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Rovner E, Chermansky C, Costantini E, Dmochowski R, Enemchukwu E, Ginsberg DA, Heesakkers J, Menefee S, Nadeau G, Rardin CR, Zimmern P. Recommendations of the SUFU/AUGS/ICS Female Stress Urinary Incontinence Surgical Publication Working Group: A Common Standard Minimum Data Set for the Literature. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024:02273501-990000000-00238. [PMID: 38838689 DOI: 10.1097/spv.0000000000001538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
INTRODUCTION AND OBJECTIVES Relevant, meaningful, and achievable data points are critical in objectively assessing quality, utility, and outcomes in female stress urinary incontinence (SUI) surgery. A minimum data set female SUI surgery studies was proposed by the first American Urological Association guidelines on the surgical management of female SUI in 1997, but recommendation adherence has been suboptimal. The Female Stress Urinary Incontinence Surgical Publication Working Group (WG) was created from members of several prominent organizations to formulate a recommended standard of study structure, description, and minimum outcome data set to be utilized in designing and publishing future SUI studies. The goal of this WG was to create a body of evidence better able to assess the outcomes of female SUI surgery. METHODS The WG reviewed the minimum data set proposed in the 1997 AUA SUI Guideline document, and other relevant literature. The body of literature was examined in the context of the profound changes in the field over the past 25 years. Through a DELPHI process, a standard study structure and minimum data set were generated. Care was taken to balance the value of several meaningful and relevant data points against the burden of creating an excessively difficult or restrictive standard that would disincentivize widespread adoption and negatively impact manuscript production and acceptance. RESULTS The WG outlined standardization in four major areas: 1) study design, 2) pretreatment demographics and characterization of the study population, 3) intraoperative events, and 4) post-treatment evaluation, and complications. Forty-two items were evaluated and graded as: STANDARD - must be included; ADDITIONAL - may be included for a specific study and is inclusive of the Standard items; OPTIMAL - may be included for a comprehensive study and is inclusive of the Standard and Additional items; UNNECESSARY/LEGACY - not relevant. CONCLUSIONS A reasonable, achievable, and clinically meaningful minimum data set has been constructed. A structured framework will allow future surgical interventions for female SUI to be objectively scrutinized and compared in a clinically significant manner. Ultimately, such a data set, if adopted by the academic community, will enhance the quality of the scientific literature, and ultimately improve short and long-term outcomes for female patients undergoing surgery to correct SUI.
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Affiliation(s)
- Eric Rovner
- Professor of Urology, Department of Urology, Medical University of South Carolina, Charleston, SC;
| | - Christopher Chermansky
- Chief of Urology, UPMC Magee Womens Hospital, Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA;
| | - Elisabetta Costantini
- Professor of Urology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy;
| | - Roger Dmochowski
- Professor of Urology, Surgery and Gynecology, Dept of Urology, Vanderbilt University Med Ctr, Nashville, TN;
| | - Ekene Enemchukwu
- Associate Professor of Urology and Obstetrics & Gynecology (Urogynecology), Department of Urology, Stanford University School of Medicine, Stanford, CA;
| | - David A Ginsberg
- Professor of Clinical Urology, Keck School of Medicine of USC, Los Angeles, CA;
| | - John Heesakkers
- Professor of Urology, Department of Urology, Maastricht UMC+, The Netherlands;
| | - Shawn Menefee
- Director, Division of Urogynecology & Reconstructive Pelvic Surgery, Kaiser Permanente San Diego. Voluntary Clinical Professor, Obstetrics, Gynecology, & Reproductive Sciences at the University of California, San Diego;
| | - Geneviève Nadeau
- Assistant Professor, Department of Urology, CHU de Québec - Université Laval, Quebec, Canada;
| | - Charles R Rardin
- Professor of Obstetrics and Gynecology, Brown University, Providence, RI;
| | - Philippe Zimmern
- Professor of Urology, Department of Urology, UT Southwestern Medical Center, Dallas, TX;
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Rovner E, Chermansky C, Costantini E, Dmochowski R, Enemchukwu E, Ginsberg DA, Heesakkers J, Menefee S, Nadeau G, Rardin C, Zimmern P. Recommendations of the SUFU/AUGS/ICS Female Stress Urinary Incontinence Surgical Publication Working Group: A common standard minimum data set for the literature. Neurourol Urodyn 2024. [PMID: 38837735 DOI: 10.1002/nau.25445] [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: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION AND OBJECTIVES Relevant, meaningful, and achievable data points are critical in objectively assessing quality, utility, and outcomes in female stress urinary incontinence (SUI) surgery. A minimum data set female SUI surgery studies was proposed by the first American Urological Association guidelines on the surgical management of female SUI in 1997, but recommendation adherence has been suboptimal. The Female Stress Urinary Incontinence Surgical Publication Working Group (WG) was created from members of several prominent organizations to formulate a recommended standard of study structure, description, and minimum outcome data set to be utilized in designing and publishing future SUI studies. The goal of this WG was to create a body of evidence better able to assess the outcomes of female SUI surgery. METHODS The WG reviewed the minimum data set proposed in the 1997 AUA SUI Guideline document, and other relevant literature. The body of literature was examined in the context of the profound changes in the field over the past 25 years. Through a DELPHI process, a standard study structure and minimum data set were generated. Care was taken to balance the value of several meaningful and relevant data points against the burden of creating an excessively difficult or restrictive standard that would disincentivize widespread adoption and negatively impact manuscript production and acceptance. RESULTS The WG outlined standardization in four major areas: (1) study design, (2) pretreatment demographics and characterization of the study population, (3) intraoperative events, and (4) posttreatment evaluation, and complications. Forty-two items were evaluated and graded as: STANDARD-must be included; ADDITIONAL-may be included for a specific study and is inclusive of the Standard items; OPTIMAL-may be included for a comprehensive study and is inclusive of the Standard and Additional items; UNNECESSARY/LEGACY-not relevant. CONCLUSIONS A reasonable, achievable, and clinically meaningful minimum data set has been constructed. A structured framework will allow future surgical interventions for female SUI to be objectively scrutinized and compared in a clinically significant manner. Ultimately, such a data set, if adopted by the academic community, will enhance the quality of the scientific literature, and ultimately improve short and long-term outcomes for female patients undergoing surgery to correct SUI.
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Affiliation(s)
- Eric Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christopher Chermansky
- Department of Urology, UPMC Magee Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Roger Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ekene Enemchukwu
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - David A Ginsberg
- Department of Urology, Keck School of Medicine of USC, Los Angeles, California, USA
| | - John Heesakkers
- Department of Urology, Maastricht UMC+, Maastricht, The Netherlands
| | - Shawn Menefee
- Division of Urogynecology & Reconstructive Pelvic Surgery, Kaiser Permanente San Diego, University of California, San Diego, California, USA
| | - Geneviève Nadeau
- Department of Urology, CHU de Québec - Université Laval, Quebec, Canada
| | - Charles Rardin
- Department of Obstetrics and Gynecology, Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Philippe Zimmern
- Department of Urology, UT Southwestern Medical Center, Dallas, Texas, USA
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Takacs P, Rátonyi D, Koroknai E, van Raalte H, Lucente V, Egorov V, Krasznai ZT, Kozma B. Biomechanical Integrity Score of the Female Pelvic Floor for Stress Urinary Incontinence. Int Urogynecol J 2024; 35:1245-1253. [PMID: 38739290 PMCID: PMC11245433 DOI: 10.1007/s00192-024-05797-1] [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: 01/19/2024] [Accepted: 03/26/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION AND HYPOTHESIS This study is aimed at developing and validating a new integral parameter, the Biomechanical Integrity score (BI-score) of the female pelvic floor for stress urinary incontinence conditions. METHODS A total of 130 subjects were included in the observational cohort study; 70 subjects had normal pelvic floor conditions, and 60 subjects had stress urinary incontinence (SUI). A Vaginal Tactile Imager (VTI) was used to acquire and automatically calculate 52 biomechanical parameters for eight VTI test procedures (probe insertion, elevation, rotation, Valsalva maneuver, voluntary muscle contractions in two planes, relaxation, and reflex contraction). Statistical methods were applied (t test, correlation) to identify the VTI parameters sensitive to the pelvic SUI conditions. RESULTS Twenty-seven parameters were identified as statistically sensitive to SUI development. They were subdivided into five groups to characterize tissue elasticity (group 1), pelvic support (group 2), pelvic muscle contraction (group 3), involuntary muscle relaxation (group 4), and pelvic muscle mobility (group 5). Every parameter was transformed to its standard deviation units using the dataset for normal pelvic conditions, similar to the T-score for bone density. Linear combinations with specified weights led to the composition of five component parameters for groups 1-5 and to the BI-score in standard deviation units. The p value for the BI-score has p = 4.0 × 10-28 for SUI versus normal conditions. CONCLUSIONS Quantitative transformations of the pelvic tissues, support structures, and functions under diseased conditions may be studied with the SUI BI-score in future research and clinical applications.
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Affiliation(s)
- Peter Takacs
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary
| | - Dávid Rátonyi
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary
| | - Erzsébet Koroknai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary
| | - Heather van Raalte
- The Institute for Female Pelvic Medicine & Reconstructive Surgery, Allentown, PA, USA
| | | | | | - Zoard Tibor Krasznai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary
| | - Bence Kozma
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Nagyerdei Krt 98, 4032, Debrecen, Hungary.
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Chancellor M, Bartolone S. A legacy of excellence: celebrating 40 years of the Diokno-Lapides essay contest. Int Urol Nephrol 2024; 56:1235-1241. [PMID: 38082094 PMCID: PMC10923967 DOI: 10.1007/s11255-023-03886-6] [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: 09/22/2023] [Accepted: 11/09/2023] [Indexed: 03/09/2024]
Abstract
The Diokno-Lapides Essay Contest was originally established in 1984 as the Jack Lapides Essay Contest on Urodynamic and Neurourology Research. Developed by Ananias Diokno to honor his mentor, Jack Lapides at the University of Michigan, it was funded by a grant from Marion Laboratories. The contest recognizes individuals doing outstanding work in neurourology and has been awarded yearly since 1985. Renamed the Diokno-Lapides Essay Contest in 2014, it has generated significant papers and discoveries in neurourology. Spanning 40 years, winners and other participants have attested to the contest's influence on their careers and its opportunities for networking and mentorship across the global urology community.
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Affiliation(s)
- Michael Chancellor
- Department of Urology, Oakland University William Beaumont School of Medicine, Corewell Health William Beaumont University Hospital, 3811 W 13 Mile Rd, Suite 504, Royal Oak, MI, USA.
| | - Sarah Bartolone
- Department of Urology, Oakland University William Beaumont School of Medicine, Corewell Health William Beaumont University Hospital, 3811 W 13 Mile Rd, Suite 504, Royal Oak, MI, USA
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Koroknai E, Rátonyi D, Pákozdy K, Sipos AG, Krasznai Z, Takacs P, Kozma B. Correlation between the female pelvic floor biomechanical parameters and the severity of stress urinary incontinence. BMC Urol 2023; 23:198. [PMID: 38036996 PMCID: PMC10687905 DOI: 10.1186/s12894-023-01375-7] [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: 06/20/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Stress urinary incontinence (SUI) is a common condition that requires proper evaluation to select a personalized therapy. Vaginal Tactile Imaging (VTI) is a novel method to assess the biomechanical parameters of the pelvic floor. METHODS Women with SUI were enrolled in this cross-sectional study. Participants completed the Medical, Epidemiologic, and Social Aspects of Aging (MESA) questionnaire and the Patient Global Impression of Severity Question (PGI-S) and underwent a VTI examination. Based on the MESA and PGI-S questionnaires, participants were divided into mild, moderate, and severe SUI groups. Fifty-two biomechanical parameters of the pelvic floor were measured by VTI and compared between the groups (mild vs. moderate and severe). SUI Score and Index were calculated from the MESA questionnaire. Pearson correlation was used to determine the strength of association between selected VTI parameters and the MESA SUI Index and MESA SUI Score. RESULTS Thirty-one women were enrolled into the study. Significant differences were observed in the VTI parameters 16, 22-24, 38, 39 when the difference between mild and severe subgroups of SUI based on the PGI-S score was examined. Parameter 16 refers to the maximum gradient at the perineal body, parameter 22-24 refers to the pressure response of the tissues behind the vaginal walls, and parameter 38, 39 refers the maximum pressure change and value on the right side at voluntary muscle contraction. VTI parameter 49, describing the displacement of the maximum pressure peak in the anterior compartment, showed a significant difference between the mild SUI and the moderate-severe SUI according to the MESA SUI score (mean ± SD 14.06 ± 5.16 vs. 7.54 ± 7.46, P = 0.04). The MESA SUI Index and SUI Score displayed a positive correlation concerning VTI parameters 4 (the maximum value of the posterior gradient) and 27 (the displacement of the maximum pressure peak in the anterior compartment) (VTI4 vs. MESA SUI Index r = 0.373, P = 0.039; VTI4 vs. MESA SUI Score r = 0.376, P = 0.037; VTI27 vs. MESA SUI Index r = 0.366, P = 0.043; VTI27 vs. MESA SUI Score r = 0.363, P = 0.044). CONCLUSIONS Female pelvic floor biomechanical parameters, as measured by VTI, correlate significantly with the severity of SUI and may help guide therapeutic decisions.
