1
|
Ng YY, Tan KY, Zhao Y, Seow-En I, Chok AY, Chuang J, Loy MS, Tan EK. Efficacy of Traditional Acupuncture Compared to Biofeedback Therapy in Fecal Incontinence: A Randomized Controlled Trial. Dis Colon Rectum 2024; 67:1313-1321. [PMID: 38954475 DOI: 10.1097/dcr.0000000000003357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
BACKGROUND Fecal incontinence has a devastating impact on quality of life and imposes a substantial socioeconomic burden. Best medical therapy, including biofeedback therapy, improves mild symptoms with minimal impact on moderate to severe symptoms. Surgical management for incontinence carries a degree of morbidity, resulting in low uptake and acceptability. Although acupuncture is common practice in Singapore for numerous medical conditions, its role in fecal incontinence is relatively novel. In our local context, however, acupuncture is accessible, inexpensive, and potentially well accepted as a treatment strategy. OBJECTIVE To determine the effectiveness of traditional Chinese medicine acupuncture, compared to biofeedback therapy, in the treatment of fecal incontinence. The secondary aim is to investigate the differences in quality of life after treatment. DESIGN Randomized controlled trial. SETTING Prospective, single-institution study. PATIENTS Patients with 2 or more episodes of fecal incontinence per week or St. Mark's incontinence score of 5 or higher were recruited. Patients were randomly assigned into biofeedback therapy, which included 3 sessions over 10 weeks, or 30 sessions of acupuncture over 10 weeks. MAIN OUTCOME MEASURES Incontinence episodes, St. Mark's score, and fecal incontinence quality-of-life scale. RESULTS Eighty-five patients were randomly assigned to biofeedback therapy (n = 46) or acupuncture (n = 39). Demographics and baseline clinical characteristics were not different ( p > 0.05). Overall median incontinence episodes were reduced in both, with the acupuncture arm reporting significantly fewer episodes at week 15 ( p < 0.001). Acupuncture also improved quality of life, with improvement in lifestyle, coping, depression, and embarrassment at week 15 ( p < 0.05). Although the St. Mark's score was significantly reduced in both arms at week 15 ( p < 0.001), the acupuncture arm's score was significantly lower ( p = 0.002). LIMITATIONS Longer follow-up is required. CONCLUSIONS Acupuncture is clinically effective and improves the quality of life in patients with fecal incontinence. See Video Abstract . CLINICAL TRIAL REGISTRATION Clinicaltrials.gov : NCT04276350. EFICACIA DE LA ACUPUNTURA TRADICIONAL COMPARADA CON LA TERAPIA DE BIORRETROALIMENTACIN EN LA INCONTINENCIA FECAL UN ENSAYO CONTROLADO ALEATORIO ANTECEDENTES:La incontinencia fecal tiene un impacto devastador en la calidad de vida e impone una carga socioeconómica sustancial. La mejor terapia médica, incluida la terapia de biorretroalimentación, mejora los síntomas leves, con un impacto mínimo sobre los síntomas moderados a graves. El tratamiento quirúrgico de la incontinencia conlleva un grado de morbilidad que resulta en una baja aceptación y aceptabilidad. Si bien la acupuntura es una práctica común en Singapur para numerosas afecciones médicas, su papel en la incontinencia fecal es relativamente novedoso. Sin embargo, en nuestro contexto local, la acupuntura es accesible, económica y potencialmente bien aceptada como estrategia de tratamiento.OBJETIVO:Determinar la efectividad de la acupuntura de la Medicina Tradicional China, en comparación con la terapia de biorretroalimentación en el tratamiento de la incontinencia fecal. El objetivo secundario es investigar las diferencias en la calidad de vida después del tratamiento.DISEÑO:Ensayo controlado aleatorio.AJUSTE:Estudio prospectivo de una sola institución.PACIENTES:Se reclutaron pacientes con >2 episodios de incontinencia fecal/semana o una puntuación de incontinencia de St. Mark's >5. Los pacientes fueron asignados aleatoriamente a una terapia de biorretroalimentación que incluyó 3 sesiones durante 10 semanas o 30 sesiones de acupuntura durante 10 semanas.PRINCIPALES MEDIDAS DE RESULTADO:Episodios de incontinencia, puntuación de St. Mark's y escala de calidad de vida de incontinencia fecal.RESULTADOS:Ochenta y cinco pacientes fueron asignados aleatoriamente a terapia de biorretroalimentación (n = 46) o acupuntura (n = 39). Las características demográficas y clínicas iniciales no fueron diferentes ( p > 0,05). La mediana general de episodios de incontinencia se redujo en ambos, y el grupo de acupuntura informó significativamente menos en la semana 15 ( p <0,001). La acupuntura también mejoró la calidad de vida, con mejoras en el estilo de vida, el afrontamiento, la depresión y la vergüenza en la semana 15 ( p <0,05). Mientras que la puntuación de St Mark se redujo significativamente en ambos brazos en la semana 15 ( p < 0,001), la puntuación del brazo de acupuntura fue significativamente menor (p = 0,002).LIMITACIONES:Se requiere un seguimiento más prolongado.CONCLUSIONES:La acupuntura es clínicamente efectiva y mejora la calidad de vida en pacientes con incontinencia fecal. (Traducción-Dr Yolanda Colorado ).
