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Kheir GB, Verbakel I, Wyndaele M, Monaghan TF, Sinha S, Larsen TH, Van Laecke E, Birder L, Hervé F, Everaert K. Lifelong LUTS: Understanding the bladder's role and implications across transition phases, a comprehensive review. Neurourol Urodyn 2024; 43:1066-1074. [PMID: 38289317 DOI: 10.1002/nau.25304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/04/2023] [Indexed: 02/01/2024]
Abstract
INTRODUCTION Lower urinary tract symptoms (LUTSs) are a diverse array of urinary and pelvic dysfunctions that can emerge from childhood, extend through adulthood, and persist into older age. This narrative review aims to provide a comprehensive perspective on the continuum of LUTS and shed light on the underlying mechanisms and clinical implications that span across the lower urinary tract. METHODS A panel of five experts from Belgium, the Netherlands, India, Denmark, and the United States participated in an intensive research to explore and pinpoint existing insights into the lifelong concept of LUTS, particularly at the pelvic level. The experts reviewed the existing literature and held a webinar to discuss their findings. RESULTS Childhood LUTS can persist, resolve, or progress into bladder underactivity, dysfunctional voiding, or pain syndromes. The Lifelong character can be explained by pelvic organ cross-talk facilitated through complex neurological and nonneurological interactions. At the molecular level, the role of vasopressin receptors in the bladder's modulation and their potential relevance to therapeutic strategies for LUTS are explored. Frailty emerges as a parallel concept to lifelong LUTS, with a complex and synergistic relationship. Frailty, not solely an age-related condition, accentuates LUTS severity with insufficient evidence regarding the effectiveness and safety profile of the available therapeutic modalities. CONCLUSION Understanding lifelong LUTSs offers insights into genetic, anatomical, neurological, and molecular mechanisms. Further research could identify predictive biomarkers, elucidate the role of clinically translatable elements in pelvic cross-talk, and uncover molecular signatures for personalized management.
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Affiliation(s)
- George Bou Kheir
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Irina Verbakel
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Michel Wyndaele
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas F Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, Telangana, India
| | - Tove Holm Larsen
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Erik Van Laecke
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Lori Birder
- Departments of Medicine and Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - François Hervé
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
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Tiwari N, Qiao LY. Sex Differences in Visceral Pain and Comorbidities: Clinical Outcomes, Preclinical Models, and Cellular and Molecular Mechanisms. Cells 2024; 13:834. [PMID: 38786056 PMCID: PMC11119472 DOI: 10.3390/cells13100834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/03/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
Sexual dimorphism of visceral pain has been documented in clinics and experimental animal models. Aside from hormones, emerging evidence suggests the sex-differential intrinsic neural regulation of pain generation and maintenance. According to the International Association for the Study of Pain (IASP) and the American College of Gastroenterology (ACG), up to 25% of the population have visceral pain at any one time, and in the United States 10-15 percent of adults suffer from irritable bowel syndrome (IBS). Here we examine the preclinical and clinical evidence of sex differences in visceral pain focusing on IBS, other forms of bowel dysfunction and IBS-associated comorbidities. We summarize preclinical animal models that provide a means to investigate the underlying molecular mechanisms in the sexual dimorphism of visceral pain. Neurons and nonneuronal cells (glia and immune cells) in the peripheral and central nervous systems, and the communication of gut microbiota and neural systems all contribute to sex-dependent nociception and nociplasticity in visceral painful signal processing. Emotion is another factor in pain perception and appears to have sexual dimorphism.