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Affiliation(s)
- Erzsébet Koroknai
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Dávid Rátonyi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Krisztina Pákozdy
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Attila G Sipos
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Zoárd Krasznai
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
| | - Peter Takacs
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 526, Norfolk, VA, 23507-2007, USA
| | - Bence Kozma
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Debrecen, Nagyerdei krt. 98, Debrecen, 4032, Hungary.
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Tu LM, Gheiler E, Hanson CE, Jalkut M, McCrery R, Parekh M, Parva M, Erickson T. Management of female stress urinary incontinence with single-incision mini-sling (Altis®): 36 month multicenter outcomes. Neurourol Urodyn 2023; 42:1722-1732. [PMID: 37555436 DOI: 10.1002/nau.25256] [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: 04/17/2023] [Revised: 07/21/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE To assess noninferiority of the safety and effectiveness of the Altis® Single Incision Sling (SIS) with standard midurethral transobturator and/or retropubic slings through 36 months in a prospective, longitudinal, nonrandomized US Food and Drug Administration (FDA) 522 cohort study. MATERIALS AND METHODS Adult females with confirmed predominant stress urinary incontinence (UI) through cough stress test (CST) or urodynamics and failed two noninvasive incontinence therapies. Effectiveness endpoints included objective dryness, negative CST, adverse events, and revision/resurgery through 36 months. The primary effectiveness endpoint was reduction from baseline in 24-h pad weight of ≥50% at 6 months, as requested by the FDA, and is included as a study point in this paper. Primary safety endpoint was rate of related serious adverse events (SAE) through 36 months. Noninferiority margins of 15% and 10% were prespecified for the effectiveness and safety endpoints. Due to the observational nature of the cohort study, a propensity methodology was conducted to assess the effect of potential confounding variables on the primary endpoints between groups. RESULTS Three hundred fifty-five women underwent the sling procedure (n = 184 Altis; n = 171 Comparator). One hundred fourty (76%) Altis subjects and 101 (59%) Comparator subjects completed follow-up through 36 months. At 36 months, for the effectiveness endpoint, the difference in proportions of -0.005 for Altis versus Comparator (95% confidence interval [CI]: -0.102 to 0.092) was statistically significant (p = 0.002), supporting the hypothesis that Altis is noninferior to Comparator. Furthermore, both groups demonstrated high objective efficacy; in the Altis arm n = 99 (81.8%) subjects were a success, and in the Comparator arm, n = 79 (82.3%) subjects were a success. Additionally, regarding the CST, Altis was found to be noninferior to the Comparator at every study visit, and the rate of negative CST remained above 80% for both groups (p < 0.001). At 36 months, Altis (n = 2; 1.1%) and Comparator (n = 4; 2.3%) subjects experienced a device and/or procedure-related SAE. The difference in proportions of 0.013 for Altis versus Comparator (95% CI: -0.023 to 0.048) was statistically significant (p < 0.001), demonstrating that Altis is noninferior to Comparator with respect to the primary safety endpoint throughout the study. There were 62 (36.3%) retropubic midurethral slings (RMUS), 96 (56.1%) transobturator midurethral slings (TMUS), and 13 (7.6%) SIS slings in the Comparator group. For the 36 month effectiveness endpoint, assessing the noninferiority of Altis versus RMUS and Altis versus TMUS, 99 (81.8%) Altis and 37 (90.2%) RMUS were a success, trending toward statistical significance, however, it cannot be determined to be noninferior (p = 0.092). Ninty-nine (81.8%) Altis and 33 (71.7%) TMUS were a success; this was statistically significant (p < 0.001), demonstrating Altis was noninferior to TMUS. Rates of negative CST were 122 (87.1%) Altis, 40 (93.0%) RMUS (p < 0.001), and 44 (91.7%) TMUS (p < 0.001). CST demonstrated that Altis was noninferior to RMUS and Altis was noninferior to TMUS at 36 months. CONCLUSION Altis single-incision sling was noninferior to standard midurethral sling for treatment of stress UI, throughout the study and at 36 months. Furthermore, adverse event rates were low.
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Affiliation(s)
- Le Mai Tu
- Department of Surgery, Division of Urology, Hospital Center of University of Sherbrooke, Sherbrooke, Canada
| | - Edward Gheiler
- Department of Gynecology, Urological Research Network LLC, Nova Southeastern University, Hialeah, Florida, USA
| | - Craig E Hanson
- Department of Urogynecology, Van Wert Health, Van Wert, Ohio, USA
| | - Mark Jalkut
- Associated Urologists of North Carolina, Raleigh, North Carolina, USA
| | - Rebecca McCrery
- Department of Urogynecology, Adult and Pediatric Urology and Urogynecology, Omaha, Nebraska, USA
| | - Mitesh Parekh
- Department of Obstetrics and Gynecology, Ohio University College of Medicine, Athens, Ohio, USA
| | - Mohamad Parva
- Department of Gynecology, The Group for Women, Tidewater Clinical Research, Norfolk, Virginia, USA
| | - Ty Erickson
- Department of Gynecology, UNLV School of Medicine, Las Vegas, Nevada, USA
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Bapir R, Bhatti KH, Eliwa A, García-Perdomo HA, Gherabi N, Hennessey D, Magri V, Mourmouris P, Ouattara A, Perletti G, Philipraj J, Stamatiou K, Tolani MA, Tzelves L, Trinchieri A, Buchholz N. Treatment of urge incontinence in postmenopausal women: A systematic review. Arch Ital Urol Androl 2023; 95:11718. [PMID: 37791545 DOI: 10.4081/aiua.2023.11718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/08/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Urinary incontinence and other urinary symptoms tend to be frequent at menopause because of hormonal modifications and aging. Urinary symptoms are associated with the genitourinary syndrome of menopause which is characterized by physical changes of the vulva, vagina and lower urinary tract. The treatment strategies for postmenopausal urinary incontinence are various and may include estrogens, anticholinergics, and pelvic floor muscle training. A comparison of these treatments is difficult due to the heterogeneity of adopted protocols. We systematically reviewed the evidence from randomized controlled trials (RCTs) focusing on treatment of postmenopausal women with urge incontinence. METHODS We conducted a systematic review and meta-analysis by searching PubMed and EMBASE databases for randomized controlled trials (RCTs) reporting results of treatments for postmenopausal urinary urge incontinence. Odds ratios for improvement of urinary incontinence were calculated using random effect Mantel-Haenszel statistics. RESULTS Out of 248 records retrieved, 35 eligible RCTs were assessed for risk of bias and included in the meta-analysis. Compared with placebo, systemic estrogens were associated with decreased odds of improving urinary incontinence in postmenopausal women (OR = 0.74, 95% CI: 0.61-0.91, 7 series, 17132 participants, Z = 2.89, P = 0.004, I2 = 72%). In most studies, no significant improvement in urinary symptoms was observed in patients treated with local estrogens, although they showed to be helpful in improving vaginal symptoms. Vitamin D, phytoestrogens and estrogen modulators were not effective in improving symptoms of incontinence and other symptoms of genitourinary menopause syndrome or yielded contradictory results. A randomized controlled trial demonstrated that oxybutynin was significantly better than placebo at improving postmenopausal urgency and urge incontinence. The combination of anticholinergics with local estrogens has not been shown to be more effective than anticholinergics alone in improving urinary incontinence symptoms in postmenopausal women. Physical therapy showed an overall positive outcome on postmenopausal urinary incontinence symptoms, although such evidence should be further validated in the frame of quality RCTs. CONCLUSIONS The evidence for effective treatment of postmenopausal urinary incontinence is still lacking. Welldesigned large studies having subjective and objective improvement primary endpoints in postmenopausal urinary incontinence are needed. At present, a combination of different treatments tailored to the characteristics of the individual patient can be suggested.
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Affiliation(s)
- Rawa Bapir
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; Smart Health Tower, Sulaymaniyah, Kurdistan region.
| | - Kamran Hassan Bhatti
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; Urology Department, HMC, Hamad Medical Corporation.
| | - Ahmed Eliwa
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; Department of Urology, Zagazig University, Zagazig, Sharkia.
| | | | - Nazim Gherabi
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; Faculty of Medicine Algiers 1, Algiers.
| | - Derek Hennessey
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; Department of Urology, Mercy University Hospital, Cork.
| | - Vittorio Magri
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; Urology Unit, ASST Fatebenefratelli Sacco, Milan.
| | - Panagiotis Mourmouris
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens.
| | - Adama Ouattara
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; Division of Urology, Souro Sanou University Teaching Hospital, Bobo-Dioulasso.
| | - Gianpaolo Perletti
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; Department of Biotechnology and Life Sciences, Section of Medical and Surgical Sciences, University of Insubria, Varese.
| | - Joseph Philipraj
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; Department of Urology, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth, Puducherry.
| | - Konstantinos Stamatiou
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; Department of Urology, Tzaneio General Hospital, Piraeus.
| | - Musliu Adetola Tolani
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; Division of Urology, Department of Surgery,Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State.
| | - Lazaros Tzelves
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; 2nd Department of Urology, National and Kapodistrian University of Athens, Sismanoglio Hospital, Athens.
| | - Alberto Trinchieri
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; Urology School, University of Milan.
| | - Noor Buchholz
- U-merge Ltd. (Urology for emerging countries), London-Athens-Dubai; Sobeh's Vascular and Medical Center, Dubai Health Care City, Dubai.
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Min EE, Thomas J. Urinary incontinence prevalence and factors associated with patients talking with doctors about urine control. J Family Med Prim Care 2023; 12:1555-1570. [PMID: 37767451 PMCID: PMC10521848 DOI: 10.4103/jfmpc.jfmpc_1955_22] [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: 10/04/2022] [Revised: 11/09/2022] [Accepted: 03/29/2023] [Indexed: 09/29/2023] Open
Abstract
Objectives Patient perceptions of their doctors may influence talking to them about urinary incontinence (UI). We estimated prevalence of UI among Medicare beneficiaries and assessed association between beneficiaries' demographic and clinical characteristics and whether they spoke to their doctor about UI and association between beneficiaries' perceptions of their doctor and whether they spoke to their doctor about UI. Methods This study was approved by the Purdue University Institutional Review Board (IRB) and determined exempt, category 4 (protocol number 1907022503, approval on August 5th, 2019). Medicare Current Beneficiary Survey (MCBS) 2016 data were analyzed. Beneficiaries who indicated that they lost urine control 2-3 times a month or above were classified as experiencing UI. An 11-item patient perception of their physician scale was created based on MCBS items. Perceptions were categorized as favorable or unfavorable. SAS version 9.4 for Unix was used for all analyses. PROC LOGISTIC was used to assess multi-variable association between beneficiaries' perceptions of their doctors and talking to their doctor about UI. Results Among 7466 persons meeting inclusion criteria, 1856 (24.9%) had UI. The perception of doctor scale scores ranged from 15 to 44, with mean score = 36.57 (standard deviation = 5.29). The scale Cronbach alpha reliability was 0.93. Using sensitivity and receiver operating characteristic analysis, a cutoff of 30 or higher was identified as a favorable perception. Beneficiaries with favorable perceptions of their doctor were more likely to speak to their doctor about experiencing UI than beneficiaries with unfavorable perceptions (odds ratio = 1.55, 95% confidence interval = 1.03 to 2.35, P-value = 0.038). Conclusion Overall, the more favorable the perception of their physicians, the more likely beneficiaries were to speak to them about their UI.
