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Clinical Approach to Recurrent Voiding Dysfunction, Dysuria, and Pelvic Pain Persisting for at Least 3 Months. Int Neurourol J 2022; 26:179-189. [PMID: 36203251 PMCID: PMC9537430 DOI: 10.5213/inj.2244200.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/18/2022] [Indexed: 11/08/2022] Open
Abstract
There are several patients with urination problems and urethral and pelvic discomfort. Usually, these patients’ symptoms are persistent and ambiguous; therefore, it is difficult to find underlying diseases associated with the patient’s symptoms. In addition, there are various conditions such as overactive bladder, cystitis, and interstitial cystitis/bladder pain syndrome (IC/BPS). Sometimes patients with other chronic disorders such as fibromyalgia, inflammatory bowel syndrome, and vulvodynia show urination problems and pelvic pain. Thus, a patient-centered approach is important to find the cause of chronic urination problems and pelvic pain. Moreover, IC/BPS should be considered during the diagnostic process because the clinical characteristics of IC/BPS are diverse. In this narrative review, we suggest an integral approach for the diagnosis and treatment of IC/ BPS.
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Effects of Pelvic Floor Muscle Training on Sexual Dysfunction, Sexual Satisfaction of Partners, Urinary Symptoms, and Pelvic Floor Muscle Strength in Women With Overactive Bladder: A Randomized Controlled Study. J Sex Med 2022; 19:1421-1430. [DOI: 10.1016/j.jsxm.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/21/2022]
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Hu X, Hu S, Wang M, Xiong W, Yang S. Localization of the nerves innervating the pelvic floor muscles: an application to pelvic pain treatment. Clin Anat 2022; 35:979-986. [PMID: 35842771 DOI: 10.1002/ca.23935] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/18/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The aim of this study was to achieve accurate localization of the body surface position and depth of the center of the intramuscular nerve dense region (CINDR) of the pelvic floor muscles and to establish a target site for treating pelvic floor muscle spasm or weakness. MATERIALS AND METHODS Thirty-six adult cadavers were studied in the prone position. To locate the CINDR of the levator ani and coccygeus muscles, horizontal (H) and longitudinal (L) reference lines were used. Sihler's staining revealed the intramuscular nerve dense region of the pelvic floor muscles. The CINDR was labeled with barium sulfate and spiral computed tomography scanning, and three-dimensional reconstructions were obtained. The anterior and posterior CINDR projection points (P and P'), the position of point P projected on to the H and L lines (PH and PL ), and the CINDR depth were determined using the Syngo system. RESULTS The PH of the CINDR of the levator ani and the coccygeus muscle were located at (24.73±0.17)% and (15.93±0.31)% of the H line, respectively. The PL were located at (84.30±2.47)% and (6.76±0.93)% of the L line. The puncture depth of the levator ani muscle was located at (5.56±0.53) cm, and the depth of the coccygeus muscle at (22.08±2.11)% of the PP' line. CONCLUSIONS The body surface position and depth of the CINDR of the pelvic floor muscles were conducive to locating the target more efficiently and enhancing the efficacy of botulinum toxin A injection for treating pelvic floor muscle spasm and weakness with electrical stimulation or biofeedback. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Xiangnan Hu
- Department of Anatomy, Zunyi Medical University, Zunyi, People's Republic of China
| | - Shuangjiang Hu
- Department of Radiology, The First Affiliated Hospital of Zunyi Medical University, Zunyi, People's Republic of China
| | - Meng Wang
- Department of Anatomy, Zunyi Medical University, Zunyi, People's Republic of China
| | - Wei Xiong
- Department of rehabilitation medicine, The First Affiliated Hospital of Zunyi Medical University, Zunyi, People's Republic of China
| | - Shengbo Yang
- Department of Anatomy, Zunyi Medical University, Zunyi, People's Republic of China
