201
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Yang TH, Chuang FC, Kuo HC. Urodynamic characteristics of detrusor underactivity in women with voiding dysfunction. PLoS One 2018; 13:e0198764. [PMID: 29924821 PMCID: PMC6010249 DOI: 10.1371/journal.pone.0198764] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/22/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND HYPOTHESIS Voiding dysfunction has gained interest due to its high prevalence in the elderly. This study characterized bladder dysfunction in women with voiding dysfunction using video urodynamic studies (VUDS) focused on detrusor underactivity (DU). METHODS We studied 1914 women in which first-line medical treatment failed. Age, comorbidities, and urodynamic parameters were analyzed to determine the association between bladder sensation and contractility. RESULTS VUDS were normal in 2.9% (n = 56) of patients and showed DU in 23.1% (n = 443), detrusor hyperactivity and impaired contractility (DHIC) in 12.0% (n = 231), hypersensitive bladder in 17.0% (n = 325), detrusor overactivity (DO) in 2.6% (n = 49) and bladder outlet obstruction in 42.3% (n = 810). The mean age of patients in the DU and DHIC groups was significantly older than in women with normal VUDS and those with hypersensitive bladders (p<0.01). Decreased bladder sensation and larger cystometric bladder capacity were noted in the DU group compared to the DHIC, HSB, and DO groups. Bladder sensation was negatively associated with the bladder contractility. Bladder contractility index and voiding efficiency were lower in the DU and DHIC groups compared to the normal group. CONCLUSIONS The bladder conditions of women with voiding dysfunction included DU, DHIC, HSB and DO. Bladder contractility index and voiding efficiency were significantly lowest in DU and DHIC groups and lower in HSB and DO groups than normal tracing group. Reduced bladder sensation was noted in DU and negatively associated with detrusor contractility.
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Affiliation(s)
- Tsai-Hwa Yang
- Department of Obstetrics and Gynecology, Chang Gang Memorial Hospital, Kaohsiung, Taiwan
| | - Fei-Chi Chuang
- Department of Obstetrics and Gynecology, Chang Gang Memorial Hospital, Kaohsiung, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
- * E-mail:
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202
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Abdulaziz M, Kavanagh A, Stothers L, Macnab AJ. Relevance of open magnetic resonance imaging position (sitting and standing) to quantify pelvic organ prolapse in women. Can Urol Assoc J 2018; 12:E453-E460. [PMID: 29989885 DOI: 10.5489/cuaj.5186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In pelvic organ prolapse (POP), posture and gravity impact organ position and symptom severity. The advanced magnet configuration in open magnetic resonance imaging (MRO) allows patients to be imaged when sitting and standing, as well in a conventional supine position. This study evaluated if sitting and standing MRO images are relevant as a means of improving quantification of POP because they allow differences in organ position not seen on supine imaging to be identified. METHODS Forty women recruited from a university urogynecology clinic had MRO imaging (0.5 T scanner) with axial and sagittal T2-weighted pelvic scans obtained when sitting, standing, and supine. Pelvic reference lines were used to quantify the degree of POP, and the relevance of imaging position on the detection of POP compared. RESULTS Images from 40 participants were evaluated (20 with POP and 20 asymptomatic controls). Our results indicate that the maximal extent of prolapse is best evaluated in the standing position using H line, M line, mid-pubic line, and perineal line as reference lines to determine POP. CONCLUSIONS MRO imaging of symptomatic patients in a standing position is relevant in the quantification of POP. Compared with supine images, standing imaging identifies that greater levels of downward movement in the anterior and posterior compartments occur, presumably under the influence of posture and gravity. In contrast, no appreciable benefit was afforded by imaging in the sitting position, which precluded use of some reference lines due to upward movement of the anorectal junction.
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Affiliation(s)
- Marwa Abdulaziz
- PhD Candidate, Department of Experimental Medicine, Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, and Principal Investigator, International Collaboration on Repair Discovery (ICORD), Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Lynn Stothers
- Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
| | - Andrew J Macnab
- Department of Urologic Sciences, University of British Columbia, and Principal Investigator, International Collaboration on Repair Discovery (ICORD), Blusson Spinal Cord Centre, Vancouver, BC, Canada.,Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
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203
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Herrity AN, Williams CS, Angeli CA, Harkema SJ, Hubscher CH. Lumbosacral spinal cord epidural stimulation improves voiding function after human spinal cord injury. Sci Rep 2018; 8:8688. [PMID: 29875362 PMCID: PMC5989228 DOI: 10.1038/s41598-018-26602-2] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/15/2018] [Indexed: 01/05/2023] Open
Abstract
Deficits in urologic function after spinal cord injury (SCI) manifest both as a failure to store and empty, greatly impacting daily life. While current management strategies are necessary for urological maintenance, they oftentimes are associated with life-long side effects. Our objective was to investigate the efficacy of spinal cord epidural stimulation (scES) as a promising therapy to improve bladder control after SCI. A bladder mapping study was undertaken for sixteen sessions over the course of four months in an individual with chronic, motor complete SCI. Varying combinations of stimulating cathode electrodes were initially tested during filling cystometry resulting in the identification of an effective configuration for reflexive bladder emptying at the caudal end of the electrode array. Subsequent systematic testing of different frequencies at a fixed stimulus intensity and pulse width yielded lowest post-void residual volumes at 30 Hz. These stimulation parameters were then tested in four additional research participants and found to also improve reflexive voiding efficiency. Taken together with SCI studies on step, stand, voluntary motor control and cardiovascular regulation, these findings further corroborate that scES has an all-encompassing potential to increase the central state of excitability, allowing for the control of multiple body functions, including the urological system.
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Affiliation(s)
- A N Herrity
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Neurological Surgery, University of Louisville, Louisville, KY, USA
| | - C S Williams
- Department of Urology, University of Louisville, Louisville, KY, USA
| | - C A Angeli
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Frazier Rehab Institute, Louisville, KY, USA
| | - S J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA.,Department of Neurological Surgery, University of Louisville, Louisville, KY, USA.,Frazier Rehab Institute, Louisville, KY, USA
| | - C H Hubscher
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, USA. .,Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, USA.
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204
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Persistent stress urinary incontinence during pregnancy and one year after delivery; its prevalence, risk factors and impact on quality of life in Taiwanese women: An observational cohort study. Taiwan J Obstet Gynecol 2018; 57:340-345. [DOI: 10.1016/j.tjog.2018.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 11/15/2022] Open
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205
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Yoshida M, Takeda M, Gotoh M, Nagai S, Kurose T. Vibegron, a Novel Potent and Selective β 3 -Adrenoreceptor Agonist, for the Treatment of Patients with Overactive Bladder: A Randomized, Double-blind, Placebo-controlled Phase 3 Study. Eur Urol 2018; 73:783-790. [DOI: 10.1016/j.eururo.2017.12.022] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 12/18/2017] [Indexed: 01/16/2023]
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206
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Aljumaily A, Al-Khazraji HAJ, Gordon A, Lau S, Jarvi KA. Chronic scrotal pain may lead to reduced sexual function and interest, while sexual activity may worsen chronic scrotal pain: "double jeopardy". Transl Androl Urol 2018; 7:S23-S28. [PMID: 29644167 PMCID: PMC5881205 DOI: 10.21037/tau.2017.12.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background While it is recognized that chronic pain may adversely impact sexual function and activity in men and we also recognize that sexual activity may worsen the pain for men with chronic scrotal pain (CSP), the effect on sexual functioning and conversely the impact of sex on CSP has not previously been documented. Methods Retrospective analysis of a prospectively collected database. Results From Feb 2014 to Sep 2015, a total of 128 men presenting for assessment of CSP completed all or parts of a standardized questionnaire. Overall 60% (69/116) of the men felt that the CSP had kept them either a "lot" or "some" of the time from sexual activity and 64% (27/43) had evidence of decreased erectile performance. Those with more severe pain (analog pain scores 7-10/10) had more significant sexual dysfunction than those with less severe pain, with 54% (45/83) vs. 0% (0/33, P<0.01: Fisher's exact test) noting that the pain kept them from sexual activity "a lot" and 70% (23/33) vs. 40% (4/10, P<0.01) noting sexual dysfunction. Diminished libido was also common in the men [43% (55/128)] as were the symptoms of testosterone deficiency [76% (97/128)]. Conversely, sexual activity often exacerbated the pain, with 37% (47/128) finding that ejaculation aggravated their pain and another 38% (48/128) patients found sexual activity aggravated their pain. Conclusions Men with severe CSP have significantly reduced sexual function and interest compared to men with moderate or minor levels of pain. The majority of men with CSP who were sexually active were faced with worsening pain with sex and ejaculation. Clinicians should be aware of the twin risks of sexual dysfunction occurring in men with CSP and sexual activity worsening the severity of the CSP.
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Affiliation(s)
- Aosama Aljumaily
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Murray Koffler Urologic Wellness Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Allan Gordon
- Wasser Pain Management Centre, Mount Sinai Hospital, Toronto, ON, Canada
| | - Susan Lau
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Murray Koffler Urologic Wellness Centre, Mount Sinai Hospital, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Keith Allen Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Murray Koffler Urologic Wellness Centre, Mount Sinai Hospital, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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207
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Soler JM, Previnaire JG, Amarenco G. Dartos reflex as autonomic assessment in persons with spinal cord injury. Spinal Cord Ser Cases 2018; 3:17097. [PMID: 29644099 DOI: 10.1038/s41394-017-0024-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/09/2022] Open
Abstract
Study design Prospective clinical series. Objectives The dartos reflex (DR) produces unilateral elevation of the testis with vermicular contraction of the scrotal skin and penile retraction. It is a somato-autonomic reflex that depends on the T11-L2 sympathetic segment. Its presence was analysed in men with various levels and severities of spinal cord injury (SCI). Setting France. Methods Male patients with SCI undergoing urodynamic or sexual assessment were included. DR of the scrotum and penis were systematically assessed in addition to the usual neurological examination that included assessment of the autonomic system, cremaster, and sacral reflexes. The DR was evoked by applying a small ice pack on the scrotum, separately to each side. Results Forty-six patients were assessed. DRs were always present when the T11-L2 segment was intact above the lesion (low paraplegia below L2) or below the lesion in an upper motor neuron (UMN) syndrome (spastic paraplegia above T10). They were more pronounced in the case of UMN syndrome. In the case of lower motor neuron (LMN) syndrome that included the T11-L2 segment, DRs disappeared in all but one patient. Patients with a LMN lesion were more prone to retrograde or absent ejaculation, loss of psychogenic erection, and open bladder neck. Conclusions The DR is a valuable test for the assessment of the integrity and excitability of the T11-L2 spinal segment. It is easy to perform and is predictive of some aspects of sexual and bladder neck function in men. DR should be considered as an addition to the autonomic standards.