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Affiliation(s)
- Elissa E. Min
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, Indiana
| | - Joseph Thomas
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafayette, Indiana
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9
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Takacs P, Pákozdy K, Koroknai E, Erdődi B, Krasznai Z, Kozma B. A randomized controlled pilot trial to assess the effectiveness of a specially formulated food supplement and pelvic floor muscle training in women with stress-predominant urinary incontinence. BMC Womens Health 2023; 23:321. [PMID: 37340306 DOI: 10.1186/s12905-023-02476-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: 10/18/2022] [Accepted: 06/10/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Pelvic floor muscle training (PFMT) is the first-line treatment approach for stress urinary incontinence. Creatine and leucine have been shown to improve muscle function. Our aim was to assess the effectiveness of a food supplement and PFMT in women with stress-predominant urinary incontinence. METHODS Women with stress-predominant urinary incontinence were randomized in 1:1 ratio to receive daily oral supplementation for six weeks with either a food supplement (treatment group) or placebo (control group). Both groups were instructed to perform standardized daily PFMT. The primary outcome was the Urogenital Distress Inventory Short Form (UDI-6) score. Secondary outcomes were the Incontinence Impact Questionnaire (IIQ-7) score, Patient's Global Impression of Severity (PGI-S), and Biomechanical Integrity score (BI-score) measured by Vaginal Tactile Imager. To have a power of 80% and a significance level of 5% to detect a decrease of 16 points in the UDI-6 score, a sample size of 32 was needed, with 16 patients in each arm of our trial. RESULTS Sixteen women in the control group and sixteen in the treatment group completed the trial. Between-group analysis revealed no significant differences between the control and treatment group except for mean change (delta) in vaginal squeeze pressure [(cmH2O, mean ± SD), 5 ± 12 vs. 15 ± 15, P = 0.04] and mean change (delta) in PGI-S score [(mean ± SD), -0.2 ± 0.9 vs. -0.8 ± 0.8, P = 0.04]. Within-group analysis showed that UDI-6 and IIQ-7 scores improved significantly from baseline to six weeks in the treatment group but not in the control group [UDI-6 score (mean ± SD) 45 ± 21 vs. 29 ± 21, P = 0.02; 43 ± 18 vs. 33 ± 26, P = 0.22] [IIQ-7 score (mean ± SD) 50 ± 30 vs. 30 ± 21, P = 0.01; 48 ± 23 vs.40 ± 28, P = 0.36]. PGI-S scores only improved in the treatment group from baseline to six weeks after treatment [PGI-S score (mean ± SD) 3.1 ± 0.8 vs. 2.3 ± 0.8, P = 0.0001]. BI-score, on average, improved significantly in the treatment and control group as well [SD unit, mean, from - 1.06 to -0.58, P = 0.001; from - 0.66 to -0.42, P = 0.04]. CONCLUSIONS Women with stress-predominant urinary incontinence receiving a specially formulated supplement in addition to daily PFMT for six weeks had significantly improved urinary symptoms (decrease in UDI-6 score and IIQ-7) and BI-score compared to their baseline. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05358769. 27/04/2022.
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Affiliation(s)
- Peter Takacs
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Eastern Virginia Medical School, 825 Fairfax Avenue, Suite 526, Norfolk, VG, 23507-2007, USA
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Krisztina Pákozdy
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Erzsébet Koroknai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Balázs Erdődi
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Zoárd Krasznai
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary
| | - Bence Kozma
- Faculty of Medicine, Department of Obstetrics and Gynecology, University of Debrecen, Pf 400, Debrecen, 4002, Hungary.
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van Geelen H, Sand PK. The female urethra: urethral function throughout a woman's lifetime. Int Urogynecol J 2023; 34:1175-1186. [PMID: 36757487 DOI: 10.1007/s00192-023-05469-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/01/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this narrative review is to describe changes in urethral function that occur during a woman's lifetime. Evaluation of urethral function includes measurements of urethral closure pressure, at rest and during stress, leak point pressure, and the detailed study of anatomical and histological changes of the urethral sphincteric mechanism. METHODS A literature search in MEDLINE, PubMed, and relevant journals from 1960 until 2020 was performed for articles dealing with urethral function and the impact of aging, pregnancy, and childbirth, female hormones, and menopausal transition on the urethral sphincteric mechanism. Longitudinal and cross-sectional epidemiological surveys, studies on histological changes in urethral anatomy during aging, and urodynamic data obtained at different points in a woman's lifetime, during pregnancy, after childbirth, as well as the effects of female hormones on urethral sphincter function are reviewed. Relevant studies presenting objective data are analyzed and briefly summarized. RESULTS AND CONCLUSIONS The findings lead one to conclude that a constitutional or genetic predisposition, aging, and senescence are the most prominent etiological factors in the development of urinary incontinence and other pelvic floor disorders. Vaginal childbirth dilates and may damage the compressed pelvic supportive tissues and is invariably associated with a decline in urethral sphincter function. Pregnancy, hormonal alterations, menopausal transition, weight gain, and obesity are at best of secondary influence on the pathology of lower urinary tract dysfunction. The decline of circulating estrogens during menopausal transition may play a role in the transition of fibroblasts to cellular senescence.
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11
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Molecular Regulation of Concomitant Lower Urinary Tract Symptoms and Erectile Dysfunction in Pelvic Ischemia. Int J Mol Sci 2022; 23:ijms232415988. [PMID: 36555629 PMCID: PMC9782153 DOI: 10.3390/ijms232415988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/09/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
Aging correlates with greater incidence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in the male population where the pathophysiological link remains elusive. The incidence of LUTS and ED correlates with the prevalence of vascular risk factors, implying potential role of arterial disorders in concomitant development of the two conditions. Human studies have revealed lower bladder and prostate blood flow in patients with LUTS suggesting that the severity of LUTS and ED correlates with the severity of vascular disorders. A close link between increased prostatic vascular resistance and greater incidence of LUTS and ED has been documented. Experimental models of atherosclerosis-induced chronic pelvic ischemia (CPI) showed increased contractile reactivity of prostatic and bladder tissues, impairment of penile erectile tissue relaxation, and simultaneous development of detrusor overactivity and ED. In the bladder, short-term ischemia caused overactive contractions while prolonged ischemia provoked degenerative responses and led to underactivity. CPI compromised structural integrity of the bladder, prostatic, and penile erectile tissues. Downstream molecular mechanisms appear to involve cellular stress and survival signaling, receptor modifications, upregulation of cytokines, and impairment of the nitric oxide pathway in cavernosal tissue. These observations may suggest pelvic ischemia as an important contributing factor in LUTS-associated ED. The aim of this narrative review is to discuss the current evidence on CPI as a possible etiologic mechanism underlying LUTS-associated ED.
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ÖZGÜRLÜK İ, ÜNLÜBİLGİN E, DÖLEN İ. Comparison of tolterodine, trospium chloride, solifenacin treatments and its side effects on patients with pure urinary and mixed incontinence. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1106031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objective: Urinary incontinence is defined as urinary incontinence that is a social or hygienic problem and can be objectively demonstrated. It is aimed to compare tolterodine, trospium chloride and solifenacin treatments, and its side effects on patients who have complaints of pure urinary and mixed incontinence.
Material and Method: Totally 98 patients, who applied to Ankara Etlik Zubeyde Hanım Gynecology Training and Research Hospital, Urogynecology Outpatient Clinic between November 2009 and October 2010 with compliants of urinary incontinence and met the criteria to participate in the research, have been included in this study.
Results: A significant improvement in each three of the drug group at third and six months was determined. Solifenacin is generally more effective than the other two treatments. When total values of UDI-6 (Urinary Distress Inventory) survey is analysed, it is seen that each of three antimuscarinic drug group ensured improvement on symptoms at the end of the third month as not to be different from the improvement at the six month. Each three antimuscarinic drug group has a significant therapeutic effect on the IIQ-7 (Incontinence Impact Questionnaire) survey which questions the life quality. Whereas complaints of constipation was seen more at patients that use tolterodine and trospium chloride, there was not a significant difference despite a slight increase in the solifenacin group (p>0.05). It is determined that solifenacin caused desert mouth less than the other two drug groups
Conclusion: Tolterodine, trospium chloride and solifenacin as anticholinergic drugs meaningfully reduced the activity of bladder and increased the quality of life. Drug therapy provided an effective and efficient improvement on incontinence.
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Affiliation(s)
- İzzet ÖZGÜRLÜK
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ANKARA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Eylem ÜNLÜBİLGİN
- University of Health Sciences, Ankara Etlik Zübeyde Hanım Gynecology Training and Research Hospital, Department of gynecology and obstetrics, Ankara, Turkey
| | - İsmail DÖLEN
- University of Health Sciences, Ankara Etlik Zübeyde Hanım Gynecology Training and Research Hospital, Department of gynecology and obstetrics, Ankara, Turkey
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13
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In Reply:. Obstet Gynecol 2022; 140:136-137. [DOI: 10.1097/aog.0000000000004844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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de Rijk MM, Wolf-Johnston A, Kullmann AF, Taiclet S, Kanai AJ, Shiva S, Birder LA. Aging-Associated Changes in Oxidative Stress Negatively Impacts the Urinary Bladder Urothelium. Int Neurourol J 2022; 26:111-118. [PMID: 35793989 PMCID: PMC9260322 DOI: 10.5213/inj.2142224.112] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/18/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Lower urinary tract symptoms are known to significantly increase with age, negatively impacting quality of life and self-reliance. The urothelium fulfills crucial tasks, serving as a barrier protecting the underlying bladder tissue from the harsh chemical composition of urine, and exhibits signaling properties via the release of mediators within the bladder wall that affect bladder functioning. Aging is associated with detrimental changes in cellular health, in part by increasing oxidative stress in the bladder mucosa, and more specifically the urothelium. This, in turn, may impact urothelial mitochondrial health and bioenergetics. METHODS We collected mucosal tissue samples from both young (3-4 months old) and aged (25-30 months old) rats. Tissue was evaluated for p21-Arc, nitrotyrosine, and cytochrome C expression by western immunoblotting. Urothelial cells were cultured for single-cell imaging to analyze basal levels of reactive oxygen species and the mitochondrial membrane potential. Mitochondrial bioenergetics and cellular respiration were investigated by the Seahorse assay, and measurements of adenosine triphosphate release were made using the luciferin-luciferase assay. RESULTS Aging was associated with a significant increase in biomarkers of cellular senescence, oxidative stress, and basal levels of reactive oxygen species. The mitochondrial membrane potential was significantly lower in urothelial cell cultures from aged animals, and cultures from aged animals showed a significant decrease in mitochondrial bioenergetics. CONCLUSION Aging-related increases in oxidative stress and excessive reactive oxygen species may be contributing factors underlying lower urinary tract symptoms in older adults. The mechanisms outlined in this study could be utilized to identify novel pharmaceutical targets to improve aging-associated bladder dysfunction.
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Affiliation(s)
- Mathijs M. de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Urology, Maastricht University Medical Center+ (MUMC+), Maastricht, The Netherlands
| | - Amanda Wolf-Johnston
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Aura F. Kullmann
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Stephanie Taiclet
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Anthony J. Kanai
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sruti Shiva
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lori A. Birder
- Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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15
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Digital Therapeutic Device for Urinary Incontinence: A Randomized Controlled Trial. Obstet Gynecol 2022; 139:606-615. [PMID: 35271539 PMCID: PMC8936159 DOI: 10.1097/aog.0000000000004725] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/30/2021] [Indexed: 11/04/2022]
Abstract
To evaluate whether pelvic floor muscle training using a motion-based digital intravaginal device is more effective than home pelvic floor muscle training for treatment of stress or stress-predominant mixed urinary incontinence (UI).