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Fang JJ, Wu MP, Yen YC, Wu JC, Chin HY. Overactive bladder syndrome is associated with detrusor overactivity and abnormal voiding pattern in nulliparous women. J Chin Med Assoc 2021; 84:865-869. [PMID: 34433190 DOI: 10.1097/jcma.0000000000000611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pregnancy and childbirth are frequently associated with overactive bladder syndrome (OAB). However, the role of parous effects in OAB among nulliparous (NP) women remains controversial. METHODS This study investigated abnormal voiding patterns and detrusor overactivity (DO) among NP women with OAB in comparison with parous women. From August 2011 to December 2018, 906 patients met the inclusion criteria for participation and were divided into three groups: 221 patients in the NP group, 571 patients in the normal spontaneous delivery (NSD) group, and 114 patients in the cesarean section (CS) group. Urodynamic study examinations were performed, and the presence of DO, abnormal voiding patterns, and maximum urethral closure pressure (MUCP) was recorded. Data were analyzed using analysis of variance, χ2 tests, and independent t tests. RESULTS Compared with parous women in the NSD and CS groups, patients in the NP group had a significantly higher prevalence of abnormal voiding patterns, DO, and MUCP. Furthermore, abnormal voiding patterns were significantly associated with DO and MUCP, respectively, especially in the NP group. CONCLUSION We hypothesized that hypertonicity or poor relaxation of the pelvic muscle in NP women may cause functional BOO, which is related to their OAB.
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Affiliation(s)
- Jessica Jay Fang
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Ming-Ping Wu
- Division of Urogynecology, Department of Obstetrics and Gynecology, Chi Mei Medical Center, Tainan and College of Medicine, Fu-Jen Catholic University, Taipei, Taiwan, ROC
| | - Yu-Chun Yen
- Biostatistics Center, Office of Data Science, Taipei Medical University, Taipei, Taiwan, ROC
| | - Jeng-Cheng Wu
- Department of Urology, Taipei Medical University Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Hung-Yen Chin
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital and School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, Taipei Country Hospital, Taipei, Taiwan, ROC
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Chiang CH, Jiang YH, Kuo HC. Therapeutic efficacy of biofeedback pelvic floor muscle exercise in women with dysfunctional voiding. Sci Rep 2021; 11:13757. [PMID: 34215820 PMCID: PMC8253800 DOI: 10.1038/s41598-021-93283-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/17/2021] [Indexed: 11/14/2022] Open
Abstract
Dysfunctional voiding (DV), a voiding dysfunction due to hyperactivity of the external urethral sphincter or pelvic floor muscles leading involuntary intermittent contractions during voiding, is not uncommon in neurologically normal women with lower urinary tract symptoms (LUTS). We aimed to investigate the therapeutic efficacy of biofeedback pelvic floor muscle training (PFMT) in female patients with DV and to identify the therapeutic efficacy. Thirty-one patients diagnosed with DV. All participates completed the 3-month biofeedback PFMT program, which was conducted by one experienced physiotherapist. At 3 months after treatment, the assessment of treatment outcomes included global response assessment (GRA), and the changes of clinical symptoms, quality of life index, and uroflowmetry parameters. 25 (80.6%) patients had successful outcomes (GRA ≥ 2), and clinical symptoms and quality of life index significantly improved after PFMT. Additionally, uroflowmetry parameters including maximum flow rate, voided volume, voiding efficiency, total bladder capacity, voiding time, and time to maximum flow rate significantly improved after PFMT treatment. Patients with the history of recurrent urinary tract infection in recent 1 year were found to have unsatisfied therapeutic outcomes. In conclusion, biofeedback PFMT is effective in female patients with DV with significant improvements in clinical symptoms, quality of life, and uroflowmetry parameters. The history of urinary tract infection in recent 1 year is a negative predictor of successful outcome.
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Affiliation(s)
- Ching-Hsiang Chiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, No. 707, Chung-Yang Rd., Sec. 3, Hualien, Taiwan, ROC
| | - Yuan-Hong Jiang
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, No. 707, Chung-Yang Rd., Sec. 3, Hualien, Taiwan, ROC
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University, No. 707, Chung-Yang Rd., Sec. 3, Hualien, Taiwan, ROC.
