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Zhou Z, Zhang Y, Deng H, Qin X, Sun Y. Comparison of acupuncture and moxibustion related non-surgical therapies for women with stress urinary incontinence: A systematic review and network meta-analysis of randomized controlled trials. Explore (NY) 2024; 20:493-500. [PMID: 38092652 DOI: 10.1016/j.explore.2023.11.010] [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: 06/25/2023] [Revised: 09/22/2023] [Accepted: 11/19/2023] [Indexed: 06/16/2024]
Abstract
BACKGROUND Stress urinary incontinence (SUI) significantly impacts women's health and imposes substantial mental and socio-economic burdens. Acupuncture and moxibustion, either alone or in combination with other non-surgical therapies, are recognized as effective treatments for SUI. This study aimed to assess the efficacy of various treatments for women with SUI using network meta-analysis (NMA). METHOD We systematically searched databases up until June 30, 2022, to identify relevant randomized controlled trials (RCTs) focusing on SUI in women. Subsequently, the quality of the included studies was assessed. NMA was performed using STATA 14.0 software. RESULTS A total of 31 RCTs involving 2922 participants were included in the analysis. A total of 18 treatment plans were identified. The treatment plan consisting of Moxibustion + PFMT + EB demonstrated the most significant reduction in ICIQ-UI-SF. Due to lack of consistency across studies, a NMA was not performed for the outcomes of effectiveness and the 1 h pad test. CONCLUSIONS The combined intervention of Moxibustion + PFMT + EB appears to be the most effective in reducing patients' reported symptoms and improving their quality of life. However, due to the limitations of the included studies, further high-quality RCTs are necessary to reinforce the current evidence.
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Affiliation(s)
- Zelin Zhou
- Pingshan General Hospital, Southern Medical University, Shenzhen, Guangdong, PR China; Pingshan District People's Hospital of Shenzhen, Shenzhen, Guangdong, PR China
| | - Yang Zhang
- Pingshan General Hospital, Southern Medical University, Shenzhen, Guangdong, PR China; Pingshan District People's Hospital of Shenzhen, Shenzhen, Guangdong, PR China
| | - Haowei Deng
- The Second Clinical College, Guangdong Medical University, Dongguan 523109, PR China
| | - Xiaowen Qin
- General Practice School, Guangxi Medical University, Nanning 530021, PR China
| | - Yuping Sun
- Pingshan General Hospital, Southern Medical University, Shenzhen, Guangdong, PR China; Pingshan District People's Hospital of Shenzhen, Shenzhen, Guangdong, PR China.
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Lorzadeh N, Jahanshahi M. The effect of duloxetine on stress urinary incontinence. Health Sci Rep 2024; 7:e2091. [PMID: 38736475 PMCID: PMC11082090 DOI: 10.1002/hsr2.2091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/28/2023] [Accepted: 03/19/2024] [Indexed: 05/14/2024] Open
Abstract
Background and Aims This study aims to evaluate the effect of duloxetine on stress urinary incontinence (SUI) episode frequency (IEF) per week IEF. Methods In this clinical trial, 100 women aged 20-80 years with urinary incontinence were assessed based on the standard questionnaire of urinary tract disorders. All the patients received a placebo for 2 weeks. Patients were then randomly divided into two groups of 50 patients each, receiving duloxetine (40 mg twice a day for 12 weeks) and placebo. The two groups were compared in terms of IEF and the mean score of quality of life and side effects. Results The two groups of duloxetine and placebo recipients were matched at the beginning of the study in terms of age, BMI, IEF, parity, and type of delivery. IEF significantly decreased in the duloxetine recipient group compared to the placebo group. The mean score of quality of life in the duloxetine recipient group increased significantly. The rate of study abandonment in the duloxetine recipient group was significantly higher than in the placebo group. Vertigo was the most common complication that caused patients to discontinue the use of the drug. Conclusion Duloxetine is therapeutically effective for SUI in women. Patients should be provided information regarding potential side effects and their management.
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Affiliation(s)
- Nahid Lorzadeh
- Department Obstetrics and Gynecology, Faculty of MedicineLorestan University of Medical SciencesKhorramabadIran
| | - Moghadaseh Jahanshahi
- Department of Obstetrics and Gynecology, School of Medicine, Sayyad Shirazi HospitalGolestan University of Medical SciencesGorganIran
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3
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Goessens EMV, Cammu H. A 10- to 20-year follow-up after tension-free vaginal tape for stress urinary incontinence. Int Urogynecol J 2023; 34:2107-2114. [PMID: 37000213 DOI: 10.1007/s00192-023-05510-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/17/2023] [Indexed: 04/01/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Midurethral slings (MUS) have become the gold standard in the treatment of stress urinary incontinence (SUI). Some information is already available on the outcome of tension-free vaginal tape (TVT) after 10 years or more. Our objective was to assess the current outcome (efficacy, adverse events) of women who had been successfully operated upon for SUI by means of a TVT procedure 10 to 20 years ago. METHODS We performed a retrospective cohort study including 291 women (mean age 69.4 years) who underwent a successful TVT procedure (retropubic bottom-to-top route) in a teaching hospital between January 2001 and December 2010. The main outcome measure was the incidence of SUI at 10-20 years' follow-up. Others were incidence of re-operation, tape exposure and de novo overactive bladder symptoms. We carried out a univariate logistic regression analysis to examine the relationship between outcomes and a set of clinical variables. RESULTS After a median of 15 years, TVT remains highly effective: 272 women (94%) experienced either no leakage under any circumstance (214=74%) or leakage less than weekly (58=20%). Mesh exposure (8=2.7%; 1.8 events per 1,000 patient-years) and repeat surgery for SUI (11=3.8%; 2.5 events per 1,000 patient-years) were low. Three women (1%) needed to perform intermittent self-catheterisation. Bothersome overactive bladder symptoms (45=15%) were common and associated with polypharmacy, cardiovascular medication and obesity. CONCLUSION The efficacy of TVT is demonstrated up to 20 years. The presence of bothersome OAB symptoms in the population may be an indicator of multimorbidity.
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Affiliation(s)
- Emilie M V Goessens
- Department of Urology, ZNA Middelheim Antwerpen, Lindendreef 1, 2020, Antwerp, Belgium.
| | - Hendrik Cammu
- Department of Gynaecology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
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Lee CL, Park JM, Lee JY, Yang SW, Na HS, Lee J, Jung S, Shin JH. A Novel Incisionless Disposable Vaginal Device for Female Stress Urinary Incontinence: Efficacy and Quality of Life. Int Neurourol J 2023; 27:S40-48. [PMID: 37280759 DOI: 10.5213/inj.2346092.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/14/2023] [Indexed: 06/08/2023] Open
Abstract
PURPOSE This clinical study sought to evaluate the possible clinical effectiveness and practicality of URINO, an innovative, incisionless, and disposable intravaginal device, designed for patients suffering from stress urinary incontinence. METHODS A prospective, multicenter, single-arm clinical trial was carried out, involving women diagnosed with stress urinary incontinence who used a self-inserted, disposable intravaginal pessary device. Comparisons were made between the results of the 20-minute pad-weight gain (PWG) test at baseline and visit 3, where the device was applied. After 1 week of device usage, compliance, satisfaction, the sensation of a foreign body, and adverse events were assessed. RESULTS Out of 45 participants, 39 completed the trial and expressed satisfaction within the modified intention-to-treat group. The average 20-minute PWG of participants was 17.2±33.6 g at baseline and significantly dropped to 5.3±16.2 g at visit 3 with device application. A total of 87.2% of participants exhibited a reduction ratio of PWG by 50% or more, surpassing the clinical trial success benchmark of 76%. The mean compliance was recorded as 76.6%±26.6%, the average visual analogue scale score for patient satisfaction was 6.4±2.6, and the sensation of a foreign body, measured on a 5-point Likert scale, was 3.1±1.2 after 1 week of device use. No serious adverse events were reported; there was 1 instance of microscopic hematuria and 2 cases of pyuria, all of which recovered. CONCLUSION The investigated device demonstrated significant clinical effectiveness and safety for patients with stress urinary incontinence. It was easy to use, showing favorable patient compliance. We propose that these disposable intravaginal pessaries could potentially be an alternative treatment for patients with stress urinary incontinence who are seeking nonsurgical options or are unable to undergo surgery. Trial Registration: The study was registered as a clinical trial (KCT0008369).