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16
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Bicudo MC, Rodrigues AF, Dalle YO, Luiz Farinhas Tomé A, Placco Araujo Glina F, Glina S. Prevalence and cost of surgical treatment for female stress urinary incontinence in Brazil: A comparison between abdominal and vaginal approaches. Int J Clin Pract 2021; 75:e14527. [PMID: 34125984 DOI: 10.1111/ijcp.14527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/09/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Report the progress of the treatment of female stress urinary incontinence (SUI) in Brazil through vaginal and abdominal approaches and the direct costs by hospitalisation, using DATASUS-a public entity of the Strategic and Participative Management Secretary of Health Ministry, with the responsibility of collecting, processing, and disseminating public health information. DESIGN Epidemiological study using the Brazilian Public Health Data Center System (DATASUS). PARTICIPANTS/MATERIALS, SETTING, AND METHODS Data were collected on all hospital admissions associated with treatment from 2008 to 2019 from the DATASUS. We analysed the records of hospitalisations associated with an abdominal or vaginal surgical SUI treatment. RESULTS The total number of procedures for the treatment of female SUI performed from 2008 to 2019 was 84.378, of which 70 238 were vaginal and 14 140 abdominal. There was an overall decrease in the number of SUI procedures in Brazil over the years analysed (F = 52.72; P < .0001); only exception was the South region (F = 1.38; P = .267). A declining trend was identified for the abdominal approach, with an increased trend of the vaginal approach (F = 170.11; P < .0001). A declining number of hospitalisation days was noted in the vaginal procedures (P = .002). Despite the fact that no differences were noted between abdominal and vaginal expenses (P = .054), hospital expenditure increased over the years for both vaginal and abdominal approaches, with no significant differences between either approaches. However, a statistically significant professional expenditure was observed in the abdominal approach (P < .001). Analysing hospitalisation and professional expenses, the total mean in the period was statistically higher for the abdominal approach (P < .0001). CONCLUSIONS The number of procedures to treat female SUI in Brazil has decreased from 2008 to 2019. Total financial expenditure per procedure and length of hospital stay were both higher for the abdominal approach (Burch colposuspension). A preference for a vaginal approach (pubovaginal sling or midurethral sling) has increased significantly since 2008, and our study favours this approach.
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Affiliation(s)
- Maria Claudia Bicudo
- Urology Division, Faculdade de Medicina do ABC do Centro Universitário de Saúde ABC, Sao Paulo, Brazil
| | - Antônio Flávio Rodrigues
- Urology Division, Faculdade de Medicina do ABC do Centro Universitário de Saúde ABC, Sao Paulo, Brazil
| | - Yasser Omar Dalle
- Urology Division, Faculdade de Medicina do ABC do Centro Universitário de Saúde ABC, Sao Paulo, Brazil
| | - André Luiz Farinhas Tomé
- Urology Division, Faculdade de Medicina do ABC do Centro Universitário de Saúde ABC, Sao Paulo, Brazil
| | | | - Sidney Glina
- Urology Division, Faculdade de Medicina do ABC do Centro Universitário de Saúde ABC, Sao Paulo, Brazil
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Yow HY, Tiong JJL, Mai CW, van der Werf E, Zainuddin ZM, Toh CC, Ngoo KS, Goh EH, Fadzli AN, Lok SH, Ong TA. Prevalence of nocturia among community-dwelling adults: a population-based study in Malaysia. BMC Urol 2021; 21:95. [PMID: 34187440 PMCID: PMC8243763 DOI: 10.1186/s12894-021-00860-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 06/14/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Nocturia is widely prevalent condition with detrimental effects on quality of life and general health. In Malaysia, there is a lack of up-to-date prevalence study on nocturia. This study aimed to investigate the prevalence of nocturia and awareness pertaining to nocturia among Malaysian adults. METHODS A cross-sectional population-based study was conducted among Malaysian adults aged ≥ 18 years old. The data was collected by mixed mode self-administered questionnaire from May 2019 to September 2019. Nocturia was defined as one or more voids at night. RESULTS There were a total of 4616 respondents with 74.5% of response rate. The overall prevalence of nocturia among Malaysian adults was found to be 57.3%. In multivariate analysis, respondents aged 31-40 (1.91 [1.52-2.40]) or > 60 years old (2.03 [1.48-2.71]), and those who presented with hypertension (2.84 [2.28-3.53]), diabetes mellitus (1.78 [1.42-2.25]), renal disease (3.58 [1.93-6.63]) or overactive bladder (1.61 [1.10-2.35]) were associated with higher prevalence of nocturia. A significantly lower disease prevalence (p < 0.05) was noted among those aged 41-50 (0.73 [0.59-0.91]), male (0.78 [0.69-0.88]) and Chinese (0.47 [0.30-0.74]) or Indian (0.34 [0.21-0.54]) ethnicities. A total of 37.3% of respondents with nocturia reported that they faced sleeping difficulty about half the time or more after waking up in the middle of night. Those who had ≥ 2 voids per night experienced significantly higher mean bother score than those who had 1 void per night (p < 0.001). Approximately half (56.7%) of all respondents were not aware that night time urination is a medical condition. Only 25.2% of respondents with nocturia had sought medical attention for their nocturia. CONCLUSIONS The prevalence of nocturia among Malaysian adults is high and strongly influenced by age, sex, race and comorbidities. However, the general awareness pertaining to nocturia being a health issue remains low among Malaysians. The findings also highlighted the impact of nocturia on sleep and the need for nocturia education to better address this disease.
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Affiliation(s)
- Hui-Yin Yow
- grid.452879.50000 0004 0647 0003School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University (Lakeside Campus), Subang Jaya, Malaysia
| | | | - Chun-Wai Mai
- grid.411729.80000 0000 8946 5787School of Pharmacy, International Medical University, Kuala Lumpur, Malaysia
| | - Esther van der Werf
- grid.425326.40000 0004 0397 0010Louis Bolk Institute, Bunnik, The Netherlands
| | - Zulkifli Md Zainuddin
- grid.412113.40000 0004 1937 1557Urology Unit, Department of Surgery, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Charng-Chee Toh
- grid.413442.40000 0004 1802 4561Department of Urology, Hospital Selayang, Selangor, Malaysia
| | - Kay-Seong Ngoo
- Department of Surgery, Hospital Angkatan Tentera Tuanku Mizan, Kuala Lumpur, Malaysia
| | - Eng-Hong Goh
- Urology, Nephrology & Men’s Health Clinic, Prince Court Medical Centre, Kuala Lumpur, Malaysia
| | - Ahmad Nazran Fadzli
- grid.10347.310000 0001 2308 5949Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Sze-Han Lok
- grid.452879.50000 0004 0647 0003School of Pharmacy, Faculty of Health and Medical Sciences, Taylor’s University (Lakeside Campus), Subang Jaya, Malaysia
| | - Teng-Aik Ong
- grid.10347.310000 0001 2308 5949Department of Surgery, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Iwata K, Koyama S, Yamazaki T, Kimura K, Sakurai H, Kanada Y. Effect of residual lower-extremity function on strategies and execution time for raising and lowering trousers in patients with hemiparetic stroke: a cross-sectional study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2020.0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/aims There are no established methods for patients with hemiparetic stroke to practice the raising and lowering of trousers. The aim of this study was to investigate the use of different strategies by patients with hemiparetic stroke for lowering and raising trousers by using the non-paretic upper limb in the standing position, based on residual motor function in the paretic lower limb. Methods A total of 28 patients with hemiparetic stroke were included in the study (n=10, 12, and 6 with lower-limb Brunnstrom stages III, IV and V respectively). Endpoints were execution time and frequency of changing the manipulation region. Results Lower-limb Brunnstrom stages III, IV and V were associated with execution times of 24.1 ± 11.1, 18.1 ± 6.5 and 16.9 ± 9.6 seconds respectively, and the mean frequency of manipulation of trousers on the posterior paretic side was significantly lower than those of the anterior paretic, anterior non-paretic, and posterior non-paretic sides in all patients (P<0.05). Conclusions Motor function of the paretic lower limb did not affect the strategies used for lowering and raising trousers with the non-paretic upper limb. Manipulation of trousers on the posterior paretic side was especially difficult.
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Affiliation(s)
- Kenji Iwata
- Rehabilitation, Medical Corporation Shoutokukai Hananooka Hospital, Matsusaka, Japan
| | - Soichiro Koyama
- School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Toshihiro Yamazaki
- Department of Rehabilitation, Shizuoka Saiseikai General Hospital, Sizuoka, Japan
| | - Keisuke Kimura
- Rehabilitation, Medical Corporation Shoutokukai Hananooka Hospital, Matsusaka, Japan
| | - Hiroaki Sakurai
- School of Health Sciences, Fujita Health University, Toyoake, Japan
| | - Yoshikiyo Kanada
- School of Health Sciences, Fujita Health University, Toyoake, Japan
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Improved global response outcome after intradetrusor injection of adult muscle-derived cells for the treatment of underactive bladder. Int Urol Nephrol 2021; 53:1331-1338. [PMID: 33840007 DOI: 10.1007/s11255-021-02847-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/25/2021] [Indexed: 12/25/2022]
Abstract
We report on the first regulatory approved clinical trial of a prospective open-label physician-initiated study assessing the safety and efficacy of intradetrusor injected Autologous Muscle Derived Cells (AMDC) treatment for underactive bladder (UAB). 20 non-neurogenic UAB patients were treated. Approximately 50-250 mg of quadriceps femoris muscle was collected using a spirotome 8-gauge needle. The muscle biopsy samples were sent to Cook MyoSite (Pittsburgh, PA) for processing, isolation, and propagation of cells. Research patients received approximately 30 intradetrusor injections of 0.5 mL delivered to the bladder, for a total of 15 mL and 125 million AMDC, performed utilizing a flexible cystoscope under direct vision using topical local anesthesia. Follow-up assessments included adverse events and efficacy via voiding diary and urodynamic testing at 1, 3, 6 and 12 months post-injection. An optional second injection was offered at the end of the 6 months visit. 20 patients received the first injection and all 20 patients requested and received a second injection. Median patient age was 65 years old (range 41-82 years). There were 16 male (80%) and 4 female (20%) patients. Etiology included 7 men (35%) with persistent urinary retention after transurethral resection of the prostate for benign prostatic hyperplasia and 13 patients (65%) with idiopathic chronic urinary retention. At the primary outcome time point of 12 months, 11/19 patients (58%) reported a global response assessment (GRA) ≥ 5, showing slight to marked improvement in their UAB symptoms, compared to 6/20 (30%) patients at 3 months post-injection. No serious procedure or treatment-related adverse events occurred. Noted improvements included: decreased post void residual urine volume, increased voiding efficiency, and decreased catheter use. Intradetrusor-injected AMDC as a treatment for UAB was successfully completed in a 20-patient trial without serious adverse event and with signal of efficacy. Cellular therapy may be a promising novel treatment for catheter-dependent chronic urinary retention. A multicenter controlled trial is needed to further assess the promise of regenerative medicine in the treatment of lower urinary tract dysfunction.
