1
|
Barba M, Cola A, Rezzan G, Costa C, Re I, Volontè S, Terzoni S, Frigerio M, Maruccia S. Flat Magnetic Stimulation for Urge Urinary Incontinence. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1999. [PMID: 38004048 PMCID: PMC10673601 DOI: 10.3390/medicina59111999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Strategies for overactive bladder syndrome (OAB) management involve, among others, strengthening the bladder outlet to suppress urgency and neuromodulating the sacral roots. Magnetic stimulation (MS) is a technology that involves an extracorporeal device that is able to provide an electromagnetic field specifically designed to interact with pelvic floor neuromuscular tissue. The resulting tissue electrical activity induces contraction of the pelvic muscle and neuromodulation of the S2-S4 sacral roots. Flat Magnetic Stimulation (FMS) is a relevant advancement involving homogeneous electromagnetic fields, which are able to optimize the effect on the entire pelvic area. However, the benefits of this new technology for OAB syndrome are poorly known. Consequently, the aim of our study is to analyze the outcomes and quality of life (QoL) impact of FMS with Dr. Arnold (DEKA, Calenzano, Italy) in women suffering from OAB syndrome associated with urinary incontinence. Materials and Methods: This prospective study included patients with OAB, urge urinary incontinence, and no ongoing OAB treatments. At baseline (T0), the Incontinence Impact Questionnaire (IIQ-7), the Female Sexual Function Index (FSFI-19), and the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) were collected. Patients underwent 8 FMS sessions of 25 min each in one month. At the termination of the therapy (T1), women repeated the ICIQ-UI SF, FSFI-19, and IIQ-7 tools. Moreover, the Patient Global Impression of Improvement (PGI-I) questionnaire was collected to evaluate the cure rate. Results: Our study enrolled a total of 57 consecutive patients. Most women had at least one second- or third-line treatment before FMS, while the remaining naive patients had contraindications to pharmacological treatments. No women reported adverse effects during the treatment. After the treatment, we observed a decrease in the IIQ-7 (p < 0.001) and ICIQ-UI SF scores (p < 0.001) and an improvement in sexual function (p < 0.001) evaluated with FSFI-19. According to PGI-I scores, 42 (73.7%) women referred to some kind of improvement, scoring ≤ 3 points. Specifically, 8.7% of patients considered themselves very much improved, 29.8% much improved, 35.1% minimally improved, and 26.3% found no changes. FMS was effective in treating OAB symptoms without any adverse effects. The mechanism is supposed to be related to suppressing the initiation of micturition. This makes FMS a promising device for treating naive and refractory urge urinary incontinence. Conclusions: The new FMS represents a promising non-pharmacological option for the treatment of naive and refractory OAB.
Collapse
Affiliation(s)
- Marta Barba
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Alice Cola
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Giorgia Rezzan
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Clarissa Costa
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Ilaria Re
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Silvia Volontè
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Stefano Terzoni
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy; (S.T.); (S.M.)
| | - Matteo Frigerio
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy; (M.B.); (A.C.); (G.R.); (C.C.); (I.R.); (S.V.)
| | - Serena Maruccia
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy; (S.T.); (S.M.)
| |
Collapse
|
2
|
von Siebenthal M, Besic M, Gheinani AH, Akshay A, Lizun-Platoni S, Kunz N, Burkhard FC, Monastyrskaya K. Urinary miRNA profiles discriminate between obstruction-induced bladder dysfunction and healthy controls. Sci Rep 2021; 11:10204. [PMID: 33986358 PMCID: PMC8119692 DOI: 10.1038/s41598-021-89535-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/28/2021] [Indexed: 02/07/2023] Open
Abstract
Urgency, frequency and incomplete emptying are the troublesome symptoms often shared between benign prostatic obstruction-induced (BLUTD) and neurogenic (NLUTD) lower urinary tract dysfunction. Previously, using bladder biopsies, we suggested a panel of miRNA biomarkers for different functional phenotypes of the bladder. Urine is a good source of circulating miRNAs, but sex- and age-matched controls are important for urinary metabolite comparison. In two groups of healthy subjects (average age 32 and 57 years old, respectively) the total protein and RNA content was very similar between age groups, but the number of secreted extracellular vesicles (uEVs) and expression of several miRNAs were higher in the young healthy male volunteers. Timing of urine collection was not important for these parameters. We also evaluated the suitability of urinary miRNAs for non-invasive diagnosis of bladder outlet obstruction (BOO). A three urinary miRNA signature (miR-10a-5p, miR-301b-3p and miR-363-3p) could discriminate between controls and patients with LUTD (BLUTD and NLUTD). This panel of representative miRNAs can be further explored to develop a non-invasive diagnostic test for BOO. The age-related discrepancy in the urinary miRNA content observed in this study points to the importance of selecting appropriate, age-matched controls.