Collapse
Affiliation(s)
- Yvonne Y Ng
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Koon Yaw Tan
- Singapore College of Traditional Chinese Medicine, Singapore
| | - Yun Zhao
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Isaac Seow-En
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Aik Yong Chok
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Julia Chuang
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Megan S Loy
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Emile K Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| |
Collapse
|
2
|
Werneburg GT, Hettel D, Adler A, Mukherjee SD, Goldman HB, Rackley RR, Zillioux J, Martin SE, Gill BC, Shoskes DA, Miller AW, Vasavada SP. Sacral neuromodulation device biofilm differs in the absence and presence of infection, harbors antibiotic resistance genes, and is reproducible in vitro. Neurourol Urodyn 2024; 43:1479-1490. [PMID: 38808686 DOI: 10.1002/nau.25511] [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: 03/11/2024] [Revised: 04/07/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION/PURPOSE Sacral neuromodulation (SNM) is effective therapy for overactive bladder refractory to oral therapies, and non-obstructive urinary retention. A subset of SNM devices is associated with infection requiring surgical removal. We sought to compare microbial compositions of explanted devices in the presence and absence of infection, by testing phase, and other clinical factors, and to investigate antibiotic resistance genes present in the biofilms. We analyzed resistance genes to antibiotics used in commercially-available anti-infective device coating/pouch formulations. We further sought to assess biofilm reconstitution by material type and microbial strain in vitro using a continuous-flow stir tank bioreactor, which mimics human tissue with an indwelling device. We hypothesized that SNM device biofilms would differ in composition by infection status, and genes encoding resistance to rifampin and minocycline would be frequently detected. MATERIALS/METHODS Patients scheduled to undergo removal or revision of SNM devices were consented per IRB-approved protocol (IRB 20-415). Devices were swabbed intraoperatively upon exposure, with controls and precautions to reduce contamination of the surrounding field. Samples and controls were analyzed with next-generation sequencing and RT-PCR, metabolomics, and culture-based approaches. Associations between microbial diversity or microbial abundance, and clinical variables were then analyzed using t-tests and ANOVA. Reconstituted biofilm deposition in vitro using the bioreactor was compared by microbial strain and material type using plate-based assays and scanning electron microscopy. RESULTS Thirty seven devices were analyzed, all of which harbored detectable microbiota. Proteobacteria, Firmicutes and Actinobacteriota were the most common phyla present overall. Beta-diversity differed in the presence versus absence of infection (p = 0.014). Total abundance, based on normalized microbial counts, differed by testing phase (p < 0.001), indication for placement (p = 0.02), diabetes mellitus (p < 0.001), cardiac disease (p = 0.008) and history of UTI (p = 0.008). Significant microbe-metabolite interaction networks were identified overall and in the absence of infection. 24% of biofilms harbored the tetA tetracycline/minocycline resistance gene and 53% harbored the rpoB rifampin resistance gene. Biofilm was reconstituted across tested strains and material types. Ceramic and titanium did not differ in biofilm deposition for any tested strain. CONCLUSIONS All analyzed SNM devices harbored microbiota. Device biofilm composition differed in the presence and absence of infection and by testing phase. Antibiotic resistance genes including to rifampin and tetracycline/minocycline, which are used in commercially-available anti-infective pouches, were frequently detected. Isolated organisms from SNM devices demonstrated the ability to reconstitute biofilm formation in vitro. Biofilm deposition was similar between ceramic and titanium, materials used in commercially-available SNM device casings. The findings and techniques used in this study together provide the basis for the investigation of the next generation of device materials and coatings, which may employ novel alternatives to traditional antibiotics. Such alternatives might include bacterial competition, quorum-sensing modulation, or antiseptic application, which could reduce infection risk without significantly selecting for antibiotic resistance.