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Success of endoscopic prostatic surgery in patients with DUA: a prospective observational and analytic study. JOURNAL OF CLINICAL UROLOGY 2021. [DOI: 10.1177/2051415821993604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: Detrusor underactivity (DUA) is a highly prevalent and poorly understood disease in urology practice. Conservative treatment in the form of clean intermittent catheterization (CIC) and pharmacotherapy are in use for DUA without good results. Endoscopic prostate surgery was initially considered ineffective in such patients. But a recent series of retrospective studies showed promising results of surgery in DUA. Therefore, we conducted this prospective study to evaluate success of endoscopic prostatic surgery in a patient with DUA. Materials and methods: This is prospective observational study of 50 patients, satisfying the inclusion criteria, at Ruby Hall Clinic, Pune, conducted between March 2017 and March 2019. Inclusion criteria are that the patients are male, aged > 50 years; urodynamically diagnosed with DUA; a bladder contractility index < 90 with associated bladder outlet obstruction index (BOOI) between 20–40 (equivocal) or > 40 (obstruction), who presented with lower urinary tract symptoms and poor flow ( Qmax < 10 ml/s in a voided volume of >150 ml. Patients were excluded from the study if they had DUA due to neurological causes or spinal trauma, an acontractile detrusor, and were < 50 years. Results: The follow-up period for each patient was 12 months. The mean international prostate specific score reduced from 24.82 ± 2.74 preoperatively to 4.4 ± 1.85 postoperatively. Mean quality of life score reduced from 4.06 ± 0.68 to 0.82 ± 0.62. Mean Qmax increased from 6.26 ±1.46 ml/s to 12.22 ±1.6 ml/s. Mean post-void residual urine volume reduced form 241.9 ±74.9 to 77.3 ±20.75. All of these were statistically significant with a p value < 0.00001. Conclusion: Transurethral resection of the prostate (monopolar/laser) to reduce BOO should be considered as an alternative, viable treatment option in men with DUA. Preoperative counselling and postoperative follow-up are crucial in the management of such patients. Level of evidence:
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Treat or Wait? Natural Perioperative Course of Overactive Bladder Symptoms at the Time of Midurethral Sling Placement. Female Pelvic Med Reconstr Surg 2021; 27:e348-e351. [PMID: 32947550 DOI: 10.1097/spv.0000000000000927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to describe the perioperative course of untreated overactive bladder (OAB) (urinary frequency [UF] and urgency urinary incontinence [UUI]) before and after isolated retropubic midurethral sling (MUS) and to identify the time point for spontaneous OAB symptom improvement in the most patients. METHODS This is a prospective cohort study of women undergoing an isolated MUS. Women completed the Urogenital Distress Inventory 6 and Incontinence Impact Questionnaire 7 preoperatively and weekly for 13 weeks postoperatively. Bothersome UF and UUI were defined as a response of "moderately" or "greatly" bothered on questions 1 and 2 of the Urogenital Distress Inventory. The treatment for OAB was deferred until 13 weeks after surgery. RESULTS Fifty-four women were included with a mean ± SD age of 48 ± 9 years. Preoperatively, 41% of women reported both bothersome UF and UUI. Six weeks after surgery, only 15% and 6% reported bothersome UF and UUI (P < 0.001 and P < 0.001, respectively). Between 6 and 13 weeks, percentages of bothersome symptoms remained low (11.7% UF and 5.8% UUI). In addition, the impact of these urinary symptoms on activities, relationships, and feelings became consistently negligible (Incontinence Impact Questionnaire 7 median score <1) at 5 weeks postoperatively. Only 3 women desired treatment for UUI after the study period. CONCLUSIONS Overactive bladder is common before and immediately after MUS. However, the majority of patients have spontaneous symptom resolution by 6 weeks after surgery; it may be reasonable to discontinue preoperatively initiated overactive bladder treatment or defer starting treatment until this time point.
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Lubba CH, Ouyang A, Jones NS, Bruns TM, Schultz S. Bladder pressure encoding by sacral dorsal root ganglion fibres: implications for decoding. J Neural Eng 2020; 18. [PMID: 33202396 DOI: 10.1088/1741-2552/abcb14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 11/17/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We aim at characterising the encoding of bladder pressure (intravesical pressure) by a population of sensory fibres. This research is motivated by the possibility to restore bladder function in elderly patients or after spinal cord injury using implanted devices, so called bioelectronic medicines. For these devices, nerve-based estimation of intravesical pressure can enable a personalized and on-demand stimulation paradigm, which has promise of being more effective and efficient. In this context, a better understanding of the encoding strategies employed by the body might in the future be exploited by informed decoding algorithms that enable a precise and robust bladder-pressure estimation. APPROACH To this end, we apply information theory to microelectrode-array recordings from the cat sacral dorsal root ganglion while filling the bladder, conduct surrogate data studies to augment the data we have, and finally decode pressure in a simple informed approach. MAIN RESULTS We find an encoding scheme by different main bladder neuron types that we divide into three response types (slow tonic, phasic, and derivative fibres). We show that an encoding by different bladder neuron types, each represented by multiple cells, offers reliability through within-type redundancy and high information rates through semi-independence of different types. Our subsequent decoding study shows a more robust decoding from mean responses of homogeneous cell pools. SIGNIFICANCE We have here, for the first time, established a link between an information theoretic analysis of the encoding of intravesical pressure by a population of sensory neurons to an informed decoding paradigm. We show that even a simple adapted decoder can exploit the redundancy in the population to be more robust against cell loss. This work thus paves the way towards principled encoding studies in the periphery and towards a new generation of informed peripheral nerve decoders for bioelectronic medicines.
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Affiliation(s)
- Carl Henning Lubba
- Bioengineering, Imperial College London, Royal School of Mines, Exhibition Road, London, SW7 2AZ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Aileen Ouyang
- Department of Biomedical Engineering, University of Michigan , Ann Arbor, Michigan, UNITED STATES
| | - Nick S Jones
- Department of Mathematics, Imperial College London, London, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
| | - Tim M Bruns
- Department of Biomedical Engineering, University of Michigan , Ann Arbor, Michigan, UNITED STATES
| | - Simon Schultz
- Imperial College London, London, SW7 2AZ, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
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Magnetic targeting of super-paramagnetic iron oxide nanoparticle labeled myogenic-induced adipose-derived stem cells in a rat model of stress urinary incontinence. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2020; 30:102281. [PMID: 32763385 DOI: 10.1016/j.nano.2020.102281] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 06/23/2020] [Accepted: 07/26/2020] [Indexed: 12/31/2022]
Abstract
Cell-based injectable therapy utilizing stem cells is a promising approach for the treatment of stress urinary incontinence (SUI). Applying a magnetically controlled cell delivery approach has enormous potential to enhance cell retention capability within the specified site. To assess the therapeutic efficacy of cellular magnetic targeting, we applied an external magnetic force to target an adipose-derived stem cell based therapy in a rat model of SUI. The results revealed that magnetic attraction of transplanted cells under the magnetic field was generated by cell uptake of superparamagnetic iron oxide nanoparticles in vitro. More importantly, magnetic targeting improved the retention rate of transplanted cells and facilitated the restoration of sphincter structure and function in a rat SUI model according to the results of histological examination and urodynamic testing. Therefore, magnetically guided targeting strategy might be a potential therapy method for treatment of SUI.
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Zhang Y, Ahmadi M, Timm G, Sezen S, Rajamani R. An Instrumented Urethral Catheter with a Distributed Array of Iontronic Force Sensors. Ann Biomed Eng 2020; 49:149-161. [PMID: 32377979 DOI: 10.1007/s10439-020-02528-7] [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] [Received: 11/19/2019] [Accepted: 04/29/2020] [Indexed: 01/11/2023]
Abstract
This paper develops a novel instrumented urethral catheter with an array of force sensors for measuring the distributed pressure in a human urethra. The catheter and integrated portions of the force sensors are fabricated by the use of 3D printing using a combination of both soft and hard polymer substrates. Other portions of the force sensors consisting of electrodes and electrolytes are fabricated separately and assembled on top of the 3D-printed catheter to create a soft flexible device. The force sensors use a novel supercapacitive (iontronic) sensing mechanism in which the contact area between a pair of electrodes and a paper-based electrolyte changes in response to force. This provides a highly sensitive measure of force that is immune to parasitic noise from liquids. The developed catheter is tested using a force calibration test rig, a cuff-based pressure application device, an extracted bladder and urethra from a sheep and by dipping inside a beaker of water. The force sensors are found to have a sensitivity of 30-50 nF/N, which is 1000 times larger than that of traditional capacitive force sensors. They exhibit negligible capacitance change when dipped completely in water. The pressure cuff tests and the extracted sheep tissue tests also verify the ability of the sensor array to work reliably in providing distributed force measurements. The developed catheter could help diagnose ailments related to urinary incontinence and inadequate urethral closure pressure.
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Affiliation(s)
- Ye Zhang
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, USA
| | - Mahdi Ahmadi
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, USA
| | - Gerald Timm
- Department of Urology, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Serdar Sezen
- Department of Mechanical and Manufacturing Engineering, St. Cloud State University, St. Cloud, USA
| | - Rajesh Rajamani
- Department of Mechanical Engineering, University of Minnesota, Minneapolis, USA.
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Mostafaei H, Sadeghi‐Bazargani H, Hajebrahimi S, Salehi‐Pourmehr H, Ghojazadeh M, Onur R, Al Mousa RT, Oelke M. Prevalence of female urinary incontinence in the developing world: A systematic review and meta‐analysis—A Report from the Developing World Committee of the International Continence Society and Iranian Research Center for Evidence Based Medicine. Neurourol Urodyn 2020; 39:1063-1086. [DOI: 10.1002/nau.24342] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/21/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Hadi Mostafaei
- Research Center for Evidence Based MedicineFaculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
- Iranian Evidence Based Medicine (EBM) CentreJoanna Briggs Institute Affiliated Group Tabriz Iran
- Department of UrologyMedical University of Vienna Vienna Austria
| | - Homayoun Sadeghi‐Bazargani
- Research Center for Evidence Based MedicineFaculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
- Iranian Evidence Based Medicine (EBM) CentreJoanna Briggs Institute Affiliated Group Tabriz Iran
| | - Sakineh Hajebrahimi
- Research Center for Evidence Based MedicineFaculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
- Iranian Evidence Based Medicine (EBM) CentreJoanna Briggs Institute Affiliated Group Tabriz Iran
- Department of UrologyImam Reza Teaching Hospital, Tabriz University of Medical Sciences Tabriz Iran
- ICS Developing World Committee Bristol UK
| | - Hanieh Salehi‐Pourmehr
- Research Center for Evidence Based MedicineFaculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
- Iranian Evidence Based Medicine (EBM) CentreJoanna Briggs Institute Affiliated Group Tabriz Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence Based MedicineFaculty of Medicine, Tabriz University of Medical Sciences Tabriz Iran
- Iranian Evidence Based Medicine (EBM) CentreJoanna Briggs Institute Affiliated Group Tabriz Iran
| | - Rahmi Onur
- Department of Urology, Faculty of MedicineMarmara University Istanbul Turkey
| | - Riyad T. Al Mousa
- Department of UrologyKing Fahd Specialist Hospital‐Dammam Dammam Saudi Arabia
| | - Matthias Oelke
- Department of Urology, Pediatric Urology and Urologic OncologySt. Antonius Hospital Gronau Germany
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Long-Term Assessment of a Prospective Cohort of Patients Undergoing Laparoscopic Sacrocolpopexy. Obstet Gynecol 2020; 134:323-332. [PMID: 31306334 DOI: 10.1097/aog.0000000000003380] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report long-term outcomes after laparoscopic sacrocolpopexy. METHODS We conducted a prospective descriptive cohort study on 331 consecutive patients who underwent laparoscopic sacrocolpopexy for symptomatic prolapse (Pelvic Organ Prolapse Quantification [POP-Q] system stage 2 or greater) at one center, with minimum 1.5 years of follow-up by April 30, 2014. Primary outcome measures were Patient Global Impression of Change score and failure at the apex (C≥-1 cm; POP-Q stage 2 or greater). Secondary outcomes were anatomical failure in other compartments, duration of follow-up, occurrence and time point of complications, reinterventions, and functional outcomes by response to a standardized 24-question interview on prolapse and bladder, bowel, and sexual function. Assessment was by an experienced clinician not involved in patient management. RESULTS The follow-up rate was 84.6% (280/331); 185 of 331 (55.9%) patients were both physically examined and interviewed, and 95 of 331 (25.7%) were interviewed only. The median age at interview was 72 years (interquartile range 13 years), with a follow-up period of 85.5 months (interquartile range 46 months). Approximately 83% (231/280) reported improvement; 5.7% (16/280) were unchanged, 5.7% (16/280) felt slightly worse, and 6.8% (17/280) reported clear deterioration. Anatomical failure at point-C was 8.6% (16/185); anterior (22.2%, 41/185) and posterior (28.6%, 53/185) prolapse were more common than apical prolapse. Of those with level-I anatomical cure, 10.1% (17/185) felt worse; half of them (9/17) because of prolapse in another compartment. The others had urinary problems (41.2%, 7/17), obstructive defecation (11.8%, 2/17), or dyspareunia (11.8%, 2/17). Conversely, the majority of patients with recurrence at the vault (62.5%, 10/16) self-reported to be improved. The reoperation rate was 17.8% (48/270), including 19 (7.0%) for graft-related complications and nine (3.3%) for prolapse. CONCLUSION More than four out of five patients (82.5%) felt improved 86 months after laparoscopic sacrocolpopexy. Of those not improved, two thirds had recurrent prolapse; however, typically mid-vaginal. The other third reported urinary or bowel problems or dyspareunia. Reintervention for prolapse was 3.3%. The most common reasons for reoperation were graft-related complications (7.0%) and urinary incontinence (6.7%).