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Affiliation(s)
- Chung Lyul Lee
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Jong Mok Park
- Department of Urology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Ji Yong Lee
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Seung Woo Yang
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Hyun Seok Na
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Jaegeun Lee
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
| | - Sunkyung Jung
- Department of Urology, Chungnam National University Sejong Hospital, Sejong, Korea
| | - Ju Hyun Shin
- Department of Urology, Chungnam National University Hospital, Daejeon, Korea
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Creating an Inclusive Urology Practice. CURRENT BLADDER DYSFUNCTION REPORTS 2023; 18:131-138. [PMID: 36817083 PMCID: PMC9925931 DOI: 10.1007/s11884-023-00694-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 02/16/2023]
Abstract
Purpose of Review Patients seeking urologic care come from diverse backgrounds. Therefore, clinics should strive for inclusivity to make all patients feel comfortable seeing a urologist. This review aims to outline and analyze literature relevant to the care of LGTBQIA+ (lesbian, gay, transgender/transexual, queer/questioning, intersex, asexual/allies, nonbinary/genderqueer +), racial and ethnic minorities, those who have disabilities, and those with a high body mass index (BMI). Although this review article presents the care of diverse communities separately, there is an overlap of the various social axes influencing healthcare outcomes. Healthcare workers should be open-minded to learning about evolving community needs. Recent Findings Creating a safe space for LGTBQIA+ requires understanding terminology, awareness of community-specific challenges and health risks, and changing heteronormative behaviors built into medicine. Specific clinical care delivery structural processes and patient-physician-centered practices can make a clinic welcoming for patients from underrepresented backgrounds and with disabilities. BMI surgical requirements may pose barriers to care, and if implemented, there should be assistance to reach specified weight goals. Summary Creating an inclusive urology clinical practice takes time, but it can be achieved by building a collaborative team. Treating patients with consideration of their personal identities and social determinants of health will lead to better patient-center care and health outcomes.
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Friedman BJ, Nguyen J, Vollstedt A, Diaz M, Hoang Roberts L, Sirls LT. A modified Altis ® mid-urethral sling that allows immediate post-operative adjustment: experience in 197 patients. Int Urol Nephrol 2022; 54:241-247. [PMID: 34981416 DOI: 10.1007/s11255-021-03081-5] [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: 10/07/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The transobturator mid-urethral Altis® "mini-sling" uses a static and a dynamic anchor on either end of a pulley suture for intraoperative tension adjustment. Given the potential for incorrect tensioning with sling placement, we adopted a modification for post-operative adjustment should stress urinary incontinence (SUI) persist. The objective is to describe technique, rate of postoperative adjustment driven by patient symptoms, and impact of preoperative/intraoperative variables. METHODS In this single-surgeon experience, retrospective chart review, demographic and clinical data were collected on patients who received the Altis® sling for SUI between 2014 and 2019. We used descriptive statistics and three-group comparison tests to assess difference in variables among tightening, loosening, or no adjustment. RESULTS Altis® sling placement was performed on 197 female patients with an average age of 58.7 years. Eighty-four percent (165/197) did not receive post-operative adjustment. Of the 32 patients with post-operative adjustment, 8 (4.1%) had loosening and 24 (12.2%) had tightening at an average of 10.5 days post-operatively. All tightening procedures were done in the clinic. Of the 8 patients with post-operative loosening, 6 were performed in clinic and 2 in the operating room. Preoperative and intraoperative variables were not significantly different among tightening, loosening, and no adjustment cohorts. CONCLUSIONS This modification of the Altis® sling provides surgeons with the ability to tighten and loosen the sling for persistent SUI. All tightening and most loosening procedures were able to be performed in the clinic. The ability to easily tighten a sling in the early post-operative period may be a critical advantage.
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Affiliation(s)
- Brett J Friedman
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
| | - Jennifer Nguyen
- Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Annah Vollstedt
- Department of Urology, University of Iowa, Iowa City, Iowa, USA
| | | | - Ly Hoang Roberts
- Department of Urology, Beaumont Health System, Royal Oak, MI, USA
| | - Larry T Sirls
- Department of Urology, Beaumont Health System, Royal Oak, MI, USA
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7
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Muller P, Gurol-Urganci I, Thakar R, Ehrenstein MR, Van Der Meulen J, Jha S. Impact of a mid-urethral synthetic mesh sling on long-term risk of systemic conditions in women with stress urinary incontinence: a national cohort study. BJOG 2021; 129:664-670. [PMID: 34524725 PMCID: PMC9292923 DOI: 10.1111/1471-0528.16917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/29/2022]
Abstract
Objective To compare the incidence of systemic conditions between women who had surgical treatment for stress incontinence with mesh and without mesh. Design National cohort study. Setting English National Health Service. Population Women with no previous record of systemic disease who had first‐time urinary incontinence surgery between 1 January 2006 and 31 December 2013, followed up to the earliest of 10 years or 31 March 2019. Methods Competing‐risks regression was used to estimate hazard ratios (HR), adjusted for patient characteristics, with HR > 1 indicating increased incidence following mesh surgery. Main outcome measures First postoperative admission with a record of autoimmune disease, fibromyalgia or myalgic encephalomyelitis up to 10 years following the first incontinence procedure. Results The cohort included 88 947 women who had mesh surgery and 3389 women who had non‐mesh surgery. Both treatment groups were similar with respect to age, socio‐economic deprivation, comorbidity and ethnicity. The 10‐year cumulative incidence of autoimmune disease, fibromyalgia or myalgic encephalomyelitis was 8.1% (95% CI 7.9–8.3%) in the mesh group and 9.0% (95% CI 8.0–10.1%) in the non‐mesh group (adjusted HR 0.89, 95% CI 0.79–1.01; P = 0.07). A sensitivity analysis including only autoimmune diseases as an outcome returned a similar result. Conclusions These findings do not support claims that synthetic mesh slings cause systemic disease. Tweetable abstract No evidence of increased risk of systemic conditions after stress incontinence treatment with a mesh sling. No evidence of increased risk of systemic conditions after stress incontinence treatment with a mesh sling.