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Affiliation(s)
- Namrata Tiwari
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Liya Y. Qiao
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
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3
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Abe T, Matsumoto S, Kunimoto M, Hachiro Y, Ota S, Ohara K, Inagaki M, Saitoh Y, Murakami M. Prevalence of Double Incontinence and Lower Urinary Tract Symptoms in Patients with Fecal Incontinence: A Single-center Observational Study. J Anus Rectum Colon 2024; 8:30-38. [PMID: 38313750 PMCID: PMC10831982 DOI: 10.23922/jarc.2023-040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/05/2023] [Indexed: 02/06/2024] Open
Abstract
Objectives Double incontinence (DI), which is the co-occurrence of fecal incontinence (FI) and urinary incontinence (UI), increases with age and has a greater negative impact on the quality of life (QOL) than either incontinence alone. We aimed to assess lower urinary tract symptoms (LUTS) in patients with FI to elucidate the prevalence and characteristics of DI. Methods This study enrolled consecutive patients who visited our hospital with FI symptoms. FI was evaluated using the Cleveland Clinic Florida Fecal Incontinence Score (CCFIS). LUTS were assessed using the International Prostate Symptom Score (IPSS), QOL score (IPSS-QOL) and Overactive Bladder Symptom Score (OABSS). Results This study evaluated 140 patients (96 women [mean age: 70.7 years] and 44 men [mean age: 74.4 years]). The mean IPSS was significantly higher in men than in women (12.0 vs. 7.5, p = 0.003). A positive correlation was found between IPSS and CCFIS in women (r = 0.256, p = 0.012) but not in men. For both sexes, the older group (aged ≥70 years) had higher OABSS scores and more urge UI instances than the younger group (aged ≤69 years). Of the 140 patients with FI, 78 (55.7%) had DI, and DI was more common in women than in men (63.5% vs. 38.6%, p = 0.006). Conclusions The characteristics of LUTS and UI in patients with FI were comparable to those in the general population for both sexes; however, the prevalence of DI was much higher among patients with FI than that in the general population.
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Affiliation(s)
- Tatsuya Abe
- Department of Proctology, Kunimoto Hospital, Asahikawa, Japan
| | - Seiji Matsumoto
- Headquarters for Research Promotion, Asahikawa Medical University, Asahikawa, Japan
| | - Masao Kunimoto
- Department of Proctology, Kunimoto Hospital, Asahikawa, Japan
| | | | - Shigenori Ota
- Department of Proctology, Kunimoto Hospital, Asahikawa, Japan
| | - Kei Ohara
- Department of Proctology, Kunimoto Hospital, Asahikawa, Japan
| | | | - Yusuke Saitoh
- Department of Gastroenterology, Kunimoto Hospital, Asahikawa, Japan
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Soysal P, Veronese N, Ippoliti S, Pizzol D, Carrie AM, Stefanescu S, López-Sánchez GF, Barnett Y, Butler L, Koyanagi A, Jacob L, Ghaydya RA, Sheyn D, Hijaz AK, Oliva-Lozano JM, Muyor JM, Trott M, Kronbichler A, Grabovac I, Tully MA, Yang L, Hwang J, Kim JY, Park S, Song J, Shin JI, Ilie PC, Smith L. The impact of urinary incontinence on multiple health outcomes: an umbrella review of meta-analysis of observational studies. Aging Clin Exp Res 2023; 35:479-495. [PMID: 36637774 DOI: 10.1007/s40520-022-02336-0] [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: 09/19/2022] [Accepted: 12/21/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIM We aimed to capture the breadth of health outcomes that have been associated with the presence of Urinary Incontinence (UI) and systematically assess the quality, strength, and credibility of these associations through an umbrella review and integrated meta-analyses. METHODS We assessed meta-analyses of observational studies based on random-effect summary effect sizes and their p-values, 95% prediction intervals, heterogeneity, small-study effects, and excess significance. We graded the evidence from convincing (Class I) to weak (Class IV). RESULTS AND DISCUSSION From 3172 articles returned in search of the literature, 9 systematic reviews were included with a total of 41 outcomes. Overall, 37 out of the 41 outcomes reported nominally significant summary results (p < 0.05), with 22 associations surviving the application of a more stringent p-value (p < 10-6). UI was associated with worse scores than controls in female sexual function (Class II), while it was also associated with a higher prevalence of depression (odds ratio [OR] = 1.815; 95% confidence interval [CI]: 1.551-2.124), and anxiety (OR = 1.498; 95% CI: 1.273-1.762) (Class IV). UI was associated with poorer quality of life (QoL), higher rate of mortality (hazard ratio = 2.392; 95% CI: 2.053-2.787) an increase in falls, frailty, pressure ulcers, diabetes, arthritis, and fecal incontinence (Class IV). CONCLUSIONS UI is associated with female sexual dysfunction, with highly suggestive evidence. However, the evidence of other adverse outcomes including depression, anxiety, poorer QoL, higher mortality, falls, pressure ulcers, diabetes, arthritis, fecal incontinence, and frailty is only weak. A multidimensional approach should be taken in managing UI in the clinical setting.