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Affiliation(s)
- J M Soler
- Centre Bouffard Vercelli, 66290 Cerbere, France
| | - J G Previnaire
- 2Spinal Unit, Centre Calve, Fondation Hopale, 62600 Berck-sur-Mer, France
| | - G Amarenco
- 3Sorbonne universités, UPMC université Paris 06, GRC 01, GREEN, Group of Clinical Research in Neuro-Urology, 75005 Paris, France.,Service de neuro-urologie, hôpital Tenon, AP-HP, 75020 Paris, France
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208
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Christmann-Schmid C, Koerting I, Ruess E, Faehnle I, Krebs J. Functional outcome after laparoscopic nerve-sparing sacrocolpopexy: a prospective cohort study. Acta Obstet Gynecol Scand 2018; 97:744-750. [PMID: 29495121 DOI: 10.1111/aogs.13337] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/21/2018] [Indexed: 01/01/2023]
Abstract
INTRODUCTION To date sacrocolpopexy is regarded as the reference standard treatment for primarily apical compartment prolapse and multicompartment prolapse. Most bladder and bowel dysfunction improves postoperatively after sacrocolpopexy; however, de novo bowel or de novo bladder dysfunction can occur. The inferior hypogastric nerve is commonly known among pelvic surgeons. However, the inferior hypogastric nerve and its fine fibers are difficult to identify; iatrogenic lesion is commonly tolerated although this can lead to bladder, bowel and sexual dysfunction. This study was performed to assess the functional outcome after nerve-sparing sacrocolpopexy. MATERIAL AND METHODS From 2014 to 2016 all women undergoing a laparoscopic sacrocolpopexy for apical or multicompartment prolapse stage >2 were included in this prospective study. Laparoscopic sacrocolpopexy was performed using the nerve-sparing approach. Objective outcome was assessed by preoperative and postoperative POP-Q changes. De novo bladder and de novo bowel dysfunction were subjectively and objectively evaluated. RESULTS In all, 137 women were included. Significant objective improvement for point Aa and C (p < 0.0001) preoperatively to postoperatively was seen. The posterior compartment remained unchanged with point Ba -2. De novo overactive bladder and de novo bladder outlet obstruction with elevated postresidual volume were seen for both in 0.7% (1/137). De novo stress urinary incontinence was seen in 0.7% (5/137). De novo constipation was seen in 5%, bowel incontinence in 0% and resolution of pre-existing obstipation in 14.5%. De novo laxative use (9%) in the first 12 weeks was the most common postoperative problem. CONCLUSION We could demonstrate that when a nerve-sparing technique is applied for sacrocolpopexy low de novo bladder (18%) and de novo bowel dysfunction can be seen.
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Affiliation(s)
| | - Isabell Koerting
- Department of Urogynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Esther Ruess
- Department of Urogynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Ivo Faehnle
- Department of Urogynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Jörg Krebs
- Department of Urogynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
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209
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Fugett J, Phillips L, Tobin E, Whitbrook E, Bennett H, Shrout J, Coad JE. Selective bladder denervation for overactive bladder (OAB) syndrome: From concept to healing outcomes using the ovine model. Neurourol Urodyn 2018; 37:2097-2105. [PMID: 29603776 PMCID: PMC6321764 DOI: 10.1002/nau.23560] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/26/2018] [Indexed: 01/23/2023]
Abstract
Aims: We evaluated a Selective Bladder Denervation (SBD) device, which uses radiofrequency ablation, for the treatment of overactive bladder syndrome in terms of its nerve denervation, ablation characteristics, and post-treatment healing. Methods: Using the SBD device, eight fresh extirpated ovine bladder trigones were treated (90°C set point for 60 s) and nitroblue tetrazolium viability stained to characterize the ablation. In addition, 12 trigones were treated in vivo with three adjacent ablations and divided into survival cohorts: Day 7, Day 30, and Day 90 to assess the ablations and their associated healing. Results: The ex vivo single trigone ablations had a 7.9 ± 0.9 mm width and 5.7 ± 1.0 mm thickness that involved the submucosa, detrusor muscle, adventitia, and vagina. Microscopic viability staining confirmed complete nerve necrosis within the targeted tissue. The in vivo Day 7 trigones supported the ex vivo ablation characteristics and showed up to minimal inflammation, granulation tissue, and collagen fibrosis. Day 30 trigones had essentially absent inflammation and granulation tissue with evolving collagen fibrosis at the ablation's periphery. Day 90 trigones had essentially absent acute inflammation, minimal chronic inflammation, essentially absent granulation tissue, and up to mild collagen fibrosis. No ureteral/urethral alterations, vesico-vaginal fistulas, or other complications were identified. Conclusions: The SBD device provided a targeted trigone ablation with resultant denervation. The tissue healing timeline followed that expected for a hyperthermic ablation and was characterized by a fibroproliferative healing response with limited inflammation and granulation tissue. The ablations did not impact the overlying bladder mucosal surface.
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Affiliation(s)
- James Fugett
- Pathology Laboratory for Translational Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | | | - Emily Tobin
- American Preclinical Services, Minneapolis, Minnesota
| | | | - Haydon Bennett
- Pathology Laboratory for Translational Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Joshua Shrout
- Pathology Laboratory for Translational Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
| | - James E Coad
- Pathology Laboratory for Translational Medicine, West Virginia University School of Medicine, Morgantown, West Virginia
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210
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Adıgüzel C, Saygılı Yılmaz ES, Arlıer S, Seyfettinoğlu S, Söker G, Uysal G, Yücel O, Sivaslıoğlu A. The importance of uterosacral ligament anatomy in overactive bladder: A preliminary study. Turk J Obstet Gynecol 2018; 15:65-69. [PMID: 29662719 PMCID: PMC5894539 DOI: 10.4274/tjod.73669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/03/2018] [Indexed: 12/20/2022] Open
Abstract
Objective: To evaluate whether uterosacral ligament (USL) thickness measured using magnetic resonance imaging (MRI) was associated with overactive bladder (OAB) in otherwise healthy women. Materials and Methods: The study comprised 27 women with OAB and 27 healthy women (control group) who were followed up at the Obstetrics and Gynecology Department of a tertiary referral center. All subjects were evaluated using pelvic MRI to determine the transverse USL thickness. These measurements were compared between the two groups. p values less than 0.05 were considered statistically significant. Results: The mean age of women in the OAB and control groups were 43.88±9.36 years and 39.92±5.36 years, respectively. The mean body mass index in the OAB group was 29.77±4.82 kg/m2 and 27.49±3.44 kg/m2 in the control group. In the comparison of Pelvic Organ Prolapse Quantification system stages between the groups, no statistically significant relationship was determined. In the OAB group, the mean right USL thickness was 2.04±0.34 mm, and the mean left USL was 2.04±0.52 mm. In the control group, the mean right USL thickness was 2.17±0.47 mm, and the mean left USL was 2.09±0.51 mm. There were no statistically significant differences in terms of USL thickness between the OAB and control groups (p>0.05). Conclusion: No previous studies have been identified in the literature that have investigated the relationship between USL thicknesses and urinary incontinence. In the present study, no significant relationship could be demonstrated between right and left USL thicknesses of the OAB and control groups. This was a preliminary study, and further research with larger sample sizes is required to reach a final conclusion.
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Affiliation(s)
- Cevdet Adıgüzel
- Adana Numune Training and Research Hospital, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | | | - Sefa Arlıer
- Adana Numune Training and Research Hospital, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | - Sevtap Seyfettinoğlu
- Adana Numune Training and Research Hospital, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | - Gökhan Söker
- Adana Numune Training and Research Hospital, Clinic of Radiology, Adana, Turkey
| | - Gülsüm Uysal
- Adana Numune Training and Research Hospital, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | - Oğuz Yücel
- Adana Numune Training and Research Hospital, Clinic of Obstetrics and Gynecology, Adana, Turkey
| | - Akın Sivaslıoğlu
- Muğla Sıtkı Koçman University Faculty of Medicine, Department of Obstetrics and Gynecology, Muğla, Turkey
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211
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Di Lena M, Tolls V, Kelly KL, Nickel JC. Mirabegron as adjuvant treatment for patients with interstitial cystitis/bladder pain syndrome. Can Urol Assoc J 2018; 12:E100-E104. [PMID: 29283084 PMCID: PMC5869033 DOI: 10.5489/cuaj.4325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Interstitial cystitis/bladder pain syndrome (IC/BPS) patients represent a heterogeneous group with pain and urinary storage symptoms and varying responses to current treatment options. The novel beta-3 agonist, mirabegron, has been shown to improve storage symptoms of patients with bladder overactivity; however, its effect on symptoms in the IC/BPS population has yet to be studied. METHODS Patients diagnosed at a single IC centre with IC/BPS undergoing standard therapy were treated with additional daily mirabegron 25 mg and seen in followup post-treatment. Patients completed the Interstitial Cystitis Symptom Index and Problem Index (ICSI/ICPI), and the Pelvic Pain and Urgency/Frequency Patient Symptom Scale (PUF) prior to and following mirabegron treatment. Global (NRS) and symptom-specific outcomes were assessed by comparing the pre- and post-treatment mean scores using tailed-t test (p<0.05 considered statistically significant). RESULTS A total of 23 patients were available for review pre- and post-mirabegron treatment. There was no significant difference in ICSI (p=0.448), ICPI (p=0.352), or PUF (p=0.869) pre- and post-treatment. Analysis of symptom-specific outcomes show statistically significant improvements in urgency (p=0.048); however, no statistically significant improvements in frequency (p=0.951) or pain (p=0.952) were observed with mirabegron therapy. CONCLUSIONS IC/BPS patients treated with mirabegron had improvement of urinary urgency, but no significant benefit in terms of pain or urinary frequency. This data suggests that mirabegron's role in the IC/BPS patient should be that of adjuvant treatment to ameliorate urgency.
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Affiliation(s)
- Michael Di Lena
- Department of Urology, Queen's University, Kingston, ON, Canada
| | - Victoria Tolls
- Department of Urology, Queen's University, Kingston, ON, Canada
| | | | - J Curtis Nickel
- Department of Urology, Queen's University, Kingston, ON, Canada
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212
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Grundy L, Brierley SM. Cross-organ sensitization between the colon and bladder: to pee or not to pee? Am J Physiol Gastrointest Liver Physiol 2018; 314:G301-G308. [PMID: 29146678 DOI: 10.1152/ajpgi.00272.2017] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Chronic abdominal and pelvic pain are common debilitating clinical conditions experienced by millions of patients around the globe. The origin of such pain commonly arises from the intestine and bladder, which share common primary roles (the collection, storage, and expulsion of waste). These visceral organs are located in close proximity to one another and also share common innervation from spinal afferent pathways. Chronic abdominal pain, constipation, or diarrhea are primary symptoms for patients with irritable bowel syndrome or inflammatory bowel disease. Chronic pelvic pain and urinary urgency and frequency are primary symptoms experienced by patients with lower urinary tract disorders such as interstitial cystitis/painful bladder syndrome. It is becoming clear that these symptoms and clinical entities do not occur in isolation, with considerable overlap in symptom profiles across patient cohorts. Here we review recent clinical and experimental evidence documenting the existence of "cross-organ sensitization" between the colon and bladder. In such circumstances, colonic inflammation may result in profound changes to the sensory pathways innervating the bladder, resulting in severe bladder dysfunction.