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Assis GM, Silva CPCD, Martins G. Proposal of a protocol for pelvic floor muscle evaluation and training to provide care to women with urinary incontinence. Rev Esc Enferm USP 2021; 55:e03705. [PMID: 34076151 DOI: 10.1590/s1980-220x2019033503705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/19/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To present a proposal of a protocol for pelvic floor muscle evaluation and training to provide care to women with urinary incontinence. METHOD Professional experience report, conducted in an outpatient facility for voiding dysfunctions in the Brazilian Unified Health System, conducted by an enterostomal therapist nurse. RESULTS Elaboration of a proposal of care protocol in nursing consultations based on a directed physical examination, nursing diagnoses of the International Classification for Nursing Practice, and the adaptation of a muscle training protocol as prescription. Steps: static observation, dynamic observation, and palpation to verify the tension and evaluation of strength, sustentation, relaxation, and muscle coordination, followed by prescriptions for relaxation, proprioception, training for strength, sustentation, abdominal and pelvic coordination, and maintenance, as per diagnosis. CONCLUSION This protocol proposal intends to support the evaluation of the pelvic muscles of women with urinary incontinence or at risk for developing this condition by nurses of all levels of healthcare, especially as part of nursing consultations in primary care.
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Affiliation(s)
- Gisela Maria Assis
- Universidade de Brasília, Departamento de Enfermagem, Programa de Pós-graduação em Enfermagem, Brasília, DF, Brazil.,Universidade Federal do Paraná, Hospital de Clínicas, Curitiba, PR, Brazil
| | | | - Gisele Martins
- Universidade de Brasília, Departamento de Enfermagem, Programa de Pós-graduação em Enfermagem, Brasília, DF, Brazil
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Therapeutic Effects of Urethral Sphincter Botulinum Toxin A Injection on Dysfunctional Voiding with Different Videourodynamic Characteristics in Non-Neurogenic Women. Toxins (Basel) 2021; 13:toxins13050362. [PMID: 34069448 PMCID: PMC8159094 DOI: 10.3390/toxins13050362] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 11/17/2022] Open
Abstract
Although female dysfunctional voiding (DV) is common in urological practice, it is difficult to treat. This study evaluated the therapeutic efficacy of urethral botulinum toxin A (BoNT-A) on non-neurogenic female DV. Based on the videourodynamic study (VUDS), the DV was classified into three subgroups according to the obstructive site. A successful treatment outcome was defined as an improvement of voiding efficiency by 10% and reported global response assessment by ≥1. The study compared therapeutic efficacy, baseline urodynamic parameters, and changes in urodynamic parameters between the treatment success and failure groups and among three DV subgroups. Predictive factors for successful treatment were also investigated. A total of 81 women with DV were categorized into three groups: 55 (67.9%) had mid-urethral DV, 19 (23.5%) had distal urethral DV, and 7 (8.6%) had combined BN dysfunction and mid-urethral DV after BN transurethral incision. The treatment outcome was successful for 55 (67.9%) patients and failed for 26 (32.1%). Successfully treated patients had a significant decrease of detrusor pressure, post-void residual volume, and bladder outlet obstruction index, as well as an increase in voiding efficiency at follow-up versus the treatment failure group. The logistic regression of urodynamic parameters and clinical variables revealed that a greater volume of first sensation of filling predicts a successful BoNT-A treatment outcome (p = 0.047). The urethral BoNT-A injection is effective in treating non-neurogenic women with DV, with a success rate of 67.9%. The videourodynamic characteristics of DV may differ among patients but does not affect the treatment outcome.
