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Decombe O, Germain T, Lenfant L, Denormandie A, Felber M, Robain G, Denys P, Chartier-Kastler E. Isolated continent cystostomy on neurologic native bladder: Functional results. THE FRENCH JOURNAL OF UROLOGY 2024; 34:102642. [PMID: 38701949 DOI: 10.1016/j.fjurol.2024.102642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/14/2024] [Accepted: 04/28/2024] [Indexed: 05/06/2024]
Abstract
INTRODUCTION Continent cutaneous urinary diversion (CCUD) is proposed to patients suffering from chronic neurologic retention and undergoing intermittent self-catheterization (ISC). In case of neurogenic detrusor overactivity (NDO), augmentation enterocystoplasty is often required. The aim was to identify the prevalence of urinary stomal and/or urethral leakage in patients who had not undergone enlargement. METHODS Monocentric, retrospective study of patients who underwent CCUD surgery in a neuro-urological context. Mitrofanoff's, Monti's or Casale's channels were performed. Patients selected had an underactive, stable, or stabilized bladder under adjuvant therapy with proper cystomanometric capacity. Prior or concomitant enterocystoplasty were excluded. Failure was defined as the occurrence of clinical leakage whatever it is through urinary stomal, or urethral. Urodynamic parameters were also reported. RESULTS Thirty-one patients underwent surgery. Nine women had a concomitant bladder neck sling and 1 urethral closure. The mean follow-up was 7 years. 8/31 (26%) had stomal leakage and 9 urethral leakage (29%). Five spinal cord injured patients (n=14) had stomal leakage (36%) and 6 urethral leakage (43%). Of the 25 postoperative urodynamic parameters, cystomanometric bladder capacity was 419mL (vs. 514mL) and 2 additional patients had de novo NDO (9 vs. 7). DISCUSSION The morbidity of augmentation enterocystoplasty is weighed against the presence of a well-controlled bladder preoperatively. Our study shows the appearance of leakage in some patients despite a well-balanced bladder, a decrease in mean cystomanometric capacity and an increase in the rate of NDO postoperatively. Good selection criteria for an isolated CCUD should be carefully revised and defined. LEVEL OF EVIDENCE Grade C - retrospective study.
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Affiliation(s)
- O Decombe
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France.
| | - T Germain
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
| | - L Lenfant
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
| | - A Denormandie
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
| | - M Felber
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
| | - G Robain
- Department of rehabilitation, Sorbonne université, Rothschild Hospital, AP-HP, Paris, France
| | - P Denys
- Department of rehabilitation, Paris-Saclay University, Raymond-Poincaré Hospital, AP-HP, Paris, France
| | - E Chartier-Kastler
- Department of Urology, Sorbonne université, Pitié-Salpêtrière Academic Hospital, AP-HP, Paris, France
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Young C, Cooper D, Mostafa A, Abdel-Fattah M. The "Aberdeen Home Continence Stress Test": a novel objective assessment tool for female stress urinary incontinence. Int Urogynecol J 2023; 34:1961-1969. [PMID: 37052645 PMCID: PMC10415466 DOI: 10.1007/s00192-023-05530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/06/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Clinical trials for stress urinary incontinence (SUI) require a robust, reliable, and responsive tool for objective assessment of SUI post-intervention. The Aberdeen Home Continence Stress Test (HCST) is a novel patient-reported objective assessment tool, aimed to be patient-friendly and reduce attrition rates by avoiding hospital appointments and prolonged pad-wearing. We aim to describe the HCST for the first time and evaluate its reliability, diagnostic accuracy, and response to change. METHODS A secondary analysis of the Single-Incision Mini-Slings (SIMS) study (a prospective multicentre randomised control trial (RCT) comparing two surgical treatments of SUI was performed. In SIMS (n = 600 women), the objective outcome was assessed by the 24-h pad test, while the patient-reported success rates were assessed using the Patient Global Impression of Improvement (PGI-I) at 15 months, 2 years and 3 years post-randomisation. Participants were instructed to perform the HCST before and after the 24-h pad test. The HCST was analysed in relation to reliability, validity, and the relationship between the 24-h pad test and HCST results and finally with regard to its responsiveness to change in PGI-I. (Trial registration-number ISRCTN93264234, registration date 14/01/2014). RESULTS Compared to the 24-h pad test, the sensitivity of the HCST ranged from 0.81-0.95, specificity was 0.76-0.79, negative predictive value was 0.96-0.99 and positive predictive value was 0.32-0.43. Reliability was indicated by high-performing Cronbach's alpha value (> 0.7). An improvement of ≥ 2 leakage groups on the HCST (for example from Large at baseline to Small leakage at follow-up) was strongly associated with patient-reported success on PGI-I (OR 4.38, 95% CI 2.31, 8.31). CONCLUSIONS The HCST is a valid and reliable patient-reported objective assessment tool that can be used for assessing SUI in surgical trials with good specificity, sensitivity, and consistency.