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Affiliation(s)
- P Muller
- London School of Hygiene & Tropical Medicine, London, UK.,Royal College of Obstetricians and Gynaecologists, London, UK
| | - I Gurol-Urganci
- London School of Hygiene & Tropical Medicine, London, UK.,Royal College of Obstetricians and Gynaecologists, London, UK
| | - R Thakar
- Royal College of Obstetricians and Gynaecologists, London, UK.,Croydon University Hospital, Croydon, UK
| | | | - J Van Der Meulen
- London School of Hygiene & Tropical Medicine, London, UK.,Royal College of Obstetricians and Gynaecologists, London, UK
| | - S Jha
- British Society of Urogynaecology, London, UK.,Sheffield Teaching Hospitals, Sheffield, UK
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8
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Yang J, Balog B, Deng K, Hanzlicek B, Rietsch A, Kuang M, Hatakeyama S, Lach-Trifilieff E, Zhu H, Damaser MS. Therapeutic potential of muscle growth promoters in a stress urinary incontinence model. Am J Physiol Renal Physiol 2020; 319:F436-F446. [PMID: 32686522 DOI: 10.1152/ajprenal.00122.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Weakness of urinary sphincter and pelvic floor muscles can cause insufficient urethral closure and lead to stress urinary incontinence. Bimagrumab is a novel myostatin inhibitor that blocks activin type II receptors, inducing skeletal muscle hypertrophy and attenuating muscle weakness. β2-Adrenergic agonists, such as 5-hydroxybenzothiazolone derivative (5-HOB) and clenbuterol, can enhance muscle growth. We hypothesized that promoting muscle growth would increase leak point pressure (LPP) by facilitating muscle recovery in a dual-injury (DI) stress urinary incontinence model. Rats underwent pudendal nerve crush (PNC) followed by vaginal distension (VD). One week after injury, each rat began subcutaneous (0.3 mL/rat) treatment daily in a blinded fashion with either bimagrumab (DI + Bim), clenbuterol (DI + Clen), 5-HOB (DI + 5-HOB), or PBS (DI + PBS). Sham-injured rats underwent sham PNC + VD and received PBS (sham + PBS). After 2 wk of treatment, rats were anesthetized for LPP and external urethral sphincter electromyography recordings. Hindlimb skeletal muscles and pelvic floor muscles were dissected and stained. At the end of 2 wk of treatment, all three treatment groups had a significant increase in body weight and individual muscle weight compared with both sham-treated and sham-injured rats. LPP in DI + Bim rats was significantly higher than LPP of DI + PBS and DI + Clen rats. There were more consistent urethral striated muscle fibers, elastin fibers in the urethra, and pelvic muscle recovery in DI + Bim rats compared with DI + PBS rats. In conclusion, bimagrumab was the most effective for increasing urethral pressure and continence by promoting injured external urethral sphincter and pelvic floor muscle recovery.
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Affiliation(s)
- Jun Yang
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Department of Urology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Brian Balog
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Kangli Deng
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Brett Hanzlicek
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Anna Rietsch
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Mei Kuang
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Shinji Hatakeyama
- Novartis Institutes for BioMedical Research, Novartis pharma AG, Basel, Switzerland
| | | | - Hui Zhu
- Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.,Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Margot S Damaser
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.,Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.,Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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Schattner A. The Wide-Ranging Spectrum of Cough-Induced Complications and Patient Harm. Am J Med 2020; 133:544-551. [PMID: 32007456 DOI: 10.1016/j.amjmed.2019.12.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 12/25/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Abstract
Cough is one of the most common complaints encountered in every setting; however, complications associated with coughing have received relatively little attention. An exhaustive systematic review of the English literature revealed an exceedingly large and varied spectrum of cough-induced complications affecting many systems, including upper airways, chest wall and thorax, abdominal wall, heart and aorta, central nervous system, eye, gastrointestinal tract, urogenital system, and emotional and psychological harm. Prospective studies and prevalence data are conspicuously missing. Reported cough-induced pathology ranges from rare (the majority) to common and from trivial (eg, lightheadedness, subconjunctival hemorrhage) to severe and life-threatening (eg, cervical artery dissection, rupture of a normal spleen). Other seemingly benign entities may mask a serious underlying pathology (eg, cough headache, cough syncope). A substantial proportion of patients experience anxiety and insomnia, and their quality of life is affected. Thus, the wide spectrum of cough-induced pathology need to be recognized and considered in patients complaining of cough. Suppression of cough must not be neglected in patients at risk, and areas of uncertainty need to be clarified by future prospective studies.
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Affiliation(s)
- Ami Schattner
- The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
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10
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Jalalinia SF, Raei M, Naseri-Salahshour V, Varaei S. The Effect of Pelvic Floor Muscle Strengthening Exercise on Urinary Incontinence and Quality of Life in Patients after Prostatectomy: a Randomized Clinical Trial. J Caring Sci 2020; 9:33-38. [PMID: 32296657 PMCID: PMC7146723 DOI: 10.34172/jcs.2020.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 09/17/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction: Urinary incontinence is a common problem after Prostatectomy that affects patients' life. Nurses can assist patients in improving urinary problems. This study aimed to assess the effects of pelvic floor muscle exercises on urinary incontinence and the quality of life in patients after Prostatectomy. Methods: This randomized clinical trial was performed on 60 patients with suprapubic prostatectomy and urinary incontinence who had referred to urology department of Vali-e-Asr Hospital in Tehran. The subjects were selected and randomly divided into control and intervention groups. The control and intervention groups received standard care and pelvic floor muscles exercises after surgery, respectively. The data were gathered in the course of seven days; one, two and three months after surgery, using three questionnaires and a check list for the evaluation of urinary incontinence and assessing Quality of Life. The data were then analyzed, using SPSS ver.13, and statistical tests such as t-test, ANOVA and Chi- square. Results: The quality of life and urinary incontinence score before intervention were not significant between two groups. The findings showed that there was a statistically significant difference between two groups in the average scores of urinary incontinence and the quality of life after intervention. Conclusion: Pelvic muscles exercises reduced urinary incontinence and enhanced quality of life. It's recommended as a non-pharmacologic, non-invasive way to control urinary incontinence. Patients with adequate cognitive and mental abilities can easily be trained on pelvic floor muscle exercises.
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Affiliation(s)
- Seyedeh Fatemeh Jalalinia
- Department of Nursing, Nursing and Midwifery Faculty, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Raei
- Department of Nursing, Nursing and Midwifery Faculty, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Naseri-Salahshour
- Department of Nursing, Nursing and Midwifery Faculty, Arak University of Medical Sciences, Arak, Iran
| | - Shokoh Varaei
- Department of Nursing, Nursing and Midwifery Faculty, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
INTRODUCTION AND HYPOTHESIS As noted in the 6th International Consultation on Incontinence (ICI) chapter "Initial Management of Urinary Incontinence in Women" recommendations call for including physiotherapy as a first-line therapy. METHODS Building on this, checking available scientific evidence and using the International Classification of Functioning, Disabilities and Health, the following represents a holistic physiotherapist approach for initial evaluation of the health problem of urinary incontinence. RESULTS This paper proposes a teaching module for every relevant health care professional dealing with the assessment of adult female urinary incontinence, focusing on optimal patient selection and appropriate treatment choice. CONCLUSION The assessment stage involves the explicit decision as to whether "physiotherapy" is the treatment indicated for the patient, based on the findings of the physiotherapy assessment and supplemented by any medical information that accompanied the referral and evaluation.