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Affiliation(s)
- Luke Grundy
- Visceral Pain Research Group, Human Physiology, Centre for Neuroscience, College of Medicine and Public Health, Flinders University , Bedford Park, South Australia , Australia.,Centre for Nutrition and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia , Australia
| | - Stuart M Brierley
- Visceral Pain Research Group, Human Physiology, Centre for Neuroscience, College of Medicine and Public Health, Flinders University , Bedford Park, South Australia , Australia.,Centre for Nutrition and Gastrointestinal Diseases, Discipline of Medicine, University of Adelaide, South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia , Australia
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213
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Frota IPR, Rocha ABO, Neto JAV, Vasconcelos CTM, De Magalhaes TF, Karbage SAL, Augusto KL, Nascimento SLD, Haddad JM, Bezerra LRPS. Pelvic floor muscle function and quality of life in postmenopausal women with and without pelvic floor dysfunction. Acta Obstet Gynecol Scand 2018; 97:552-559. [PMID: 29352460 DOI: 10.1111/aogs.13305] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 12/27/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION This study aims to compare pelvic floor muscle (PFM) function in postmenopausal women with and without pelvic floor dysfunction (PFD) and the relation between PFM function and quality of life. MATERIAL AND METHODS A case-control study with 216 postmenopausal women with (n = 126) and without (n = 90) PFD. PFM function was assessed by digital vaginal palpation using the PERFECT scale. Specific quality of life was evaluated using the King's Health Questionnaire for women with urinary incontinence and the Prolapse Quality-of-Life Questionnaire for women with pelvic organ prolapse. We analyzed women with PFD into two categories: Oxford's grade ≤2 or ≥3 using a chi-squared test. RESULTS Out of 126 womem with PFD 44 (34.9%) presented stress urinary incontinence, 21 (16.6%) had pelvic organ prolapse and 61 (48.4%) had urinary incontinence + pelvic organ prolapse. Strength had a median value 2 (0-5) in all women studied and most of them had insufficient strength, reduced endurance and repetition without statistical difference between groups. Incontinent women with strength ≤2 had worse perception of general health domain of King's Health Questionnaire (p = 0.007). No association was found between PFM function and Prolapse Quality-of-Life Questionnaire. CONCLUSIONS PFM function assessed by bidigital palpation in postmenopausal women was not sufficiently sensitive to differentiate between women with vs. women without PFM dysfunction and was not related with specific quality of life in women with urinary incontinence and pelvic organ prolapse, respectively. These data should be used to reinforce the widespread recommendation that PFM training is essencial in PFD treatment.
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Affiliation(s)
- Isabella Parente Ribeiro Frota
- Department of Surgery, Maternidade Escola Assis Chateaubriand and Department of Maternal-Child Health, Federal University of Ceará, Fortaleza, CE, Brazil
| | | | - José Ananias Vasconcelos Neto
- Department of Surgery, Maternidade Escola Assis Chateaubriand and Department of Maternal-Child Health, Federal University of Ceará, Fortaleza, CE, Brazil
| | | | - Thais Fontes De Magalhaes
- Department of Surgery, Maternidade Escola Assis Chateaubriand and Department of Maternal-Child Health, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Sara Arcanjo Lino Karbage
- Department of Surgery, Maternidade Escola Assis Chateaubriand and Department of Maternal-Child Health, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Kathiane Lustosa Augusto
- Department of Surgery, Maternidade Escola Assis Chateaubriand and Department of Maternal-Child Health, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Simony Lira Do Nascimento
- Department of Physical Therapy, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Jorge Millem Haddad
- Department of Gynecology, Faculty of Medicine, University of Sao Paulo, São Paulo, SP, Brazil
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Kinlaw AC, Funk MJ, Conover MM, Pate V, Markland AD, Wu JM. Impact of New Medications and $4 Generic Programs on Overactive Bladder Treatment Among Older Adults in the United States, 2000-2015. Med Care 2018; 56:162-170. [PMID: 29287033 PMCID: PMC5766403 DOI: 10.1097/mlr.0000000000000858] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite several new medications being Food and Drug Administration-approved for overactive bladder (OAB) and new prescription drug payment programs, there are limited population-based data regarding OAB medication use among older adults. OBJECTIVES To examine: (1) impacts of new medications and $4 generic programs on time trends for OAB-related medication dispensing for older adults in the United States; (2) differences by age and sex; and (3) temporal changes in OAB-related medication payments. METHODS Using Truven Health Analytics' Medicare Supplemental Database (2000-2015), we analyzed OAB-related medication claims for 9,477,061 Medigap beneficiaries age 65-104. We estimated dispensing rates (per 1000 person-months), assessed dispensing trends using interrupted time-series methods, compared dispensing rates by age and sex, and summarized payment trends. RESULTS From 2000 to 2015, 771,609 individuals filled 13,863,998 OAB-related prescriptions. During 2000-2007, 3 new extended-release medications became available (tolterodine, darifenacin, solifenacin), leading to increases in overall OAB-related dispensing rates by 19.1 (99% confidence interval, 17.0-21.2), a 92% increase since 2000; overall rates remained stable during 2008-2015. By 2015, the most common medications were oxybutynin (38%), solifenacin (20%), tolterodine (19%), and mirabegron (12%). Dispensing rates peaked at age 90 (rate, 53.4; 99% confidence interval, 53.1-53.7). Women had higher rates than men at all ages (average ratewomen-ratemen, 22.0). The gap between upper and lower percentiles of medication payments widened between 2008-2015; by 2015, 25% of reimbursed dispensed prescriptions had total payments exceeding $250. CONCLUSIONS Medication-specific dispensing rates for OAB changed when new alternatives became available. Recent changes in utilization and cost of OAB medications have implications for clinical guidelines, pharmacoepidemiologic studies, and payment policies.
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Affiliation(s)
- Alan C. Kinlaw
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
| | - Michele Jonsson Funk
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
| | - Mitchell M. Conover
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
| | - Virginia Pate
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
| | - Alayne D. Markland
- Birmingham/Atlanta Veterans Affairs, Geriatric Research Education and Clinical Center, 700 South 19th Street, Birmingham, AL USA 35233
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL USA 35233
| | - Jennifer M. Wu
- Center for Women’s Health Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
- Department of Obstetrics & Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
- Center for Aging and Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA 27599
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215
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Differences in Urodynamic Parameters According to the Presence of a Hunner Lesion in Women With Interstitial Cystitis/Bladder Pain Syndrome. Int Neurourol J 2018; 22:S55-61. [PMID: 29385787 PMCID: PMC5798639 DOI: 10.5213/inj.1835044.522] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/11/2018] [Indexed: 02/04/2023] Open
Abstract
Purpose Differences in the severity of subjective symptoms have been noted depending on whether a Hunner lesion is present in women with interstitial cystitis/bladder pain syndrome (IC/BPS). In this study, we aimed to identify differences in objective urodynamic parameters in women with IC/BPS according to the presence of a Hunner lesion. Methods This cross-sectional study included a total of 55 patients with IC/BPS. IC/BPS and the presence of a Hunner lesion on cystoscopy were diagnosed according to American Urological Association guidelines. The patients were categorized into a Hunner IC/BPS group and a non-Hunner IC/BPS group according to the presence of a Hunner lesion on cystoscopy. At the initial visit, a medical history was taken from all patients with IC/BPS, and they underwent symptom assessment using a 3-day voiding diary and laboratory tests. A urodynamic study was then performed before any treatment was performed. Baseline characteristics and urodynamic parameters were compared between the 2 groups. Results Of the 55 patients, 23 (41.8%) had a Hunner lesion on cystoscopy. As documented in the voiding diaries, the Hunner IC/BPS group had more frequent voids and a smaller maximal voided volume (P=0.045, P<0.001, respectively). Regarding urodynamic parameters, the mean volume at the first desire to void, normal desire to void, strong desire to void (SDV), and maximum cystometric bladder capacity (MBC) was significantly lower in the Hunner IC/BPS group (P=0.001, P=0.004, P<0.001, and P<0.001, respectively). On receiver operating characteristic curve analysis, patients with an SDV≤210 mL (area under the curve [AUC]=0.838, P<0.001) and an MBC≤234 mL (AUC=0.857, P<0.001) were likely to be in the Hunner IC/BPS group. Conclusions The differences in patients’ subjective symptoms between the Hunner IC/BPS and non-Hunner IC/BPS groups were confirmed to correspond to differences in objective urodynamic parameters.
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216
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Powell LC, Szabo SM, Walker D, Gooch K. The economic burden of overactive bladder in the United States: A systematic literature review. Neurourol Urodyn 2018; 37:1241-1249. [DOI: 10.1002/nau.23477] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/29/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Lauren C. Powell
- Broadstreet Health Economics and Outcomes ResearchVancouverBritish ColumbiaCanada
| | - Shelagh M. Szabo
- Broadstreet Health Economics and Outcomes ResearchVancouverBritish ColumbiaCanada
| | - David Walker
- Astellas Pharma Global Development, Inc.NorthbrookIllinois
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217
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Pourmomeny A, Alebouye-Langeroudi S, Zargham M. Reliability and Validity of the Persian Language Version of the Female Lower Urinary Tract Symptoms' Long form Questionnaire. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2018; 23:421-425. [PMID: 30386390 PMCID: PMC6178575 DOI: 10.4103/ijnmr.ijnmr_130_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: Lower urinary tract symptoms (LUTS) are important and prevalent health problems that seriously affect many women and their quality of life (QOL). The female LUTS long form (FLUTS-LF) is a robust measure to assess the QOL of women. This study aimed at translating FLUTS-LF and assessing the reliability and validity of this questionnaire among Iranian patients with LUTS. Materials and Methods: Forward and backward translations of FLUTS-LF questionnaire were carried out by the research team. Data collection was conducted from November 2015 to March 2016 in Isfahan, Iran. A total of 237 women completed the Persian version of FLUTS-LF, incontinence QOL, and International Prostate Symptom Score (IPSS) questionnaires. We evaluated Cronbach's alpha coefficient, intraclass correlation coefficient (ICC), stability (reliability), and confirmatory factor analysis (CFA) of the questionnaire. Results: The mean (standard deviation) age of the participants was 45.4 (12.50) years (range 20–70 years). Face and content validities were acceptable and missing data comprise 2% of the total data. Internal consistency (Cronbach's alpha) of the urinary symptoms was 0.78. ICC of the total score in urinary symptoms section was 0.95. Indexes of factor analysis were assessed and found to be acceptable. A high correlation was observed between the total scores of FLUTS-LF and IPSS. Conclusions: It seems that FLUTS-LF questionnaire can be a suitable instrument for assessing LUTS and their impacts on Iranian women's QOL.