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Affiliation(s)
- Catriona Young
- The Aberdeen Centre for Women's Health Research, University of Aberdeen, Foresterhill, AB25 2ZD, Aberdeen, UK.
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Alyaa Mostafa
- The Aberdeen Centre for Women's Health Research, University of Aberdeen, Foresterhill, AB25 2ZD, Aberdeen, UK
| | - Mohamed Abdel-Fattah
- The Aberdeen Centre for Women's Health Research, University of Aberdeen, Foresterhill, AB25 2ZD, Aberdeen, UK
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Barba M, Cola A, Rezzan G, Costa C, Melocchi T, De Vicari D, Terzoni S, Frigerio M, Maruccia S. Flat Magnetic Stimulation for Stress Urinary Incontinence: A 3-Month Follow-Up Study. Healthcare (Basel) 2023; 11:1730. [PMID: 37372848 DOI: 10.3390/healthcare11121730] [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: 05/04/2023] [Revised: 06/05/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND flat magnetic stimulation is based on a stimulation produced by electromagnetic fields with a homogenous profile. Patients with stress urinary incontinence (SUI) can take advantage of this treatment. We aimed to evaluate medium-term subjective, objective, and quality-of-life outcomes in patients with stress urinary incontinence to evaluate possible maintenance schedules. METHODS a prospective evaluation through the administration of the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the Incontinence Impact Questionnaire (IIQ7), and the Female Sexual Function Index (FSFI) was performed at three different time points: at the baseline (T0), at the end of treatment (T1), and at 3-month follow-up (T2). The stress test and the Patient Global Impression of Improvement questionnaire (PGI-I) defined objective and subjective outcomes, respectively. RESULTS 25 consecutive patients were enrolled. A statistically significant reduction in the IIQ7 and ICIQ-SF scores was noticed at T1 returned to levels comparable to the baseline at T2. However, objective improvement remained significant even at a 3-month follow-up. Moreover, the PGI-I scores at T1 and T2 were comparable, demonstrating stable subjective satisfaction. CONCLUSION despite a certain persistence of the objective and subjective continence improvement, the urinary-related quality of life decreases and returns to baseline values three months after the end of flat magnetic stimulation. These findings indicate that a further cycle of treatment is probably indicated after 3 months since benefits are only partially maintained after this timespan.
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Affiliation(s)
- Marta Barba
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Alice Cola
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Giorgia Rezzan
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Clarissa Costa
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Tomaso Melocchi
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Desirèe De Vicari
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Stefano Terzoni
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy
| | - Matteo Frigerio
- Department of Gynecology, IRCCS San Gerardo dei Tintori, University of Milano-Bicocca, 20900 Monza, Italy
| | - Serena Maruccia
- Department of Urology, ASST Santi Paolo e Carlo, San Paolo Hospital, 20142 Milano, Italy
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Frigerio M, Barba M, Marino G, Volontè S, Melocchi T, De Vicari D, Torella M, Salvatore S, Braga A, Serati M, Manodoro S, Cola A. Coexistent Detrusor Overactivity-Underactivity in Patients with Pelvic Floor Disorders. Healthcare (Basel) 2022; 10:healthcare10091720. [PMID: 36141332 PMCID: PMC9498318 DOI: 10.3390/healthcare10091720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction and Hypothesis: Pelvic floor disorders represent a series of conditions that share, in part, the same etiological mechanisms, so they tend to be concomitant. Recently, awareness of a new lower urinary tract clinical syndrome has risen, namely the coexisting overactive–underactive bladder (COUB). The etiopathogenetic process, prevalence, and related instrumental findings of COUB are not well-established. We aimed to evaluate the prevalence, clinical features, and urodynamic findings of patients with COUB in a large cohort of patients with pelvic floor disorders. Methods: A cohort of 2092 women was retrospectively analyzed. A clinical interview, urogenital examination, and urodynamic assessment were performed by a trained urogynecologist. Based on baseline symptoms, patients were divided into COUB and non-COUB groups, and the degree of concordance between COUB and urodynamic findings, and other parameters related to the clinical aspects of these patients were measured and analyzed. Results: 18.8% of patients were classified as COUB. The association between COUB and patients with coexisting detrusor overactivity–underactivity (DOU) was statistically significant and there were substantial similarities in terms of population characteristics, symptoms, and urodynamic findings. Conclusions: Our study showed a high prevalence of COUB, and a link between this clinical syndrome and DOU was demonstrated. They showed substantial similarities in terms of clinical and urodynamics correlates. Based on these findings, we do think that urodynamic tests can be useful to improve knowledge on COUB and may be of help in the management of this condition.
