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Ye AL, Johnston E, Hwang S. Pelvic Floor Therapy and Initial Interventions for Pelvic Floor Dysfunction in Gynecologic Malignancies. Curr Oncol Rep 2024; 26:212-220. [PMID: 38294706 DOI: 10.1007/s11912-024-01498-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW This review provides evidence-based updates for the first-line management approaches for pelvic floor disorders in patients with gynecologic malignancies, as well as important provider considerations when referring for pelvic floor physical therapy. RECENT FINDINGS Currently, there is strong evidence to recommend pelvic floor muscle training as initial treatment for urinary incontinence and for pelvic organ prolapse; some evidence to recommend a more targeted pelvic floor muscle training program for fecal incontinence; and mostly expertise-based evidence to recommend vaginal gels or estrogen to aid with dyspareunia causing sexual dysfunction. More research is greatly needed to understand the role of overactive pelvic floor muscles in survivors with chronic pelvic pain and the treatment of post-radiation pelvic complications such as vaginal stenosis and cystitis. While pelvic floor disorders are common concerns in gynecologic cancer survivors, there are evidence-based initial noninvasive treatment approaches that can provide relief for many individuals.
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Affiliation(s)
- Alice L Ye
- Department of Pain Medicine, FC13.3017, The University of Texas MD Anderson Texas Cancer Center, 1400 Holcombe Blvd., Houston, TX, 77030, USA.
| | - Eleanor Johnston
- Creighton School of Medicine, Creighton University, Phoenix, AZ, USA
| | - Sarah Hwang
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL, USA
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DE Nunzio C, Nacchia A, Gravina C, Turchi B, Gallo G, Trucchi A, DI Giacomo F, Disabato G, Franco A, Rovesti L, Lombardo R, Cicione A, Tubaro A. Adverse events related to antimuscarinics and beta-3-agonist: "real-life" data from the Eudra-Vigilance Database. Minerva Urol Nephrol 2022; 74:761-779. [PMID: 35708534 DOI: 10.23736/s2724-6051.22.04849-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Antimuscarinic (AM) and beta-3-agonist (B3A) treatment are the standard first-line pharmacological treatment used to manage overactive bladder (OAB) patients. Aim of our study was to analyze real-life data of adverse events related to AMs and B3A reported on Eudra-Vigilance (EV) Database. METHODS EV database is the system for managing and analyzing information on suspected adverse reactions to medicines which have been authorized or being studied in clinical trials in the European Economic Area (EEA). We recorded the number of AEs for antimuscarinic and beta-3-agonist per category and severity until January 2021. RESULTS Overall, 2313 AEs were reported for oxybutinin, 5129 for solifenacin, 2483 for tolterodine, 3523 for fesoterodine, 787 for trospium, 621 for propiverine and 7213 for mirabegron. Urinary retention was higher for fesoterodine (43%) and tolterodine (23%) when compared to solifenacin (10%), mirabegron (11%) and oxybutinin (4%). Cognitive disorder was uncommon for all the analyzed drugs analyzed. Regarding anticolinergic AEs: vision blurred, dry mouth and constipation were higher for AMs when compared to mirabegron. Their prevalence was higher in female patients. Mirabegron presented a higher risk of hypertension (7%) when compared to oxybutinin (2%, P<0.01), solifenacin (2%, P<0.01), tolterodine (2%, P<0.01) and fesoterodine (1%, P<0.01); the rate of hypertension was higher in females (63%) than males (29%) (P<0.01). The risk of acute urinary retention was also significantly higher (15% vs. 10%, P<0.01) in older patients (>85 years). CONCLUSIONS Real life data is consistent with registry studies regarding the rate of AEs related to antimuscarinic and beta-3-agonist. However some differences were observed. Female patients present higher rates of AEs when compared to male patients. The risk of acute urinary retention was particularly evident in the octogenarians.