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Affiliation(s)
- AbbasAli Pourmomeny
- Pelvic Floor Research Centre, Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samane Alebouye-Langeroudi
- Pelvic Floor Research Centre, Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahtab Zargham
- Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Li X, Liao LM, Chen GQ, Wang ZX, Lu TJ, Deng H. Clinical and urodynamic characteristics of underactive bladder: Data analysis of 1726 cases from a single center. Medicine (Baltimore) 2018; 97:e9610. [PMID: 29504988 PMCID: PMC5779757 DOI: 10.1097/md.0000000000009610] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
There have no universally accepted criteria and have been established for classification of underactive bladder (UAB) at present. Thus, the study described the comprehensive clinical and urodynamic characteristics of UAB in patients with lower urinary tract symptoms.A total of 1726 patients (1259 men and 467 women; 6-88 years old) who were admitted to our center with a diagnosis of UAB were included in this retrospective study. It was due to the type of rehabilitation hospital, so higher percentage of neurological patients were included. The demographics, clinical characteristics, and urodynamic recordings were reviewed. The clinical characteristics and urodynamic findings of UAB were further classified.For the etiologic analysis, UAB with aging and without clear causes accounted for 11.5% of cases (199/1726), UAB with bladder outflow obstruction accounted for 2.6% (45/1726), and UAB acting on the nerve pathway of the voiding reflex accounted for 84.6% (1460/1726). There were a number of cases (1.3% [22/1726]) which had >2 factors assigned. For studies involving urodynamic findings and clinical symptoms, the percentage of patients with detrusor hyperreflexia with impaired contractility (DHIC), detrusor underactivity (DU), and acontractile detrusor (AcD) was 0.7%, 5.6%, and 93.7%, respectively.UAB can be classified into 4 types based on possible etiologic mechanisms (idiopathic, myogenic, neurogenic, and integrative). Based on urodynamic findings and symptoms, UAB can be classified into 3 types (DU, AcD, and DHIC). The classification of UAB can provide a reasonable basis for the future research.
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Affiliation(s)
- Xing Li
- The Rehabilitation School of Capital Medical University and Department of Urology at China Rehabilitation Research Centre
- Beijing Key Laboratory of Neural Injury and Rehabilitation and Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Li-Min Liao
- The Rehabilitation School of Capital Medical University and Department of Urology at China Rehabilitation Research Centre
- Beijing Key Laboratory of Neural Injury and Rehabilitation and Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Guo-Qing Chen
- The Rehabilitation School of Capital Medical University and Department of Urology at China Rehabilitation Research Centre
- Beijing Key Laboratory of Neural Injury and Rehabilitation and Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhao-Xia Wang
- The Rehabilitation School of Capital Medical University and Department of Urology at China Rehabilitation Research Centre
- Beijing Key Laboratory of Neural Injury and Rehabilitation and Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Tian-Ji Lu
- The Rehabilitation School of Capital Medical University and Department of Urology at China Rehabilitation Research Centre
- Beijing Key Laboratory of Neural Injury and Rehabilitation and Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
| | - Han Deng
- The Rehabilitation School of Capital Medical University and Department of Urology at China Rehabilitation Research Centre
- Beijing Key Laboratory of Neural Injury and Rehabilitation and Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing, China
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Eder SE. Early effect of fractional CO 2 laser treatment in Post-menopausal women with vaginal atrophy. Laser Ther 2018; 27:41-47. [PMID: 29795970 DOI: 10.5978/islsm.18-or-04] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/11/2017] [Indexed: 01/28/2023]
Abstract
Background and Aim Fractional CO2 lasers have been shown to provide improvement of vulvovaginal atrophy (VVA). The aim of the current study was to assess the early effect of a fractional CO2 laser system in treating postmenopausal women with clinical symptoms of VVA. Methods 28 healthy post-menopausal women (mean age 60.1 ± 5.55 years) with VVA-related symptoms were treated with fractional CO2 laser 3 times, in 4-week intervals. At each study visit, VHIS score and VVA symptom severity were recorded. Sexual function was assessed with the Female Sexual Function Index (FSFI). Results One month following the first laser treatment, the mean VHIS score was significantly improved (13.89 ± 4.25 vs. baseline 11.93 ± 3.82; p < 0.05), and improved further at 3 and 6 months following all three laser treatments (16.43 ± 4.20 and 17.46 ± 4.07, respectively). Almost all VVA symptoms were significantly improved at one month following the first treatment. A further significant improvement in VVA symptoms was noted at 3 and 6 months following the third laser treatment. Following treatments, the FSFI score increased significantly (22.36 ± 10.40 vs. baseline 13.78 ± 7.70; p < 0.05), and remained significantly higher than baseline at the 3- and 6-month follow-up visits. Conclusion CO2 laser therapy for post-menopausal women can be considered an effective therapeutic option providing relief of symptoms already noted after one laser treatment.
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Affiliation(s)
- Scott Evan Eder
- The Center for Women's Health & Wellness, Plainsboro, New Jersey, USA
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220
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Are There Pharmacotherapeutic Options for Underactive Bladder? Eur Urol Focus 2018; 4:6-7. [DOI: 10.1016/j.euf.2018.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 03/09/2018] [Accepted: 03/24/2018] [Indexed: 12/14/2022]
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Neuropelveology: An Emerging Discipline for the Management of Chronic Pelvic Pain. Int Neurourol J 2017; 21:243-246. [PMID: 29298475 PMCID: PMC5756824 DOI: 10.5213/inj.1735036.518] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 12/06/2017] [Indexed: 02/06/2023] Open
Abstract
Chronic pelvic pain (CPP) is a common condition involving multiple, organ-specific medical specialties, each with its own approach to diagnosis and treatment. Management requires knowledge of the interplay between pelvic organ function and neuro-functional anatomy, and of the neurologic and psychological aspects of CPP, but no current specialty fully encompasses this approach. Neuropelveology is an emerging discipline focusing on pathologies of the pelvic nervous system on a cross-disciplinary basis. It involves a neurological/neurosurgical approach, combining the knowledge required for a proper neurologic diagnosis, confirmation by transvaginal/transrectal examination of the pelvic nerves, and advanced laparoscopic surgery in selected cases of CPP. The management of CPP requires multidisciplinary contributions, and neuropelveology may offer an educational framework for the interdisciplinary exchange of knowledge between clinical physicians and basic researchers.
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Mateus-Vasconcelos ECL, Ribeiro AM, Antônio FI, Brito LGDO, Ferreira CHJ. Physiotherapy methods to facilitate pelvic floor muscle contraction: A systematic review. Physiother Theory Pract 2017; 34:420-432. [PMID: 29278967 DOI: 10.1080/09593985.2017.1419520] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
AIM To undertake a systematic review of the literature on physical therapy methods to facilitate voluntary pelvic floor muscles (PFM) contraction. METHODS The databases consulted were PubMed, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, PEDro and CINHAL. The study included randomized controlled trials, quasi-experimental trials and systematic reviews. The GRADE scale was used to assess methodological quality. RESULTS Six manuscripts were included. The methods investigated included instruction regarding the anatomy and function of the PFM, vaginal palpation, palpation on the central perineal tendon, interruption of urinary flow, biofeedback using a perineometer, vaginal cones, hypopressive exercise, PFM contraction associated with diaphragmatic breathing; and coactivation of abdominal muscles. The studies showed improvement in PFM contraction, but most were of low methodological quality. Only one study was characterized as being of high methodological quality. CONCLUSION All the studies observed improvement in PFM contraction using various methods, but none were superior over the others. The studies revealed no adverse effects of the interventions used. Patient preferences should be taken into account in clinical decision-making. More studies of high methodological quality on this topic are needed.
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Affiliation(s)
- Elaine Cristine Lemes Mateus-Vasconcelos
- a Rehabilitation Center of Clinical Hospital of the Medical School of Ribeirão Preto , University of São Paulo , Ribeirão Preto , SP , Brazil.,b Barão de Mauá University Center , Ribeirão Preto , SP , Brazil.,c Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Course of Physiotherapy , Department of Health Sciences - RibeirãPreto Medical School , Ribeirão Preto , SP , Brazil
| | - Aline Moreira Ribeiro
- a Rehabilitation Center of Clinical Hospital of the Medical School of Ribeirão Preto , University of São Paulo , Ribeirão Preto , SP , Brazil
| | - Flávia Ignácio Antônio
- c Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Course of Physiotherapy , Department of Health Sciences - RibeirãPreto Medical School , Ribeirão Preto , SP , Brazil
| | - Luiz Gustavo de Oliveira Brito
- d Department of Gynecology and Obstetrics , Ribeirão Preto School of Medicine, University of São Paulo , Ribeirão Preto , SP , Brazil
| | - Cristine Homsi Jorge Ferreira
- c Department of Biomechanics, Medicine and Rehabilitation of the Locomotor System, Course of Physiotherapy , Department of Health Sciences - RibeirãPreto Medical School , Ribeirão Preto , SP , Brazil
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Impact of posterior urethral diameter/external urethral sphincter diameter as a new tool to predict detrusor pressure in the voiding phase. Int Urol Nephrol 2017; 50:211-215. [PMID: 29243203 DOI: 10.1007/s11255-017-1770-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
PURPOSES We measured posterior urethra diameter (PUD) and external urethral sphincter diameter (EUSD), which can also be measured by voiding cystourethrography (VCUG) and investigated the relationship between PUD/EUSD and detrusor pressure (Pdet) during voiding by videourodynamics (VUDS). METHODS Sixty-three children, who were 3 years old or less and underwent VUDS, were enrolled in the present study. We measured PUD and EUSD in addition to detrusor pressure at the time of the widest EUS during voiding (Pdet-voiding) by VUDS, and PUD/EUSD was investigated compared to Pdet-voiding. RESULTS Seventy-eight VUDS were performed in 63 patients, and the median age at VUDS was 10.2 months. These studies revealed a significant correlation between PUD/EUSD and Pdet-voiding (r = 0.641, p < 0.001). However, a significant correlation was not observed between PUD/EUSD and age (r = 0.180). We defined Pdet-voiding of more than 80 cmH2O as a high voiding pressure, and a PUD/EUSD of 2.4 was a good predictor for the cutoff value for high voiding pressure. Pdet-voiding was significantly higher in children with a PUD/EUSD of ≥ 2.4 (p < 0.001). In 19 children who had neurological diseases, a significant correlation was found between PUD/EUSD and Pdet-voiding (r = 0.842, p < 0.001), and a PUD/EUSD of 2.4 was a useful cutoff value for high voiding pressure. CONCLUSIONS PUD/EUSD is a valuable tool to predict high voiding pressure in pediatric patients. A PUD/EUSD of ≥ 2.4 in VCUG indicates the need to perform more invasive tests, such as VUDS, in pediatric patients aged 3 and under with neuropathic diseases.