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Affiliation(s)
- Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Adnan Menderes Bulvarı (Vatan Street), Fatih, 34093, Istanbul, Turkey
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Simona Ippoliti
- Urology Department, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Damiano Pizzol
- Italian Agency for Development Cooperation, 33 Street, Amarat, 79371, Khartoum, Sudan
| | | | | | - Guillermo F López-Sánchez
- Division of Preventive Medicine and Public Health, Department of Public Health Sciences, School of Medicine, University of Murcia, Murcia, Spain
| | - Yvonne Barnett
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Laurie Butler
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, 08830, Barcelona, Spain.,ICREA, Pg. Lluis Companys 23, 08010, Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, 08830, Barcelona, Spain.,Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78180, Montigny-le-Bretonneux, France
| | - Ramy Abou Ghaydya
- Department of Urology, University Hospitals Cleveland Medical Center, 11000 Euclid Avenue, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - David Sheyn
- Department of Urology, University Hospitals Cleveland Medical Center, 11000 Euclid Avenue, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Adonis K Hijaz
- Department of Urology, University Hospitals Cleveland Medical Center, 11000 Euclid Avenue, Cleveland, OH, USA.,Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Jose M Muyor
- Health Research Centre, University of Almeria, Almeria, Spain
| | - Mike Trott
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Andreas Kronbichler
- Department of Internal Medicine IV, Medical University Innsbruck, Innsbruck, Austria
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090, Vienna, Austria
| | - Mark A Tully
- School of Medicine, Ulster University, Londonderry, BT48 7JL, UK
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Control Alberta, Alberta Health Services, Calgary, Canada.,Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada
| | - Jimin Hwang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jong Yeob Kim
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seoyeon Park
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junmin Song
- Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, 03722, Republic of Korea.
| | - Petre-Cristian Ilie
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
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Quaghebeur J, Petros P, Wyndaele JJ, De Wachter S. The innervation of the bladder, the pelvic floor, and emotion: A review. Auton Neurosci 2021; 235:102868. [PMID: 34391125 DOI: 10.1016/j.autneu.2021.102868] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/26/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022]
Abstract
The innervation of the pelvic region is complex and includes extensive neurologic pathways. The higher centres' organisation determining the pelvic floor and organs' function remains a challenge understanding the physiological and pain mechanisms. Psychological and emotional factors have a profound influence on the pelvic floor and organ dysfunction such as LUTS. LUTS are associated with stress, depression, and anxiety. Neuroception is a subconscious neuronal system for detecting threats and safety and might explain the permanent disturbance of higher brain centres maintaining functional urological and gastrointestinal disorders and sphincter dysfunction.
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Affiliation(s)
- Jörgen Quaghebeur
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.