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Chuang FC, Yang TH, Kuo HC. Botulinum toxin A injection in the treatment of chronic pelvic pain with hypertonic pelvic floor in women: Treatment techniques and results. Low Urin Tract Symptoms 2020; 13:5-12. [PMID: 32654386 DOI: 10.1111/luts.12334] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/29/2020] [Accepted: 05/22/2020] [Indexed: 11/27/2022]
Abstract
Chronic pelvic pain (CPP) is an extremely bothersome condition which leads to major effects in women's everyday life. In addition to visceral sources of pain, pelvic floor dysfunction including myofascial pain and spasm on the pelvic floor muscles causing hypertonicity are causes often overlooked. Injecting botulinum toxin type A (BoNT-A) into hypertonic pelvic floor muscles may aid the relaxation of pelvic floor musculature. The muscles that are injected in CPP treatment include the obturator internus, levator ani (pubococcygeus, iliococcygeus, and puborectalis), and coccygeus. Generally, injections can be performed tolerably with safety under conscious sedation combined with local anesthesia. Most practitioners perform BoNT-A injection of pelvic floor muscles using anatomical landmarks identified by manual palpation only. For the precise location of injection sites, some needle guidance techniques were proposed, including electromyography, electrical stimulation, ultrasound, fluoroscopy, and/or computed tomography. Side effects of BoNT-A injection in CPP are rare and self-limiting. Because of the reversible nature of BoNT-A, reinjection appears to be necessary. Increasing proof points out that BoNT-A is a promising treatment option for CPP in women. We conducted a review of published literature in Pubmed, using chronic pelvic pain in women, hypertonic pelvic floor, and botulinum toxin as the keywords. This article aims to summarize the treatment techniques and results of BoNT-A injection for hypertonic pelvic floor in women with chronic pelvic pain.
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Affiliation(s)
- Fei-Chi Chuang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsai-Hwa Yang
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Hurt K, Zahalka F, Halaska M, Rakovicova I, Krajcova A. Extracorporeal shock wave therapy for treatment of vulvodynia: a prospective, randomized, double-blind, placebo-controlled study. Eur J Phys Rehabil Med 2020; 56:169-174. [PMID: 31939265 DOI: 10.23736/s1973-9087.20.05903-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Currently, there are no effective therapy strategies for idiopathic, non-organic vulvodynia in women. ESWT (extracorporeal shock wave therapy) is a nonsurgical/noninvasive technique widely used to treat musculoskeletal diseases, muscle spasticity and hypertonia, renal and biliary calculi and urological disorders. AIM We examined the effects of ESWT on vulvodynia in women. DESIGN A prospective, randomized, double-blind, placebo-controlled study was conducted between 2015 and 2018 following a feasibility study. SETTING Obstetrics and Gynecology Hospital departments. POPULATION The study included 62 women with vulvodynia for at least 3 months. METHODS The women were randomly assigned to either a treatment group (N.=31) or a placebo group (N.=31). The patients in the treatment group received perineally applied ESWT weekly (3000 pulses each for four consecutive weeks). The energy flux density was 0.25 mJ/mm2, frequency 4 Hz, focus zone 0-30 mm, therapeutic efficacy 0-90 mm, stand-off II. The device used was a standard electromagnetic shock wave unit with a focused shock wave handpiece. The position of the shock wave transducer was changed six times after every 500 pulses. Patients in the placebo group underwent the same treatment procedure, but the handpiece was provided with a placebo stand-off that disabled energy transmission. Subjective pain was self-evaluated by each patient using two tools before and after treatment: a 10 cm linear visual analogue scale (VAS, 0-10) and a cotton-swab test (CST, Goetsch scale 0-4). Follow-ups were done 1, 4, and 12 weeks post-ESWT. RESULTS In all, 61 women completed the study. We tested for differences in the VAS and CST within and between the treatment and placebo groups. The testing was between before treatment and particular follow-up. We found significant changes in the treatment group. Reductions in VAS (P<0.01) and CST (P<0.01) were observed at all three follow-ups. At all assessments, pain reduction was always >30%. In the placebo group there were no statistically significant changes between before and after treatment. There were no differences between the treatment and placebo groups before treatment but statistically significant differences at all three follow-ups (VAS P<0.01); CST P<0.01). CONCLUSIONS ESWT seems to reduce pain perception in our treatment group. Thus, we are encouraged to explore this technique further. CLINICAL REHABILITATION IMPACT The method is easily replicable, inexpensive, and without known side effects.