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Malde S, Kelly S, Saad S, Sahai A. Case‐finding tools for the diagnosis of OAB in women: A narrative review. Neurourol Urodyn 2020; 39:13-24. [DOI: 10.1002/nau.24171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/11/2019] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Sanad Saad
- Department of Urology Guy's Hospital London UK
| | - Arun Sahai
- Department of Urology Guy's Hospital London UK
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Sun Y, Liu Y, Su T, Yuan J, Liu Z. Medical, epidemiologic, and social aspects of aging urinary incontinence questionnaire: Study protocol for the translation and validation of a Chinese language version. Medicine (Baltimore) 2019; 98:e17719. [PMID: 31689809 PMCID: PMC6946395 DOI: 10.1097/md.0000000000017719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Mixed urinary incontinence (MUI) is a coexistence of both urgency urinary incontinence and stress urinary incontinence. Medical, Epidemiologic, and Social aspects of Aging (MESA) questionnaire is a validated and commonly used tool to diagnose predominant components of it and assess the severity, which can offer help in clinic. However, MESA questionnaire is still not available in China. The aim of the study is to translate English MESA questionnaire into a Chinese version, adapt it in Chinese culture, and validate the measurement properties among female patients with MUI and urgency-predominant MUI. METHODS MESA questionnaire will be translated and culturally adapted in China. The validation will be embedded in a multicentered randomized controlled trial targeted at women with urgency-predominant MUI. Apart from MESA questionnaire, 3 groups of patients are to receive clinical extended assessment, keep 3-day voiding diary, and complete International Consultation on Incontinence Questionnaire Short Form to evaluate the measurement properties of reliability and validity (internal consistence, test-retest reliability, construct validity, and responsiveness). DISCUSSION If MESA questionnaire is of relatively high reliability and validity in diagnosing subtypes of MUI and assessing the severity, it can help to choose more appropriate therapy for patients and simplify the workload of clinicians. TRIAL REGISTRATION ClinicalTrials.gov NCT03803878, January 11, 2019.
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Affiliation(s)
- Yuanjie Sun
- Department of Acupuncture Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Liu
- Key Laboratory of Chinese Internal Medicine of Ministry of Education, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Tongsheng Su
- Shanxi Province Hospital of Traditional Chinese Medicine, Xi’an, China
| | - Jingxue Yuan
- Beijing University of Chinese Medicine, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Rosenblatt P, McKinney J, Rosenberg RA, Iglesias RJ, Sutherland RC, Pulliam SJ. Evaluation of an accelerometer-based digital health system for the treatment of female urinary incontinence: A pilot study. Neurourol Urodyn 2019; 38:1944-1952. [PMID: 31310369 PMCID: PMC6852391 DOI: 10.1002/nau.24097] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/17/2019] [Indexed: 11/20/2022]
Abstract
Aims To assess the effectiveness and patient satisfaction of pelvic floor muscle training (PFMT) guided by an intravaginal accelerometer‐based system for the treatment of female urinary incontinence (UI). Methods Premenopausal women with mild‐to‐moderate stress or mixed UI were recruited to participate in PFMT with an accelerometer‐based system for 6 weeks with supervision. Objective outcomes included pelvic floor muscle (PFM) contraction duration, number of contractions in 15 seconds, and angular displacement of the accelerometer relative to earth during PFM contraction. Subjective outcomes and quality‐of‐life were assessed with validated, condition‐specific questionnaires. Results are presented as means, standard error of the mean, and 95% confidence intervals unless otherwise indicated. Results Twenty‐three women (age 42.0 ± 10.7 years, mean ± standard deviation) completed the study. Scores on the Urogenital Distress Inventory (UDI) decreased from 36.7 ± 4.7 at baseline to 1.45 ± 0.8 at 6 weeks (P < .0001). The Patient's Global Impression of Severity score decreased from 1.5 ± 0.1 to 0.2 ± 0.1 (P < .0001) at study endpoint. At 6 weeks, the PFM contraction duration increased from 13 ± 2.6 at baseline to 187 ± 9.6 seconds (P < .0001). Repeated contractions in 15 seconds increased from 5.9 ± 0.4 at enrollment to 9.6 ± 0.5 at 6 weeks (P < .0001). Maximum pelvic floor angle (a measure of lift) increased from 65.1 ± 2.0° to 81.1 ± 1.8° (P < .0001). Increasing PFM contraction duration and maximum pelvic floor angle correlated with decreasing UDI‐6 scores, r = −0.87, P = .01; r = −0.97, P = .0003, respectively. No device‐related adverse events occurred. Conclusions Pilot testing of this accelerometer‐based system demonstrates improvements in objective PFM measures, patient‐reported UI severity and condition‐specific quality of life, with results evident after 1 week of use.
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Affiliation(s)
- Peter Rosenblatt
- Division of Urogynecology, Harvard Medical School, Mount Auburn Hospital, Cambridge, Massachusetts
| | | | - Robert A Rosenberg
- Department of clinical research, New England Spine Care Associates, Stoneham, Massachusetts.,Department of clinical research, The Spine Center at Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | - Samantha J Pulliam
- Tufts University Medical School, Division of Urogyncology, Boston, Massachusetts
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Callewaert G, Housmans S, Cattani L, Pacquée S, D'Hoore A, Wyndaele J, Van der Aa F, Deprest J. Medium-term outcome of laparoscopic sacrocolpopexy using polivinylidene fluoride as compared to a hybrid polyglecaprone and polypropylene mesh: A matched control study. Neurourol Urodyn 2019; 38:1874-1882. [PMID: 31290173 DOI: 10.1002/nau.24083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 06/07/2019] [Indexed: 11/11/2022]
Abstract
AIM To compare 2-year outcomes of laparoscopic sacrocolpopexy (LSCP) either with polyvinylidene fluoride (PVDF) or hybrid polypropylene containing a resorbable polyglecaprone (PP+ PG) mesh. MATERIALS AND METHODS Retrospective audit on 105 consecutive patients undergoing LSCP a with PVDF-mesh (DynaMesh, FEG Textiltechniken), matched by prolapse stage and cervicopexy or vault suspension to 105 controls undergoing LSCP with a hybrid PP + PG-mesh (Ultrapro, Ethicon). Patients are part of an ongoing prospective study. The primary outcome measure was the Patient Global Impression of Change score (PGIC), the coprimary variable was failure rate at the vault (≤1 cm). Other outcomes were intraoperative and postoperative complications within 3 months categorized by the Clavien-Dindo classification, reinterventions, graft-related complications (GRCs) and functional outcomes. All assessments were performed by an independent assessor. Data are reported as median (interquartile range) number and percent as appropriate, the Mann-Whitney U, χ2 , or Fisher exact were used for comparison. RESULTS Patient satisfaction in the PVDF group, as measured with the PGIC, was high (90.9% PGIC, ≥4) as well as was the anatomical success (97.3%) at a follow-up of 26 months. These outcomes were comparable to those of PP + PG-patients (84.8% PGIC, ≥4; 94.9% anatomical success). There were five patients (2.4%) with Dindo-III or higher complications and three patients had GRCs (1.5%), without differences between mesh type. Level-II posterior defects (Bp ≥ -1) were less likely in PVDF patients (34.1% vs 50% for PP + PG-patients; P = .003). Women in the PVDF group also were less bothered by prolapse (7.5% vs 26.4%; P = .001), yet they complained more of constipation (15.0% vs 9.0%; P = .01). CONCLUSION There were no differences in patient satisfaction and anatomical outcomes after LSCP either with PVDF or PP + PG mesh.
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Affiliation(s)
- Geertje Callewaert
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Susanne Housmans
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium
| | - Laura Cattani
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Stefaan Pacquée
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - André D'Hoore
- Pelvic Floor Unit, Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium.,Oncology and Biomedical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jan Wyndaele
- Pelvic Floor Unit, Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Frank Van der Aa
- Pelvic Floor Unit, Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Jan Deprest
- Pelvic Floor Unit, Department of Gynaecology, University Hospitals Leuven, Leuven, Belgium.,Academic Department of Development and Regeneration, Katholieke Universiteit Leuven, Leuven, Belgium
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Kim HJ, Moon JH, Oh YH, Kong MH, Huh JS. Association between urinary incontinence and bone health in Korean elderly women based on data from the Korea National Health and Nutrition Examination Survey. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/99586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Korkes F, Baccaglini W, Silveira MA. Is ureteral stent an effective way to deliver drugs such as bacillus Calmette-Guérin to the upper urinary tract? An experimental study. Ther Adv Urol 2019; 11:1756287219836895. [PMID: 30944588 PMCID: PMC6437322 DOI: 10.1177/1756287219836895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/18/2019] [Indexed: 11/30/2022] Open
Abstract
Background: We aim to evaluate the distribution in the upper urinary tract of intravesical-delivered fluids, after inducing vesicoureteral reflux (VUR) with a double J stent. Methods: In group 1 (n = 35) patients were maintained in a 20° Trendelenburg position and were evaluated after immediate insertion of ureteral stent, while in group 2 (n = 16) patients were evaluated after several days with ureteral stent placement. Patients in both groups were submitted to a cystogram with progressive volumes of iodine contrast and were evaluated according to VUR of contrast medium to the renal pelvis. Additionally, in group 2 visual confirmation was performed by endoscopic inspection of upper tract mucosal impregnation with methylene blue. Results: In group 1, after immediate insertion of ureteral stent reflux occurred in 51.4% (n = 18/35), and after several days with ureteral stent placement reflux was observed in 87.5% (n = 14/16) of patients. Reflux was progressively more frequent according to increasing bladder volume (p < 0.001). At 60 ml bladder volume no reflux was observed, while at 120 ml, 180 ml, 240 ml, 300 ml and 360 ml bladder volume reflux was observed in 14%, 25%, 41%, 55% and 63% of patients, respectively. Conclusion: Retrograde delivery of fluids such as bacillus Calmette-Guérin to the upper urinary tract through double J stents can be effective; however, it is mainly effective after several days with ureteral stent and relatively large volumes might be instilled into the bladder.
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Affiliation(s)
- Fernando Korkes
- Discipline of Urology, Faculdade de Medicina do ABC, Santo André, SP, Brazil Division of Urology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Willy Baccaglini
- Discipline of Urology - Faculdade de Medicina do ABC, Av. Lauro Gomes, 2000 - Anexo II, Vila Sacadura Cabral - Santo André, SP, CEP: 09060-870, Brazil
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Hu Y, Lou Y, Liao L, Xu M, Zhang H, Yang Q, Wu H. Comparison of Urodynamics and Perineal Ultrasonography for the Diagnosis of Mixed Urinary Incontinence in Women. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2647-2656. [PMID: 29608019 DOI: 10.1002/jum.14626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/25/2018] [Accepted: 02/04/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study aimed to compare urodynamic studies (UDS) and perineal ultrasonography (US) for the assessment of mixed urinary incontinence (MUI) in women in China. METHODS Adult women with MUI and healthy control participants were enrolled from 2 centers in China (Zhejiang and Beijing) between September 2010 and April 2017. Baseline clinical characteristics were recorded. The MUI type was categorized by the King's Health Questionnaire: stress-predominant, urge-predominant, or equal predominance. Urodynamic studies were performed, followed within 1 week by perineal US. Tolerability of the investigations was compared by a 3-point scale: better than, worse than, or equal to. RESULTS For UDS parameters, compared with controls, the urge-predominant MUI group had a lower maximal flow rate, smaller bladder volume, higher detrusor pressure at urethral opening, higher detrusor pressure at maximal flow, and higher incidence of detrusor overactivity; the stress-predominant MUI group had a lower maximal urethral closure pressure and functional urethral length; and the equal MUI group had a higher detrusor pressure at maximal flow and lower maximal urethral closure pressure (P < .05). For US parameters, compared with controls, the stress-predominant MUI group had a greater dynamic posterior urethral angle, dynamic angle of urethral inclination, descent of the bladder neck, and dynamic pubourethral distance; the urge-predominant MUI group had a greater detrusor thickness; and the equal MUI group had a greater descent of the bladder neck (P < .05). All UDS and US parameters differed significantly between the stress-predominant and urge-predominant groups (P < .05). The dynamic angle of urethral inclination, descent of the bladder neck, and dynamic pubourethral distance were inversely correlated with detrusor pressure at maximal flow and functional urethral length, while detrusor wall thickness was positively correlated with detrusor pressure at maximal flow and functional urethral length. Perineal US was better tolerated than UDS. CONCLUSIONS Perineal US parameters show good correlations with UDS parameters. Ultrasonography is better tolerated than UDS and provides additional morphologic data. Perineal US could facilitate the diagnosis of urge-predominant MUI.
