social Pharmacy, Laboratory of Preclinical Testing, Medical University of Lublin, Lublin, Poland
| | - Ewa Poleszak
- Chair and Department of Applied and Social Pharmacy, Laboratory of Preclinical Testing, Medical University of Lublin, Lublin, Poland
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93
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Kmiecik MJ, Tu FF, Silton RL, Dillane KE, Roth GE, Harte SE, Hellman KM. Cortical Mechanisms of Visual Hypersensitivity in Women at Risk for Chronic Pelvic Pain. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021. [PMID: 33501463 PMCID: PMC7836135 DOI: 10.1101/2020.12.03.20242032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Multisensory hypersensitivity (MSH), which refers to persistent discomfort across sensory modalities, is a risk factor for chronic pain. Developing a better understanding of the neural contributions of disparate sensory systems to MSH may clarify its role in the development of chronic pain. We recruited a cohort of women (n=147) enriched with participants with menstrual pain at risk for developing chronic pain. Visual sensitivity was measured using a periodic pattern-reversal stimulus during EEG. Self-reported visual unpleasantness ratings were also recorded. Bladder pain sensitivity was evaluated with an experimental bladder-filling task associated with early clinical symptoms of chronic pelvic pain. Visual stimulation induced unpleasantness was associated with bladder pain and evoked primary visual cortex excitation; however, the relationship between unpleasantness and cortical excitation was moderated by bladder pain. Thus, future studies aimed at reversing the progression of MSH into chronic pain should prioritize targeting of cortical mechanisms responsible for maladaptive sensory input integration.
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Affiliation(s)
- Matthew J Kmiecik
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Frank F Tu
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
| | - Rebecca L Silton
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Katlyn E Dillane
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Genevieve E Roth
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States
| | - Steven E Harte
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, University of Michigan, Ann Arbor, MI
| | - Kevin M Hellman
- Department of Ob/Gyn, NorthShore University HealthSystem, Evanston, IL, United States.,Department of Ob/Gyn, Pritzker School of Medicine, University of Chicago, Chicago, IL, United States
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Potential Role of Monocyte Chemoattractant Protein-1 in Monitoring Disease Progression and Response to Treatment in Overactive Bladder Patients. Int Neurourol J 2021; 24:341-348. [PMID: 33401355 PMCID: PMC7788331 DOI: 10.5213/inj.2040366.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/08/2020] [Indexed: 01/12/2023] Open
Abstract
Purpose To compare urinary levels of monocyte chemoattractant protein-1 (MCP-1), an inflammatory cytokine, in healthy controls and overactive bladder (OAB) patients, to correlate changes in urinary MCP-1 with OAB treatment response and symptom severity, and to study the diagnostic potential of MCP-1 for OAB, as well as the efficacy of MCP-1 as a potential biomarker for different phenotypes of OAB. Methods We used enzyme-linked immunosorbent assay to measure normalized urinary MCP-1 levels in 56 individuals (43 OAB patients and 13 controls). We assessed the OAB patients at 3 visits with 2 validated symptom severity questionnaires (OAB-V8 and Patient Perception of Bladder Condition). Results The mean pretreatment urinary MCP-1 level at visit 1 (229.2-pg/mg creatinine) was significantly greater than the MCP-1 levels at visit 3 in both the treatment (107.0-pg/mg creatinine) (P<0.001) and control (52.35-pg/mg creatinine) groups (P<0.001). Average OAB symptom severity decreased significantly from visit 1 (baseline) to visits 2 (4 weeks) and 3 (12–14 weeks) and was significantly correlated with urinary MCP-1 levels. Urinary MCP-1 levels dropped significantly (P=0.002) posttreatment in patients whose symptom severity improved by >30%, whereas nonresponders displayed no significant MCP-1 decrease (P=0.164). The receiver operating characteristic analysis of the OAB visit 1 and control groups produced an area under the curve of 0.891. We found no significant differences in sex, race, or age between the OAB and control groups. Conclusions MCP-1 levels differed significantly between the control and OAB groups and were closely correlated with symptom severity and treatment response. The good diagnostic accuracy of MCP-1 for OAB suggests the potential usage of MCP-1 for OAB diagnosis. The varying response of urinary MCP-1 levels to treatment may indicate at least 2 potential phenotypes of OAB. MCP-1, in combination with other biomarkers and symptom severity questionnaires, could potentially aid in developing a patient-centered OAB treatment approach.