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Affiliation(s)
- Karel Hurt
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, Czech Republic -
| | - Frantisek Zahalka
- Sports Motoric Laboratory, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Michael Halaska
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Aneta Krajcova
- Department of Plastic Surgery, First Faculty of Medicine, Charles University, Prague, Czech Republic
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Pelvic floor dysfunction at transperineal ultrasound and voiding alteration in women with posterior deep endometriosis. Int Urogynecol J 2019; 30:1527-1532. [PMID: 31049643 DOI: 10.1007/s00192-019-03963-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/17/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Posterior deep infiltrating endometriosis (DIE) has been associated with pelvic floor muscle (PFM) alteration and voiding dysfunction (VD). The aim of this study is to evaluate the correlation between the presence of VD and altered PFM morphometry, objectively evaluated using 3D/4D transperineal ultrasound at rest and during dynamic maneuvers, in patients with posterior DIE. METHODS A prospective study was conducted on 108 symptomatic women scheduled for surgical removal of posterior DIE. The study population was divided in two groups according to presence or absence of VD on the Bristol Female Lower Urinary Tract Symptoms (BFLUTS). A 3D/4D transperineal ultrasound was performed to compare the following PFM morphometric parameters: levator hiatus area (LHA), antero-posterior (AP) and left-right (LR) diameters and levator ani muscle (LAM) coactivation. LAM coactivation was defined as the paradoxical contraction of the pelvic floor muscle during the Valsalva maneuver causing a smaller LHA than in the resting state. RESULTS Forty-eight (45.2%) women presented VD, while 60 (54.8%) women did not report any voiding complaints. Baseline characteristics did not significantly differ between the two groups. We did not find any significant statistical differences in PFM parameters between the two groups, except for a higher rate of levator ani muscle coactivation in women with VD compared with women without VD [64.6% (31/48) versus 31.7% (19/60), respectively; p = < 0.001]. CONCLUSIONS In women affected by posterior DIE, LAM coactivation at 3D/4D transperineal ultrasound seems to be more frequent in patients with than without VD.
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Wolff BJ, Joyce CJ, Brincat CA, Mueller ER, Fitzgerald CM. Pelvic floor myofascial pain in patients with symptoms of urinary tract infection. Int J Gynaecol Obstet 2019; 145:205-211. [PMID: 30758844 DOI: 10.1002/ijgo.12784] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 09/26/2018] [Accepted: 02/11/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To correlate lower urinary tract symptoms typically associated with a urinary tract infection (UTI) with physical examination findings of pelvic floor myofascial pain (PFMP). METHODS This retrospective review included all new patients presenting to a urogynecology clinic between August 2 and December 19, 2016. Patients completed validated questionnaires, had a catheterized urine specimen, and underwent pelvic examination. Associations between demographics, symptoms, urine culture, and PFMP were analyzed. RESULTS We included 250 patients with urinary frequency (n=160, 64.0%), urgency (n=155, 62.0%), urgency incontinence (n=140, 56.0%), pelvic pain (n=43, 17.2%), and dysuria (n=25, 10.0%). PFMP was detected in 125 (50.0%) patients and culture-proven UTI in 15 (6.0%) patients. Demographics associated with PFMP were lower prolapse stage (P<0.001), age younger than 50 years (P<0.001), lower parity (P=0.028), and non-white ethnicity (P=0.003). Symptoms associated with PFMP were dysuria (adjusted odds ratio 4.13, 95% confidence interval 1.08-15.78), urgency/frequency (2.72, 1.47-5.04), and patient-reported pelvic pain (2.57, 1.08-6.12). These symptoms were independent predictors in multivariable logistic regression analysis. CONCLUSIONS Most patients had symptoms associated with UTI; however, culture-confirmed diagnosis was infrequent and PFMT was diagnosed in half of participants. Clinicians treating women with these symptoms are advised to examine the pelvic floor muscles.