| | - Peter Petros
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia
| | | | - Stefan De Wachter
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
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6
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Panicker JN, Marcelissen T, von Gontard A, Vrijens D, Abrams P, Wyndaele M. Bladder-bowel interactions: Do we understand pelvic organ cross-sensitization? International Consultation on Incontinence Research Society (ICI-RS) 2018. Neurourol Urodyn 2020; 38 Suppl 5:S25-S34. [PMID: 31821639 DOI: 10.1002/nau.24111] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 06/30/2019] [Indexed: 12/26/2022]
Abstract
AIMS Mounting evidence from experimental animal and human studies suggests that cross-sensitization exists between different organs. Lower urinary tract (LUT) and bowel dysfunction commonly overlap, and the role of cross-sensitization between pelvic visceral organs is uncertain. METHODS At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2018, a panel of clinicians participated in a discussion on bladder and bowel interactions in the context of pelvic organ cross-sensitization. RESULTS Bladder and bowel problems commonly co-occur in adults and children across different disorders, and the mechanism responsible for overlapping dysfunction is uncertain in most instances. At a neuronal level, cross-sensitization occurs as a result of afferent signaling from the LUT and lower bowel through different central and peripheral mechanisms. Studies in animals and humans have demonstrated evidence for cross-organ sensitization following experimental inflammation or distension of the lower bowel, affecting the LUT. Nerve stimulation is an effective treatment for different functional LUT and bowel disorders, and whether this treatment may influence cross-organ sensitization remains uncertain. The role of physiologically dormant C-fibers, the bladder-gut-brain axis, and gut microbiome in cross-sensitization are speculative. CONCLUSION Recommendations for research were made to explore the role of cross-organ sensitization in the pathogenesis of co-occurring LUT and bowel dysfunction in humans.
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Affiliation(s)
- Jalesh N Panicker
- Department of Uro-Neurology and UCL Queen Square Institute of Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Paul Abrams
- Professor of Urology, Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Michel Wyndaele
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Zhou F, Newman DK, Palmer MH. Urinary Urgency in Working Women: What Factors Are Associated with Urinary Urgency Progression? J Womens Health (Larchmt) 2018; 27:575-583. [PMID: 29394127 DOI: 10.1089/jwh.2017.6555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urinary urgency is the primary symptom of overactive bladder (OAB). This study aimed to identify targets for effective intervention to delay progression of urinary urgency. MATERIAL AND METHODS Secondary analyses of data from a study conducted with female employees of a large academic medical center were conducted. Women were ≥18 years and nonpregnant at the time of the survey. An online questionnaire obtained demographic information, presence of lower urinary tract symptoms, and toileting behaviors. Bivariate analyses and multivariate logistic regression were applied to explore factors related to different stages of urinary urgency. RESULTS Four stages of urinary urgency were constructed: (1) Stage 1: no urinary symptoms (n = 20), (2) Stage 2: continent but urinary urgency reported (n = 19), (3) Stage 3: nonsevere urgency urinary incontinence (UUI) (incontinent but leakage ≤1/day, n = 74); and (4) Stage 4: severe UUI (leakage ≥1/day, n = 26). In multivariate analyses, older women were more likely to be in Stage 3 than in Stage 2 (aOR 1.053, 95% CI 1.012-1.096). Women who lost urine with defecation were more likely to be in Stage 4 than Stage 3 (aOR 3.828, 95% CI 1.921-7.629). Women who habitually strained to empty the bladder faster were more likely to be in Stage 4 than in Stage 3 (aOR 6.588, 95% CI 1.317-32.971). CONCLUSIONS Losing urine with defecation and making the bladder empty faster by pushing down should be explored as intervention targets to prevent women from progressing from Stage 3 to Stage 4.