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95
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Herrity AN, Aslan SC, Ugiliweneza B, Mohamed AZ, Hubscher CH, Harkema SJ. Improvements in Bladder Function Following Activity-Based Recovery Training With Epidural Stimulation After Chronic Spinal Cord Injury. Front Syst Neurosci 2021; 14:614691. [PMID: 33469421 PMCID: PMC7813989 DOI: 10.3389/fnsys.2020.614691] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/03/2020] [Indexed: 12/27/2022] Open
Abstract
Spinal cord injury (SCI) results in profound neurologic impairment with widespread deficits in sensorimotor and autonomic systems. Voluntary and autonomic control of bladder function is disrupted resulting in possible detrusor overactivity, low compliance, and uncoordinated bladder and external urethral sphincter contractions impairing storage and/or voiding. Conservative treatments managing neurogenic bladder post-injury, such as oral pharmacotherapy and catheterization, are important components of urological surveillance and clinical care. However, as urinary complications continue to impact long-term morbidity in this population, additional therapeutic and rehabilitative approaches are needed that aim to improve function by targeting the recovery of underlying impairments. Several human and animal studies, including our previously published reports, have documented gains in bladder function due to activity-based recovery strategies, such as locomotor training. Furthermore, epidural stimulation of the spinal cord (scES) combined with intense activity-based recovery training has been shown to produce volitional lower extremity movement, standing, as well as improve the regulation of cardiovascular function. In our center, several participants anecdotally reported improvements in bladder function as a result of training with epidural stimulation configured for motor systems. Thus, in this study, the effects of activity-based recovery training in combination with scES were tested on bladder function, resulting in improvements in overall bladder storage parameters relative to a control cohort (no intervention). However, elevated blood pressure elicited during bladder distention, characteristic of autonomic dysreflexia, was not attenuated with training. We then examined, in a separate, large cross-sectional cohort, the interaction between detrusor pressure and blood pressure at maximum capacity, and found that the functional relationship between urinary bladder distention and blood pressure regulation is disrupted. Regardless of one’s bladder emptying method (indwelling suprapubic catheter vs. intermittent catheterization), autonomic instability can play a critical role in the ability to improve bladder storage, with SCI enhancing the vesico-vascular reflex. These results support the role of intersystem stimulation, integrating scES for both bladder and cardiovascular function to further improve bladder storage.
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Affiliation(s)
- April N Herrity
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Sevda C Aslan
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Ahmad Z Mohamed
- Department of Urology, University of Louisville, Louisville, KY, United States
| | - Charles H Hubscher
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, United States
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
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Igwe S, Ojukwu C, Orji P, Ede S, Ezeigwe A, Uchenwoke C, Anekwu E. Contraction techniques adopted for pelvic floor muscle exercise education by Nigeria-based physiotherapists: A preliminary study. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_93_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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97
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Pizzol D, Demurtas J, Celotto S, Maggi S, Smith L, Angiolelli G, Trott M, Yang L, Veronese N. Urinary incontinence and quality of life: a systematic review and meta-analysis. Aging Clin Exp Res 2021; 33:25-35. [PMID: 32964401 PMCID: PMC7897623 DOI: 10.1007/s40520-020-01712-y] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Urinary incontinence (UI) and low quality of life (QoL) are two common conditions. Some recent literature proposed that these two entities can be associated. However, no attempt was made to collate this literature. Therefore, the aim of this study was to conduct a systematic review and meta-analysis of existing data to estimate the strength of the association between UI and QoL. METHODS An electronic search of major databases up to 18th April 2020 was carried out. Meta-analysis of cross-sectional and case-control studies comparing mean values in QoL between patients with UI and controls was performed, reporting random-effects standardized mean differences (SMDs) ± 95% confidence intervals (CIs) as the effect size. Heterogeneity was assessed with the I2. RESULTS Out of 8279 articles initially screened, 23 were finally included for a total of 24,983 participants, mainly women. The mean age was ≥ 50 years in 12/23 studies. UI was significantly associated with poor QoL as assessed by the short-form 36 (SF-36) total score (n = 6 studies; UI: 473 vs. 2971 controls; SMD = - 0.89; 95% CI - 1.3 to - 0.42; I2 = 93.5) and by the sub-scales of SF-36 and 5/8 of the domains included in the SF-36. Similar results were found using other QoL tools. The risk of bias of the studies included was generally high. CONCLUSIONS UI is associated with a poor QoL, with a strong level of certainty. This work, however, mainly based on cross-sectional and case-control studies, highlights the necessity of future longitudinal studies for better understanding the importance of UI on QoL.