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Affiliation(s)
| | - Antonio Nacchia
- IRCCS Oncological Referrence Center of Basilicata, Rionero in Vulture, Potenza, Italy
| | - Carmen Gravina
- Department of Urology, Sant'Andrea Hospital, Rome, Italy
| | | | - Giacomo Gallo
- Department of Urology, Sant'Andrea Hospital, Rome, Italy
| | | | - Ferdinando DI Giacomo
- IRCCS Oncological Referrence Center of Basilicata, Rionero in Vulture, Potenza, Italy
| | - Giuseppe Disabato
- IRCCS Oncological Referrence Center of Basilicata, Rionero in Vulture, Potenza, Italy
| | - Antonio Franco
- Department of Urology, Sant'Andrea Hospital, Rome, Italy
| | | | | | | | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Rome, Italy
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Astasio-Picado Á, García-Cano M. Neuromodulation of the Posterior Tibial Nerve for the Control of Urinary Incontinence. Medicina (B Aires) 2022; 58:medicina58030442. [PMID: 35334618 PMCID: PMC8955811 DOI: 10.3390/medicina58030442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/08/2022] [Accepted: 03/16/2022] [Indexed: 12/01/2022] Open
Abstract
Urinary incontinence is considered a health problem that both elderly and young people can suffer, most often elderly women. This problem can lead to difficulties in establishing social relationships and dependence, negatively affecting the quality of life of the people who suffer from it. To evaluate and analyze the studies that demonstrate the efficacy of interventions based on the neuromodulation of the posterior tibial nerve as a treatment for the control of urinary incontinence. The search period for articles focused on those published between March 2011 to March 2021, in five databases (Pubmed, Cochrane Library, Scielo, Google Academic and WOS) based on the clinical question, using the keywords derived from the DeCS and MeSH thesauri, combined with the Boolean operators “AND”, “NOT” and “OR”. The search was limited to publications from the last 10 years, in English and Spanish. After applying the selection criteria and evaluating the quality of the methodology, 5.28% (n = 27) of the 511 results were included with filters: 9 systematic reviews, 10 cohorts and 8 randomized controlled trials. After comparing the different articles, it was found that percutaneous stimulation of the tibial nerve is a suitable technique for treating overactive bladder. It is a promising technique in case of pelvic floor dysfunctions and effective for the control of urinary incontinence.
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Carzoli JP, Alenazy M, Richmond SB, Enoka RM. Bursting TENS increases walking endurance more than Continuous TENS in middle-aged adults. J Electromyogr Kinesiol 2022; 63:102644. [DOI: 10.1016/j.jelekin.2022.102644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 11/30/2022] Open
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Alkis O, Sevim M, Güven Kartal İ, Baser A, İbrahim İvelik H, Aras B. Comparison of transcutaneous tibial nerve stimulation (TTNS) protocols for women with refractory overactive bladder (OAB): A prospective randomised trial. Int J Clin Pract 2021; 75:e14342. [PMID: 33966335 DOI: 10.1111/ijcp.14342] [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] [Received: 02/22/2021] [Accepted: 05/04/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Transcutaneous tibial nerve stimulation (TTNS) is a noninvasive method used in OAB treatment. Purpose of this study is to compare the effectiveness of the TTNS procedure applied once a week and three times a week in women diagnosed with wet type refractory OAB. METHODS A total of 60 patients diagnosed with wet type OAB that was refractory to medical treatment were included in the study. Participants were equally and randomly divided into two groups: TTNS treatment was performed with a duration of 30 minutes for 12 weeks, once a week to Group I and three times a week to Group II. Pretreatment and posttreatment OAB-V8/ICIQ-SF scores and voiding frequencies recorded in the bladder diary were compared between groups. RESULTS Four patients in Group 1 and eight in Group 2 left the study without completing the treatment. TTNS was performed in both groups for 12 weeks. There was a significant decrease in the voiding frequency, OAB-V8, ICIQ-SF scores in both group 1 and group 2 (P < .001). A significant decrease in the OAB-V8 score was observed in the 5th week in Group 1, and in the 3rd week in Group 2. Complete response was observed in 6 patients (23.1%) in Group 1 after 12 weeks of TTNS procedure. In Group 2, 10 patients (45.5%) had a complete response. After the 12-week TTNS procedure, no significant difference was observed between the groups in terms of treatment response. CONCLUSION TTNS can be safely used before invasive treatments in resistant OAB. TTNS procedure three times a week seems more effective than performing it once a week. What's known TTNS is one of the effective alternative treatments in resistant OAB treatment. What's new As the number of sessions is increased in TTNS treatment, the success of the treatment can increase.