Collapse
Affiliation(s)
- Michelle von Siebenthal
- Urology Research Laboratory, Department for BioMedical Research DBMR, University of Bern, Bern, Switzerland
| | - Mustafa Besic
- Urology Research Laboratory, Department for BioMedical Research DBMR, University of Bern, Bern, Switzerland
| | - Ali Hashemi Gheinani
- Urological Diseases Research Center, Boston Children's Hospital, Harvard Medical School, Boston, USA.,Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Akshay Akshay
- Urology Research Laboratory, Department for BioMedical Research DBMR, University of Bern, Bern, Switzerland
| | | | - Nadine Kunz
- Department of Urology, Inselspital University Hospital, 3010, Bern, Switzerland
| | - Fiona C Burkhard
- Urology Research Laboratory, Department for BioMedical Research DBMR, University of Bern, Bern, Switzerland.,Department of Urology, Inselspital University Hospital, 3010, Bern, Switzerland
| | - Katia Monastyrskaya
- Urology Research Laboratory, Department for BioMedical Research DBMR, University of Bern, Bern, Switzerland. .,Department of Urology, Inselspital University Hospital, 3010, Bern, Switzerland.
| |
Collapse
|
3
|
Imboden S, Bollinger Y, Härmä K, Knabben L, Fluri M, Nirgianakis K, Mohr S, Kuhn A, Mueller MD. Predictive Factors for Voiding Dysfunction after Surgery for Deep Infiltrating Endometriosis. J Minim Invasive Gynecol 2021; 28:1544-1551. [PMID: 33476749 DOI: 10.1016/j.jmig.2021.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 01/03/2021] [Accepted: 01/10/2021] [Indexed: 12/27/2022]
Abstract
STUDY OBJECTIVE To evaluate the prognostic value of pre- and perioperative factors for voiding dysfunction after surgery for deep infiltrating endometriosis (DIE). DESIGN Single-center retrospective cohort study. SETTING University hospital. PATIENTS A total of 198 women with DIE in the posterior compartment who underwent surgery and a postoperative bladder scan. INTERVENTIONS Surgical resection of the DIE nodule from the dorsal compartment. MEASUREMENTS AND MAIN RESULTS After surgery, 41% of the patients initially experienced voiding dysfunction (defined as >100 mL postvoid residual urine volume at second bladder scan). The number decreased to 11% by the time of hospital discharge. Among those with a need for self-catheterization after discharge (n = 17), voiding dysfunction lasted for a median of 41 days before a return to normal bladder function, with a residual urine volume of <100 mL. The preoperative presence of DIE nodules in the ENZIAN compartment B was associated with postoperative voiding dysfunction (p = .001). The hazard ratio for elevated residual urine volume was highest when the disease stage was B3 (hazard ratio 6.43; CI, 2.3-18.2; p <.001), describing a nodule diameter of >3 cm in lateral distension. Receiver operating characteristic curve analyses showed that a first residual urine volume >220 mL has a good predictive value for the risk of intermittent self-catheterization (area under the receiver operating characteristic curve 0.893; p <.001). CONCLUSION Postoperative voiding dysfunction is frequent; of note, in most cases the problem is temporary. When DIE with an ENZIAN classification B is noted intraoperatively and, most of all, when the diameter of the lesion is >3 cm, a higher risk of postoperative voiding dysfunction is to be expected.
Collapse
Affiliation(s)
- Sara Imboden
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)..
| | - Yaelle Bollinger
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Kirsi Härmä
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Laura Knabben
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Mihaela Fluri
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Konstantinos Nirgianakis
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Stefan Mohr
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Annette Kuhn
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| | - Michael D Mueller
- Department of Gynecology and Obstetrics, University Hospital of Bern and University of Bern, Bern, Switzerland (all authors)
| |
Collapse
|
4
|
Leandro A, Marta L, Gracia G, Ariel M, Pablo VJ, Bengió Rubén G. Prevalence of "uncomplicated" and "complicated" stress urinary incontinence in Argentinian women: Assessing the role of the urodynamic study. Eur J Obstet Gynecol Reprod Biol 2020; 256:466-470. [PMID: 33162151 DOI: 10.1016/j.ejogrb.2020.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/05/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the percentage of Argentinian patients with "uncomplicated" and "complicated" stress urinary incontinence (SUI) in whom preoperative urodynamics study (UDS) was performed. The secondary objective of the study was to evaluate differences between clinical observation and urodynamics in both groups of women. METHODS A retrospective study of women with IOE derivatives for UDS prior to surgical treatment is performed. The analyzed patients were classified in complicated and not complicated according to the criteria of the study VALUE. The prevalence of different urodynamics observations was assessed in patients with complicated and uncomplicated SUI. RESULTS We studied 792 patients with SUI derivatives for UDS. Of the patients studied, 313 (39.5%) were considered as uncomplicated SUI and 479 (60.5%) as complicated SUI. The Urodynamics observation was considered different from the clinical data in 415/792 (52.4%), although in greater proportion in SUI complicated (59.9% vs. 40.9%, p < 0.001). There was a higher incidence of voiding dysfunction in patients with complicated SUI (32.4% vs. 14.7%, p < 0,001). CONCLUSIONS Patients with uncomplicated SUI represent 39% of patients studied with SUI. The differences between clinical evaluation and urodynamics are higher in patients with complicated SUI contributing new information in 60% of the cases.