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Affiliation(s)
- Damiano Pizzol
- Italian Agency for Development Cooperation, Khartoum, Sudan
| | - Jacopo Demurtas
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Primary Care Department, USL Toscana Sud Est-Grosseto, Grosseto, Italy
| | - Stefano Celotto
- Primary Care Department, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Stefania Maggi
- National Research Council, Neuroscience Institute, Aging Branch, Padua, Italy
| | - Lee Smith
- Faculty of Sport Sciences, University of Murcia, Murcia, Spain
| | - Gabriele Angiolelli
- Primary Care Department, Azienda Unità Locale Socio Sanitaria 3 "Serenissima", Venice, Italy
| | - Mike Trott
- Faculty of Sport Sciences, University of Murcia, Murcia, Spain
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Canada
- Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Nicola Veronese
- Primary Care Department, Azienda Unità Locale Socio Sanitaria 3 "Serenissima", Venice, Italy.
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy.
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Are White Matter Tract Integrities Different in Multiple Sclerosis Women With Voiding Dysfunction? Female Pelvic Med Reconstr Surg 2021; 27:e101-e105. [PMID: 32265400 PMCID: PMC9744261 DOI: 10.1097/spv.0000000000000830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Two white matter tracts (WMTs) are proposed to be involved in bladder function: anterior thalamic radiation and superior longitudinal fasciculus. Multiple sclerosis (MS) patients with voiding dysfunction (VD) may have distinct changes in these 2 WMTs. This study aims to compare the fractional anisotropy (FA) and mean diffusivity (MD) from diffusion tensor imaging of MS females with and without VD versus healthy controls (HCs). METHODS Prospective observational cohorts of 28 female MS patients and 11 HCs were recruited. Multiple sclerosis patients were divided into 2 groups: voiders (patients without VD, n = 14) and VD (patients with VD, n = 14). Diffusion tensor imaging of each subject was obtained, from which FA and MD maps were generated. The mean FA and MD of each WMT on both sides were analyzed using one-way analysis of variance and pairwise comparison with adjusted P values. RESULTS Overall MS patients had significantly lower mean FA (loss of coherence) and significantly higher mean MD (increased free diffusion) than HCs in both WMTs, indicating more damage. Furthermore, VD showed a trend of loss of integrity in both WMTs when compared with voiders with lower FA and higher MD. CONCLUSIONS There is damage reflected by lower FA and higher MD values in the proposed WMTs involved in bladder function in MS women. Voiding dysfunction in this patient population can be attributed to these damages considering women with VD demonstrated a trend of deterioration in these WMTs compared with women without VD. Future studies with larger sample sizes should be done to further confirm this correlation.