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Gajewski JB, Schurch B, Hamid R, Averbeck M, Sakakibara R, Agrò EF, Dickinson T, Payne CK, Drake MJ, Haylen BT. An International Continence Society (ICS) report on the terminology for adult neurogenic lower urinary tract dysfunction (ANLUTD). Neurourol Urodyn 2017; 37:1152-1161. [PMID: 29149505 DOI: 10.1002/nau.23397] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/03/2017] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The terminology for adult neurogenic lower urinary tract dysfunction (ANLUTD) should be defined and organized in a clinically based consensus Report. METHODS This Report has been created by a Working Group under the auspices and guidelines of the International Continence Society (ICS) Standardization Steering Committee (SSC) assisted at intervals by external referees. All relevant definitions for ANLUTD were updated on the basis of research over the last 14 years. An extensive process of 18 rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS A Terminology Report for ANLUTD, encompassing 97 definitions (42 NEW and 8 CHANGED, 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 all the different groups involved not only in lower urinary tract dysfunction but additionally in many other medical specialties. CONCLUSION A consensus-based Terminology Report for ANLUTD has been produced to aid clinical practice and research.
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Affiliation(s)
| | - Brigitte Schurch
- Neurourology Unit, Department of Clinical Neurosciences, CHUV, University Hospital, Lausanne, Switzerland
| | - Rizwan Hamid
- Department of Neuro-Urology, Spinal Injuries Unit, RNOH, Stanmore/London, United Kingdom
| | - Márcio Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
| | - Ryuji Sakakibara
- Neurology, Internal Medicine, Sakura Medical Center, Toho University, Sakura, Japan
| | - Enrico F Agrò
- Department of Experimental Medicine and Surgery, Tor Vergata University, Rome, Italy
| | - Tamara Dickinson
- Department of Urology, UT Southwestern Medical Center Dallas, Texas
| | | | - Marcus J Drake
- Bristol Urological Institute, Southmead Hospital, Westbury-on-Trym Bristol, United Kingdom
| | - Bernie T Haylen
- University of New South Wales, Sydney, New South Wales, Australia
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Douglas-Moore JL, Goddard J. Current best practice in the management of cystitis and pelvic pain. Ther Adv Urol 2017; 10:17-22. [PMID: 29344093 DOI: 10.1177/1756287217734167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 08/21/2017] [Indexed: 01/08/2023] Open
Abstract
Bladder pain syndrome (BPS) is a difficult disorder to diagnose and subsequently manage despite having been recognized for more than 200 years according to references in medical literature. There are currently three widely accepted guidelines on BPS: the American Urological Association Guidelines; the Royal College of Obstetricians and Gynaecologists in conjunction with the British Society of Urogynaecologists Guidelines; and the European Association of Urology Guidelines. These guidelines have similarities to each other but also significant differences. This leaves clinicians still confused about this condition and how to appropriately manage the 'real' patient. We review the current guidelines and appropriate literature and put forward a clinically usable management strategy.
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Kilinc MF, Yasar E, Aydin HI, Yildiz Y, Doluoglu OG. Association between coronary artery disease severity and overactive bladder in geriatric patients. World J Urol 2017; 36:35-40. [DOI: 10.1007/s00345-017-2098-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 10/05/2017] [Indexed: 10/18/2022] Open
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Peterson AC, Sehgal A, Crump RT, Baverstock R, Sutherland JM, Carlson K. Evaluating the 8-item overactive bladder questionnaire (OAB-v8) using item response theory. Neurourol Urodyn 2017; 37:1095-1100. [DOI: 10.1002/nau.23420] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/12/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Alexander C. Peterson
- Centre for Health Services and Policy Research; University of British Columbia; Vancouver British Columbia Canada
| | - Anika Sehgal
- Vesia [Alberta Bladder Centre]; Calgary Alberta Canada
| | - R. Trafford Crump
- Department of Surgery; University of Calgary; Calgary Alberta Canada
| | - Richard Baverstock
- Vesia [Alberta Bladder Centre]; Calgary Alberta Canada
- Department of Surgery; University of Calgary; Calgary Alberta Canada
| | - Jason M. Sutherland
- Centre for Health Services and Policy Research; University of British Columbia; Vancouver British Columbia Canada
| | - Kevin Carlson
- Vesia [Alberta Bladder Centre]; Calgary Alberta Canada
- Department of Surgery; University of Calgary; Calgary Alberta Canada
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Jürgensen SP, Borghi-Silva A, Bastos AMFG, Correia GN, Pereira-Baldon VS, Cabiddu R, Catai AM, Driusso P. Relationship between aerobic capacity and pelvic floor muscles function: a cross-sectional study. ACTA ACUST UNITED AC 2017; 50:e5996. [PMID: 28953985 PMCID: PMC5609598 DOI: 10.1590/1414-431x20175996] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 07/28/2017] [Indexed: 11/22/2022]
Abstract
The objective of this study was to evaluate the relationship between aerobic capacity and pelvic floor muscles (PFM) function in adult women. Women aged 18 or over and without urinary dysfunction or other chronic diseases were eligible to participate. They completed the habitual physical activity (HPA) questionnaire, underwent a PFM functional evaluation by palpation and perineometry, and performed a submaximal (between 75 and 85% of maximum heart rate) cardiopulmonary exercise (CPX) test to determine the ventilatory anaerobic threshold (VAT). Forty-one women were included (35±16 years, 75% physically active, 17% very active, and 8% sedentary and 17% presented grade 1 PFM contraction, 31.8% grade 2, 26.8% grade 3, and 24.4% grade 4, according to the modified Oxford Scale). The average PFM contraction pressure obtained by perineometer was 53±26 cmH2O and the average oxygen consumption at VAT (VO2VAT) obtained from CPX was 14±2 mL·kg-1·min-1. Significant correlations were found between PFM contraction pressure and VO2VAT (r=0.55; P<0.001); between PFM contraction pressure and HPA score (r=0.38; P=0.02); between age and VO2VAT (r=-0.25; P=0.049); and between VO2VAT and HPA score (r=0.36; P=0.02). An age-adjusted multiple linear regression equation (R2=0.32) was derived to estimate VO2VAT from the contraction value obtained by perineometer, so that the PFM contraction pressure was able to predict VO2VAT. The equation was validated using data from another group of 20 healthy women (33±12 years; PFM contraction: 49±23 cmH2O) and no significant difference was found between actual VO2VAT and predicted VO2VAT (13.1±1.9 vs 13.8±2.0 mL·kg-1·min-1). In conclusion, PFM function is associated with aerobic capacity in healthy women and PFM contraction pressure may be used to estimate VO2VAT in this population.
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Affiliation(s)
- S P Jürgensen
- Laboratório de Pesquisa em Saúde da Mulher, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - A Borghi-Silva
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - A M F G Bastos
- Laboratório de Pesquisa em Saúde da Mulher, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - G N Correia
- Laboratório de Pesquisa em Saúde da Mulher, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - V S Pereira-Baldon
- Laboratório de Pesquisa em Saúde da Mulher, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - R Cabiddu
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - A M Catai
- Laboratório de Fisioterapia Cardiovascular, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - P Driusso
- Laboratório de Pesquisa em Saúde da Mulher, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
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229
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Fung CH, Vaughan CP, Markland AD, Huang AJ, Mitchell MN, Bliwise DL, Ancoli-Israel S, Redline S, Alessi CA, Stone K. Nocturia is Associated with Poor Sleep Quality Among Older Women in the Study of Osteoporotic Fractures. J Am Geriatr Soc 2017; 65:2502-2509. [PMID: 28914959 DOI: 10.1111/jgs.15027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES (1) To examine relationships between frequency of nocturia and self-reported sleep quality and objective sleep measures in older women, and (2) to estimate the amount of variation in sleep measures that is specifically attributable to frequency of nocturia. DESIGN AND SETTING Secondary, cross sectional analysis of the multicenter prospective cohort Study of Osteoporotic Fractures (SOF). PARTICIPANTS Community-dwelling women aged ≥80 years. MEASUREMENTS Frequency of nocturia in the previous 12 months, Pittsburgh Sleep Quality Index sleep quality subscale, and actigraphy-measured wake after sleep onset (WASO) and total sleep time (TST). RESULTS Of 1,520 participants, 25% (n = 392) reported their nocturia frequency was 3-4 times/night and an additional 60% (n = 917) reported their nocturia frequency was 1-2 times/night. More frequent nocturia was associated with poor sleep quality (3-4/night: 26.8% reported fairly bad or very bad sleep quality; 1-2/night: 14.7%; 0/night: 7.7%; P < .001) and longer WASO (3-4/night: 89.8 minutes; 1-2/night: 70.6; 0/night: 55.5; P < .001). In nested regression models, a nocturia frequency of 3-4/night quadrupled the odds of poor sleep quality (odds ratio: 4.26 [95% CI 1.65, 11.01]; P = .003) and was associated with a 37-minute worsening in WASO (95% CI 26.0, 49.0; P < .001). Frequency of nocturia explained an additional 6% variation in WASO, above and beyond demographic, medical/psychiatric conditions, and medication factors (∆R2 = 0.06). CONCLUSIONS Nocturia is common among octogenarian and nonagenarian women and is independently associated with poor sleep quality and longer wake time at night. Interventions that improve nocturia may be useful in improving sleep quality and wake time at night.