Collapse
Affiliation(s)
- Arribillaga Leandro
- Centro Urológico Profesor Bengió, Córdoba, Argentina; Clínica Universitaria Reina Fabiola, Córdoba, Argentina.
| | - Ledesma Marta
- Centro Urológico Profesor Bengió, Córdoba, Argentina
| | | | | | | | - Bengió Rubén G
- Centro Urológico Profesor Bengió, Córdoba, Argentina; Clínica Universitaria Reina Fabiola, Córdoba, Argentina
| |
Collapse
|
5
|
Giannini A, Caretto M, Russo E, Mannella P, Simoncini T. Advances in surgical strategies for prolapse. Climacteric 2020; 22:60-64. [PMID: 30721638 DOI: 10.1080/13697137.2018.1543266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pelvic floor dysfunctions are a complex condition in elderly women; pelvic organ prolapse, urinary or fecal incontinence, constipation, pelvic pain, and sexual dysfunction are common problems. The goal of surgical treatment is functional reconstruction with symptom management and repair of anatomic defects. The recent advancements in surgical treatment of pelvic floor dysfunction allow several good options for choosing the best surgery for each patient. The vaginal procedure is traditionally the gold standard approach for elderly patients, but abdominal surgery is increasing as a mini-invasive approach and the robotic approach is gaining acceptance for treatment of pelvic floor dysfunctions. In elderly individuals, a multitude of factors affects the final result of any reconstructive surgery such as postmenopausal or aging-associated changes in muscle tone and nerve function or changes in the function of the bladder or of the rectum: an understanding of the underlining functional status of pelvic organs is very important in aging women before proceeding to surgery. In this context, pelvic floor dysfunction, particularly in elderly women, should be addressed in a multidisciplinary manner and, at the forefront, centers for surgical planning could be helpful to perform safer, patient-tailored surgery.
Collapse
Affiliation(s)
- A Giannini
- a Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine , University of Pisa , Pisa , Italy
| | - M Caretto
- a Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine , University of Pisa , Pisa , Italy
| | - E Russo
- a Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine , University of Pisa , Pisa , Italy
| | - P Mannella
- a Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine , University of Pisa , Pisa , Italy
| | - T Simoncini
- a Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine , University of Pisa , Pisa , Italy
| |
Collapse
|
6
|
Serati M, Iacovelli V, Cantaluppi S, Braga A, Balzarro M, Pletto S, Soligo M, Finazzi Agrò E. Impact of urodynamic evaluation on the treatment of women with idiopathic overactive bladder: a systematic review. MINERVA UROL NEFROL 2020; 72:420-426. [PMID: 32026667 DOI: 10.23736/s0393-2249.20.03685-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Overactive bladder (OAB) is a common clinical condition affecting women. The impact of urodynamics (UDS) on the management of idiopathic OAB in women is highly debated. This systematic review analyzes the impact of UDS on the choice and on the outcomes of treatment of female idiopathic OAB. EVIDENCE ACQUISITION A systematic literature search in the PubMed/Medline, Web of Science, Scopus and Cochrane databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement to identify clinical trials, randomized controlled trials, meta-analyses, and guidelines on female OAB and UDS published from 2000. A total of 1554 records were initially identified and 12 articles were included in the final qualitative synthesis. EVIDENCE SYNTHESIS UDS represents the main tool to diagnose detrusor overactivity (DO) in OAB female patients which is considered one of the major OAB underlying pathophysiology factor. UDS can underline the presence of voiding dysfunction that could be considered as another underlying cause of uncomplicated female OAB. On the basis of this urodynamic findings, we can better define different aspects of OAB syndrome leading to a more tailored and proper treatment. CONCLUSIONS UDS can have a useful role in the diagnosis of idiopathic OAB in women given the possibility to gain a precise diagnosis and, therefore, a tailored treatment based on the underlying cause. The integration of clinics with UDS and all the other diagnostic available tools is desirable.
Collapse
Affiliation(s)
- Maurizio Serati
- Unit of Urogynecology, Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy -
| | - Valerio Iacovelli
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Rome, Italy.,San Carlo di Nancy General Hospital, Rome, Italy
| | - Simona Cantaluppi
- Unit of Urogynecology, Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, Beata Vergine Hospital, Mendrisio, Switzerland
| | | | - Simone Pletto
- School of Specialization in Urology, Tor Vergata University, Rome, Italy
| | - Marco Soligo
- Department of Obstetrics and Gynecology, Buzzi Hospital - ASST FBF Sacco, University of Milan, Milan, Italy
| | - Enrico Finazzi Agrò
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Rome, Italy
| |
Collapse
|
7
|
Gammie A, Speich JE, Damaser MS, Gajewski JB, Abrams P, Rosier PFWM, Arlandis S, Tarcan T, Finazzi Agrò E. What developments are needed to achieve less-invasive urodynamics? ICI-RS 2019. Neurourol Urodyn 2020; 39 Suppl 3:S36-S42. [PMID: 32022941 DOI: 10.1002/nau.24300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/27/2020] [Indexed: 11/07/2022]
Abstract
AIMS To assess the state of technologies for urodynamics that are less invasive than standard cystometry and pressure-flow studies and to suggest areas needing research to improve this. METHODS A summary of a Think Tank debate held at the 2019 meeting of the International Consultation on Incontinence Research Society is provided, with subsequent analysis by the authors. Less-invasive techniques were summarized, classified by method, and possible developments considered. Discussions and recommendations were summarized by the co-chairs and edited into the form of this paper by all authors. RESULTS There is a full spectrum of technologies available for less-invasive assessment, ranging from simple uroflowmetry through imaging techniques to emerging complex technologies. Less-invasive diagnostics will not necessarily need to replace diagnosis by, or even provide the same level of diagnostic accuracy as, invasive urodynamics. Rather than aiming for a technique that is merely less invasive, the priority is to develop methods that are either as accurate as current invasive methods, or spare patients from the necessity of invasive methods by improving early triaging. CONCLUSIONS Technologies offering less-invasive urodynamic measurement of specific elements of function can be potentially beneficial. Less-invasive techniques may sometimes be useful as an adjunct to invasive urodynamics. The potential for current less-invasive tests to completely replace invasive urodynamic testing is considered, however, to be low. Less-invasive techniques must, therefore, be tested as screening/triaging tools, with the aim to spare some patients from invasive urodynamics early in the treatment pathway.