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12
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Rodrigues-Amorim D, Olivares JM, Spuch C, Rivera-Baltanás T. A Systematic Review of Efficacy, Safety, and Tolerability of Duloxetine. Front Psychiatry 2020; 11:554899. [PMID: 33192668 PMCID: PMC7644852 DOI: 10.3389/fpsyt.2020.554899] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022] Open
Abstract
Duloxetine is a serotonin-norepinephrine reuptake inhibitor approved for the treatment of patients affected by major depressive disorder (MDD), generalized anxiety disorder (GAD), neuropathic pain (NP), fibromyalgia (FMS), and stress incontinence urinary (SUI). These conditions share parallel pathophysiological pathways, and duloxetine treatment might be an effective and safe alternative. Thus, a systematic review was conducted following the 2009 Preferred Reporting Items (PRISMA) recommendations and Joanna Briggs Institute Critical (JBI) Appraisals guidelines. Eighty-five studies focused on efficacy, safety, and tolerability of duloxetine were included in our systematic review. Studies were subdivided by clinical condition and evaluated individually. Thus, 32 studies of MDD, 11 studies of GAD, 19 studies of NP, 9 studies of FMS, and 14 studies of SUI demonstrated that the measured outcomes indicate the suitability of duloxetine in the treatment of these clinical conditions. This systematic review confirms that the dual mechanism of duloxetine benefits the treatment of comorbid clinical conditions, and supports the efficacy, safety, and tolerability of duloxetine in short- and long-term treatments.
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Affiliation(s)
- Daniela Rodrigues-Amorim
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), University of Vigo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
| | - José Manuel Olivares
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), University of Vigo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain.,Head of Department of Psychiatry, Health Area of Vigo, Servizo Galego de Saúde (SERGAS), Vigo, Spain.,Director Neuroscience Area, Galicia Sur Health Research Institute (IISGS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
| | - Carlos Spuch
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), University of Vigo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
| | - Tania Rivera-Baltanás
- Translational Neuroscience Research Group, Galicia Sur Health Research Institute (IISGS), Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Vigo, Spain
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13
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Bakas P, Papadakis E, Karachalios C, Liapis I, Panagopoulos N, Liapis A. Assessment of the long-term outcome of TVT procedure for stress urinary incontinence in a female population: results at 17 years’ follow-up. Int Urogynecol J 2018; 30:265-269. [DOI: 10.1007/s00192-018-3713-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/21/2018] [Indexed: 11/28/2022]
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Urinary incontinence among Muslim women in Israel: risk factors and help-seeking behavior. Int Urogynecol J 2017; 29:539-546. [PMID: 28779417 DOI: 10.1007/s00192-017-3438-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 07/17/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The prevalence of urinary incontinence (UI) varies among women in different cultures. Muslim women with UI have complex issues related to the need for cleaning (ablution) before prayer. The aim was to assess the prevalence of UI, factors associated with it, its effect on quality of life, and help-seeking behavior among Muslim women. METHODS This was a cross-sectional study. Self-administered questionnaires completed by women 18-75 years of age who visited the primary care clinic between 21 June 2015 and 9 October 2015 and additional data collected from their medical records. RESULTS A total of 492 women (mean age 31.8 ± 9.5 years) participated in the study. Of these, 43% suffered from UI and 19% from severe to very severe UI. The mean score for interference in daily life (0-10) was 6.3 ± 3.7. Sixty percent of women with UI had stress incontinence, 23% urge incontinence, and 9% mixed incontinence. Only 10% had consulted previously with their physician regarding UI. Increased BMI (OR = 1.048, 95% CI 1.009-1.089) and polygamy (OR = 1.943, 95% CI 1.007-3.749) were associated with severe to very severe UI. Age, parity, and more severe degrees of UI were associated with help-seeking behavior (OR = 1.065 95% CI 1.008-1.125, OR = 0.763 95% CI 0.624-0.934, OR = 4.073 95% CI 1.410-11.765 respectively). CONCLUSIONS Urinary incontinence is very common among Muslim women in primary care in southern Israel and significantly impairs their quality of life. Only a small percentage consults with their physician.
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Silva VR, Riccetto CLZ, Martinho NM, Marques J, Carvalho LC, Botelho S. Training through gametherapy promotes coactivation of the pelvic floor and abdominal muscles in young women, nulliparous and continents. Int Braz J Urol 2017; 42:779-86. [PMID: 27564290 PMCID: PMC5006775 DOI: 10.1590/s1677-5538.ibju.2014.0580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 02/01/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction and objectives: Several studies have been investigated co-activation can enhance the effectveness of PFM training protocols allowing preventive and therapeutic goals in pelvic floor dysfunctions. The objective of the present study was to investigate if an abdominal-pelvic protocol of training (APT) using gametherapy would allow co-activation of PFM and transversus abdominis/oblique internal (TrA/OI) muscles. Patients and methods: Twenty-five nulliparous, continent, young females, with median age 24.76 (±3.76) years were evaluated using digital palpation (DP) of PFM and surface electromyography of PFM and TrA/OI simultaneously, during maximal voluntary contraction (MVC), alternating PFM and TrA/OI contraction requests. All women participated on a supervised program of APT using gametherapy, that included exercises of pelvic mobilization associated to contraction of TrA/OI muscles oriented by virtual games, for 30 minutes, three times a week, in a total of 10 sessions. Electromyographic data were processed and analyzed by ANOVA - analysis of variance. Results: When MVC of TrA/OI was solicited, it was observed simultaneous increase of electromyographic activity of PFM (p=0.001) following ATP. However, EMG activity did not change significantly during MVC of PFM. Conclusion: Training using gametherapy allowed better co-activation of pelvic floor muscles in response to contraction of TrA, in young nulliparous and continent women.
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Affiliation(s)
- Valeria Regina Silva
- Departamento de Cirurgia da Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), SP, Brasil
| | | | - Natalia Miguel Martinho
- Departamento de Cirurgia da Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), SP, Brasil.,Escola de Enfermagem, Universidade Federal de Alfenas (UNIFAL-MG), MG, Brasil
| | - Joseane Marques
- Departamento de Cirurgia da Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), SP, Brasil
| | | | - Simone Botelho
- Departamento de Cirurgia da Faculdade de Ciências Médicas - Universidade Estadual de Campinas (UNICAMP), SP, Brasil.,Escola de Enfermagem, Universidade Federal de Alfenas (UNIFAL-MG), MG, Brasil
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Prevalence and risk factors for cardiac arrest and myocardial infarction after pelvic reconstructive surgery: a national, multi-institutional, surgical database study. Int Urogynecol J 2017. [DOI: 10.1007/s00192-017-3394-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Tan J, Markland AD. Nonsurgical Management of Urinary Incontinence in Older Women. CURRENT GERIATRICS REPORTS 2017. [DOI: 10.1007/s13670-017-0200-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Angelini K. Pelvic Floor Muscle Training to Manage Overactive Bladder and Urinary Incontinence. Nurs Womens Health 2017; 21:51-57. [PMID: 28187840 DOI: 10.1016/j.nwh.2016.12.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/20/2016] [Indexed: 06/06/2023]
Abstract
Overactive bladder (OAB) and urinary incontinence (UI) are common chronic conditions that can negatively affect women's quality of life. Pelvic floor muscle training is the first-line treatment. Two recent Cochrane Reviews examining pelvic floor muscle training for the treatment of UI and OAB are summarized here to provide women's health nurses with current recommendations for UI and OAB management. This column also identifies practice improvement education in the area of pelvic floor muscle training and treatment for OAB and UI.