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Affiliation(s)
- Constance H Fung
- Department of Veterans Affairs Greater, Los Angeles Geriatric Research, Education, and Clinical Center, Los Angeles, California.,Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Camille P Vaughan
- Department of Veterans Affairs Birmingham, Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama.,Department of Medicine, Division of General Medicine and Geriatrics, Emory University, Atlanta, Georgia
| | - Alayne D Markland
- Department of Veterans Affairs Birmingham, Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama.,Department of Medicine, Division of Geriatrics, Gerontology and Palliative Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Alison J Huang
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Michael N Mitchell
- Department of Veterans Affairs Greater, Los Angeles Geriatric Research, Education, and Clinical Center, Los Angeles, California
| | - Donald L Bliwise
- Sleep Program, Emory University School of Medicine, Atlanta, Georgia
| | - Sonia Ancoli-Israel
- Departments of Psychiatry and Medicine, University of California, San Diego, La Jolla, California
| | - Susan Redline
- Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Cathy A Alessi
- Department of Veterans Affairs Greater, Los Angeles Geriatric Research, Education, and Clinical Center, Los Angeles, California.,Department of Medicine, University of California Los Angeles, Los Angeles, California
| | - Katie Stone
- California Pacific Medical Center, San Francisco, California
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230
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Heesakkers JPFA, Digesu GA, van Breda J, Van Kerrebroeck P, Elneil S. A novel leadless, miniature implantable Tibial Nerve Neuromodulation System for the management of overactive bladder complaints. Neurourol Urodyn 2017; 37:1060-1067. [PMID: 28892221 DOI: 10.1002/nau.23401] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/16/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND Overactive bladder is a chronic condition affecting lower urinary tract function that has a significant negative impact on QoL. OBJECTIVE Evaluation of the BlueWind implantable tibial nerve system performance and safety in refractory OAB. DESIGN, SETTING, AND PARTICIPANTS INTERVENTION A 6-month multi-center prospective intervention study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Objective assessment was done by voiding diary parameters including voids/day, volume voided/day, urgency assessment, leaking episodes/day, pads used/day, leak severity, and clinical success defined as a ≥50% reduction in the number of leaks/day or number of voids/day or number of episodes with degree of urgency >2 or a return to <8 voids/day on a 3 Day diary. Subjective assessment was based on OAB-q including HRQL and symptom severity score. Safety was evaluated by adverse event (AE) analysis. RESULTS AND LIMITATIONS Thirty-four of the 36 implanted subjects completed the study. One subject withdrew voluntarily and one developed inflammation necessitating removal of the system. In the remaining subjects, 71% experienced clinical success at 6 months. Leaks/day, leak severity, and pad changes/day decreased significantly over time with 27.6% of urge incontinence subjects that became "dry." Voids/day, degree of urgency, volume/void, pads changed improved significantly. All quality of life aspects (concern, coping, sleep, and social) improved as well as symptom severity scores measured by the OAB-q. Adverse events included: implant site pain (13.9%), suspected infection (22.2%), and procedural wound complications (8.3%). CONCLUSIONS The BlueWind implantable tibial nerve stimulator is a safe, minimally invasive system that affords OAB patients significant improvements. PATIENT SUMMARY The performance and safety of the BlueWind RENOVA™ implantable tibial nerve neuromodulator for OAB was tested. Our preliminary results demonstrate that the system has a low risk safety profile and may be considered an effective treatment option for OAB management.
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Affiliation(s)
- John P F A Heesakkers
- Department of Urology 610, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jetske van Breda
- Department of Urology 610, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sohier Elneil
- Department of Uro-Neurology, National Hospital of Neurology and Neurosurgery, London, UK
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231
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Pyun JH, Kang SG, Kang SH, Cheon J, Kim JJ, Lee JG. Efficacy of holmium laser enucleation of the prostate (HoLEP) in men with bladder outlet obstruction (BOO) and non-neurogenic bladder dysfunction. Kaohsiung J Med Sci 2017; 33:458-463. [DOI: 10.1016/j.kjms.2017.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/25/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022] Open
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232
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Chen TF, Huang HC, Lin YH, Liao CH, Chiang BJ. Preliminary experience and possible predictors of successful mirabegron treatment for overactive bladder. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2017.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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233
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Deng H, Liao L, Wu J, Chen G, Li X, Wang Z, Wan L. Clinical efficacy of intravesical electrical stimulation on detrusor underactivity: 8 Years of experience from a single center. Medicine (Baltimore) 2017; 96:e8020. [PMID: 28930838 PMCID: PMC5617705 DOI: 10.1097/md.0000000000008020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to retrospectively evaluate the effectiveness of intravesical electrical stimulation (IVES) on detrusor underactivity (DU).From 2009 to 2016, a total of 105 patients with symptoms of DU who were treated with IVES were included in this retrospective study. The medical records, physical examination findings, urine culture results, and video-urodynamic studies were reviewed. Changes in post-void residual urine (PVR) and voiding efficiency (VE) were included for evaluation of efficacy. Patients achieving a >50% reduction in the PVR were regarded as responders. A >80% reduction in the PVR was considered obvious improvement. A questionnaire was administered to patients with bladder sensation.Of the 105 patients, the information of residual urine volume and voiding volume was obtained in 89 patients, and detailed pre- and post-IVES bladder sensation information was available on 96 patients. Of the 89 patients, 47.2% (42/89) were responders and achieved a >50% reduction in the PVR. Obvious improvement in the PVR, defined as a >80% reduction, occurred in 27% (24/89) of the patients. VE developed in 76.4% (68/89) of the patients, and 30.3% (27/89) of the patients increased >50%. Significant improvements in the PVR and VE were observed during IVES treatment (P < .05). Based on the questionnaire, bladder sensation developed and was sustained in 44.8% (43/96) of the patients.IVES provides a promising method for improving the PVR and VE in a majority of patients with DU. Thus, IVES is worth to further study and carry out.
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Affiliation(s)
- Han Deng
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Juan Wu
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Guoqing Chen
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Xing Li
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Zhaoxia Wang
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
| | - Li Wan
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing, China
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234
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Quantification of bladder wall biomechanics during urodynamics: A methodologic investigation using ultrasound. J Biomech 2017; 61:232-241. [PMID: 28835340 DOI: 10.1016/j.jbiomech.2017.07.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 06/20/2017] [Accepted: 07/22/2017] [Indexed: 01/22/2023]
Abstract
Overactive bladder is often characterized by biomechanical changes in the bladder wall, but there is no established method to measure these changes in vivo. The goal of this study was to develop a novel method to determine detrusor wall biomechanical parameters during urodynamics through the incorporation of transabdominal ultrasound imaging. Individuals with overactive bladder (OAB) underwent ultrasound imaging during filling. The fill rate was 10% of the cystometric capacity per minute as determined by an initial fill. Transabdominal ultrasound images were captured in the midsagittal and transverse planes at 1min intervals. Using image data and Pves, detrusor wall tension, stress, and compliance were calculated. From each cross-sectional image, luminal and wall areas along with inner perimeters were measured. In the sagittal and transverse planes, wall tension was calculated as Pves∗luminal area, wall stress as tension/wall area, and strain as the change in perimeter normalized to the perimeter at 10% capacity. Elastic modulus was calculated as stress/strain in the medial-lateral and cranial-caudal directions. Patient-reported fullness sensation was continuously recorded. Data from five individuals with OAB showed that detrusor wall tension, volume, and strain had the highest correlations to continuous bladder sensation of all quantities measured. This study demonstrates how detrusor wall tension, stress, strain, and elastic modulus can be quantified by adding ultrasound imaging to standard urodynamics. This technique may be useful in diagnosing and better understanding the biomechanics involved in OAB and other bladder disorders.
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235
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Gu HY, Song JK, Zhang WJ, Xie J, Yao QS, Zeng WJ, Zhang C, Niu YM. A systematic review and meta-analysis of effectiveness and safety of therapy for overactive bladder using botulinum toxin A at different dosages. Oncotarget 2017; 8:90338-90350. [PMID: 29163833 PMCID: PMC5685754 DOI: 10.18632/oncotarget.20056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 07/25/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess the effectiveness and safety of botulinum toxin A (BTX-A) at different dosages for overactive bladder (OAB). Materials and Methods The MEDLINE, EMBASE, and Cochrane Controlled Trials Register databases were searched through November 3, 2016 to identify relevant randomized controlled trials (RCTs). Results Eleven studies were identified in this meta-analysis. Compared with placebo, the urinary incontinence (UI) episodes per week as the primary outcomes, urodynamic parameters including maximum cystometric capacity (MCC), and maximum detrusor pressure (MDP) for neurogenic detrusor overactivity (NDO) at 6 weeks, and for idiopathic detrusor overactivity (IDO) at 36 weeks were evaluated. These and other outcomes for effectiveness of BTX-A at different dosages in two observation periods indicate that a dose greater than 50 U is significantly more effective for certain symptoms of OAB compared with placebo. However, there were no significant differences between some dosages. Compared with placebo, the outcomes of total adverse events for NDO and for IDO show that doses of 300 U and 200 U for NDO are associated with more complications. Conclusions In consideration that the treatments of BTX-A were with minimal, local, and manageable adverse effects, this meta-analysis demonstrates that BTX-A 200 U is recommended for management of NDO for short-term treatment for there was no significant difference from the larger dose of 300U. The short-term efficacies of BTX-A for IDO remain to be investigated.
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Affiliation(s)
- Hui-Yun Gu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Ju-Kun Song
- Department of Oral and Maxillary Surgery, Guizhou Provincial People's Hospital, Guiyang 550002, China
| | - Wen-Jun Zhang
- Department of Ultrasound, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Jin Xie
- Administrative Office, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Qi-Sheng Yao
- Department of Urinary Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Wen-Jing Zeng
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
| | - Yu-Ming Niu
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China.,Department of Urinary Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, China
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236
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Chen SF, Jiang YH, Kuo HC. Urinary biomarkers in patients with detrusor underactivity with and without bladder function recovery. Int Urol Nephrol 2017; 49:1763-1770. [PMID: 28770419 DOI: 10.1007/s11255-017-1666-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/21/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Detrusor underactivity (DU) is frequently encountered in elderly patients. Part of patients with DU might have bladder function recovery after treatment. This study investigated urinary proteins in these DU patients with and without bladder function recovery. METHODS A total of 37 patients with chronic urinary retention and urodynamically proven DU were enrolled. After treatment, 24 DU patients had bladder function recovery whereas 13 had not, after 1-year follow-up. Urine collection at baseline was performed, and the urinary protein including nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF) and prostaglandin E2 (PGE2) were measured by ELISA. Twenty urodynamically normal, 34 detrusor overactivity (DO) and 15 detrusor hyperactivity and inadequate contractility (DHIC) patients served as comparative groups. RESULTS Urinary NGF levels were significantly higher than normal in patients with DU (9.2 ± 20.3 vs 1.85 ± 2.9 pg/ml, p = 0.037). Urinary BDNF level was only significantly higher in patients with DU than that of the control group (153 ± 199 vs 77.4 ± 47.7 pg/ml, p = 0.033) but not in patients with DHIC or DO. Compared with the control group, the urinary BDNF level was significantly higher in DU patients with bladder function recovery (190 ± 239 pg/ml, p = 0.033) but not in patients without recovery (85.8 ± 43.7 pg/ml, p = 0.612). The PGE2 level was significantly higher than the control group in DU patients with bladder function recovery (1290 ± 836 pg/ml, p < 0.0001) but not in patients without recovery (383 ± 237 pg/ml, p = 0.130). CONCLUSION Patients with DU and higher urinary PGE2 and BDNF levels might have a chance to recover bladder function than those with a lower protein level.
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Affiliation(s)
- Sheng-Fu Chen
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien, Taiwan
| | - Yuan-Hong Jiang
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, 707, Section 3, Chung-Yang Road, Hualien, Taiwan.