Collapse
Affiliation(s)
- Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - John E Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, Virginia
| | - Margot S Damaser
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio
| | - Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | | | | | - Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, İstanbul, Turkey
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | | |
Collapse
|
8
|
He YL, Chen Y, Wen YB, Zhai RQ, Ma Y, Wang JJ, Pu QS, Sihoe JD, Franco I, Wen JG. Changes in bladder function with time following cystostomy in rats. Neurourol Urodyn 2019; 39:565-575. [PMID: 31782979 DOI: 10.1002/nau.24241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 11/11/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Yu Lin He
- Department of Urology, Pediatric Urodynamic Centre, The First Affiliated Hospital of Zhengzhou University Zhengzhou University Zhengzhou China
- Henan Joint International Pediatric Urodynamic Laboratory The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Yan Chen
- Department of Urology, Pediatric Urodynamic Centre, The First Affiliated Hospital of Zhengzhou University Zhengzhou University Zhengzhou China
- Henan Joint International Pediatric Urodynamic Laboratory The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Yi Bo Wen
- Department of Urology, Pediatric Urodynamic Centre, The First Affiliated Hospital of Zhengzhou University Zhengzhou University Zhengzhou China
- Henan Joint International Pediatric Urodynamic Laboratory The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Rong Qun Zhai
- Department of Urology, Pediatric Urodynamic Centre, The First Affiliated Hospital of Zhengzhou University Zhengzhou University Zhengzhou China
- Henan Joint International Pediatric Urodynamic Laboratory The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Yuan Ma
- Department of Urology, Pediatric Urodynamic Centre, The First Affiliated Hospital of Zhengzhou University Zhengzhou University Zhengzhou China
- Henan Joint International Pediatric Urodynamic Laboratory The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Jian Jian Wang
- Department of Urology, Pediatric Urodynamic Centre, The First Affiliated Hospital of Zhengzhou University Zhengzhou University Zhengzhou China
- Henan Joint International Pediatric Urodynamic Laboratory The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Qing Song Pu
- Department of Urology, Pediatric Urodynamic Centre, The First Affiliated Hospital of Zhengzhou University Zhengzhou University Zhengzhou China
- Henan Joint International Pediatric Urodynamic Laboratory The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Jennifer D. Sihoe
- Department of Urology, Pediatric Urodynamic Centre, The First Affiliated Hospital of Zhengzhou University Zhengzhou University Zhengzhou China
- Henan Joint International Pediatric Urodynamic Laboratory The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| | - Israel Franco
- Department of Urology Yale University New Haven Connecticut
| | - Jian Guo Wen
- Department of Urology, Pediatric Urodynamic Centre, The First Affiliated Hospital of Zhengzhou University Zhengzhou University Zhengzhou China
- Henan Joint International Pediatric Urodynamic Laboratory The First Affiliated Hospital of Zhengzhou University Zhengzhou China
| |
Collapse
|
9
|
Urodynamic Mechanisms Underlying Overactive Bladder Symptoms in Patients With Parkinson Disease. Int Neurourol J 2019; 23:211-218. [PMID: 31607100 PMCID: PMC6790817 DOI: 10.5213/inj.1938086.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 06/27/2019] [Indexed: 01/16/2023] Open
Abstract
PURPOSE To assess the urodynamic findings in patients with Parkinson disease (PD) with overactive bladder symptoms. METHODS We performed a retrospective chart review of all PD patients who were seen in an outpatient clinic for lower urinary tract symptoms (LUTS) between 2010 and 2017 in a single-institution. Only patients who complained of overactive bladder (OAB) symptoms and underwent a video-urodynamic study for these symptoms were included. We excluded patients with neurological disorders other than PD and patients with voiding LUTS but without OAB symptoms. RESULTS We included 42 patients (29 men, 13 women, 74.5±8.1 years old). Seven patients (16.7%) had a postvoid residual (PVR) bladder volume >100 mL and only one reported incomplete bladder emptying. Detrusor overactivity (DO) was found in all 42 patients (100%) and was terminal in 19 (45.2%) and phasic in 22 patients (52.4%). Eighteen patients had detrusor underactivity (DU) (42.3%). Later age of PD diagnosis was the only parameter associated with DU (P=0.02). Patients with bladder outlet obstruction (BOO) were younger than patients without BOO (70.1 years vs. 76.5 years, P=0.004), had later first sensation of bladder filling (173.5 mL vs. 120.3 mL, P=0.02) and first involuntary detrusor contraction (226.4 mL vs. 130.4 mL, P=0.009). CONCLUSION DO is almost universal in all patients with PD complaining of OAB symptoms (97.1%). However, a significant percentage of patients also had BOO (36.8%), DU (47%), and increased PVR (16.7%) indicating that neurogenic DO may not be the only cause of OAB symptoms in PD patients.