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Affiliation(s)
- Birte J Wolff
- Department of Obstetrics/Gynecology and Urology, Loyola University Chicago Stritch School of Medicine and Loyola University Medical Center, Maywood, IL, USA
| | - Cara J Joyce
- Biostatistics Core, Public Health Sciences, Center for Translational Research and Education, Loyola University Chicago, Maywood, IL, USA
| | - Cynthia A Brincat
- Department of Obstetrics/Gynecology and Urology, Loyola University Chicago Stritch School of Medicine and Loyola University Medical Center, Maywood, IL, USA
| | - Elizabeth R Mueller
- Department of Obstetrics/Gynecology and Urology, Loyola University Chicago Stritch School of Medicine and Loyola University Medical Center, Maywood, IL, USA
| | - Colleen M Fitzgerald
- Department of Obstetrics/Gynecology and Urology, Loyola University Chicago Stritch School of Medicine and Loyola University Medical Center, Maywood, IL, USA
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Petrikovets A, Veizi IE, Hijaz A, Mahajan ST, Daneshgari F, Buffington CAT, McCabe P, Chelimsky T. Comparison of Voiding Dysfunction Phenotypes in Women with Interstitial Cystitis/Bladder Pain and Myofascial Pelvic Pain: Results from the ICEPAC Trial. Urology 2019; 126:54-58. [PMID: 30682465 DOI: 10.1016/j.urology.2019.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate whether voiding parameters differ in patients with the common overlapping pelvic pain disorders, interstitial cystitis/bladder pain syndrome (IC/BPS), and myofascial pelvic pain (MPP). METHODS Uroflow and voiding diary assessed voiding phenotypes in this prospective cohort study (ICEPAC) of women comparing IC/BPS, IC/BPS +MPP, MPP, and healthy control (HC) subjects. RESULTS In 36 HC, 24 IC/BPS, 37 IC/BPS + MPP, and 14 MPP subjects, the voiding diary measurements indicate lower voided volumes in IC/BPS and IC/BPS + MPP groups (185 ± 24 mL, 169 ± 20 mL, respectively) compared to HC and MPP groups (294 ± 24 mL, 226 ± 36 mL, respectively; P <.05, P <.05), as well as higher 24-hour voiding frequency (11.6 ± 0.8 and 11 ± 1.2 voids/24 hours, respectively; HC 7.1 ± 0.5 voids/24 hours; P <.05, P <.05; MPP group 9 ± 1.2 voids/24 hours; P <.05, P <.05). Uroflow showed higher HC average flow rate (12.87 ± 0.92) compared to IC/BPS, IC/BPS+MPP, and MPP (8.31 ± 1.20, 8.02 ± 0.80, 8.17 ± 1.38, respectively; P <.01, P <.01, P <.05) and peak flow rate (27.0 ± 1.83) and IC/BPS, IC/BPS+MPP and MPP (16.20 ± 2.2, 17.33 ± 1.64, 17.21 ± 2.69 respectively; P <.01, P <.01, P <.05). CONCLUSION This quantitative evaluation of voiding diary and uroflow metrics reveals distinct voiding phenotypes, which can aid in the diagnosis of chronic pelvic pain syndromes. Patients with IC/BPS had more pain with a full bladder despite similar overall pain scores. Peak and average flow rates do not provide any differentiating power between IC/BPS and MPP patients. A longer time to peak flow may favor MPP though this finding needs confirmation.
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Affiliation(s)
- A Petrikovets
- Departments of Urology and Gynecology, Case Western Reserve University, Cleveland, OH
| | - I E Veizi
- Department of Pain Medicine, Cleveland VA Medical Center, Cleveland, OH
| | - A Hijaz
- Departments of Urology and Gynecology, Case Western Reserve University, Cleveland, OH
| | - S T Mahajan
- Departments of Urology and Gynecology, Case Western Reserve University, Cleveland, OH
| | | | | | - P McCabe
- University of California, Los Angeles, CA
| | - T Chelimsky
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI.