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Affiliation(s)
- Fang Zhou
- 1 School of Nursing, Xuzhou Medical University , Xuzhou, China
| | - Diane K Newman
- 2 Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Mary H Palmer
- 3 University of North Carolina at Chapel Hill , School of Nursing, Chapel Hill, North Carolina
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8
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Defecatory Dysfunction and the Pelvic Floor. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2017. [DOI: 10.1007/s13669-017-0218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Routine enema before urodynamics has no impact on the quality of abdominal pressure curves: Results of a prospective controlled study. Prog Urol 2016; 26:1200-1205. [PMID: 27776992 DOI: 10.1016/j.purol.2016.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 11/22/2022]
Abstract
AIMS The presence of stools in the rectum might affect the quality of the abdominal pressure curve during filling cystometry, but, to date, no study has evaluated the impact of bowel preparation before urodynamics. We evaluated the influence of a sodium phosphate enema before urodynamics on the quality of the abdominal pressure curve. METHODS A prospective, controlled, single-blind study was conducted in a single center from May to June 2013. The patients were divided into 2 consecutive groups: patients seen in outpatient clinics during the first 6 weeks (group A) who underwent urodynamics without bowel preparation and patients seen in outpatient clinics during the second 6 weeks (group B) who had a prescription of sodium phosphate enema before urodynamics. The primary endpoint was the quality of the abdominal pressure curve evaluated independently by three physicians who were blinded to the study group. The following data were also collected: age, gender, the presence of a neurological disorder, complicated nature of urodynamics and bother related to preparation for it, assessed using a Likert scale (0 to 10), and the equipment used. A per protocol analysis and an intent-to-treat analysis were conducted. RESULTS One hundred and thirty-nine patients were included: 54 in group A and 85 in group B. One-third of patients had neurological conditions. 14 patients in group B did not perform their scheduled enema. Thus, 68 patients performed an enema before urodynamics and 71 did not. There was no difference between groups A and B regarding the complicated nature of urodynamics (Likert scale: 3.12 vs. 3.18; P=0.91) or bother related to preparation for it (Likert scale: 3.46 vs. 2.97; P=0.43). In the per protocol analysis, the abdominal pressure curve was considered perfectly interpretable (PI) in 69% of patients who did not receive an enema before urodynamics and in 65% of patients who did (P=0.61). The between-group difference was not statistically significant in intent-to-treat analysis (P=0.99). In patients who did not receive an enema before urodynamics, the only factors statistically associated with better quality of abdominal pressure curves were age <60years (P=0.001) and the urodynamic equipment used (Dantec®>Laborie®; P=0.01). CONCLUSION In this prospective study, routine enema before urodynamics did not improve the quality of the abdominal pressure curve and did not increase the complicated nature of urodynamics or the bother of preparation for it. LEVEL OF EVIDENCE 3.
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Reynolds WS, Dmochowski R, Wein A, Bruehl S. Does central sensitization help explain idiopathic overactive bladder? Nat Rev Urol 2016; 13:481-91. [PMID: 27245505 PMCID: PMC4969200 DOI: 10.1038/nrurol.2016.95] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The pathophysiological mechanisms underlying overactive bladder syndrome (OAB) can include dysfunction of sensory pathways of the peripheral and central nervous systems, resulting in bladder hypersensitivity. Central sensitization describes an induced state of spinal hypersensitivity that is associated with a variety of chronic pain disorders that share many attributes with OAB, albeit without the presence of pain. As such, the concept of central sensitization might be relevant to understanding the mechanisms and clinical manifestations of OAB syndrome. An understanding of the pathophysiology and clinical manifestations of central sensitization, and the evidence that supports a role of central sensitization in OAB, including the potential implications of mechanisms of central sensitization for the treatment of patients with OAB could provide a novel approach to the treatment of patients with this disease. Such an approach would be especially relevant to those patients with central sensitization-related comorbidities, and has the potential to improve the outcomes of these patients in particular.