Collapse
|
10
|
Braga A, Serati M, Illiano E, Manassero F, Milanesi M, Natale F, Torella M, Pistolesi D, De Nunzio C, Soligo M, Finazzi Agrò E. When should we use urodynamic testing? Recommendations of the Italian Society of Urodynamics (SIUD). Part 2 - Male and neurogical population. MINERVA UROL NEFROL 2019; 72:187-199. [PMID: 31166102 DOI: 10.23736/s0393-2249.19.03447-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent studies in literature, have raised some doubts on the routine use of urodynamic testing. Many physicians and articles recommend a selective use of this tool, considering carefully risks and benefits. These recommendations are intended to guide clinicians in the right selection of the male and neurological patients to submit to a urodynamic evaluation. This is the second part of a previous article regarding the urodynamic recommendations in the female population. We reviewed the literature, regarding the use of UDS in male and neurological population with lower urinary tract symptoms (LUTS). Specifically, we analyzed and compared the guidelines and recommendations of the most important urology and urogynecology international scientific societies. These publications were used to create the evidence basis for characterizing the recommendations to perform urodynamic testing. A panel of 10 experts was composed and Delphi process was followed to obtain the panelist consensus. The final recommendations were approved by the unanimous consensus of the panel and compared with the best practice recommendations available in the literature. The recommendations are provided for diagnosis and management of common LUTS in male and neurological population. This review provides a summary of the most effective utilization of urodynamic studies for the global evaluation of patients with LUTS, and how to use them when really needed, avoiding unnecessary costs and patient inconveniences.
Collapse
Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland -
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Ester Illiano
- Division of Urology and Andrology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Francesca Manassero
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Martina Milanesi
- Department of Urology, AOU Careggi Hospital, University of Florence, Florence, Italy
| | - Franca Natale
- Department of Urogynecology, San Carlo of Nancy Hospital, Rome, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Donatella Pistolesi
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Soligo
- Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
| | | |
Collapse
|
11
|
Abstract
Introduction: Diagnosis of lower urinary tract (LUT) dysfunction starts with categorization in clinical syndromes, and initial management is based on the assumptions about pathophysiology that these syndromes contain. However, clinical practice guidelines are ambiguous in clinical specialists' diagnosis of dysfunction after failure of initial management. This is a narrative and critical review of the existing evidence, and the aim is to suggest practice improvements in the process of clinical specialists' diagnosis for patients resistant to initial management. Methods and Results: Evidence is collated on the basis of the author's personal preference in combination with good clinical practice general principles. Statements and suggestions to improve reflect personal opinion. For two groups of patients with LUT dysfunction, the strategy of initial diagnosis is summarized and desirable principles of secondary care diagnosis are discussed. More specifically, a structure for the contemporary care of women with signs and symptoms of urinary incontinence is described and for that of the group of men older than 45 years with symptoms of LUT dysfunction. Conclusions: Urodynamic testing is the undisputed gold standard for objective assessment and is the only way to stage and grade the dysfunction. Clinical practice guidelines and clinical specialists are too modest about the use and applicability of objective or urodynamic testing for referred persons with LUT dysfunction that is resistant to initial pragmatic management. Objective assessment and diagnosis are mainstays in secondary care, and the indication to perform objective assessments in patients with LUT dysfunction should be advised much more specifically in guidelines and practice recommendations.
Collapse
Affiliation(s)
- Peter Rosier
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
12
|
Rosier PFWM, Kuo HC, De Gennaro M, Gammie A, Finazzi Agro E, Kakizaki H, Hashim H, Toozs-Hobson P. International Consultation on Incontinence 2016; Executive summary: Urodynamic testing. Neurourol Urodyn 2018; 38:545-552. [PMID: 30576004 DOI: 10.1002/nau.23903] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/01/2018] [Indexed: 11/10/2022]
Abstract
AIMS The International Consultation on Incontinence has published an update of the recommendations for the diagnosis and management of urine incontinence (ICI2016). This manuscript summarizes the consultations committee-recommendations with regard to urodynamic assessment. METHODS Expert consensus on the basis of structured evidence assessment has been the basis of the consultations publication and has been summarized by the committee for this manuscript. RESULTS Patients that are not satisfied with their initial management on the basis of their reported signs and symptoms of urinary incontinence, as well as all patients with neurological abnormalities that are potentially relevant for the function of the lower urinary tract, may very likely profit from objective diagnosis and staging and grading of their dysfunction, with urodynamic testing, regardless their age, vulnerability and/or comorbidities. The principles and technical innovations as well as the principal recommendations for the utilization of (invasive) urodynamic assessment for women, men, children, and vulnerable elderly, with or without neurogenic lower urinary tract dysfunction with urinary incontinence are provided in this abbreviated ICI recommendations-document. CONCLUSIONS The ICI2016 committee on urodynamics presents an executive summary of the most important reasons and recommendations for the use of urodynamic investigations for patients with urinary incontinence.