Collapse
Affiliation(s)
- Glenn T Werneburg
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Daniel Hettel
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Ava Adler
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sromona D Mukherjee
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Howard B Goldman
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Raymond R Rackley
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jacqueline Zillioux
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sarah E Martin
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Bradley C Gill
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Daniel A Shoskes
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Aaron W Miller
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sandip P Vasavada
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| |
Collapse
|
3
|
Cao G, Zhang X, Wang F, Man D, Wu L, Pan X, Chen S. Biofeedback combined with percutaneous electrical pudendal nerve stimulation for the treatment of low anterior rectal resection syndrome: a study protocol for a randomized controlled trial. Trials 2024; 25:440. [PMID: 38956630 PMCID: PMC11221096 DOI: 10.1186/s13063-024-08300-9] [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: 03/01/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Low anterior resection syndrome (LARS) is a distressing condition that affects approximately 25-80% of patients following surgery for rectal cancer. LARS is characterized by debilitating bowel dysfunction symptoms, including fecal incontinence, urgent bowel movements, and increased frequency of bowel movements. Although biofeedback therapy has demonstrated effectiveness in improving postoperative rectal control, the research results have not fulfilled expectations. Recent research has highlighted that stimulating the pudendal perineal nerves has a superior impact on enhancing pelvic floor muscle function than biofeedback alone. Hence, this study aims to evaluate the efficacy of a combined approach integrating biofeedback with percutaneous electrical pudendal nerve stimulation (B-PEPNS) in patients with LARS through a randomized controlled trial (RCT). METHODS AND ANALYSIS In this two-armed multicenter RCT, 242 participants with LARS after rectal surgery will be randomly assigned to undergo B-PEPNS (intervention group) or biofeedback (control group). Over 4 weeks, each participant will undergo 20 treatment sessions. The primary outcome will be the LARS score. The secondary outcomes will be anorectal manometry and pelvic floor muscle electromyography findings and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Colorectal 29 (EORTC QLQ-CR29) scores. Data will be collected at baseline, post-intervention (1 month), and follow-up (6 months). DISCUSSION We anticipate that this study will contribute further evidence regarding the efficacy of B-PEPNS in alleviating LARS symptoms and enhancing the quality of life for patients following rectal cancer surgery. TRIAL REGISTRATION Chinese Clincal Trials Register ChiCTR2300078101. Registered 28 November 2023.
Collapse
Affiliation(s)
- Gaoyang Cao
- Department of Colorectal surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000, Zhejiang, China
| | - Xinjie Zhang
- Department of Colorectal surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000, Zhejiang, China
| | - Fei Wang
- Department of Colorectal surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000, Zhejiang, China
| | - Da Man
- Department of Colorectal surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, 310000, Zhejiang, China
| | - Lijie Wu
- Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, 310000, Zhejiang, China
| | - Xuchu Pan
- Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, 310000, Zhejiang, China
| | - Shan Chen
- Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, 310000, Zhejiang, China.
| |
Collapse
|
4
|
Wynn J, Kelsey E, McLeod K. Treatment of the infected sacral nerve stimulator: A scoping review. Neurourol Urodyn 2024; 43:579-594. [PMID: 38318878 DOI: 10.1002/nau.25411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/13/2024] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Sacral nerve stimulators (SNSs) are a widely accepted, efficacious surgical option to treat patients who have failed conservative management for overactive bladder, nonobstructive urinary retention, fecal incontinence, or pelvic pain. As with all implanted devices, there are associated risks for surgical site and implant infections. There are currently no clear published data or guidelines regarding treating such infections. AIMS We present a scoping review aiming to examine the existing literature on the treatment approaches of infected SNSs. METHODS A scoping review was conducted using Preferred Reporting Items for Systematic Review and Meta-Analysis. The search strategy focused on "sacral modulation," and "infection," and "explantation," and conservative management methods such as "antibiotics." A search was conducted on medical databases, and a grey literature search was performed. RESULTS Thirty articles were included for data extraction. Articles were published between 2006 and 2022. Outcomes were reported for 7446 patients. Two hundred and seventy-four infection events were reported, giving an overall 3.7% infection rate. Most infection events were treated with explantation, although there is some discussion on the role of conservative management using oral and intravenous antibiotics in the literature. Articles also discussed considerations for future reimplantation after explantation of SNS. CONCLUSIONS There are currently no treatment protocols in the literature to help guide whether a patient is suited to conservative or surgical management. There is future scope for developing treatment algorithms to guide clinicians for optimal treatment of infected sacral neuromodulation devices.
Collapse
Affiliation(s)
- Jessica Wynn
- Department of Urology, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Ellen Kelsey
- Department of Urology, University Hospital Geelong, Barwon Health, Geelong, Australia
| | - Kathryn McLeod
- Department of Urology, University Hospital Geelong, Barwon Health, Geelong, Australia
- Faculty of Health, Deakin University School of Medicine, Geelong, Australia
| |
Collapse
|
5
|
Agnello M, Brugnano S, Vottero M, Bertapelle P. Infection Rate of a Prolonged Sacral Neuromodulation Test: A Large Retrospective Study. Neuromodulation 2023; 26:1845-1850. [PMID: 36202715 DOI: 10.1016/j.neurom.2022.08.453] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/01/2022] [Accepted: 08/22/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES It is estimated that 3.8% to 12.5% of patients develop a device infection during the two to four weeks of the sacral neuromodulation (SNM) test, leading to removal of the entire system. It is possible to prolong the test phase up to the clinician's decision, particularly when benefits are unclear. The aim of our study is to assess the device infection rate in a prolonged SNM test. MATERIALS AND METHODS We retrospectively enrolled patients who performed a prolonged SNM test (at least eight weeks) in the last five years (2017-2021). All procedures were performed using a standardized technique and the same prophylactic antibiotic protocol. In case of a clinical suspicion of infection, all components were explanted. Patient information (age at implantation, medical history of diabetes, metabolic syndrome, immunologic diseases, or chronic immunosuppressive therapy), surgical data (operative time, intraoperative complications), and infection data (timing of onset, symptoms reported, wound culture results) were recorded. RESULTS We enrolled 232 patients who underwent a prolonged SNM test (mean duration 65.5 days). A local infection that led to the removal of the entire system occurred in six patients (2.6%). The gluteal pocket was always involved, and in two cases, infection was also extended to the exit point of the extension wire. No significant correlations with clinical data were found. Infection occurred beyond four weeks in two cases, between three and four weeks in three cases, and within two weeks in one case. Intraoperative wound culture was performed in five of six patients, and Staphylococcus aureus (S aureus) was isolated in four cases. One culture test gave negative bacterial growth results. CONCLUSIONS The infection rate of a prolonged eight-week SNM test is low and does not differ from that reported in the literature for a two-to-four-week SNM test. S aureus remains the most frequent bacterium involved.