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Affiliation(s)
- W Stuart Reynolds
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, Tennessee 37232, USA
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, A1302 Medical Center North, Nashville, Tennessee 37232, USA
| | - Alan Wein
- Division of Urology, University of Pennsylvania Health System, 34th &Civic Center Boulevard, Philadelphia, Pennsylvania 19104, USA
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, 701 Medical Arts Building, Nashville, Tennessee 37232, USA
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11
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Ambartsumyan L, Siddiqui A, Bauer S, Nurko S. Simultaneous urodynamic and anorectal manometry studies in children: insights into the relationship between the lower gastrointestinal and lower urinary tracts. Neurogastroenterol Motil 2016; 28:924-33. [PMID: 27214097 PMCID: PMC4880423 DOI: 10.1111/nmo.12794] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 01/13/2016] [Indexed: 12/07/2022]
Abstract
BACKGROUND Children with urinary incontinence (UI) have associated functional constipation (FC) and fecal incontinence (FI). The physiology between lower urinary tract (LUT) and anorectum in children has not been elucidated. AIMS Observe the effect of rectal distention (RD) on LUT function, and bladder filling and voiding on anorectal function. METHODS Children with voiding dysfunction referred to Boston Children's Hospital were prospectively enrolled in combined urodynamic (UDS) and anorectal manometry (ARM). Anorectal and urodynamic parameters were simultaneously measured. Patients underwent two micturition cycles, first with rectal balloon deflated and second with it inflated (RD). Lower urinary tract and anorectal parameters were compared between cycles. KEY RESULTS Ten children (seven UI, four recurrent UTIs, nine FC ± FI) were enrolled. Postvoid residual (PVR) increased (p = 0.02) with RD. No differences were observed in percent of bladder filling to expected bladder capacity, sensation, and bladder compliance with and without RD. Bladder and abdominal pressures increased at voiding with RD (p < 0.05). Intra-anal pressures decreased at voiding (p < 0.05), at 25% (p = 0.03) and 50% (p = 0.06) of total volume of bladder filling. CONCLUSIONS & INFERENCES The PVR volume increased with RD. Stool in the rectum does not alter filling cystometric capacity but decreases the bladder's ability to empty predisposing patients with fecal retention to UI and UTIs. Bladder and abdominal pressures increased during voiding, demonstrating a physiological correlate of voiding dysfunction. Intra-anal pressures decreased during bladder filling and voiding. This is the first time intra-anal relaxation during bladder filling and voiding has been described.
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Affiliation(s)
- L Ambartsumyan
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA, USA
| | - A Siddiqui
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA, USA
| | - S Bauer
- Department of Urology, Boston Children's Hospital, Boston, MA, USA
| | - S Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, MA, USA
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12
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Abstract
Abstract
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13
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Results of sacral nerve neuromodulation for double incontinence in adults. Tech Coloproctol 2014; 18:1147-51. [DOI: 10.1007/s10151-014-1231-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 10/23/2014] [Indexed: 10/24/2022]
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14
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Persyn S, De Wachter S, Wyndaele M, Birder L, Wyndaele JJ. Mechanisms of Pelvic Organ Cross-Talk: Impact of Urethral Ligation on the Inhibitory Rectovesical Reflex. J Urol 2014; 192:1574-9. [DOI: 10.1016/j.juro.2014.05.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2014] [Indexed: 12/30/2022]
Affiliation(s)
- Sara Persyn
- Department of Urology, Antwerp University Hospital and Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital and Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Michel Wyndaele
- Department of Urology, Antwerp University Hospital and Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Lori Birder
- Department of Urology, Antwerp University Hospital and Faculty of Medicine, University of Antwerp, Antwerp, Belgium
- Departments of Medicine and Pharmacology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jean-Jacques Wyndaele
- Department of Urology, Antwerp University Hospital and Faculty of Medicine, University of Antwerp, Antwerp, Belgium
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Wyndaele M, De Winter BY, Pelckmans PA, De Wachter S, Van Outryve M, Wyndaele JJ. Exploring associations between lower urinary tract symptoms (LUTS) and gastrointestinal (GI) problems in women: a study in women with urological and GI problems vs a control population. BJU Int 2014; 115:958-67. [DOI: 10.1111/bju.12904] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Michel Wyndaele
- Laboratory of Translational Neurosciences; Division of Urology; University of Antwerp and Antwerp University Hospital; Antwerp Belgium