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Saadia Z. Effect of Age, Educational Status, Parity and BMI on Development of Urinary Incontinence - a Cross Sectional Study in Saudi Population. Mater Sociomed 2015; 27:251-4. [PMID: 26543417 PMCID: PMC4610655 DOI: 10.5455/msm.2015.27.251-254] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The research article looks at the background of women with urinary incontinence and exposed to different demographic factors. Women who had urinary incontinence and women without urinary incontinence were compared with regards to their demographic features and risk of development of urinary problems. These risk factors can either cause short term or temporary urinary incontinence or they can cause long term or permanent urinary incontinence. This article explores the association of age, educational status, body mass index (BMI) and parity on the development of urinary incontinence. AIM OF STUDY This study aimed at conducting an analysis into the risk factors that are related to urinary incontinence. RESULTS AND ANALYSIS Z-tests were conducted for every demographic factor and the results are then discussed comprehensively citing various studies that have been conducted before. Analysis shows that age and BMI increase chances of urinary infection and consequently urinary incontinence. Women of lower educational levels record more cases of urinary incontinence due to lack of general information about the condition. Women with higher parity levels also record more cases of urinary infections and subsequently urinary incontinence. CONCLUSION From the analysis above, it can be seen that these factors usually play great roles in the existence and absence of urinary incontinence especially in women in Saudi Arabia. Most important is that, its prevention is mostly by use of the risk factors mentioned here in the research. This will usually involve observing a given risk factor to a state that makes it unfavorable for urinary incontinence to occur.
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Affiliation(s)
- Zaheera Saadia
- Department of Obstetrics and Gynecology, Qassim University, College of Medicine, Saudi Arabia
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Mousa NA, Abou-Taleb HA, Orabi H. Stem cell applications for pathologies of the urinary bladder. World J Stem Cells 2015; 7:815-822. [PMID: 26131312 PMCID: PMC4478628 DOI: 10.4252/wjsc.v7.i5.815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/05/2015] [Accepted: 04/07/2015] [Indexed: 02/06/2023] Open
Abstract
New stem cell based therapies are undergoing intense research and are widely investigated in clinical fields including the urinary system. The urinary bladder performs critical complex functions that rely on its highly coordinated anatomical composition and multiplex of regulatory mechanisms. Bladder pathologies resulting in severe dysfunction are common clinical encounter and often cause significant impairment of patient’s quality of life. Current surgical and medical interventions to correct urinary dysfunction or to replace an absent or defective bladder are sub-optimal and are associated with notable complications. As a result, stem cell based therapies for the urinary bladder are hoped to offer new venues that could make up for limitations of existing therapies. In this article, we review research efforts that describe the use of different types of stem cells in bladder reconstruction, urinary incontinence and retention disorders. In particular, stress urinary incontinence has been a popular target for stem cell based therapies in reported clinical trials. Furthermore, we discuss the relevance of the cancer stem cell hypothesis to the development of bladder cancer. A key subject that should not be overlooked is the safety and quality of stem cell based therapies introduced to human subjects either in a research or a clinical context.
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Files JA, Mayer AP, Chutka DS. Urinary incontinence: not just a mid-laugh crisis. J Womens Health (Larchmt) 2015; 24:107-8. [PMID: 25531148 DOI: 10.1089/jwh.2014.5126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Julia A Files
- 1 Division of Women's Health-Internal Medicine, Mayo Clinic in Arizona , Scottsdale, Arizona
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Tenfelde S, Janusek LW. Yoga: A Biobehavioral Approach to Reduce Symptom Distress in Women with Urge Urinary Incontinence. J Altern Complement Med 2014; 20:737-42. [DOI: 10.1089/acm.2013.0308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sandi Tenfelde
- Department of Health Promotion, Loyola University Chicago, Marcella Niehoff School of Nursing, Chicago, IL
| | - Linda Witek Janusek
- Department of Health Promotion, Loyola University Chicago, Marcella Niehoff School of Nursing, Chicago, IL
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Rafii F, Shareinia H, Seyedalshohahadaee M, Sarraf P, Mahmoodi F. The effect of Pelvic Floor Muscle Exercise Training on Urinary Incontinence in Patients with Multiple Sclerosis. ACTA ACUST UNITED AC 2014. [DOI: 10.29252/ijn.27.87.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Aref-Adib M, Lamb BW, Lee HB, Akinnawo E, Raza MMA, Hughes A, Mehta VS, Odonde RI, Yoong W. Stem cell therapy for stress urinary incontinence: a systematic review in human subjects. Arch Gynecol Obstet 2013; 288:1213-21. [PMID: 24077813 DOI: 10.1007/s00404-013-3028-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Accepted: 09/10/2013] [Indexed: 12/20/2022]
Abstract
PURPOSE To systematically evaluate the current evidence on the safety and efficacy of stem cell therapy (SCT) in stress urinary incontinence (SUI) to allow objective comparison with existing surgical techniques. METHODS Systematic literature search of Medline from years 1946-2012 using terms: "stem", "cell", "stress", "urinary", and "incontinence". Included studies presented empirical data on the treatment of SUI using SCT. OUTCOMES adverse events, incontinence, quality of life, urodynamic, transurethral ultrasound and urethral EMG findings. RESULTS Eight studies met inclusion criteria (seven observational and one randomized). Quality score: median 10.75 of 20 (range 2-12.5). Adverse events: one patient had bladder perforation and two procedures could not be completed due to pain. Temporary urinary retention and cystitis were also reported. Incontinence score: Four studies describe significant improvement. Quality of life: significant improvement in four studies. Urodynamic outcomes: four studies show significant improvement in contractility of urethral sphincter; three studies demonstrate no change in bladder capacity and significant reduction in residual volume; significant improvement in urinary flow three studies, although two found no difference; increase in leak point pressure and detrusor pressure in three studies. Urethral ultrasound: three studies found significant increases in rhabdosphincter thickness and contractility. Urethral EMG: two studies found significant increases in the EMG at rest and at contraction. CONCLUSION Data suggest that SC treatment for SUI is safe and effective in the short term. However, the quality and maturity of the data are limited. Robust data from better quality studies comparing this to current surgical techniques are needed.
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Aigmueller T, Bjelic-Radisic V, Kargl J, Hinterholzer S, Laky R, Trutnovsky G, Kolovetsiou-Kreiner V, Tamussino K. Reasons for dissatisfaction ten years after TVT procedure. Int Urogynecol J 2013; 25:213-7. [DOI: 10.1007/s00192-013-2213-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 08/17/2013] [Indexed: 10/26/2022]
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Chen F, Li HL, Li YH, Tan YF, Zhang JQ. Quantitative analysis of the major constituents in Chinese medicinal preparation SuoQuan formulae by ultra fast high performance liquid chromatography/quadrupole tandem mass spectrometry. Chem Cent J 2013; 7:131. [PMID: 23899222 PMCID: PMC3733971 DOI: 10.1186/1752-153x-7-131] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 07/28/2013] [Indexed: 12/29/2022] Open
Abstract
Background The SuoQuan formulae containing Fructus Alpiniae Oxyphyllae has been used to combat the urinary incontinence symptoms including frequency, urgency and nocturia for hundreds of years in China. However, the chemical information was not well characterized. The quality control marker constituent only focused on one single compound in the current Chinese Pharmacopeia. Hence it is prudent to identify and quantify the main constituents in this herbal product. This study aimed to analyze the main constituents using ultra-fast performance liquid chromatography coupled to tandem mass spectrometry (UFLC-MS/MS). Results Fourteen phytochemicals originated from five chemical classes constituents were identified by comparing the molecular mass, fragmentation pattern and retention time with those of the reference standards. A newly developed UFLC-MS/MS was validated demonstrating that the new assay was valid, reproducible and reliable. This method was successfully applied to simultaneously quantify the fourteen phytochemicals. Notably, the content of these constituents showed significant differences in three pharmaceutical preparations. The major constituent originated from each of chemical class was isolinderalactone, norisoboldine, nootkatone, yakuchinone A and apigenin-4’,7-dimethylther, respectively. The variation among these compounds was more than 1000 times. Furthermore, the significant content variation between the two different Suoquan pills was also observed. Conclusion The proposed method is sensitive and reliable; hence it can be used to analyze a variety of SuoQuan formulae products produced by different pharmaceutical manufacturers.