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237
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Arslan B, Onuk O, Eroglu A, Gezmis TC, Aydin M. Female sexual function following a novel transobturator sling procedure without paraurethral dissection (modified-TOT). Int Braz J Urol 2017; 43:142-149. [PMID: 28124537 PMCID: PMC5293395 DOI: 10.1590/s1677-5538.ibju.2016.0270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 07/28/2016] [Indexed: 01/23/2023] Open
Abstract
PURPOSE To determine whether there is a difference in sexual function after modified and classical TOT procedures. MATERIALS AND METHODS Of the 80 sexually active women with SUI, 36 underwent na original outside-in TOT as described by Delorme, and 44 underwent modified TOT procedure, between 2011 and 2015. The severity of incontinence and sexual function were evaluated using International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Female Sexual Function Index (FSFI) questionnaires preoperatively and 3 months after surgery. RESULTS The postoperative ICIQ-SF score was significantly lower than the preoperative ICIQ-SF score in both groups (p=0.004 for modified TOT and p=0.002 for classical TOT). There was no significant difference in the ICIQ-SF score reduction between the two groups (14.1±2.1 vs. 14.4±1.9; p=0.892). Complication rates according to the Clavien-Dindo classification were also similar in both groups. In both groups, difference between preoperative and postoperative FSFI scores revealed a statistically significant improvement in all domains. Comparison of postoperative 3-month FSFI scores of modified and classical TOT groups showed statistically significant differences in arousal, lubrication and orgasm domains. Desire, satisfaction, pain and total FSFI scores did not differ significantly between two groups. CONCLUSION The modified TOT technique is a simple, reliable and minimal invasive procedure. The cure rate of incontinence and complication rates are the same as those of the classical TOT technique. However, due to the positive effects of minimal tissue damage on sexual arousal and orgasmic function, modified TOT has an advantage over the classical TOT.
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Affiliation(s)
- Burak Arslan
- Department of Urology, Istanbul Taksim Training and Research Hospital, Turkey
| | - Ozkan Onuk
- Department of Urology, Istanbul Taksim Training and Research Hospital, Turkey
| | - Ali Eroglu
- Department of Urology, Istanbul Taksim Training and Research Hospital, Turkey
| | - Tugrul Cem Gezmis
- Department of Urology, Istanbul Taksim Training and Research Hospital, Turkey
| | - Memduh Aydin
- Department of Urology, Istanbul Taksim Training and Research Hospital, Turkey
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238
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[Prevalence and characterization of overactive bladder detected in a population in Madrid with self-administered OAB-V3 questionnaire in Primary Care]. Aten Primaria 2017; 50:79-87. [PMID: 28751103 PMCID: PMC6836945 DOI: 10.1016/j.aprim.2017.01.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/02/2017] [Accepted: 01/13/2017] [Indexed: 11/21/2022] Open
Abstract
Objetivo Determinar la prevalencia de síntomas sugestivos de vejiga hiperactiva (VH) en una población española y evaluar su impacto en el bienestar y la productividad laboral de esta población. Diseño Estudio transversal. Emplazamiento Atención primaria, Madrid, España. Participantes Varones y mujeres > 30 años. Intervenciones Clasificación con el instrumento abreviado Overactive Bladder Awareness Tool (OAB-V3). Sujetos con puntuación ≥ 3 y una población control similar con puntuación < 3 fueron investigados clínicamente. Mediciones principales Anamnesis, exploración física, análisis de orina, ecografía, escala de bienestar general y cuestionarios PPBC, OAB-q y WPAI-SHP. Resultados Se cribaron 923 sujetos, 209 (22,6%) de los cuales —35% hombres y 65% mujeres— presentaron probable VH. La distribución por edad aumentó del 11,1% en la cuarta década al 44,4% en la novena década. El coeficiente kappa entre probable VH y diagnóstico definitivo fue de 0,83. El área bajo la curva ROC para el diagnóstico según el cuestionario OAB-V3 y la constatación de molestias percibidas y estrategias de afrontamiento fue del 92%. Los sujetos clasificados por OAB-V3 ≥ 3 tuvieron peor bienestar, mayor puntuación PPBC y peores parámetros en las puntuaciones OAB-q total y transformadas para cada subescala OAB-q (p < 0,0001). Su productividad laboral no se vio afectada (p = 0,14), pero sí la capacidad de realizar actividades cotidianas (p < 0,0001). Conclusiones OAB-V3 es un cuestionario simple para el cribado de VH con buena exactitud de predicción en atención primaria y que conlleva implicaciones importantes en la calidad de vida relacionada con la salud.
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239
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Angulo J, Calderín M, Fernández Y, González M, Gómez E, Herreros M, Peñasco P, Zapatero M, Dorado J. Comparative study of the B-SAQ, OAB-V8 and OAB-V3 questionnaires as screening tools for overactive bladders in clinical practice. Actas Urol Esp 2017; 41:383-390. [PMID: 28268078 DOI: 10.1016/j.acuro.2016.12.007] [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: 10/15/2016] [Revised: 12/10/2016] [Accepted: 12/12/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare the capacity shown by 3 self-assessment questionnaires validated in Spanish (B-SAQ, OAB-V8 and OAB-V3) for the screening of patients with overactive bladder (OAB) in clinical practice. MATERIAL AND METHOD A noninterventional observational study was conducted of men and women older than 30 years evaluated in primary care consultations. The clinical diagnosis of OAB was conducted through a case history review, physical examination, urine analysis, ultrasonography and voiding diary. The presence of coping strategies and discomfort was investigated. The differential diagnosis was established in patients with symptoms not due to OAB. We assessed the correlation between the clinical tests and diagnosis (kappa <.4 poor; .4-.6 moderate; >.6 good; >.8 excellent) and ROC curves to define the capacity to screen the assessed questionnaires. RESULTS A total of 411 patients were investigated. OAB was detected in 207 (50.4%) patients, other causes for the lower urinary tract symptoms were detected in 63 (15.3%), and 141 (34.3%) patients had no diagnosis. The voiding diary suggested OAB in 197 (47.9%) patients. The correlation between the clinical diagnosis and the diagnosis based on the voiding diary was .702. The correlation between the clinical diagnosis and B-SAQ, OAB-V8 and OAB-V3 was .59, .673 and .732, respectively. The area under the curve (AUC) was .799 for B-SAQ; .837 for OAB-V8 and .867 for OAB-V3 (OAB-V3 vs. OAB-V8, P=.02; OAB-V3 vs. B-SAQ, P<.0001). The AUC for the voiding diary was .852 (OAB-V3 vs. diary, P=.47). CONCLUSIONS OAB-V3 is a simple questionnaire with excellent performance for screening OAB in a specific population and that is superior to the OAB-V8 and B-SAQ. The accuracy of the voiding diary for the same indication is equivalent to that of the OAB-V3 in our setting.
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Abstract
The underactive bladder (UAB)/detrusor underactivity (DU) is a relatively common condition. It is difficult to diagnose and can be difficult to manage. The aim of this review is to provide a review of the diagnosis and different surgical treatment options for UAB/DU. A comprehensive literature review using medical search engines was performed. The search included a combination of the following terms, UAB, DU, TURP, reduction cystoplasty, bladder diverticulectomy and sacral neuromodulation (SNM). Search results were assessed for their overall relevance to this review. Definitions, general overview and management options were extracted from the relevant medical literature. DU affects up to 45% of men and women >70 years of age. The symptoms of DU overlap significantly with overactive bladder (OAB) and bladder outlet obstruction (BOO). Urodynamic findings include low voiding pressure combined with slow intermittent flow and incomplete bladder emptying. Non-operative management for DU is acceptable; only 1 in 6 male patients may need a TURP and acute urinary retention (AUR) is rare. TURP for DU is feasible and is associated with good short and medium term outcomes, but over time, there is a return to baseline symptoms. Bladder diverticulectomy can also improve DU, but there is a paucity of guidelines on patient selection. SNM provides excellent outcomes for DU, but patient selection is important.
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Affiliation(s)
- Johan Gani
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Urology, Western Health, Footscray, Victoria, Australia
| | - Derek Hennessey
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
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241
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Hennessey DB, Hoag N, Gani J. Impact of bladder dysfunction in the management of post radical prostatectomy stress urinary incontinence-a review. Transl Androl Urol 2017; 6:S103-S111. [PMID: 28791229 PMCID: PMC5522793 DOI: 10.21037/tau.2017.04.14] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Bladder dysfunction is a relatively common urodynamic finding post radical prostatectomy (RP). It can be the sole cause of post prostatectomy incontinence (PPI) or may be found in association with stress urinary incontinence (SUI). The aim of this review is to provide a comprehensive review of the diagnosis and different treatments of post RP bladder dysfunction. A comprehensive literature review using medical search engines was performed. The search included a combination of the following terms, PPI, detrusor overactivity (DO), detrusor underactivity (DU), impaired compliance, anticholinergic, onabotulinumtoxinA (Botox®) and sacral neuromodulation (SNM). Definitions, general overview and management options were extracted from the relevant medical literature. DO, DU and impaired compliance are common and may occur alone or in combination with SUI. In some patients the conditions exist pre RP, in others they arise due to denervation and surgical changes. DO can be treated with anticholinergics, Botox® and SNM. DO may need to be treated before SUI surgery. DU may be a contraindication to male sling surgery as some patients may go into urinary retention. Severely impaired bladder compliance may be a contraindication to SUI surgery as the upper tracts may be at risk. Each individual dysfunction may affect the outcome of PPI treatments and clinicians should be alert to managing bladder dysfunction in PPI patients.
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Affiliation(s)
- Derek B Hennessey
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Nathan Hoag
- Department of Urology, Victoria General Hospital, Victoria, British Columbia, Canada
| | - Johan Gani
- Department of Urology, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Urology, Western Health, Footscray, Victoria, Australia
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242
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Yang R, Liu L, Li G, Yu J. Efficacy of solifenacin in the prevention of short-term complications after laparoscopic radical prostatectomy. J Int Med Res 2017; 45:2119-2127. [PMID: 28661264 PMCID: PMC5805213 DOI: 10.1177/0300060517713405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Objective To evaluate the efficacy of solifenacin in the prevention of short-term
complications after laparoscopic radical prostatectomy (LRP). Methods This randomized placebo-controlled study enrolled patients with
histologically proven prostate cancer who underwent LRP. The patients were
randomized to receive either solifenacin (5 mg once daily; study group) or
placebo (control group) for the 15-day period beginning on the first day
after surgery. The mean duration of detrusor overactivity (DO), the
frequency of DO, the duration of macroscopic haematuria, and the days before
catheter removal were recorded. The International Continence Society Short
Form Male questionnaire, bladder neck stenosis episodes, and maximum urinary
flow rate were evaluated at 1 month after surgery. The side-effects after
using solifenacin were also recorded. Results A total of 120 patients were randomly assigned to the study group
(n = 62) or the control group
(n = 58). There were significantly lower rates of DO
episodes during the daytime and night-time, haematuria and transient
incontinence in the study group compared with the control group. Conclusion Solifenacin was a well-tolerated and effective treatment for the prevention
of complications after LRP, with the main advantage compared with placebo
being the decreased frequency of DO episodes during the daytime and
night-time.