| | - Benedicte Y. De Winter
- Laboratory of Experimental Medicine and Paediatrics; Division of Gastroenterology; University of Antwerp and Antwerp University Hospital; Antwerp Belgium
| | - Paul A. Pelckmans
- Laboratory of Experimental Medicine and Paediatrics; Division of Gastroenterology; University of Antwerp and Antwerp University Hospital; Antwerp Belgium
- Department of Gastroenterology; Faculty of Medicine; University of Antwerp and Antwerp University Hospital; Antwerp Belgium
| | - Stefan De Wachter
- Laboratory of Translational Neurosciences; Division of Urology; University of Antwerp and Antwerp University Hospital; Antwerp Belgium
| | - Mark Van Outryve
- Department of Gastroenterology; Faculty of Medicine; University of Antwerp and Antwerp University Hospital; Antwerp Belgium
| | - Jean Jacques Wyndaele
- Laboratory of Translational Neurosciences; Division of Urology; University of Antwerp and Antwerp University Hospital; Antwerp Belgium
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Muls AC. Acta Oncologica Lecture. Gastrointestinal consequences of cancer treatment and the wider context: a bad gut feeling. Acta Oncol 2014; 53:297-306. [PMID: 24460087 DOI: 10.3109/0284186x.2013.873140] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The percentage of people living with a diagnosis of cancer is rising globally. Between 20% and 25% of people treated for cancer experience a consequence of cancer which has an adverse impact on the quality of their life. Gastrointestinal (GI) symptoms are the most common of all consequences of cancer treatment and have the greatest impact on daily activity. PATHOPHYSIOLOGY OF LONG-TERM BOWEL DAMAGE AFTER PELVIC RADIOTHERAPY: Long-term damage to the bowel after radiotherapy is mediated by ischaemic changes and fibrosis. Each fraction of radiotherapy causes a series of repetitive injuries to the intestinal tissue resulting in an altered healing process, which affects the integrity of the repair and changes the architecture of the bowel wall. THE NATURE OF GI SYMPTOMS THAT DEVELOP: Patient-reported outcome measures show that diarrhoea, urgency, increased bowel frequency, tenesmus and flatulence are the five most prevalent GI symptoms with a moderate or severe impact on patients' daily lives after treatment with pelvic radiotherapy. Many patients also experience fatigue, urinary problems and have sexual concerns. SYSTEMATIC ASSESSMENT AND MANAGEMENT: The complex nature of those symptoms warrants systematic assessment and management. The use of a tested algorithm can assist in achieving this. The most common contributing factors to ongoing bowel problems after pelvic radiotherapy are small intestinal bacterial overgrowth, bile acid malabsorption, pancreatic insufficiency, rectal bleeding and its impact on bone health. THE WIDER CONTEXT Symptom burden, socio-psychosocial impact, memory and cognitive function, fatigue, urinary problems and sexual concerns need to be taken into account when thinking about consequences of cancer treatment. CONCLUSION As our understanding of consequences of cancer treatments continues to emerge and encompass a wide variety of specialties, a holistic, multifaceted and multidisciplinary approach is required to manage those consequences long-term.
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Coyne KS, Wein A, Nicholson S, Kvasz M, Chen CI, Milsom I. Comorbidities and personal burden of urgency urinary incontinence: a systematic review. Int J Clin Pract 2013; 67:1015-33. [PMID: 24073974 DOI: 10.1111/ijcp.12164] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 02/21/2013] [Indexed: 11/30/2022] Open
Abstract
AIMS Studies on the burden and comorbidities associated with urgency urinary incontinence (UUI) are difficult to compare, partly because of the evolution of definitions for lower urinary tract symptoms and the various instruments used to assess health-related quality of life (HRQL). This article summarises published evidence on comorbidities and the personal burden associated specifically with UUI to provide clinicians with a clear perspective on the impact of UUI on patients. METHODS A PubMed search was conducted using the terms: (urgency urinary incontinence OR urge incontinence OR mixed incontinence OR overactive bladder) AND (burden OR quality of life OR well-being OR depression OR mental health OR sexual health OR comorbid), with limits for English-language articles published between 1991 and 2011. RESULTS Of 1364 identified articles, data from 70 retained articles indicate that UUI is a bothersome condition that has a marked negative impact on HRQL, with the severity of UUI a predictor of HRQL. UUI is significantly associated with falls in elderly individuals, depression, urinary tract infections, increased body mass index, diabetes and deaths. The burden of UUI appears to be greater than that of stress urinary incontinence or overactive bladder symptoms without UUI. UUI adversely impacts physical and mental health, sexual function and work productivity. CONCLUSIONS UUI is associated with numerous comorbid conditions and inflicts a substantial personal burden on many aspects of patients' lives. Healthcare providers should discuss UUI with patients and be aware of the impact of UUI and its associated comorbidities on patients' lives.