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Jiang YH, Chen SF, Jhang JF, Kuo HC. Therapeutic effect of urethral sphincter onabotulinumtoxinA injection for urethral sphincter hyperactivity. Neurourol Urodyn 2018; 37:2651-2657. [PMID: 29797345 DOI: 10.1002/nau.23714] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 04/28/2018] [Indexed: 11/08/2022]
Abstract
PURPOSE Urethral sphincter hyperactivity resulting in voiding dysfunction is frequently encountered. Medical treatment might not achieve a satisfactory result. OnabotlinumtoxinA urethral sphincter injection relaxes sphincter tonicity and possibly resumes efficient voiding. This study analyzed the treatment outcomes and predictor for successful onabotulinumtoxinA treatment on these patients. METHODS Patients with voiding dysfunction due to urethral sphincter hyperactivity and treated with injections of 100 U onabotulinumtoxinA into the urethral sphincter were retrospectively reviewed. Treatment outcomes were assessed 1 month after injection using the Global Response Assessment and were analyzed by demographic and baseline video-urodynamic characteristics. RESULTS Of the 95 patients included, satisfactory outcomes were reported in 58 (61.1%) patients. Treatment outcome was not related to age, gender, or voiding dysfunction subtype. Patients with satisfactory outcomes had a significantly smaller volume at first sensation of filling (P = 0.046), greater detrusor pressure (P = 0.027), higher maximum flow rate (P = 0.017), and smaller post-void residual (P = 0.006). In multivariate analysis, an open bladder neck during voiding was the only predictor for successful outcome (88% in satisfactory outcome, 12% in failure outcome, P < 0.001). Patients with non-neurogenic voiding dysfunction had a significantly longer therapeutic duration than those with neurogenic voiding dysfunction (9.55 ± 4.18 vs 7.44 ± 2.91 months, P = 0.033). Increased urinary incontinence was reported in 18 patients, including 6 with stress urinary incontinence and 12 with urgency urinary incontinence. CONCLUSION Subjective improvement was reported in 61.1% of patients with voiding dysfunction due to urethral sphincter hyperactivity after onabotulinumtoxinA urethral sphincter injection. An open bladder neck during voiding at baseline predicts a successful outcome.
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Affiliation(s)
- Yuan-Hong Jiang
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Sheng-Fu Chen
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Jia-Fong Jhang
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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Abstract
Female urethral stricture (FUS) represents a rare condition, yet one that can cause significant, bothersome lower urinary tract symptoms (LUTS). Historically, urethral dilation has been a preferred treatment choice for these patients. A variety of reconstructive surgical techniques have been described in recent years to provide more definitive management in this challenging group of patients. We present an overview of FUS and a summary of surgical management options.
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Affiliation(s)
- Nathan Hoag
- Department of Urology, Austin Hospital, University of Melbourne, Heidelberg, Victoria 3084, Australia
| | - Justin Chee
- Department of Urology, Austin Hospital, University of Melbourne, Heidelberg, Victoria 3084, Australia.,MURAC Health, East Melbourne, Victoria 3112, Australia
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15
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Zago M, Camerota TC, Pisu S, Ciprandi D, Sforza C. Gait analysis of young male patients diagnosed with primary bladder neck obstruction. J Electromyogr Kinesiol 2017; 35:69-75. [PMID: 28601565 DOI: 10.1016/j.jelekin.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/05/2017] [Accepted: 05/24/2017] [Indexed: 02/07/2023] Open
Abstract
Primary bladder neck obstruction (PBNO) represents an inappropriate or inadequate relaxation of the bladder neck during micturition. Based on the observation of an increased rate of postural imbalances in male patients with PBNO, we hypothesized a possible role of an unbalanced biomechanics of the pelvis on urethral sphincters activity. Our aim was to identify kinematic imbalances, usually disregarded in PBNO patients, and which could eventually be involved in the etiopathogenesis of the disease. Seven male adult patients (39.6±7.1years) were recruited; in all patients, PBNO was suspected at bladder diary and uroflowmetry, and was endoscopically confirmed with urethroscopy. Participants gait was recorded with a motion capture system (BTS Spa, Italy) to obtain three-dimensional joint angles and gait parameters. Multivariate statistics based on a Principal Component model allowed to assess the similarity of patients' gait patterns with respect to control subjects. The main finding is that patients with PBNO showed significant discordance in the observations at the ankle and pelvis level. Additionally, 6/7 patients demonstrated altered trunk positions compared to normal curves. We suggest that the identified postural imbalances could represent the cause for an anomalous activation of pelvic floor muscles (hypertonia). The consequent urinary sphincters hypercontraction may be responsible for the development of voiding dysfunction in male patients with no significant morphological alterations. Results reinforced the hypothesis of an etiopathogenetic role of postural imbalances on primary bladder neck obstruction in male patients.