Collapse
Affiliation(s)
- Marco Agnello
- University of Studies of Turin, School of Medicine, Department of Surgical Sciences, Neuro-Urology, AOU City of Health and Science of Turin, Turin, Italy.
| | - Salvatore Brugnano
- University of Studies of Turin, School of Medicine, Department of Surgical Sciences, Neuro-Urology, AOU City of Health and Science of Turin, Turin, Italy
| | - Mario Vottero
- Neuro-Urology, AOU City of Health and Science of Turin, Turin, Italy
| | - Paola Bertapelle
- Neuro-Urology, AOU City of Health and Science of Turin, Turin, Italy
| |
Collapse
|
6
|
Trump T, Mitchell K, Werner Z, Duenas-Garcia O, Shapiro R, Zaslau S. Assessing the effectiveness of antimicrobial pouch use for infection prevention in sacral neuromodulation. Int Urogynecol J 2023; 34:2513-2517. [PMID: 37222739 DOI: 10.1007/s00192-023-05570-w] [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: 02/14/2023] [Accepted: 04/22/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Sacral neuromodulation (SNM) is a commonly performed procedure for various conditions. Infection rates range as high as 10% and often require operative explantation with resultant increased cost and morbidity. Pouches impregnated with antibiotic have been utilized in cardiovascular procedures with decreasing infectious complications. TYRX is an antibiotic pouch utilizing minocycline and rifampin manufactured by Medtronic. The objective of this study is to investigate the utility of antimicrobial pouches for patients undergoing SNM. METHODS We retrospectively analyzed our patients undergoing SNM using an antimicrobial pouch and compared them with a historic cohort. Additional variables of interest included post-operative infection, diagnosis of diabetes, weight, and revision case or virgin implant. RESULTS A total of 170 cases were identified, ranging from March 2017 to November 2022. Overall infection rate was 2.9% with 0 in the antimicrobial pouch cohort (0%) versus 5 in the historic cohort (5.5%; p = 0.04). Groups were similar in terms of body habitus. The group receiving an antimicrobial pouch was noted to be older with a higher percentage of female patients. 85 patients received an antimicrobial pouch and 85 did not. Of the infections, 4 occurred in revision cases (6.9%) and 1 in a virgin implant (0.9%; p = 0.03). No difference was noted in infection rate with regard to a diagnosis of diabetes or body habitus. CONCLUSION The use of antimicrobial pouches in SNM is associated with a decreased rate of infectious complications. Revision cases displayed a higher rate of infectious complications.
Collapse
Affiliation(s)
- Tyler Trump
- Department of Urology, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA.
| | - Katharina Mitchell
- Department of Urology, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Zachary Werner
- Department of Urology, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA
| | - Omar Duenas-Garcia
- Department of Obstetrics and Gynecology, West Virginia University, Morgantown, WV, USA
| | - Robert Shapiro
- Department of Obstetrics and Gynecology, West Virginia University, Morgantown, WV, USA
| | - Stanley Zaslau
- Department of Urology, West Virginia University, 1 Medical Center Drive, Morgantown, WV, 26506, USA
| |
Collapse
|
7
|
Goudelocke C, Hill H, Major N, Couvaras A, Long A. A novel sacral neuromodulation protocol is associated with reduction in removal for device infection. Int Urogynecol J 2023; 34:2421-2428. [PMID: 37154899 DOI: 10.1007/s00192-023-05543-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/26/2023] [Indexed: 05/10/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Sacral neuromodulation (SNM) has been established as an effective third-line therapy for non-obstructive urinary retention and urinary urgency-frequency syndrome. Device infection, ranging from 2-10%, is a severe complication usually necessitating device explanation. This study sought to demonstrate an infection protocol founded upon established device implantation risk factors and novel approaches to reduce the incidence of device infection, while maintaining good antibiotic stewardship following best practice statements. METHODS A single-surgeon protocol was enacted from 2013 to 2022. Preoperatively, nasal swabs were cultured from each patient. If positive for methicillin-resistant Staphylococcus aureus or methicillin-sensitive Staphylococcus aureus, preoperative treatment with intranasal mupirocin was employed. Preoperative cefazolin was administered in patients with negative cultures or MSSA-positive. All protocol patients were given chlorhexidine wipes before surgery and prepped with a chlorhexidine scrub followed by alcohol/iodine paint. Post-procedural antibiotics were not given. Pre-protocol patients from 2011 to 2013 served as controls. RESULTS Pre-protocol (n = 87) patients had a significantly higher rate of device infection compared to protocol patients (n = 444) in both the percentage of patients experiencing device infection (4.6% vs 0.9%, p = 0.01) and percentage of procedures associated with device infection (2.9% vs 0.5%, p < 0.05). A successful culture of the nares was achieved in 91.4% of protocol patients, with 11.6% MRSA-positive. Risk ratio for infection of pre-protocol/protocol patients was 0.19 (0.05-0.77) with odds ratio 5.1 (1.3-20.0). CONCLUSIONS Utilization of a novel SNM infection protocol tailored to a patient's preoperative MRSA colonization is associated with a reduction in the overall incidence of explant for device infection while avoiding prolonged postoperative antibiotic regimens. CLINICAL TRIAL REGISTRATION The study was initiated prior to January 18, 2017 and does not meet the definition of an applicable clinical trial (ACT) as defined in section 402 (J) of the US PHS Act.