Collapse
Affiliation(s)
- Peter F W M Rosier
- Department of Urology, University Medical Center, Utrecht, The Netherlands
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Mario De Gennaro
- Department of Nephrology-Urology Pediatric Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Andrew Gammie
- Bristol Urological Institute, Bristol, United Kingdom
| | | | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Japan
| | - Hashim Hashim
- Bristol Urological Institute, Bristol, United Kingdom
| | - Philip Toozs-Hobson
- Department of Gynaecology and Pelvic Floor Medicine, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
13
|
Guralnick ML, Fritel X, Tarcan T, Espuna-Pons M, Rosier PFWM. ICS Educational Module: Cough stress test in the evaluation of female urinary incontinence: Introducing the ICS-Uniform Cough Stress Test. Neurourol Urodyn 2018; 37:1849-1855. [DOI: 10.1002/nau.23519] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 01/06/2023]
Affiliation(s)
| | - Xavier Fritel
- Faculté de Médecine et Pharmacie; Université de Poitiers; Poitiers France
| | - Tufan Tarcan
- Marmara University School of Medicine; Istanbul Turkey
| | | | | |
Collapse
|
14
|
Cardozo L, Shakir F, Araklitis G, Rantell A, Robinson D. Narrated video demonstrating the procedure of videourodynamics. Neurourol Urodyn 2017; 37:1176-1177. [DOI: 10.1002/nau.23437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 09/25/2017] [Indexed: 11/06/2022]
|
15
|
Jiang YH, Kuo HC. Recent research on the role of urodynamic study in the diagnosis and treatment of male lower urinary tract symptoms and urinary incontinence. CI JI YI XUE ZA ZHI = TZU-CHI MEDICAL JOURNAL 2017; 29:72-78. [PMID: 28757770 PMCID: PMC5509199 DOI: 10.4103/tcmj.tcmj_19_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Although evidence shows that urodynamic study may not improve outcomes, it can be used to evaluate men with lower urinary tract symptoms (LUTSs) which have not been adequately delineated and treated. In young men with LUTS not responding to treatment based on clinical examination, or elderly men with LUTS and incontinence, a complete urodynamic evaluation is mandatory to understand the pathophysiology underlying LUTS, such as bladder outlet obstruction (BOO), detrusor overactivity, and detrusor underactivity. Preoperative urodynamic study-proven BOO is a predictor of a successful surgical outcome. An urodynamic study should be performed when patients with LUTS are planning to undergo surgical treatment for benign prostatic obstruction.
Collapse
Affiliation(s)
- Yuan-Hong Jiang
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
16
|
Yang Y, Yang J, Chen L, Hu J, Xing S, Amend B, Stenzl A, Wei X, Hu H. Minimal Invasive Cystometry and Intra-Abdominal Pressure Assessments in Rodents: A Novel Animal Study. Med Sci Monit 2017; 23:2500-2507. [PMID: 28538709 PMCID: PMC5450855 DOI: 10.12659/msm.904760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The abdominal straining pattern can act as a novel parameter for improving the prediction of bladder outlet obstruction (BOO). To preserve detrusor function in the early stage of urinary system impairment, such as BOO, we establish a novel method for cystometry and Intra-abdominal pressure (IAP) assessments in rodents without cystostomy. MATERIAL AND METHODS Twenty mice and rats were divided into three groups (control, sham-operated and BOO group) respectively. The cystometry and IAP assessments were measured by the pediatric venous indwelling sheath and coronary dilatation catheter connected to Laborie urodynamic system on postoperative day 7. Data was collected simultaneously through urethra and rectum in each group. In addition, bladder histology was assessed to confirm BOO. RESULTS The novel method can collect the urodynamic parameters successfully, including the BLPP, IAP, MBC, etc. IAP was elevated in BOO rats, but no significantly difference was found between the sham-operated rats and the control rats. The hypertrophy of detrusor muscle in bladder section was observed by Masson trichrome staining in BOO group compared with other groups. CONCLUSIONS Our novel method based on innovative research implement for cystometry and IAP assessments in rodents is a reliable and replicable approach for evaluating the lower urinary tract function. Especially it provides detailed information to evaluate lower urinary tract structures and function in the early stage of BOO.
Collapse
Affiliation(s)
- Yafei Yang
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China (mainland)
| | - Jin Yang
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China (mainland)
| | - Lin Chen
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China (mainland)
| | - Jianyun Hu
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China (mainland)
| | - Shasha Xing
- Central Laboratory, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China (mainland)
| | - Bastian Amend
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Arnulf Stenzl
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Xin Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Haifeng Hu
- Department of Urology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China (mainland)
| |
Collapse
|
17
|
D'Ancona CAL, Gomes MJ, Rosier PF. ICS teaching module: Cystometry (basic module). Neurourol Urodyn 2016; 36:1673-1676. [DOI: 10.1002/nau.23181] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 09/19/2016] [Indexed: 11/11/2022]
|
18
|
Nowakowski Ł, Futyma K, Ziętek A, Bogusiewicz M, Gałczyński K, Rechberger T. Use of free uroflowmetry vs pressure-flow studies in the diagnosis of overactive bladder syndrome in females. Eur J Obstet Gynecol Reprod Biol 2016; 207:137-140. [PMID: 27852010 DOI: 10.1016/j.ejogrb.2016.10.054] [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: 05/19/2016] [Revised: 08/09/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To determine if pressure-flow study (PFS) parameters, including flow index (FI) calculated by dividing average urethral flow by maximal urethral flow, increase the accuracy of urodynamic studies in the diagnosis of overactive bladder (OAB). STUDY DESIGN Retrospective study to evaluate the medical history and urodynamic examination results of female patients diagnosed with lower urinary tract symptoms (LUTS) between January 2014 and December 2015. Patients were stratified into four groups depending on the type of LUTS: OAB; stress urinary incontinence (SUI); mixed urinary incontinence with predominant SUI symptoms (MUI-SUI); and mixed urinary incontinence with predominant OAB symptoms (MUI-OAB). RESULTS OAB was diagnosed in 26 (15%) patients, SUI was diagnosed in 93 (52%) patients, MUI-OAB was diagnosed in 43 (24%) patients, and MUI-SUI was diagnosed in 17 (9%) patients. FI calculated using free uroflowmetry (FI-free) was significantly lower in the OAB group compared with the other groups (p<0.01). Analysis revealed no difference in FI-free between the SUI, MUI-SUI and MUI-OAB groups. Significant differences were found between the study groups for most free uroflowmetric parameters, including maximal urethral flow, average urethral flow and micturition volume (p<0.05). Similar differences were not found in PFS parameters. CONCLUSIONS The decrease in the urethral lumen due to the presence of a transurethral catheter in patients with OAB, in contrast to women with SUI and MUI, was not found to influence FI calculated using free uroflowmetry or PFS. FI may serve as an important objective diagnostic tool for OAB, but only when calculated from free uroflowmetry parameters when assessing patients with LUTS.