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Brown SJ, Conway LJ, FitzPatrick KM, Hegarty K, Mensah FK, Papadopoullos S, Woolhouse H, Giallo R, Gartland D. Physical and mental health of women exposed to intimate partner violence in the 10 years after having their first child: an Australian prospective cohort study of first-time mothers. BMJ Open 2020; 10:e040891. [PMID: 33371030 PMCID: PMC7754634 DOI: 10.1136/bmjopen-2020-040891] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To investigate mental and physical health of mothers exposed to recent and early postpartum intimate partner violence (IPV) in the 10 years after having their first child. DESIGN Prospective pregnancy cohort study. SETTING Women were recruited at six metropolitan public maternity hospitals in Melbourne, Australia and followed up at 1, 4 and 10 years post partum. STUDY MEASURES Exposure to physical and/or emotional IPV was measured using the Composite Abuse Scale at 1, 4 and 10 years. At 10-year follow-up, mothers reported on physical and mental health, and functional health status. PARTICIPANTS 1507 first-time mothers enrolled at mean of 15 weeks' gestation. RESULTS One in three women experienced IPV during the 10 years after having their first child. Women experiencing recent IPV (19.1%) reported worse physical and mental health than women not reporting IPV. Compared with women not reporting IPV, women experiencing recent IPV had higher odds of poor functional health status (Adj OR=4.5, 95% CI 3.2 to 6.3), back pain (Adj OR=2.0, 95% CI 1.4 to 2.9), incontinence (Adj OR=1.8, 95% CI 1.2 to 2.6), depressive symptoms (Adj OR=4.9, 95% CI 3.2 to 7.5), anxiety (Adj OR=5.1, 95% CI 3.0 to 8.6) and post-traumatic stress symptoms (Adj OR=7.2, 95% CI 4.6 to 11.1) at 10 years. Women with past IPV at 1 and/or 4 years (15.7% of the cohort) also had higher odds of physical and mental health problems. There was evidence of a gradient in health outcomes by recency of exposure to IPV. CONCLUSIONS Both recent and past exposure to IPV are associated with poor maternal physical and mental health 10 years after a first birth. Health services and advocacy organisations providing support to women need to be aware of the consistent relationship between IPV and a range of physical and mental health conditions, which may persist even after IPV appears to have ceased.
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Affiliation(s)
- Stephanie J Brown
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Laura J Conway
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly M FitzPatrick
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Kelsey Hegarty
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona K Mensah
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Sandra Papadopoullos
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Hannah Woolhouse
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Rebecca Giallo
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Deirdre Gartland
- Intergenerational Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Azizi M, Azadi A, Otaghi M. The effect of a self-care programme on urinary incontinence and self-esteem in elderly men dwelling in nursing homes in Iran. Aging Male 2020; 23:687-693. [PMID: 30767639 DOI: 10.1080/13685538.2019.1573891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Whilst self-care programme involving comprehensive lifestyle plans including physical and behavioural interventions have reported positive outcomes for the aged suffering from urinary incontinence (UI), very few programmes have been implemented amongst Iranian nursing home residents, particularly in men. OBJECTIVES The aim of this study was to examine the effect of a self-care programme on UI and self-esteem in elderly men dwelling in nursing homes in Iran. MATERIALS AND METHODS Sixty-one elderly men (aged 60-75 years of age), at two different sites and living in nursing homes in the west of Iran, suffering from urinary incontinence were included in this study. Participants were selected using convenience sampling based on selected and randomized criteria in experimental and control groups. Data collection tools included Mini-Mental State Examination (MMSE), Rosenberg Self-Esteem Scale Questionnaire (RSES), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and demographic information form. Data were analysed using SPSS vesion18 (SPSS Inc., Chicago, IL). RESULTS A significant decrease in the mean scores of ICIQ-SF in the experimental group compared with the control group following intervention (p < .001). Furthermore, a significant increase was observed in self-esteem in the experimental group compared to the control group (p < .001). CONCLUSION The study findings demonstrate that the self-care programme significantly reduced UI in elderly men living in nursing homes, and that this in turn contributed to boosting their self-esteem. Implementing such an intervention has shown to be useful in managing both UI and improving self-esteem in this patient population.
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Affiliation(s)
- Milad Azizi
- Student Research Committee, Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical sciences, Ilam, Iran
| | - Arman Azadi
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
| | - Masoumeh Otaghi
- Department of Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran
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