Collapse
Affiliation(s)
- Colin Goudelocke
- Department of Urology, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA.
| | - Hayden Hill
- Department of Urology, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA
| | - Nicholas Major
- Department of Urology, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA
| | - Anastasia Couvaras
- Department of Urology, Ochsner Medical Center, 1514 Jefferson Hwy, New Orleans, LA, 70121, USA
| | - Amy Long
- Department of Urology, Erlanger Health Center, Chattanooga, TN, USA
| |
Collapse
|
8
|
Hu JC, Hsu LN, Lee WC, Chuang YC, Wang HJ. Role of Urological Botulinum Toxin-A Injection for Overactive Bladder and Voiding Dysfunction in Patients with Parkinson's Disease or Post-Stroke. Toxins (Basel) 2023; 15:166. [PMID: 36828479 PMCID: PMC9965145 DOI: 10.3390/toxins15020166] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/01/2023] [Accepted: 02/11/2023] [Indexed: 02/22/2023] Open
Abstract
Botulinum toxin A (BoNT-A) paralyzes muscle by blocking acetylcholine release at the synaptic junction. BoNT-A has shown its therapeutic effects in neurological disorders such as Parkinson's disease (PD) and post-stroke spasticity. A high proportion of patients with PD and post-stroke develop neurogenic detrusor overactivity (nDO) and then develop urinary incontinence and overactive bladder (OAB) symptoms. This study aimed to disclose the safety and efficacy of BoNT-A injection in treating bladder and voiding dysfunction in PD and post-stroke patients by reviewing the current evidence. At present, intradetrusor injection of BoNT-A is a Food and Drug Administration (FDA)-approved third-line therapy for nDO and idiopathic OAB. Although intradetrusor injection of onaBoNT-A 200 U is already approved for nDO treatment, most researchers would like to manage PD and post-stroke patients by using onaBoNT-A 100 U intradetrusor injection to achieve long-term efficacy and reduce adverse effects. However, in contrast to its inclusion in the International Continence Society guidelines for PD treatment, the clinical use of BoNT-A for post-stroke patients is limited to experimental use due to the development of urinary retention in about one-fifth of patients. For treating urethral pseudodyssynergia, half of patients may respond to onaBoNT-A 100 U urethral injection. However, refinement is needed to reduce unwanted urinary incontinence.
Collapse
Affiliation(s)
- Ju-Chuan Hu
- Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Lin-Nei Hsu
- Department of Urology, An Nan Hospital, China Medical University, Tainan City 833, Taiwan
| | - Wei-Chia Lee
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 807, Taiwan
| | - Yao-Chi Chuang
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 807, Taiwan
- Center for Shock Wave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 807, Taiwan
| | - Hung-Jen Wang
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 807, Taiwan
- Center for Shock Wave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 807, Taiwan
| |
Collapse
|
9
|
Abstract
INTRODUCTION Sacral neuromodulation (SNM) aims to improve anorectal function in patients with disorders of anal continence and rectal emptying. The mechanism of action of SNM is not well known, and its indications are still under evaluation. We report the functional results and morbidity of a prospective cohort treated between 2002 and 2019. RESULTS A total of 284 patients (of 423 tested) had implantation of a SNM. Five patients (1.8%) were lost to follow-up. Among those who had implantation, the indications for SNM were anal incontinence (n=376), refractory constipation (n=17), anterior resection syndrome (n=13), solitary rectal ulcer syndrome (n=7), and chronic inflammatory bowel disease (IBD) (n=10). The morbidity rate was 2.7% (Dindo-Clavien>2), 33 patients (11%) required explantation for infection (n=5), pain (n=2), inefficacy (n=24) or other reasons (rectal cancer) (n=3). It was necessary to change the stimulator in 68 patients (24%) during the follow-up period. Regarding the group of patients with anal incontinence, functional results showed improvement of the incontinence score in 40% and of quality of life in 25% after a mean follow-up of 55months. CONCLUSION SNM constitutes a mini-invasive treatment associated with low morbidity. Its' efficacy in anal incontinence makes it a priority approach. Other indications are still under evaluation; while results are promising, they are highly variable.