Collapse
Affiliation(s)
- Ł Nowakowski
- Second Department of Gynaecology, Medical University of Lublin, Lublin, Poland.
| | - K Futyma
- Second Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | - A Ziętek
- Second Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | - M Bogusiewicz
- Second Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | - K Gałczyński
- Second Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| | - T Rechberger
- Second Department of Gynaecology, Medical University of Lublin, Lublin, Poland
| |
Collapse
|
19
|
Frequent nocturia episodes, a suboptimal response to treatment, and small bladder capacity predict the need for persistent antimuscarinic therapy or re-treatment after discontinuation of antimuscarinics in female overactive bladder. Menopause 2016; 24:100-104. [PMID: 27648660 DOI: 10.1097/gme.0000000000000730] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to investigate predictive factors of the need for persistent antimuscarinic therapy or re-treatment (PR) after discontinuation of antimuscarinic therapy for women with overactive bladder syndrome (OAB). METHODS All consecutive OAB women were enrolled in a prospective cohort study, and treated with solifenacin for 12 weeks in a University Hospital. Factors affecting PR were analyzed by Cox regression analysis. RESULTS A total of 122 women were enrolled, and 107 women underwent 12-week solifenacin treatment. The dropout rate was 12.3%. The median follow-up period was 20.4 weeks (25-75 interquartile range: 16-102.3 wk). Twenty-seven (25%) women had PR. The median PR-free interval was 125.4 weeks (95% CI = 58.4 to - wk). Nocturia episodes (hazard ratio = 1.54), a suboptimal response (hazard ratio = 2.53), and the strong-desire volume (hazard ratio = 0.992) were independent predictors of PR by Cox backward stepwise regression analysis. The areas under the receiver-operating characteristic curves for nocturia episodes, a suboptimal response, and the strong-desire volume to predict PR were only 0.65, 0.63, and 0.59, respectively. In addition, normalized urinary nerve growth factor level was not significant (hazard ratio = 1.005, P = 0.68) for predicting PR. Furthermore, normalized urodynamic findings did not correlate with PR, a suboptimal response, or changes of Overactive Bladder Symptom Score and urinary nerve growth factor level. CONCLUSIONS Frequent nocturia episodes, a suboptimal response, and small bladder capacity may predict PR after solifenacin treatment. These findings may serve as an initial guide in consultation regarding the treatment of OAB.
Collapse
|
20
|
Urinary incontinence after high-dose-rate brachytherapy boost treatment for prostate cancer. Brachytherapy 2016; 15:442-449. [DOI: 10.1016/j.brachy.2016.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 03/22/2016] [Accepted: 03/23/2016] [Indexed: 12/14/2022]
|
21
|
Al-Zahrani AA, Gajewski J. Urodynamic findings in women with refractory overactive bladder symptoms. Int J Urol 2015; 23:75-9. [PMID: 26417863 DOI: 10.1111/iju.12954] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 08/30/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess: (i) the correlation between overactive bladder symptoms and urodynamic findings in female patients; and (ii) the association of urinary symptoms with the presence of detrusor overactivity and/or bladder outlet obstruction. METHODS The present retrospective study included female patients with overactive bladder symptoms who underwent urodynamic evaluation by a single physician. Patients with previous anti-incontinence surgery or neurogenic bladder were excluded. Spearman's correlation coefficients were calculated to correlate overactive bladder symptoms with the urodynamic findings. Univariate and multivariate logistic regression analyses were used to determine the independent factors for detrusor overactivity and bladder outlet obstruction. RESULTS Overall, 1737 reports were analyzed. All patients had urgency with or without urgency urinary incontinence. Urgency, urgency urinary incontinence and nocturia correlated with detrusor overactivity. The severity of frequency, nocturia and slow stream correlated with bladder outlet obstruction. In contrast, stress urinary incontinence showed an inverse, but weak, correlation with bladder outlet obstruction. Stress urinary incontinence correlated moderately with urine leak. Storage symptoms showed an inverse, but weak, correlation with maximum cystometric capacity. Multivariate analysis data showed that age, urgency, urgency urinary incontinence and nocturia were independent predictors of detrusor overactivity, whereas the severity of frequency was a predictor of bladder outlet obstruction. CONCLUSION As overactive bladder symptoms increase in severity, female patients tend to have a smaller bladder capacity and a higher incidence of detrusor overactivity. A significant number of these patients have bladder outlet obstruction.