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Affiliation(s)
- Feng Chen
- School of Pharmacy, Hainan Medical University, Hainan Provincial Key Laboratory of R&D of Tropical Herbs, Haikou 571101, China.
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Abstract
BACKGROUND The use of acupuncture for stress urinary incontinence is increasing in frequency, especially in Asian area. However, its effectiveness and side effects have not been evaluated. OBJECTIVES To assess the effectiveness and side effects of acupuncture for stress urinary incontinence in adults. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register (searched 28 January 2013), EMBASE, AMED, Chinese Biomedical Literature Database (CBM), Chinese Acupuncture Trials Register and China National Knowledge Infrastructure (CNKI) (all searched 20 February 2013). In addition, we searched the reference lists of relevant articles and contacted authors and trialists in the field. SELECTION CRITERIA Randomised and quasi-randomised controlled trials of acupuncture interventions without other treatments for the management of stress urinary incontinence for adults. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility, trial quality and extracted data. We meta-analysed data where appropriate. MAIN RESULTS We identified 17 possibly eligible studies but only one small trial with 60 women met our inclusion criteria. The trial compared acupuncture versus midodrine, a drug for treating hypotension. The risk of bias was high as there was no concealment of randomised allocation, and there was no blinding of assessment of outcome. In addition, it was not possible to blind participants or health providers to the interventions. The statistical methods were not described.More women improved in the acupuncture group (73% with acupuncture versus 33% with midodrine; risk ratio (RR) 2.20, 95% confidence interval (CI) 1.27 to 3.81) but the cure rates were low and not statistically significantly different (13% versus 7%; RR 2.00, 95% CI 0.40 to 10.11). There were adverse events in the drug group only. AUTHORS' CONCLUSIONS The effect of acupuncture for stress urinary incontinence for adults is uncertain. There is not enough evidence to determine whether acupuncture is more effective than drug treatment.
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Affiliation(s)
- Yang Wang
- Department of Acupuncture and Moxibustion, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing,China.
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28
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Shirvan MK, Alamdari DH, Mahboub MD, Ghanadi A, Rahimi HR, Seifalian AM. A novel cell therapy for stress urinary incontinence, short-term outcome. Neurourol Urodyn 2012; 32:377-82. [PMID: 22972395 DOI: 10.1002/nau.22301] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 07/30/2012] [Indexed: 12/27/2022]
Abstract
AIMS The aim of this study was the safety assessment of urethra injections of autologous total nucleated cells (TNCs) along with platelets, which focused on the outcome over a 6 month period. METHODS An open, prospective study was conducted on 9 patients with severe stress urinary incontinence (SUI). At the baseline, 1, 3, and 6 months after external urethral sphincteric and submucosal injections of autologous TNCs along with platelets, the patients were assessed according to cough tests, Q-Tip tests, urodynamics, 1 hr pad tests, upper tract ultrasonography (UTU), post voiding residue (PVR), International Consultation on Incontinence Questionnaire-Urinary incontinence (ICIQ-UI), and International Consultation on Incontinence Modular Questionnaire-Quality of Life (ICIQ-QOL). On the 3rd month post-injection, the maximum urethral closure pressure (MUCP) and abdominal leak point pressure (ALPP) were measured in one patient with intrinsic sphincteric deficiency (ISD; the baseline: ALPP < 60 and MUCP < 30 cmH(2)O). RESULTS No complications were observed after injection. At 6-months' follow up (F/U), all the patients considered themselves clinically cured with eight women completely continent and one marked improvement. Mean age was 48.9 ± 13.8 years. Before the injection, urodynamics, UTU, and PVR were normal and cough tests, 1 hr pad tests were positive in patients. At 1, 3, and 6 months post-injection, there was a significant improvement in ICIQ-UI, ICIQ-QOL (P < 0.05). UTU and PVR were normal, cough tests, and 1 hr pad tests were negative, except for ISD patient with severe coughs (at month 3: ALPP = 92 and MUCP > 30 cmH(2)O). CONCLUSION Cell therapy consisting of intrasphincteric and submucosal injections of autologous TNCs along with platelets in SUI patients is a feasible and safe procedure. The results point out those subjects cured or with marked improvement after 6 months F/U.
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Affiliation(s)
- Maliheh Keshvari Shirvan
- Department of Urology, Imam Reza Academic Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Friedman B. Conservative treatment for female stress urinary incontinence: simple, reasonable and safe. Can Urol Assoc J 2012; 6:61-3. [PMID: 22396373 DOI: 10.5489/cuaj.12021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Boris Friedman
- Department of Urologic Sciences, Bladder Care Center, University of British Columbia, Vancouver, BC
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Kafri R, Shames J, Golomb J, Melzer I. Self-report function and disability: a comparison between women with and without urgency urinary incontinence. Disabil Rehabil 2012; 34:1699-705. [DOI: 10.3109/09638288.2012.660597] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chong EC, Khan AA, Anger JT. The financial burden of stress urinary incontinence among women in the United States. Curr Urol Rep 2012; 12:358-62. [PMID: 21847532 DOI: 10.1007/s11934-011-0209-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Stress urinary incontinence (SUI) is a common medical problem affecting 25% to 50% of women in the United States. This article reviews the literature on the current systems- and population-based costs of management of SUI in women. A PubMed search was conducted to seek studies examining the cost of various management options. Both nonsurgical and surgical management can effectively improve symptoms of SUI at a wide spectrum of costs. Over $12 billion are spent annually, an amount that continues to grow. Patients pay out-of-pocket for 70% of conservative management, amounting to a significant individual financial burden. Systems-based cost of SUI management continues to rise with the aging population. Costs to both individuals and systems may be mitigated if more patients are treated with intent to cure and as surgical management transitions from inpatient to outpatient procedures.
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Affiliation(s)
- Erin C Chong
- David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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Davila GW. Nonsurgical outpatient therapies for the management of female stress urinary incontinence: long-term effectiveness and durability. Adv Urol 2011; 2011:176498. [PMID: 21738529 PMCID: PMC3124122 DOI: 10.1155/2011/176498] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2011] [Accepted: 03/27/2011] [Indexed: 11/17/2022] Open
Abstract
Objective. To evaluate long-term effectiveness and safety of conservative and minimally invasive outpatient treatments for female stress urinary incontinence (SUI) through a review of the literature. Methods. PubMed was searched for reports on prospective clinical trials with at least 12-month follow-up of minimally invasive treatments, pelvic floor rehabilitation, or pharmacotherapy in women with SUI. Each report was examined for long-term rates of effectiveness and safety. Results. Thirty-two clinical trial reports were included. Prospective long-term studies of pelvic floor rehabilitation were limited but indicated significant improvements with treatment adherence for at least 12 months. Poor initial tolerability with duloxetine resulted in substantial discontinuation. Most patients receiving transurethral radiofrequency collagen denaturation or urethral bulking agents reported significant long-term improvements, generally good tolerability, and safety. Conclusions. Conservative therapy is an appropriate initial approach for female SUI, but if therapy fails, radiofrequency collagen denaturation or bulking agents may be an attractive intermediate management step or alternative to surgery.