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Affiliation(s)
- Yang Hu
- Department of Urology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Yelin Lou
- Department of Ultrasonography , Jinhua Municipal Central Hospital, Jinhua, China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Center, Rehabilitation College of Capital Medical University, Beijing, China
| | - Min Xu
- Department of Urology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Heng Zhang
- Department of Urology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Qing Yang
- Department of Urology, Jinhua Municipal Central Hospital, Jinhua, China
| | - Haixiao Wu
- Department of Urology, Jinhua Municipal Central Hospital, Jinhua, China
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Trabuco EC, Linder BJ, Klingele CJ, Blandon RE, Occhino JA, Weaver AL, McGree ME, Gebhart JB. Two-Year Results of Burch Compared With Midurethral Sling With Sacrocolpopexy: A Randomized Controlled Trial. Obstet Gynecol 2018; 131:31-38. [PMID: 29215517 PMCID: PMC5740001 DOI: 10.1097/aog.0000000000002415] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate 1- and 2-year urinary continence rates after Burch retropubic urethropexy compared with a retropubic midurethral sling for women with urinary incontinence undergoing sacrocolpopexy. METHODS We conducted a planned secondary analysis of a multicenter, randomized, single-blind trial comparing Burch with a sling that enrolled participants from June 2009 to August 2013. Objective outcome measures of continence were assessed at 1- and 2-year follow-up through office visits and validated questionnaires. Overall continence was defined as a negative stress test, no retreatment for stress incontinence, and no self-reported urinary incontinence (International Consultation on Incontinence Questionnaire, Short Form, score, 0). Stress-specific continence was defined as fulfillment of the first two criteria and no self-reported stress-related incontinence. Primary outcomes were assessed with intention-to-treat and within-protocol analyses. Comparisons between groups were evaluated using χ or Fisher exact test. RESULTS The two groups were similar in all measured baseline features. Outcome assessments at 2 years were available for 48 of 57 patients (84%) in the sling group and 45 of 56 patients (80%) in the Burch group. With intention-to-treat analysis, the sling group had significantly higher rates of overall continence than the Burch group (49% [28/57] vs 29% [16/56]; 95% CI for absolute risk difference 3.0-38.1; P=.03) at 1- but not 2-year follow-up (47% [27/57] vs 32% [18/56]; 95% CI for absolute risk difference -2.6 to 33.1; P=.10). The sling group had significantly higher rates of stress-specific continence than the Burch group at 1-year (70% [40/57] vs 46% [26/56]; 95% CI for absolute risk difference 6.1-41.4; P=.01) and 2-year (70% [40/57] vs 45% [25/56]; 95% CI for absolute risk difference 7.9-43.2; P=.006) follow-up. No difference was detected in prolapse recurrence, voiding dysfunction, antimuscarinic medication use, urgency incontinence, or patient satisfaction. CONCLUSION Among women with baseline urinary incontinence undergoing sacrocolpopexy, the retropubic midurethral sling resulted in higher stress-specific continence rates than Burch retropubic urethropexy at 1- and 2-year follow-up.
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Affiliation(s)
- Emanuel C Trabuco
- Divisions of Gynecologic Surgery and Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota; and the Department of Obstetrics and Gynecology, University of Missouri, Kansas City, Missouri
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Blaivas JG, Forde JC, Davila JL, Policastro L, Tyler M, Aizen J, Badri A, Purohit RS, Weiss JP. Surgical treatment of detrusor underactivity: a short term proof of concept study. Int Braz J Urol 2017; 43:540-548. [PMID: 28266820 PMCID: PMC5462147 DOI: 10.1590/s1677-5538.ibju.2016.0405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Accepted: 10/25/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To compare the surgical outcomes of men with bladder outlet obstruction (BOO) due to benign prostatic obstruction (BPO) to those with detrusor underactivity (DU) or acontractile detrusor (DA). MATERIALS AND METHODS This retrospective, IRB approved study included men who underwent BPO surgery for refractory LUTS or urinary retention. Patients were grouped based on videourodynamic (VUDS) findings: 1) men with BOO, 2) men with DU and 3) men with DA. The primary outcome measure was the Patient Global Impression of Improvement (PGII). Secondary outcome measures included uroflow (Qmax), post-void residual volume (PVR) and the need for clean intermittent catheterization (CIC). RESULTS One hundred and nineteen patients were evaluated: 1) 34 with BOO, 2) 62 with DU and 3) 23 with DA. Subjective success rate (PGII) was highest in the BOO group (97%) and those with DU (98%), while DA patients had a PGII success of 26%, (p<0.0001). After surgery, patients with BOO had the lowest PVR (68.5mL). Fifty-six patients (47%) performed CIC pre-operatively (47% of BOO, 32% of DU and 87% of DA patients). None of the patients in the BOO and DU groups required CIC post operatively compared to16/23 (69%) of patients in the DA group (p<0.0001). CONCLUSIONS BPO surgery is a viable treatment option in men with presumed BOO and DU while DA is a poor prognostic sign in men who do not void spontaneously pre-operatively.
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Affiliation(s)
- Jerry G Blaivas
- Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.,Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - James C Forde
- Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Jonathan L Davila
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Lucas Policastro
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Michael Tyler
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Joshua Aizen
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Anand Badri
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Rajveer S Purohit
- Department of Urology, Weill Medical College of Cornell University, New York, NY, USA.,Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Medical School, Brooklyn, NY, USA.,Institute for Bladder and Prostate Research, New York, NY, USA
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Burch Retropubic Urethropexy Compared With Midurethral Sling With Concurrent Sacrocolpopexy: A Randomized Controlled Trial. Obstet Gynecol 2017; 128:828-35. [PMID: 27607858 DOI: 10.1097/aog.0000000000001651] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare efficacy and safety of retropubic Burch urethropexy and a midurethral sling in women with stress urinary incontinence (SUI) undergoing concomitant pelvic floor repair with sacrocolpopexy. METHODS Women were randomly assigned to Burch retropubic urethropexy (n=56) or retropubic midurethral sling (n=57) through dynamic allocation balancing age, body mass index, history of prior incontinence surgery, intrinsic sphincter deficiency, preoperative incontinence diagnosis, and prolapse stage. Overall and stress-specific continence primary outcomes were ascertained with validated questionnaires and a blinded cough stress test. RESULTS Enrollment was June 1, 2009, through August 31, 2013. At 6 months, no difference was found in overall (29 midurethral sling [51%] compared with 23 Burch [41%]; P=.30) (odds ratio [OR] 1.49, 95% confidence interval [CI] 0.71-3.13) or stress-specific continence rates (42 midurethral sling [74%] compared with 32 Burch [57%]; P=.06) (OR 2.10, 95% CI 0.95-4.64) between groups. However, the midurethral sling group reported greater satisfaction (78% compared with 57%; P=.04) and were more likely to report successful surgery for SUI (71% compared with 50%; P=.04) and to resolve pre-existing urgency incontinence (72% compared with 41%; P=.03). No difference was found in patient global impression of severity or symptom improvement, complication rates, or mesh exposures. CONCLUSION There was no difference in overall or stress-specific continence rates between midurethral sling and Burch urethropexy groups at 6 months. However, the midurethral sling group reported better patient-centered secondary outcomes.
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Lee HY, Li CC, Juan YS, Chang YH, Yeh HC, Tsai CC, Chueh KS, Wu WJ, Yang YH. Urinary Incontinence in Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2017; 32:51-55. [PMID: 28100075 PMCID: PMC10852810 DOI: 10.1177/1533317516680900] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
OBJECTIVES Urinary incontinence (UI) is more prevalent in the elderly populations with dementia than without dementia, and Alzheimer's disease (AD) is the most common cause of dementia. Urinary incontinence may complicate AD morbidity and mortality. Therefore, this study aimed to evaluate the prevalence and annual incidence and determine the risk possibility of UI, which is the main type of incontinence in patients with AD in Taiwan. METHODS A total of 933 patients with AD were included in the study cohort, and a total of 2799 patients without AD by 1:3 proportion compared to the study cohort were used as a matched cohort. All participants were selected from the National Health Insurance Research Database in 2000 sample population. We utilize Cox proportional hazard regression to evaluate the risk of UI and cumulative incidence ratio curve to analyze the cumulative incidence function. Prevalence and annual incidence rate are calculated in individual medication including rivastigmine, donepezil, galantamine, and memantine only being initiated in patients with AD. RESULTS The risk of UI is higher in AD cohort (hazard ratio: 1.54, 95% confidence interval: 1.13-2.09). The cumulative incidence ratio of UI event between AD cohort and matched cohort presents statistical significance ( P < .001). Annual incidence and prevalence of UI in patients with AD are 6.2% and 4.2%, respectively. CONCLUSION The present results suggest that the risk of UI is higher in patients with AD than in the general population.
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Affiliation(s)
- Hsiang-Ying Lee
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Ching-Chia Li
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yung-Shun Juan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan
| | - Yu-Han Chang
- Management Office, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Hsin-Chih Yeh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Chun Tsai
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Kuang-Shun Chueh
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
| | - Wen-Jeng Wu
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Faculty of Medicine, Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yuan-Han Yang
- Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
- Department of and Master’s Program in Neurology, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Kim HJ. Management of urinary incontinence in geriatric hospitals. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.7.542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hyung Jee Kim
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
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Andersson KE, Boedtkjer DB, Forman A. The link between vascular dysfunction, bladder ischemia, and aging bladder dysfunction. Ther Adv Urol 2016; 9:11-27. [PMID: 28042309 DOI: 10.1177/1756287216675778] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The vascular supply to the human bladder is derived mainly from the superior and inferior vesical arteries, the latter being directly connected to the internal iliac artery. Aging is associated with an impairment of blood vessel function and changes may occur in the vasculature at the molecular, cellular and functional level. Pelvic arterial insufficiency may play an important role in the development of bladder dysfunctions such as detrusor overactivity (DO) and the overactive bladder syndrome. Chronic ischemia-related bladder dysfunction may progress to bladder underactivity and it would be desirable to treat not only lower urinary tract symptoms (LUTS) induced by chronic ischemia, but also the progression of the morphological bladder changes. Studies in experimental models in rabbits and rats have shown that pelvic arterial insufficiency may result in significant bladder ischemia with reduced bladder wall oxygen tension. In turn, this will lead to oxidative stress associated with upregulation of oxidative stress-sensitive genes, increased muscarinic receptor activity, ultrastructural damage, and neurodegeneration. The phosphodiesterase type 5 (PDE5) inhibitor tadalafil, the α1-adrenoceptor (AR) blocker silodosin, the β3-AR agonist mirabegron, and the free radical scavenger melatonin, exerted a protecting effect on urodynamic parameters, and on functional and morphological changes of the bladder demonstrable in vitro. Since the agents tested are used clinically for relieving LUTS, the results from the animal models seem to have translational value, and may be of relevance for designing clinical studies to demonstrate if the drugs may prevent progression of ischemia-related functional and morphological bladder changes.