Collapse
Affiliation(s)
- Ali A Al-Zahrani
- Department of Urology, College of Medicine, King Fahd Hospital, University of Dammam, Dammam, Saudi Arabia
| | - Jerzy Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
22
|
Mannella P, Giannini A, Russo E, Naldini G, Simoncini T. Personalizing pelvic floor reconstructive surgery in aging women. Maturitas 2015; 82:109-15. [DOI: 10.1016/j.maturitas.2015.06.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/14/2015] [Indexed: 10/23/2022]
|
23
|
Serati M, Topazio L, Bogani G, Costantini E, Pietropaolo A, Palleschi G, Carbone A, Soligo M, Del Popolo G, Li Marzi V, Salvatore S, Finazzi Agrò E. Urodynamics useless before surgery for female stress urinary incontinence: Are you sure? Results from a multicenter single nation database. Neurourol Urodyn 2015; 35:809-12. [PMID: 26061435 DOI: 10.1002/nau.22804] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/18/2015] [Indexed: 01/28/2023]
Abstract
AIMS The role of urodynamics (UDS) before surgery for stress urinary incontinence (SUI) remains a debated issue in female urology as well as in urogynaecology and it has been recently questioned on the basis of data coming from selected population of patients defined as "uncomplicated." The aim of this study was to investigate the percentage of "uncomplicated" patients undergoing urodynamic evaluations in six referral Italian centers. The secondary aim was to assess the prevalence of women, for whom the urodynamic evaluation could add new information to the pre-urodynamic picture and in how many cases these findings had a significant impact on patient management. METHODS The data of women who underwent urodynamic evaluation prior to surgery for stress urinary incontinence between 2008 and 2013 were retrospectively analyzed. According to the definition of the Value of Urodynamic Evaluation (ValUE) trial criteria, patients presenting with SUI were classified as "uncomplicated" or "complicated." Urodynamic observations were then compared with pre-urodynamic data. RESULTS Overall, 2,053 female patients were considered. Only 740/2,053 (36.0%) patients were defined "uncomplicated" according to the definition used in the ValUE trial. The urodynamic observations were not consistent with the pre-urodynamic diagnosis in 1,276 out of 2,053 patients (62.2%). Voiding dysfunctions were urodynamically diagnosed in 394 patients (19.2%). Planned surgery was cancelled or modified in 304 patients (19.2%), due to urodynamic findings. CONCLUSIONS "Uncomplicated" patients represent a minority among female SUI patients evaluated before surgery. In "complicated" patients, the role of urodynamic has not been challenged yet and UDS seems still mandatory. Neurourol. Urodynam. 35:809-812, 2016. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynaecology, University Insubria, Varese, Italia
| | - Luca Topazio
- School of Specialization in Urology, University Tor Vergata, Roma, Italia
| | - Giorgio Bogani
- Department of Obstetrics and Gynaecology, University Insubria, Varese, Italia
| | | | - Amelia Pietropaolo
- School of Specialization in Urology, University of Perugia, Perugia, Italia
| | | | - Antonio Carbone
- Department of Urology, University La Sapienza, Latina, Italia
| | - Marco Soligo
- Department of Obstetrics and Gynaecology, Buzzi Hospital, Milano, Italia
| | | | | | - Stefano Salvatore
- Department of Obstetrics and Gynaecology, University Vita e Salute, Milano, Italia
| | - Enrico Finazzi Agrò
- Department of Experimental Medicine and Surgery, University Tor Vergata, Roma, Italia
| |
Collapse
|
24
|
A pragmatic approach to the characterization and effective treatment of male patients with postprostatectomy incontinence. Curr Opin Urol 2015; 24:566-70. [PMID: 25203242 DOI: 10.1097/mou.0000000000000112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF REVIEW To highlight the recent developments in the past 12 months in the field of postprostatectomy incontinence. RECENT FINDINGS The evaluation of postprostatectomy incontinence is mainly based on clinical details and symptoms assessment. The situation in which urodynamics will change the management and influence clinical decision-making is still unknown. MRI may play a role in the future for postprostatectomy incontinence assessment. Artificial urinary sphincter is the most widely used treatment, and the literature is full of technical reports to improve the management of challenging cases and minimize the risk of complications. Advance male sling has been the subject of multiple reports that support its safety and efficacy. Many other innovative devices have been presented but not adequately tested. SUMMARY Evaluation of postprostatectomy incontinence is based on clinical data, involving symptoms assessment, quality of life, and incontinence severity. Endoscopy is requested, and urodynamic study indications are debated. The treatment is mainly focused on surgical options, of which artificial urinary sphincter and transobturator male slings are the two leaders. The field is critically lacking of comparative studies.
Collapse
|
25
|
Abstract
Urinary incontinence is a common condition, which, although not life-threatening, impairs the health-related quality of life of affected individuals. All women complaining of incontinence require a basic assessment and those with complex or refractory symptoms may benefit from urodynamic studies. Initial treatment includes lifestyle advice, behavioral modifications, bladder retraining and pelvic floor muscle training. For those women with persistent stress urinary incontinence following conservative therapy, surgical management might be considered. The development of the minimally invasive, retropubic, synthetic, mid-urethral sling procedures has revolutionized stress incontinence surgery and reduced the popularity of 'traditional' procedures, such as colposuspension and autologous fascial sling. In an attempt to reduce further the morbidity, transobturator and single-incision slings have been introduced. While antimuscarinic agents are the mainstay of the current medical management of urgency urinary incontinence, a recently developed selective β3-adrenergic receptor agonist (mirabegron) offers an alternative pharmacological option. Modalities such as intravesical botulinum toxin and neuromodulation (peripheral or sacral) are available to women with refractory urgency incontinence. Finally, when all other options have been explored and proven unsuccessful, inappropriate or not feasible, reconstructive surgery or catheter insertion might be considered as a last resort. The aim of this paper is to review conservative, medical and surgical management for urinary incontinence by using the best available evidence in the literature.
Collapse
Affiliation(s)
- I Giarenis
- Department of Urogynaecology, King's College Hospital NHS Foundation Trust , London , UK
| | | |
Collapse
|