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Affiliation(s)
- K S Coyne
- Center for Health Outcomes Research, United BioSource Corporation, Bethesda, MD, USA
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Neuromodulation for fecal and urinary incontinence: functional results in 57 consecutive patients from a single institution. Dis Colon Rectum 2012; 55:1278-83. [PMID: 23135587 DOI: 10.1097/dcr.0b013e31826c7789] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Sacral nerve stimulation is a recognized treatment for fecal and urinary incontinence. Few articles have been published about patients presenting with both types of incontinence. OBJECTIVE The aim of this study was to report the functional results in patients operated on for simultaneous fecal and urinary incontinence by the use of sacral nerve stimulation. DESIGN This study is a retrospective analysis of prospectively collected data. SETTINGS The investigation was conducted in the academic departments of colorectal surgery and urology. PATIENTS Between January 2001 and March 2010, 57 consecutive patients (54 women) with a mean age of 58 years (range, 16-76) were included. INTERVENTIONS Two-stage sacral nerve modulation (test and implant) was performed. MAIN OUTCOME MEASURES Functional study before testing, at 6 months, and at the end of follow-up after implantation included the use of the Cleveland Clinic incontinence score, Urinary Symptoms Profile, Fecal Incontinence Quality of Life score, and the Ditrovie score. Patient satisfaction with the technique was evaluated at a median follow-up of 62.8 months. RESULTS : Fecal incontinence improved from 14.1/20 to 7.2/20 at 6 months and 6.9/20 at the end of follow-up. Urinary incontinence, mainly urge incontinence (47% of patients), and urgency frequency (34% of patients) improved at 6 months and end of follow-up, but not retention and dysuria. Specific quality of life was improved for fecal and urinary incontinence at 6 months and end of follow-up. At the end of follow-up, 73% patients were highly satisfied with the technique, but 9% felt their condition had deteriorated. The reoperation rate was 29%, of which 12% were indicated because of a complication. LIMITATIONS This study was limited by its retrospective nature and the multiple causes of incontinence. CONCLUSION Fecal and urinary incontinence, studied by symptoms scores and specific quality-of-life scores, are improved in patients receiving sacral nerve stimulation for double incontinence.
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Malykhina AP, Wyndaele JJ, Andersson KE, De Wachter S, Dmochowski RR. Do the urinary bladder and large bowel interact, in sickness or in health? ICI-RS 2011. Neurourol Urodyn 2012; 31:352-8. [PMID: 22378593 DOI: 10.1002/nau.21228] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 09/14/2011] [Indexed: 12/26/2022]
Abstract
Normal functioning of the urinary bladder and the distal gut is an essential part of daily physiological activity coordinated by the peripheral and central nervous systems. Pathological changes in one of these organs may induce the development of cross-organ sensitization in the pelvis and underlie clinical co-morbidity of genitourinary and GI dysfunctions. Experimental human and animal data suggest that the bladder and distal colon interact under both normal and pathological conditions, however, the directions of these interactions can change dramatically depending on the nature and duration of the applied stimuli. This review article aimed to summarize the clinical data on colon-bladder cross-reflexes in healthy individuals, as well as in patients with co-morbid disorders. It also discusses currently used animal models, experimental approaches, and suggested mechanisms of colon-bladder cross-talk. Additionally, it provides an overview of the potential pharmacological targets to develop treatment options for patients with co-morbid disorders. Presented work resulted from the discussion of colon/bladder interactions during "Think Tank 9" presentations at the International Consultation on Incontinence Research Society meeting held in Bristol, UK, 2011.
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Affiliation(s)
- Anna P Malykhina
- Department of Surgery, University of Pennsylvania, Glenolden, Pennsylvania 19036-2307, USA.
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Gungor I, Beji NK. Lifestyle changes for the prevention and management of lower urinary tract symptoms in women. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2011. [DOI: 10.1111/j.1749-771x.2011.01112.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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