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Affiliation(s)
- Karl-Erik Andersson
- Institute of Clinical Medicine, Department of Obstetrics and Gynecology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK 8200 Aarhus N, Denmark
| | | | - Axel Forman
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Denmark
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Garcia-Gordillo MA, Collado-Mateo D, Olivares PR, Adsuar JC. Application of EQ-5D-5L questionnaire in patients suffering from urinary incontinence. Actas Urol Esp 2016; 40:457-62. [PMID: 26975979 DOI: 10.1016/j.acuro.2016.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Urinary incontinence is associated with reduced quality of life and given the high prevalence of people with this condition, it could be useful to know the impact of having urinary incontinence on physical, psychological and social aspects. The Spanish value set of EQ-5D was used to assign single scores to the EQ-5D-5L health states. EQ-5D-5L is a health-related quality of life questionnaire, which allows assessing health status. The aim of this study was to provide normative values of EQ-5D-5L in a population sample with urinary incontinence. STUDY DESIGN Cross-sectional study. METHODS A total of 965 people with urinary incontinence (297 men and 668 women) were included in this study. EQ-5D-5L index, VAS and health status are showed in the current study considering gender, age group, region, marital status, smoking status, net monthly incomes of household and educational level. RESULTS Higher prevalence was observed in women (69.22%) compared with men (30.78%). Mean (SD) EQ-5D-5L utility index and VAS score were 0.58 (0.40) and 53.91 (22.16), respectively, for overall population. The 16.1% (155 people) reported perfect health status (11111). The utility equivalent to set values 55555 was not reported by anyone. CONCLUSION This study provides normative values of EQ-5D-5L in a Spanish population sample with urinary incontinence.
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Affiliation(s)
- M A Garcia-Gordillo
- Departamento de Economía, Universidad de Extremadura, Badajoz, España; Departamento de Economía Aplicada, Universidad de Murcia, Murcia, España.
| | - D Collado-Mateo
- Facultad de Ciencias del Deporte, Universidad de Extremadura, Cáceres, España
| | - P R Olivares
- Instituto de Actividad Física y Salud, Universidad Autonoma de Chile, Talca, Chile
| | - J C Adsuar
- Departamento de Economía Aplicada, Universidad de Murcia, Murcia, España; Facultad de Ciencias del Deporte, Universidad de Extremadura, Cáceres, España
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Ruby CM, Hanlon JT, Fillenbaum GG, Pieper CF, Branch LG, Bump RC. Medication Use and Control of Urination Among Community-Dwelling Older Adults. J Aging Health 2016; 17:661-74. [PMID: 16177455 DOI: 10.1177/0898264305279875] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The purpose of this study is to evaluate whether the use of medications with urological activity (UA) is associated with self-reported difficulty in control of urination. Methods: This is a cross-sectional study using data from the Duke Established Populations for Epidemiologic Studies of the Elderly. Results: Difficulty holding urine was reported by 49.5% of men and 54.0% of the women. Overall, 50.9% of men and 72.7% of the women took one or more medications with UA. Multivariable logistic regression for men revealed that neither use of any medication with UA (Adjusted [Adj.] Odds Ratio [OR] 1.12, 95% confidence interval [CI] 0.84-1.50) nor the number of medications with UA used was associated with urinary difficulties (Adj. OR 1.08, 95% CI 0.97-1.21). For women, there was a significant association (p < .05) between use of any medication with UA and reported urinary difficulty (Adj. OR = 1.31, 95% CI = 1.05-1.62). Discussion: Medications with UA may be related to difficulty in controlling urine among community-dwelling elderly women.
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Affiliation(s)
- Christine M Ruby
- Duke University Medical Center, Veterans Affairs Medical Center, University of North Carolina, USA
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Kincade JE, Johnson TM, Ashford-Works C, Clarke MK, Busby-Whitehead J. A Pilot Study to Determine Reasons for Patient Withdrawal From a Pelvic Muscle Rehabilitation Program for Urinary Incontinence. J Appl Gerontol 2016. [DOI: 10.1177/073346489901800307] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This project explored reasons why patients with urinary incontinence withdrew from a behavioral treatment program before completion of all sessions. In-depth, semistructured interviews were conducted with 10 of 25 patients who had not completed prescribed behavioral treatment at the University of North Carolina–Chapel Hill School of Medicine Continence Clinic. The women interviewed made positive or neutral comments about Kegel exercises and understood the relationship between urinary incontinence and pelvic muscle weakness. They perceived a relationship between age and urinary incontinence but did not think that incontinence was inevitable with aging. Treatment of urinary incontinence became less of a priority when work, physical impairments, or illness intervened and when there appeared to be some misunderstanding about the treatment. These findings suggest that clinicians need to better understand perceived barriers to adherence in order to discuss these barriers and to design a more individualized approach for each patient in a continence clinic.
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Li X, Liao L. Updates of underactive bladder: a review of the recent literature. Int Urol Nephrol 2016; 48:919-30. [DOI: 10.1007/s11255-016-1251-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/16/2016] [Indexed: 12/21/2022]
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Ahmadi M, Rajamani R, Timm G, Sezen A. Flexible Distributed Pressure Sensing Strip for a Urethral Catheter. JOURNAL OF MICROELECTROMECHANICAL SYSTEMS : A JOINT IEEE AND ASME PUBLICATION ON MICROSTRUCTURES, MICROACTUATORS, MICROSENSORS, AND MICROSYSTEMS 2015; 24:1840-1847. [PMID: 27065719 PMCID: PMC4824413 DOI: 10.1109/jmems.2015.2444992] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A multi-sensor flexible strip is developed for a urethral catheter to measure distributed pressure in a human urethra. The developed sensor strip has important clinical applications in urodynamic testing for analyzing the causes of urinary incontinence in patients. There are two major challenges in the development of the sensor. First, a highly sensitive sensor strip that is flexible enough for urethral insertion into a human body is required and second, the sensor has to work reliably in a liquid in-vivo environment in the human body. Capacitive force sensors are designed and micro-fabricated using polyimide/PDMS substrates and copper electrodes. To remove the parasitic influence of urethral tissues which create fringe capacitance that can lead to significant errors, a reference fringe capacitance measurement sensor is incorporated on the strip. The sensing strip is embedded on a catheter and experimental in-vitro evaluation is presented using a bench-top pressure chamber. The sensors on the strip are able to provide the required sensitivity and range. Preliminary experimental results also show promise that by using measurements from the reference parasitic sensor on the strip, the influence of parasitics from human tissue on the pressure measurements can be removed.
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Affiliation(s)
- Mahdi Ahmadi
- Department of Mechanical Engineering, University of Minnesota, Twin Cities, MN 55455
| | - Rajesh Rajamani
- Department of Mechanical Engineering, University of Minnesota, Twin Cities, MN 55455
- Corresponding author: , tel: (612) 626-7961
| | - Gerald Timm
- Department of Urology, University of Minnesota, Twin Cities, MN 55455
| | - A.S. Sezen
- Department of Mechanical Engineering, University of Minnesota, Twin Cities, MN 55455
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Kachorovski LW, Moraes CCS, Rosa EDM, Gruber CR. Effect of isostretching on the quality of life of incontinent older women. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.004.ao18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract Introduction : Urinary incontinence (UI) can be defined as a brief involuntary loss of urine. It is a hygienic and social problem that affects mainly older women and contributes to reduced quality of life (QoL). There are currently several therapeutic strategies available for the treatment of UI, including the method of Isometric Stretching, which is based on balance exercises that lead to greater flexibility and stronger joints, tendons and muscles. Objective : To investigate the effect of Isometric Stretching on the QoL of 10 institutionalized older women with complaint of UI. Materials and methods : We used the ICIQ-SF to assess women's QoL pre- and post-treatment. The study duration was 12 weeks. Results : 80% of the women showed a significant improvement in UI (p = 0.007061) and QoL (p = 0.011). Conclusion : We concluded that Isometric Stretching contributed to a significant improvement in urinary incontinence symptoms and quality of life in incontinent older women.
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de Groat WC, Yoshimura N. Anatomy and physiology of the lower urinary tract. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:61-108. [PMID: 26003239 DOI: 10.1016/b978-0-444-63247-0.00005-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. Neural control of micturition is organized as a hierarchic system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brainstem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brainstem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily during the early postnatal period, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults cause re-emergence of involuntary micturition, leading to urinary incontinence. The mechanisms underlying these pathologic changes are discussed.
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Affiliation(s)
- William C de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Naoki Yoshimura
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Fujimori I, Yukawa T, Kamei T, Nakada Y, Sakauchi N, Yamada M, Ohba Y, Takiguchi M, Kuno M, Kamo I, Nakagawa H, Hamada T, Igari T, Okuda T, Yamamoto S, Tsukamoto T, Ishichi Y, Ueno H. Design, synthesis and biological evaluation of a novel series of peripheral-selective noradrenaline reuptake inhibitor. Bioorg Med Chem 2015; 23:5000-5014. [DOI: 10.1016/j.bmc.2015.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 05/06/2015] [Accepted: 05/08/2015] [Indexed: 11/29/2022]
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Arslanturk S, Siadat MR, Ogunyemi T, Killinger K, Diokno A. Analysis of incomplete and inconsistent clinical survey data. Knowl Inf Syst 2015. [DOI: 10.1007/s10115-015-0850-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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MacLachlan LS, Rovner ES. New treatments for incontinence. Adv Chronic Kidney Dis 2015; 22:279-88. [PMID: 26088072 DOI: 10.1053/j.ackd.2015.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 03/03/2015] [Accepted: 03/06/2015] [Indexed: 11/11/2022]
Abstract
Urinary incontinence (UI) is a common, yet underdetected and under-reported, health problem that can significantly affect quality of life. UI may also have serious medical and economic ramifications for untreated or undertreated patients, including perineal dermatitis, worsening of pressure ulcers, urinary tract infections, and falls. To prevent incontinence, the urethral sphincter must maintain adequate closure to resist the flow of urine from the bladder at all times until voluntary voiding is initiated and the bladder must accommodate increasing volumes of urine at a low pressure. UI can be categorized as a result of urethral underactivity (stress UI), bladder overactivity (urge UI), a combination of the 2 (mixed incontinence), or urethral overactivity/bladder underactivity (overflow incontinence). The main goal of therapy for the management of UI is to reduce the number of UI episodes, prevent complications, and, if possible, restore continence. This review highlights the existing treatment of stress, urge, mixed, and overflow UI in adult men and women and discusses many of the novel treatments including potential future or emerging therapies.
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Continence Index: a new screening questionnaire to predict the probability of future incontinence in older women in the community. Int Urol Nephrol 2015; 47:1091-7. [PMID: 25982584 DOI: 10.1007/s11255-015-1006-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/30/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Urinary incontinence (UI) is a chronic, costly condition that impairs quality of life. To identify older women most at risk, the Medical Epidemiologic and Social Aspects of Aging (MESA) datasets were mined to create a set of questions that can reliably predict future UI. METHODS MESA data were collected during four household interviews at approximately 1 year intervals. Factors associated with becoming incontinent at the second interview (HH2) were identified using logistic regression (construction datasets). Based on p values and odds ratios, eight potential predictive factors with their 256 combinations and corresponding prediction probabilities formed the Continence Index. Its predictive and discriminatory capability was tested against the same cohort's outcome in the fourth survey (HH4 validation datasets). Sensitivity analysis, area under receiver operating characteristic (ROC) curve, predicted probabilities and confidence intervals were used to statistically validate the Continence Index. RESULTS Body mass index, sneezing, post-partum UI, urinary frequency, mild UI, belief of developing UI in the future, difficulty stopping urinary stream and remembering names emerged as the strongest predictors of UI. The confidence intervals for prediction probabilities strongly agreed between construction and validation datasets. Calculated sensitivity, specificity, false-positive and false-negative values revealed that the areas under the ROCs (0.802 and 0.799) for the construction and validation datasets, respectively, indicated good discriminatory capabilities of the index as a predictor. CONCLUSION The Continence Index will help identify older women most at risk of UI in order to apply targeted prevention strategies in women that are most likely to benefit.
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