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Affiliation(s)
- Ranxing Yang
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lijie Liu
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Gaofeng Li
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jianjun Yu
- 1 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,2 Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Campus, Shanghai, China
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243
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Wang Y, Wang W, Wang X, Wang Y, Wang J, Fu Q, Shi G. Tissue-engineered sling with adipose-derived stem cells under static mechanical strain. Exp Ther Med 2017; 14:1337-1342. [PMID: 28810594 PMCID: PMC5525904 DOI: 10.3892/etm.2017.4705] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 03/17/2017] [Indexed: 12/29/2022] Open
Abstract
The implantation of a suburethral sling is an important treatment for stress urinary incontinence (SUI). However, the slings used current have a number of inherent limitations, such as tissue rejection and infection. The present study investigated the potential of engineering sling tissue in vitro using adipose-derived stem cells (ADSCs). The ADSCs were obtained from Sprague-Dawley rats and were characterized in vitro. The ADSCs were seeded on polyglycolic acid (PGA) fibers that formed a scaffold with a shape mimicking a sling complex. The results demonstrated that following in vitro culture for 12 weeks under static strain, neo-sling tissue could be generated using ADSCs. With increasing culture time, the engineered neo-sling tissue exhibited a significant improvement in biomechanical properties, including maximal load and Young's modulus (P<0.05), and the tissue and collagen structures matured. Furthermore, differentiated ADSCs cultured under static strain were maintained their myoblast phenotype within the PGA scaffolds. These results indicate that ADSCs may serve as a novel cell source for tissue sling engineering and could improve treatment for patients with SUI.
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Affiliation(s)
- Ying Wang
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, P.R. China
| | - Wei Wang
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, P.R. China
| | - Xilong Wang
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, P.R. China
| | - Yangyun Wang
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, P.R. China
| | - Jihong Wang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Qiang Fu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Guowei Shi
- Department of Urology, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai 200240, P.R. China
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244
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Christmann-Schmid C, Hediger M, Gröger S, Krebs J, Günthert AR. Vulvar lichen sclerosus in women is associated with lower urinary tract symptoms. Int Urogynecol J 2017; 29:217-221. [DOI: 10.1007/s00192-017-3358-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 04/12/2017] [Indexed: 11/25/2022]
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245
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Chang CJ, Pei D, Wu CC, Palmer MH, Su CC, Kuo SF, Liao YM. Correlates of Nocturia and Relationships of Nocturia With Sleep Quality and Glycemic Control in Women With Type 2 Diabetes. J Nurs Scholarsh 2017; 49:400-410. [PMID: 28544465 DOI: 10.1111/jnu.12302] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2017] [Indexed: 12/01/2022]
Abstract
PURPOSES To explore correlates of nocturia, compare sleep quality and glycemic control for women with and without nocturia, and examine relationships of nocturia with sleep quality and glycemic control in women with diabetes. DESIGN This study was a cross-sectional, correlational study with data collected from 275 women with type 2 diabetes. METHODS Data were collected using a structured questionnaire. Multivariate logistic regression analyses were used to identify correlates. Chi-squared tests were used to identify candidate variables for the first logistic regression model. A one-way analysis of variance was used to compare sleep quality and glycemic control for women with and those without nocturia. Pearson correlations were used to examine the relationships of nocturia with sleep quality and glycemic control. FINDINGS Of the 275 participants, 124 (45.1%) had experienced nocturia (at least two voids per night). Waist circumference, parity, time since diagnosis of diabetes, sleep quality, and increased daytime urinary frequency were correlated with nocturia after adjusting for age. Compared to women without nocturia, women who had nocturia reported poorer sleep quality. A significant correlation was found between the number of nocturnal episodes and sleep quality. CONCLUSIONS Nocturia and poor sleep are common among women with diabetes. The multifactorial nature of nocturia supports the delivered management and treatments being targeted to underlying etiologies in order to optimize women's symptom management. Interventions aimed at modifiable correlates may include maintaining a normal body weight and regular physical exercise for maintaining a normal waist circumference, and decreasing caffeine consumption, implementing feasible modifications in sleeping environments and maintaining sleep hygiene to improve sleep quality. CLINICAL RELEVANCE Healthcare professionals should screen for nocturia and poor sleep and offer appropriate nonpharmacological lifestyle management, behavioral interventions, or pharmacotherapy for women with diabetes.
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Affiliation(s)
- Chun-Jen Chang
- Attending Physician and Head, Department of Endocrinology, Taipei Municipal Wanfang Hospital, Taipei City, Taiwan
| | - Dee Pei
- Professor and Chairman, College of Medicine, Fu Jen Catholic University, and Attending Physician, Department of Endocrinology, Cardinal Tien Hospital, New Taipei City, Taiwan
| | - Chien-Chih Wu
- Attending Physician and Urologist, Department of Urology, Taipei Medical University Hospital and Associate Professor, Department of Urology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Mary H Palmer
- Helen W. & Thomas L. Umphlet Distinguished Professor in Aging, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ching-Chieh Su
- Attending Physician and Head, Department of Endocrinology, Cardinal Tien Hospital, Assistant Professor, College of Medicine, Fu Jen Catholic University, and PhD Candidate, Graduate Institute of Applied Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shu-Fen Kuo
- Assistant Professor, School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Yuan-Mei Liao
- Associate Professor, Institute of Clinical Nursing, School of Nursing, National Yang-Ming University and School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
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246
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Rantell A, Apostolidis A, Anding R, Kirschner-Hermanns R, Cardozo L. How does lower urinary tract dysfunction affect sexual function in men and women? ICI-RS 2015-Part 1. Neurourol Urodyn 2017; 36:949-952. [DOI: 10.1002/nau.23040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 04/18/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Angie Rantell
- Department of Urogynaecology; King's College Hospital; London United Kingdom
| | - Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
| | - Ralf Anding
- Department of Neurourology; University Hospital Bonn; Bonn Germany
| | | | - Linda Cardozo
- Department of Urogynaecology; King's College Hospital; London United Kingdom
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247
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Uy J, Yu M, Jiang X, Jones C, Shen B, Wang J, Roppolo JR, de Groat WC, Tai C. Glutamatergic Mechanisms Involved in Bladder Overactivity and Pudendal Neuromodulation in Cats. J Pharmacol Exp Ther 2017; 362:53-58. [PMID: 28428223 DOI: 10.1124/jpet.117.240895] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 04/19/2017] [Indexed: 01/12/2023] Open
Abstract
The involvement of ionotropic glutamate receptors in bladder overactivity and pudendal neuromodulation was determined in α-chloralose anesthetized cats by intravenously administering MK801 (a NMDA receptor antagonist) or CP465022 (an AMPA receptor antagonist). Infusion of 0.5% acetic acid (AA) into the bladder produced bladder overactivity. In the first group of 5 cats, bladder capacity was significantly (P < 0.05) reduced to 55.3±10.0% of saline control by AA irritation. Pudendal nerve stimulation (PNS) significantly (P < 0.05) increased bladder capacity to 106.8 ± 15.0% and 106.7 ± 13.3% of saline control at 2T and 4T intensity, respectively. T is threshold intensity for inducing anal twitching. MK801 at 0.3 mg/kg prevented the increase in capacity by 2T or 4T PNS. In the second group of 5 cats, bladder capacity was significantly (P < 0.05) reduced to 49.0 ± 7.5% of saline control by AA irritation. It was then significantly (P < 0.05) increased to 80.8±13.5% and 79.0±14.0% of saline control by 2T and 4T PNS, respectively. CP465022 at 0.03-1 mg/kg prevented the increase in capacity by 2T PNS and at 0.3-1 mg/kg prevented the increase in capacity by 4T PNS. In both groups, MK801 at 0.3 mg/kg and CP465022 at 1 mg/kg significantly (P < 0.05) increased the prestimulation bladder capacity (about 80% and 20%, respectively) and reduced the amplitude of bladder contractions (about 30 and 20 cmH2O, respectively). These results indicate that NMDA and AMPA glutamate receptors are important for PNS to inhibit bladder overactivity and that tonic activation of these receptors also contributes to the bladder overactivity induced by AA irritation.
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Affiliation(s)
- Jamie Uy
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Michelle Yu
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Xuewen Jiang
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Cameron Jones
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Bing Shen
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Jicheng Wang
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - James R Roppolo
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - William C de Groat
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
| | - Changfeng Tai
- Department of Urology (J.U., M.Y., X.J., C.J., B.S., J.W., C.T.), Department of Pharmacology and Chemical Biology (J.R.R., W.C.D., C.T.), and Department of Bioengineering (C.T.),University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Urology, Qilu Hospital, Shandong University, Jinan, P.R. China (X.J.)
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248
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Abstract
: Overactive bladder is a term used to describe a group of lower urinary tract symptoms that are prevalent in women, particularly as they age. Those with overactive bladder often experience related physical and psychological symptoms or conditions and report a poorer quality of life than other women. Many factors that increase the risk of developing overactive bladder are modifiable; therefore, lifestyle and behavioral interventions are first-line treatments. More treatment options are becoming available to women as research provides new information about the underlying pathophysiology of overactive bladder. Nurses play a major role in its screening, assessment, and management in women, many of whom do not seek help and try to self-manage symptoms, leading to a continuing cycle of unpredictable urgency and incontinence.
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249
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Validation of overactive bladder questionnaire (1-week recall version) in medically complex elderly patients with overactive bladder. Int Urogynecol J 2017; 28:1857-1863. [DOI: 10.1007/s00192-017-3305-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 02/21/2017] [Indexed: 10/19/2022]
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250
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Glindtvad C, Chen M, Vinge Nygaard J, Wogensen L, Forman A, Danielsen CC, Taskin MB, Andersson KE, Axelsen SM. Electrospun biodegradable microfibers induce new collagen formation in a rat abdominal wall defect model: A possible treatment for pelvic floor repair? J Biomed Mater Res B Appl Biomater 2017; 106:680-688. [DOI: 10.1002/jbm.b.33875] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 01/15/2017] [Accepted: 02/20/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Cecilie Glindtvad
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Denmark
| | - Menglin Chen
- iNANO, Department of Engineering - Nano Fiber Technology and Cellular Engineering; Aarhus University; Denmark
| | - Jens Vinge Nygaard
- Department of Engineering - Biomechanics and Mechanobiology; Aarhus University; Denmark
| | - Lise Wogensen
- Faculty Secretariat, Faculty of Health Sciences; Aarhus University; Denmark
| | - Axel Forman
- Department of Gynecology and Obstetrics, Aarhus University Hospital; Denmark
| | | | - Mehmet Berat Taskin
- iNANO Department of Engineering - Nano Fiber Technology and Cellular Engineering; Aarhus University; Denmark
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