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Affiliation(s)
- G. Willy Davila
- Section of Urogynecology, Department of Gynecology, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL 33331, USA
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Chen LP, Lin SJ, Fu TY, Yu MS. Locally advanced female urethral adenocarcinoma of enteric origin: the role of adjuvant chemoradiation and brief review. Kaohsiung J Med Sci 2011; 27:150-4. [PMID: 21463838 DOI: 10.1016/j.kjms.2010.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 09/02/2010] [Indexed: 12/27/2022] Open
Abstract
Primary female urethral adenocarcinoma (FUA) is rare and has a poor prognosis. The common manifestations include urethrorrhagia, urinary frequency, dysuria, urethral obstructions, focal tenderness, and urinary tract infection. These symptoms are neither diagnostic nor pathognomonic; therefore, a delay in diagnosis and even a misdiagnosis is hardly uncommon. The histogenesis of FUAs may have derived from urethritis glandularis, Mullerian ducts, Skene's glands, or mixed origins. Tumors of different embryologic origins displayed heterogeneous pathological morphology and immunohistochemistical phenotypes. Because of its rarity and the lack of large-scale studies, there is no current consensus on the optimal treatment of urethral adenocarcinomas. Here, we report two cases of locally advanced FUA of enteric origin. They manifested as slightest warning symptoms of urinary tract infection and stress urinary incontinence, respectively. One patient died of disease progression 2 months after curative operation. The other patient underwent surgery followed by adjuvant irinotecan-containing chemoradiation, and the effect was at least modest. Hence, we recommend adjuvant chemoradiation in locally advanced FUA. Individualizing cancer care of chemoregimens in accordance with the tumor origins may probably be beneficial in FUAs.
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Affiliation(s)
- Ling-Ping Chen
- Division of Hematology and Oncology, Department of Internal Medicine, Kaohsiung, Taiwan
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Intrasphincteric injections of autologous muscular cells in women with refractory stress urinary incontinence: a prospective study. Int Urogynecol J 2010; 22:183-9. [PMID: 20821309 DOI: 10.1007/s00192-010-1255-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 08/10/2010] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Cell therapy for stress urinary incontinence (SUI) management has been experienced with encouraging results. METHODS We conducted an open prospective study on 12 women presenting severe SUI with fixed urethra, after previous failed surgical management. Patients underwent intrasphincteric injections of autologous progenitor muscular cells isolated from a biopsy of deltoid muscle. Primary endpoint focused on safety (measurement of Q(max) variation after 3 months). Secondary endpoints assessed side effects and efficacy. RESULTS No variation was diagnosed on Q(max) measurements. Efficacy data show that three of 12 patients are dry at 12 months, seven other patients are improved on pad test but not on voiding diary, and two patients were slightly worsened by the procedure. Quality of life was improved in half of patients. CONCLUSIONS Cell therapy for severe multioperated cases of SUI is a mini-invasive, feasible, and safe procedure that can improve urinary condition in as a second line therapy.
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Cammu H, Saeys F, Haentjens P. Dramatic increase (1997-2007) in the number of procedures for stress urinary incontinence in Belgium. Int Urogynecol J 2010; 21:1511-5. [PMID: 20821312 DOI: 10.1007/s00192-010-1226-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Accepted: 07/05/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We wondered if the tension-free vaginal tape approach, introduced in 1998, influenced the rate of anti-incontinence surgery. METHODS We determined the rates of anti-incontinence surgery in Belgium between 1997 and 2007, using the Belgian National Health Insurance Fund register covering the entire adult female population of nearly 4,420,000 women in Belgium. RESULTS The rate per 1,000 women of anti-incontinence surgery increased from 0.54 in 1997 to 2.03 in 2004, after which a plateau was reached (2.01 in 2007). This nearly fourfold increase coincided with the introduction in 1998 on the Belgian market of the tension-free vaginal tape (+66% more interventions between 1998 and 2001). After the introduction of the transobturator tape in 2001, the rate increased even more dramatically (+118% between 2001 and 2004). CONCLUSIONS Rates of anti-incontinence surgery increased by 272% in Belgium between 1997 and 2007. This increase coincided with the availability of tension-free mesh sling operations.
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Affiliation(s)
- Hendrik Cammu
- Division of Uro-gynaecology, Universitair Ziekenhuis Brussel, Brussels, Belgium.
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Hendriks EJM, Kessels AGH, de Vet HCW, Bernards ATM, de Bie RA. Prognostic indicators of poor short-term outcome of physiotherapy intervention in women with stress urinary incontinence. Neurourol Urodyn 2010; 29:336-43. [PMID: 19475574 DOI: 10.1002/nau.20752] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIMS To identify prognostic indicators independently associated with poor outcome of physiotherapy intervention in women with primary or recurrent stress urinary incontinence (stress UI). METHODS A prospective cohort study was performed in physiotherapy practices in primary care to identify prognostic indicators 12 weeks after initiation of physiotherapy intervention. Patients were referred by general practitioners or urogynecologists. Risk factors for stress UI were examined as potential prognostic indicators of poor outcome. The primary outcomes were defined as poor outcome on the binary Leakage Severity scale (LS scale) and the binary global perceived effectiveness (GPE) score. RESULTS Two hundred sixty-seven women, with a mean age of 47.7 (SD = 8.3), with stress UI for at least 6 months were included. At 12 weeks, 43% and 59% of the women were considered recovered on the binary LS scale and the binary GPE score, respectively. Prognostic indicators associated with poor outcome included 11 indicators based on the binary LS scale and 8 based on the binary GPE score. The prognostic indicators shared by both models show that poor recovery was associated with women with severe stress UI, POP-Q stage > II, poor outcome of physiotherapy intervention for a previous UI episode, prolonged second stage of labor, BMI > 30, high psychological distress, and poor physical health. CONCLUSIONS This study provides robust evidence of clinically meaningful prognostic indicators of poor short-term outcome. These findings need to be confirmed by replication studies.
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Affiliation(s)
- Erik J M Hendriks
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
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Siu K, Lopez V. Intrinsic Motivation Inventory: translation and validation in Chinese women with urinary incontinence. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2010. [DOI: 10.1111/j.1749-771x.2010.01086.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Culligan PJ, Scherer J, Dyer K, Priestley JL, Guingon-White G, Delvecchio D, Vangeli M. A randomized clinical trial comparing pelvic floor muscle training to a Pilates exercise program for improving pelvic muscle strength. Int Urogynecol J 2010; 21:401-8. [PMID: 20094704 DOI: 10.1007/s00192-009-1046-z] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Accepted: 10/30/2009] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of this study is to determine whether a Pilates exercise program and a pelvic floor muscle-training (PFMT) program could provide similar improvements in pelvic muscle strength. METHODS Sixty-two women with little or no pelvic floor dysfunction were randomized to Pilates or PFMT. Each group had 24 biweekly 1-h sessions with either a physical therapist or Pilates instructor. Strength was measured via perineometry (cmH(2)O). Two questionnaires--pelvic floor distress inventory (PFDI-20) and pelvic floor impact questionnaire (PFIQ-7)--were also collected. RESULTS At baseline, the Pilates and PFMT groups measured 14.9 +/- 12.5 and 12.5 +/- 10.4 cmH(2)O, respectively (p = 0.41). Both the Pilates and PFMT groups got stronger (6.2 +/- 7.5 cmH(2)O, p = 0.0002 and 6.6 +/- 7.4 cmH(2)O, p = 0.0002, respectively), with no difference between groups p = 0.85. PFIQ and PFDI scores improved from baseline but not between groups. CONCLUSIONS Further study is required to determine if Pilates can actually treat pelvic floor dysfunction.