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Affiliation(s)
- Matteo Frigerio
- San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
- Correspondence: ; Tel.: +39-2339434; Fax: +39-2339433
| | - Marta Barba
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Giuseppe Marino
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Silvia Volontè
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Tomaso Melocchi
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Desirèe De Vicari
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
| | - Marco Torella
- Department of Woman, Luigi Vanvitelli University of Campania, 80138 Naples, Italy
| | - Stefano Salvatore
- Obstetrics and Gynaecology Department, Vita-Salute University and IRCCS San Raffaele Hospital, 20133 Milan, Italy
| | - Andrea Braga
- EOC-Beata Vergine Hospital, 6850 Mendrisio, Switzerland
| | - Maurizio Serati
- Del Ponte Hospital, University of Insubria, 21100 Varese, Italy
| | - Stefano Manodoro
- ASST Santi Paolo e Carlo, San Paolo Hospital, 20132 Milano, Italy
| | - Alice Cola
- San Gerardo Hospital, ASST Monza, 20900 Monza, Italy
- Department of Obstetrics and Gynecology, Milano-Bicocca University, 20900 Monza, Italy
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Abou Chaaya C, Neuville P, Ruffion A, Arber T. [Isolated continent urinary diversion: An interesting or often regretted indication?]. Prog Urol 2022; 32:1498-1504. [PMID: 36068151 DOI: 10.1016/j.purol.2022.07.149] [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: 04/14/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The aim of this study is to evaluate the percentage of patients developing vesical overactivity after the realization of a continent stoma without bladder enlargement. MATERIAL AND METHOD This is a retrospective monocentric study between January 2007 and April 2021. Patients undergoing an isolated continent urinary diversion for neurological or non-neurological reasons were included. The data collected concerned the clinical symptoms of bladder overactivity and their treatment as well as the pre- and postoperative urodynamic information. RESULTS During the period, 9 patients were included. The main indications for continent urinary diversion were patients with spinal cord injury. Clinical bladder overactivity was found postoperatively in 78% (7) of the patients, and detrusor overactivity in 57% (4) of them. The main symptoms were urinary incontinence (67%) and pollakiuria (56%, 5 patients). Most of the patients benefited from associated treatments (78% pre- and postoperative), mainly anticholinergic drugs. No patient required botulinum toxin injections preoperatively, compared with 6 (67%) postoperatively. The time of initiation of these injections varied between 3 and 8 months postoperatively. CONCLUSION Isolated continent urinary diversion seems to induce or increase bladder overactivity. A larger multicentric study is necessary to validate our hypothesis. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- C Abou Chaaya
- Service d'urologie du Pr. Ruffion, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Benite, France.
| | - P Neuville
- Service d'urologie du Pr. Ruffion, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Benite, France
| | - A Ruffion
- Service d'urologie du Pr. Ruffion, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Benite, France
| | - T Arber
- Service d'urologie du Pr. Ruffion, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Benite, France
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Volonte' S, Barba M, Cola A, Marino G, Frigerio M. Italian validation of the short form of the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). Int Urogynecol J 2022; 33:3171-3175. [PMID: 35648181 PMCID: PMC9569287 DOI: 10.1007/s00192-022-05235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 05/10/2022] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this study was to translate the English short form of Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and evaluate its validity, internal consistency, and test-retest reliability. METHODS The questionnaire was translated into Italian by standardized procedural steps, and the final version was submitted to women referred to urogynecological outpatient care for genital prolapse or urinary incontinence reporting sexual disorders (cases) or not (controls). For the test-retest evaluation, cases received the questionnaire 2 weeks later. The Wilcoxon test (non-parametric) was used to assess differences between cases and controls. Convergent validity was tested with the Italian version of the FSFI-19. The internal consistency was tested using Cronbach's alpha. The degree of concordance/agreement was measured with Cohen's kappa. The absolute agreement of test-retest results was tested with the intraclass correlation coefficient (ICC). RESULTS Sixty women were recruited for the study and answered the questionnaire. The overall rate of missing items was 1.3%. Construct validity was demonstrated, as the questionnaire discriminated significantly between patients with and without symptoms. Convergent validity with FSFI-19 was tested, and a linear correlation between scores was demonstrated (F < 0.001). Internal consistency reliability evaluated with Cronbach's alpha was satisfactory (0.54-0.81). Cohen's kappa values as absolute agreement coefficients were between 0.59 and 0.80 (good agreement). Intraclass correlation coefficients ranged between 0.88 and 0.94 (very satisfactory agreement) for each functional domain. CONCLUSIONS The Italian version of the PISQ-12 is reliable, valid, and consistent.
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Affiliation(s)
- Silvia Volonte'
- ASST Monza, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy.
| | - Marta Barba
- ASST Monza, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy
| | - Alice Cola
- ASST Monza, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy
| | - Giuseppe Marino
- ASST Monza, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy
| | - Matteo Frigerio
- ASST Monza, Ospedale San Gerardo, Via Pergolesi 33, Monza, Italy
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