Collapse
|
10
|
Chen S, Wang S, Gao Y, Lu X, Yan J, Xuan L, Wang S. Bilateral electrical pudendal nerve stimulation as additional therapy for lower urinary tract dysfunction when stage II sacral neuromodulator fails: a case report. BMC Urol 2021; 21:37. [PMID: 33691669 PMCID: PMC7945661 DOI: 10.1186/s12894-021-00808-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 03/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background Sacral neuromodulation (SNM) has become an effective therapy for patients with lower urinary tract dysfunction (LUTD) who do not respond to conservative treatment. However, an effective treatment strategy for patients who fail SNM has not yet been identified. An option for LUTD is needed when the clinical response to the SNM diminishes. Case presentation A 51-year-old Chinese man presented to an outpatient clinic complaining of difficulty in urination for > 3 years. The patient also complained of urinary frequency and urgency, accompanied by perineal discomfort. He was diagnosed with LUTD based on his symptoms and previous examinations. The patient underwent sacral neuromodulation with a permanent implantable pulse generator (IPG) (provided free of charge by Chengnuo Medical Technology Co., Ltd.; General Stim, Hangzhou, China) in the left buttock, as he participated in the company’s clinical trial to test the long-term effects of IPG. He reported loss of efficacy of the device 3 months after the implantation. We performed bilateral electrical pudendal nerve stimulation (EPNS) therapy for him. After 2 weeks of treatment, he began to report smooth voiding within 2 h after EPNS, and a moderate improvement in urinary frequency, urgency, and perineal discomfort. After 4 weeks of EPNS, the patient reported > 50% improvement in his urination, evaluated with the short form of the International Consultation on Incontinence Questionnaire for Male Lower Urinary Tract Symptoms. He reported smooth voiding, moderate improvements in urinary frequency and urgency, and the disappearance of the perineal discomfort. He also reported improved sleep and erections. The patient was discharged after 8 weeks of EPNS treatment. Conclusion EPNS could be an option as an additional therapy for patients with LUTD who have failed SNM. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-021-00808-5.
Collapse
Affiliation(s)
- Shan Chen
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Siyou Wang
- Clinical Research Section, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Yunqiu Gao
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou, 310006, Zhejiang Province, China
| | - Xiaolian Lu
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiasheng Yan
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou, 310006, Zhejiang Province, China
| | - Lihua Xuan
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Shenhong Wang
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medical University, No. 54 Youdian Road, Hangzhou, 310006, Zhejiang Province, China.
| |
Collapse
|
11
|
Chen S, Wang S, Xuan L, Xu F, Lu H, Lu J. Sacral electroacupuncture as a treatment for urge urinary incontinence: a prospective case series. Acupunct Med 2020; 39:522-528. [PMID: 33334120 DOI: 10.1177/0964528420968846] [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: 11/16/2022]
Abstract
OBJECTIVE To examine the impact of electroacupuncture (EA) at the 'four sacral points' on urge urinary incontinence (UUI). METHODS Twenty-five patients diagnosed with UUI or urgency-predominant mixed urinary incontinence (MUI) were treated by EA at the 'four sacral points'. EA was performed in the sacrococcygeal region using disposable sterile 0.40-mm-diameter acupuncture needles that were either 100 or 125 mm in length. Treatments were delivered once every other day. Before and after treatment, a questionnaire measuring symptom severity and quality of life associated with UUI was administered. RESULTS The median total score (interquartile range) from the severity of symptoms and the quality of life questionnaire (Q-score) of the participants was significantly reduced from 12 (7.5, 15) before treatment to 3 (0, 6) after 6 (6, 12) EA treatments. The Q-score of urgency-predominant MUI and UUI was 8 (5, 14.5) and 12.5 (11, 15), respectively, before treatment; after treatment these were reduced to 2 (0, 7.5) and 4.5 (2, 6), respectively. There was no statistically significant difference in the Q-score between urgency-predominant MUI and UUI before and after treatment. Upon treatment completion, seven patients (28%) were 'cured' (improvement rate 100%). Treatments were considered 'markedly effective' (improvement rate 75% to <100%) in four patients (16%), 'effective' (improvement rate 50% to <75%) in eight patients (32%), 'minimally effective' (improvement rate 25% to <50%) in three patients (12%), and 'ineffective' (improvement rate <25%) in three patients (12%). The overall success rate (comprising 'cured', 'markedly effective' and 'effective' categories) was 76%, and no adverse effects associated with acupuncture treatment were reported. CONCLUSION EA at the 'four sacral points' was associated with statistically significant improvements in UUI.