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Affiliation(s)
- Patrick J Culligan
- Atlantic Health Division of Urogynecology, 95 Madison Ave Suite 204, Morristown, NJ 07960, USA.
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Serati M, Salvatore S, Uccella S, Artibani W, Novara G, Cardozo L, Bolis P. Surgical treatment for female stress urinary incontinence: what is the gold-standard procedure? Int Urogynecol J 2009; 20:619-21. [PMID: 19271091 DOI: 10.1007/s00192-009-0850-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the last few years, the Burch colposuspension and the fascial slings were often defined from the pages of the most relevant journals of general medicine, as gold-standard procedures for the surgical treatment of stress urinary incontinence (SUI), whereas mid-urethral slings (tension-free vaginal tape (TVT) and tension-free vaginal tape obturator) were attributed a marginal and almost experimental role in this field. This poorly reflect the current scenario of the surgical management of SUI: Recently, a number of meta-analysis have demonstrated that TVT is significantly more effective if compared to colposuspension and that it is followed by significantly lower perioperative morbidity if compared to pubovaginal slings. It is not realistic to suggest to general practitioners that the surgical gold standard for SUI includes the performance of a wide laparotomy, long hospital stays and a high risk of long-lasting intermittent self-catheterisation. This would inevitably discourage women from embarking on surgical treatment, which instead could actually improve their quality of life.
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Affiliation(s)
- Maurizio Serati
- Urogynaecology Unit, Del Ponte Hospital, University of Insubria, Varese, Italy.
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Kelly CJ, Vichayavilas PE. Weight loss for urinary incontinence in overweight and obese women. N Engl J Med 2009; 360:2256; author reply 2257. [PMID: 19458377 DOI: 10.1056/nejmc090431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Mehnert U, Boy S, Widmer-Simitovic S, Reitz A, Schurch B. The facilitatory effect of duloxetine combined with pelvic floor muscle training on the excitability of urethral sphincter motor neurons. Int Urogynecol J 2009; 20:659-66. [DOI: 10.1007/s00192-009-0836-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 02/06/2009] [Indexed: 11/25/2022]
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Gil KM, Somerville AM, Cichowski S, Savitski JL. Distress and quality of life characteristics associated with seeking surgical treatment for stress urinary incontinence. Health Qual Life Outcomes 2009; 7:8. [PMID: 19196462 PMCID: PMC2645374 DOI: 10.1186/1477-7525-7-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Accepted: 02/05/2009] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Current research focuses on three variables in evaluating the impact of stress urinary incontinence (SUI) on daily living: severity of incontinence, distress or bother resulting from incontinence, and effect on health related quality of life (HRQoL). Understanding the impact of these variables is important as they are the driving force behind women seeking surgical treatment. Given the importance of HRQoL in determining need for treatment, as well as evaluating treatment success, this review provides an assessment of the degree to which HRQoL is impaired in women seeking surgical treatment. METHODS PubMed searches for the terms "quality of life and distress and urinary incontinence" and "quality of life and bother and urinary incontinence" were performed with limits of English, human and female subjects through May 2008. All studies using validated instruments were included. No time limit was placed on the search. RESULTS Of 178 articles retrieved, 21 met the inclusion criteria, and 17 reported methods of scoring. The studies used the Urogenital Distress Inventory (UDI) and the Incontinence Impact Questionnaire (IIQ). Wide ranges of mean and individual levels of severity of symptoms, UDI and IIQ scores were seen among women seeking surgical treatment. Fourteen studies reported baseline and post-surgical treatment distress and QoL data. Statistically significant improvements between baseline and post-surgical UDI and IIQ scores were reported in 12 studies. Reported cure rates ranged from 46% to 97%. Satisfaction with the procedure was reported in 4 studies and ranged from 84% to 91%. A minority of studies reported the relationship between reduction in symptoms and change in HRQoL. CONCLUSION HRQoL is the main reason women seek surgical treatment for incontinence and surgical treatment leads to a significant improvement in mean HRQoL scores. Assessment of HRQoL has proved less useful in identifying why individual women seek treatment for incontinence. Preliminary work has begun to characterize the interaction between severity of symptoms, distress or bother resulting from these urinary symptoms, impact on HRQoL, and treatment seeking behavior, but further research is needed. Greater standardization in the reporting of results of distress or bother and HRQoL would allow for comparison across studies.
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Affiliation(s)
- Karen M Gil
- Department of Obstetrics and Gynecology, Akron General Medical Center, Akron, OH, USA
- Northeastern Ohio Universities College of Medicine and Pharmacy, Rootstown, OH, USA
| | - Amber M Somerville
- Northeastern Ohio Universities College of Medicine and Pharmacy, Rootstown, OH, USA
| | - Sara Cichowski
- Department of Obstetrics and Gynecology, Akron General Medical Center, Akron, OH, USA
| | - Jennifer L Savitski
- Department of Obstetrics and Gynecology, Akron General Medical Center, Akron, OH, USA
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Affiliation(s)
- Rodney A Appell
- Scott Department of Urology, Baylor College of Medicine, 6400 Fannin Street, Suite 2300, Houston, TX 77030, USA.
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Nicholson JM, Parry S, Caughey AB, Rosen S, Keen A, Macones GA. The impact of the active management of risk in pregnancy at term on birth outcomes: a randomized clinical trial. Am J Obstet Gynecol 2008; 198:511.e1-15. [PMID: 18455526 PMCID: PMC2855849 DOI: 10.1016/j.ajog.2008.03.037] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 02/19/2008] [Accepted: 03/11/2008] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to compare birth outcomes that result from the active management of risk in pregnancy at term (AMOR-IPAT) to those outcomes that result from standard management. STUDY DESIGN This was a randomized clinical trial with 270 women of mixed parity. AMOR-IPAT used preventive labor induction to ensure delivery before the end of an estimated optimal time of delivery. Rates of 4 adverse obstetric events and 2 composite measures were used to evaluate birth outcomes. RESULTS The AMOR-IPAT-exposed group had a similar cesarean delivery rate (10.3% vs 14.9%; P = .25), but a lower neonatal intensive care unit admission rate (1.5% vs 6.7%; P = .03), a higher uncomplicated vaginal birth rate (73.5% vs 62.8%; P = .046), and a lower mean Adverse Outcome Index score (1.4 vs 8.6; P = .03). CONCLUSION AMOR-IPAT exposure improved the pattern of birth outcomes. Larger randomized clinical trials are needed to explore further the impact of AMOR-IPAT on birth outcomes and to determine the best methods of preventive labor induction.
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Affiliation(s)
- James M Nicholson
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
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