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Affiliation(s)
- Matteo Zago
- Dpt. of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milano, Italy; Current address: Dept. of Electronics, Information and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy.
| | - Tommaso Ciro Camerota
- Dpt. of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milano, Italy.
| | - Stefano Pisu
- Dpt. of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milano, Italy.
| | - Daniela Ciprandi
- Dpt. of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milano, Italy.
| | - Chiarella Sforza
- Dpt. of Biomedical Sciences for Health, Università degli Studi di Milano, via Mangiagalli 31, 20133 Milano, Italy.
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16
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Primary bladder neck obstruction may be determined by postural imbalances. Med Hypotheses 2016; 97:114-116. [DOI: 10.1016/j.mehy.2016.10.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 10/26/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022]
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17
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Cohn JA, Brown ET, Reynolds WS, Kaufman MR, Dmochowski RR. Pharmacologic management of non-neurogenic functional obstruction in women. Expert Opin Drug Metab Toxicol 2016; 12:657-67. [PMID: 27095013 DOI: 10.1080/17425255.2016.1178239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Impaired bladder emptying in women without neurologic disease may be related to urethral obstruction and/or impaired bladder contractility. Mechanical obstruction generally requires surgical management and options are limited for impaired bladder contractility. However, functional obstruction from voiding dysfunction or primary bladder neck obstruction may present an opportunity for pharmacologic intervention. AREAS COVERED In this review, the authors extensively reviewed available literature regarding the use of off-label medications for functional bladder outlet obstruction in women. In addition, side effect profiles and pharmacology of these medications determined from on-label indications are reviewed. Specific medications reviewed include vaginal diazepam, baclofen, urethral botulinum toxin injection, and alpha-adrenergic blockers. EXPERT OPINION Alpha-blockers in particular have demonstrated promise in women with demonstrable or suspected bladder outlet obstruction with side effect profiles similar to those observed in men. However, lack of quality data hinders informed decision making with alpha-blockers or any of the other agents studied in women with non-neurogenic functional outlet obstruction. In the absence of well-designed, placebo-controlled multi-institutional trials, those prescribing these medications must be aware of special considerations and side effects associated with relatively unfamiliar treatments in the context of uncertain benefit.
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Affiliation(s)
- Joshua A Cohn
- a Department of Urologic Surgery , University Medical Center , Nashville , TN , USA
| | - Elizabeth T Brown
- a Department of Urologic Surgery , University Medical Center , Nashville , TN , USA
| | - W Stuart Reynolds
- a Department of Urologic Surgery , University Medical Center , Nashville , TN , USA
| | - Melissa R Kaufman
- a Department of Urologic Surgery , University Medical Center , Nashville , TN , USA
| | - Roger R Dmochowski
- a Department of Urologic Surgery , University Medical Center , Nashville , TN , USA
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Neuromodulation for the Treatment of Endometriosis-Related Symptoms. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2016. [DOI: 10.5301/je.5000243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sacral and pudendal neuromodulation have been advocated for the treatment of refractory pelvic pain, urinary urgency and retention, as well as fecal incontinence or constipation, all of which are commonly related to endometriosis and/or its surgical treatment. In this review, the mechanisms of action and different routes of neuromodulation will be detailed, as well as all the studied applications of neuromodulation on ameliorating symptoms related to endometriosis and/or its treatment.
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