Collapse
Affiliation(s)
- Shan Chen
- Department of Acupuncture and Moxibustion, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Siyou Wang
- Clinical Research Section, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Lihua Xuan
- Department of Acupuncture and Moxibustion, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Fu Xu
- Department of Acupuncture and Moxibustion, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hanti Lu
- Clinical Evaluation and Analysis Centre, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Jing Lu
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Nanjing Medical University, Hangzhou, China
| |
Collapse
|
12
|
Broken Sacral Neuromodulation Lead Migration Into the Sigmoid Colon: A Case Report. Female Pelvic Med Reconstr Surg 2019; 24:e49-e50. [PMID: 29979356 DOI: 10.1097/spv.0000000000000601] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sacral neuromodulation is an effective treatment of urinary incontinence, fecal incontinence, and idiopathic urinary retention. The procedure is considered low risk with overall low complication rates. This report describes a 40-year-old woman who underwent sacral neuromodulation explant and full-system implant for weaning efficacy of her device. During device removal, the tined lead broke and was left in situ. Four months later, she was diagnosed as having a wound infection at the site of the retained lead. Imaging revealed lead fragment migration into the sigmoid colon. A colocutaneous fistula was noted soon thereafter. The retained lead was removed during a colonoscopy and the fistula healed. A retained lead can result in migration through the peritoneum and into the colon. This can be managed with assistance from colorectal or gastroenterology consultants.
Collapse
|
13
|
Kirss J, Pinta T, Varpe P, Rautio T, Kairaluoma M, Hyöty M, Hurme S, Böckelman C, Kairaluoma V, Salmenkylä S, Victorzon M. Outcomes of treatment of faecal incontinence with sacral nerve stimulation - a Finnish multicentre study. Colorectal Dis 2019; 21:59-65. [PMID: 30192431 DOI: 10.1111/codi.14406] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/23/2018] [Indexed: 02/08/2023]
Abstract
AIM The aim of this multicentre study is to report the results of sacral nerve stimulation (SNS) treatment for faecal incontinence (FI) in Finland and determine factors that could influence SNS treatment outcomes. METHOD This is a national multicentre study, involving all patients tested for SNS implantation in Finland from 1999 to 2017. Data were collected retrospectively from electronic patient archives and analysed for possible effects on treatment outcome. RESULTS Of the 432 patients with FI tested for SNS, 365 were women. Three hundred and thirteen (72.5%) of the tested patients advanced to permanent implantation of a stimulator. A successful final treatment outcome, with subjective alleviation of FI, was reported by 59.3% of the patients at the end of follow-up (mean 2.4 years, range 8 days to 13.3 years). Patients with obstetric sphincter injury and idiopathic FI had more permanent stimulator implantations than patients with iatrogenic injury (P = 0.012). Male patients had significantly worse test phase outcomes than female patients (P < 0.001). Age did not influence treatment outcome (P = 0.446) CONCLUSION: Subjective final success of SNS treatment for FI was achieved in 59.3% of patients at a mean of 2.4 years. Gender and the aetiology of FI influenced the test phase and final treatment outcome of SNS treatment.
Collapse
Affiliation(s)
- J Kirss
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland.,University of Turku, Turku, Finland
| | - T Pinta
- Department of Surgery, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - P Varpe
- Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
| | - T Rautio
- Oulu University Hospital, Oulu, Finland
| | - M Kairaluoma
- Central Finland Central Hospital, Jyväskylä, Finland
| | - M Hyöty
- Tampere University Hospital, Tampere, Finland
| | - S Hurme
- University of Turku, Turku, Finland.,Department of Biostatistics, University of Turku, Turku, Finland
| | - C Böckelman
- Helsinki University Hospital, Helsinki, Finland
| | | | | | - M Victorzon
- University of Turku, Turku, Finland.,Department of Surgery, Vaasa Central Hospital, Vaasa, Finland
| |
Collapse
|
14
|
Chen S, Wang S, Xuan L, Lu H, Hu Z, Zhang C, Zhang H. Comparison of efficacy and safety between electroacupuncture at 'four sacral points' and conventional electroacupuncture for the treatment of urinary incontinence after stroke: study protocol for a randomised controlled trial. BMJ Open 2018; 8:e021783. [PMID: 30397007 PMCID: PMC6231555 DOI: 10.1136/bmjopen-2018-021783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Electroacupuncture at 'four sacral points', also known as electrical pudendal nerve stimulation therapy, combines the advantages of pudendal nerve neuromodulation and the technique of deep insertion of long acupuncture needles. It has been used to treat stress urinary incontinence, female urgency-frequency syndrome, idiopathic urgency urinary incontinence and neurological bladders in previous studies. Here, we describe the protocol for a randomised controlled trial for evaluation of the efficacy and safety of electroacupuncture at 'four sacral points' for the management of urinary incontinence after stroke. METHODS AND ANALYSIS This is an open-label randomised controlled trial with blinded assessments and analyses. A total of 140 eligible patients will be randomly allocated to two groups. The treatment group (n=70) will receive electroacupuncture at 'four sacral points' along with routine medical care, while the control group will receive conventional electroacupuncture along with routine medical care. Twenty treatment sessions will occur over a period of 4 weeks. The primary outcome measures will be the self-recorded findings in an incontinent episode diary at baseline and at 4 weeks after baseline. The secondary outcome measures will be the International Consultation on Incontinence Questionnaire Urinary Incontinence-Short Form (ICIQ-UI SF) score and the Barthel Activities of Daily Living Index (Barthel ADL Index) score at baseline and at 4 and 28 weeks after baseline. ETHICS AND DISSEMINATION This protocol has been approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang Chinese Medical University (approval No. 2018-K-059-01). Written informed consent will be obtained from each participant. The results of the study will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR-IOR-17012847; Pre-result.
Collapse
Affiliation(s)
- Shan Chen
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Siyou Wang
- Clinical Research Section, Shanghai Research Institute of Acupuncture and Meridian, Shanghai, China
| | - Lihua Xuan
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Hanti Lu
- Clinical Evaluation and Analysis Center, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, China
| | - Zhikai Hu
- Department of Computer Science, Huaqiao University, Xiamen, China
| | - Chao Zhang
- Rehabilitation Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Huifang Zhang
- Department of Acupuncture and Moxibustion, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
15
|
Myer EN, Petrikovets A, Slocum PD, Lee TG, Carter-Brooks CM, Noor N, Carlos DM, Wu E, Van Eck K, Fashokun TB, Yurteri-Kaplan L, Chen CCG. Risk factors for explantation due to infection after sacral neuromodulation: a multicenter retrospective case-control study. Am J Obstet Gynecol 2018; 219:78.e1-78.e9. [PMID: 29630890 DOI: 10.1016/j.ajog.2018.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/23/2018] [Accepted: 04/02/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Sacral neuromodulation is an effective therapy for overactive bladder, urinary retention, and fecal incontinence. Infection after sacral neurostimulation is costly and burdensome. Determining optimal perioperative management strategies to reduce the risk of infection is important to reduce this burden. OBJECTIVE We sought to identify risk factors associated with sacral neurostimulator infection requiring explantation, to estimate the incidence of infection requiring explantation, and identify associated microbial pathogens. STUDY DESIGN This is a multicenter retrospective case-control study of sacral neuromodulation procedures completed from Jan. 1, 2004, through Dec. 31, 2014. We identified all sacral neuromodulation implantable pulse generator implants as well as explants due to infection at 8 participating institutions. Cases were patients who required implantable pulse generator explantation for infection during the review period. Cases were included if age ≥18 years old, follow-up data were available ≥30 days after implantable pulse generator implant, and the implant was performed at the institution performing the explant. Two controls were matched to each case. These controls were the patients who had an implantable pulse generator implanted by the same surgeon immediately preceding and immediately following the identified case who met inclusion criteria. Controls were included if age ≥18 years old, no infection after implantable pulse generator implant, follow-up data were available ≥180 days after implant, and no explant for any reason <180 days from implant. Controls may have had an explant for reasons other than infection at >180 days after implant. Fisher exact test (for categorical variables) and Student t test (for continuous variables) were used to test the strength of the association between infection and patient and surgery characteristics. Significant variables were then considered in a multivariable logistic regression model to determine risk factors independently associated with infection. RESULTS Over a 10-year period at 8 academic institutions, 1930 sacral neuromodulator implants were performed by 17 surgeons. In all, 38 cases requiring device explant for infection and 72 corresponding controls were identified. The incidence of infection requiring explant was 1.97%. Hematoma formation (13% cases, 0% controls; P = .004) and pocket depth of ≥3 cm (21% cases, 0% controls; P = .031) were independently associated with an increased risk of infection requiring explant. On multivariable regression analysis controlling for significant variables, both hematoma formation (P = .006) and pocket depth ≥3 cm (P = .020, odds ratio 3.26; 95% confidence interval, 1.20-8.89) remained significantly associated with infection requiring explant. Of the 38 cases requiring explant, 32 had cultures collected and 24 had positive cultures. All 5 cases with a hematoma had a positive culture (100%). Of the 4 cases with a pocket depth ≥3 cm, 2 had positive cultures, 1 had negative cultures, and 1 had a missing culture result. The most common organism identified was methicillin-resistant Staphylococcus aureus (38%). CONCLUSION Infection after sacral neuromodulation requiring device explant is low. The most common infectious pathogen identified was methicillin-resistant S aureus. Demographic and health characteristics did not predict risk of explant due to infection, however, having a postoperative hematoma or a deep pocket ≥3 cm significantly increased the risk of explant due to infection. These findings highlight the importance of meticulous hemostasis as well as ensuring the pocket depth is <3 cm at the time of device implant.
Collapse
|
16
|
Post-Implant Management of Sacral Neuromodulation. CURRENT BLADDER DYSFUNCTION REPORTS 2018. [DOI: 10.1007/s11884-018-0475-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Abstract
Female voiding dysfunction and incontinence are common in the general population and symptoms have been shown to have a significant negative impact on health-related quality of life. This article highlights the epidemiology, evaluation, diagnosis, pharmacologic therapies, and surgical treatment for overactive bladder, stress urinary incontinence, and urogenital fistulas.
Collapse
Affiliation(s)
- Amanda Vo
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Tarry 16-703, Chicago, IL 60611, USA
| | - Stephanie J Kielb
- Department of Urology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Tarry 16-703, Chicago, IL 60611, USA.
| |
Collapse
|