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Affiliation(s)
- Okan Alkis
- Department of Urology, Faculty of Medicine, Kütahya University of Health Sciences, Kutahya, Turkey
| | - Mehmet Sevim
- Department of Urology, Faculty of Medicine, Kütahya University of Health Sciences, Kutahya, Turkey
| | - İbrahim Güven Kartal
- Department of Urology, Faculty of Medicine, Kütahya University of Health Sciences, Kutahya, Turkey
| | - Aykut Baser
- Department of Urology, Faculty of Medicine, Hitit University, Çorum, Turkey
| | - Halil İbrahim İvelik
- Department of Urology, Faculty of Medicine, Kütahya University of Health Sciences, Kutahya, Turkey
| | - Bekir Aras
- Department of Urology, Faculty of Medicine, Kütahya University of Health Sciences, Kutahya, Turkey
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Kajbafzadeh AM, Ahmadi H, Montaser-Kouhsari L, Sabetkish S, Ladi-Seyedian S, Sotoudeh M. Intravesical electromotive administration of botulinum toxin type A in improving the bladder and bowel functions: Evidence for novel mechanism of action. J Spinal Cord Med 2021; 44:89-95. [PMID: 30998432 PMCID: PMC7919921 DOI: 10.1080/10790268.2019.1603490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: To examine the hypothesis that what is the concomitant mechanism of action botulinum toxin type A (BoNTA) administration by intravesical electromotive into the bladder resulting in bladder function improvement. We also tried to confirm the possibility of retrograde trans-axonal transportation of toxin.Design: Animal study.Setting: Ten male rabbits were divided into two groups.Participants: Group 1 (G1) (n = 5) (BoNTA/EMDA), and group 2 (G2) (n = 5) the control group.Interventions: Animals in G1received 10 IU/Kg of intravesical BoNTA through a specific catheter for electromotive drug administration (BoNTA/EMDA). About 0.1-0.15 ml of toxin was diluted in 1 ml of distilled water. The maximum frequency of the device for drug solution delivery was set at 4 mA for 15 min. In G2 as the control group, the same procedure was performed to deliver normal saline to the bladder.Outcome measures: Multiple biopsies were taken from bladder's contiguous structures one month postoperatively. The immunohistochemical (IHC) evaluation was performed with anti-clostridium botulinum toxoid type A mouse IgM monoclonal antibody.Results: In specimens of G1, BoNTA penetrated through muscular layers of the bladder wall and the staining was uniform in the urothelium, interstitium, and muscular layers. Positive IHC staining showed that BoNTA was traced in the upper and lower spinal cord in addition to pelvic nerve, sacral nerve plexus, intestine wall, and pelvic floor muscle. In G2, all the specimens were intact in IHC staining.Conclusions: The presence of BoNTA in lower and upper spinal cord suggests the possibility of retrograde trans-axonal transfer of toxin to lower and upper neural pathways which may result in simultaneous improvement in bladder and bowel functions.
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Affiliation(s)
- Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Ahmadi
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Laleh Montaser-Kouhsari
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shabnam Sabetkish
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanam Ladi-Seyedian
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Sotoudeh
- Department of pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Lee UJ, Ward JB, Feinstein L, Matlaga BR, Martinez-Miller E, Bavendam T, Kirkali Z, Kobashi KC. National Trends in Neuromodulation for Urinary Incontinence Among Insured Adult Women and Men, 2004-2013: The Urologic Diseases in America Project. Urology 2020; 150:86-91. [PMID: 33296698 DOI: 10.1016/j.urology.2020.11.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine US trends in neuromodulation for urinary incontinence (UI) treatment from 2004 to 2013. METHODS This study utilized 2 data sources: the Optum© de-identified Clinformatics® Data Mart Database for privately insured adults aged 18-64 years with a UI diagnosis (N≈40,000 women and men annually) and the Medicare 5% Sample for beneficiaries aged ≥65 years with a UI diagnosis (N≈65,000 women and men annually). We created annual cross-sectional cohorts and assessed prevalence of UI-related neuromodulation procedures among men and women separately from 2004 to 2013. Analyses were conducted overall and stratified by age, race/ethnicity, and geographic region. RESULTS Nearly all neuromodulation procedures occurred in outpatient settings. Sacral neuromodulation (SNM) procedures for UI in both women and men grew steadily from 2004 to 2013, with more procedures performed in women than men. Among women with UI, SNM prevalence grew from 0.1%-0.2% in 2004 to 0.5%-0.6% in 2013. Posterior tibial nerve stimulation (PTNS) experienced growth from 2011 to 2013. Chemodenervation of the bladder with onabotulinumtoxinA (BTX) combined with other injectable procedures (including urethral bulking) remained stable over time. CONCLUSIONS From 2004 to 2013, SNM procedures remained relatively uncommon but increased consistently. PTNS experienced growth starting in 2011 when PTNS-specific insurance claims became available. BTX trends remain unclear; future studies should assess it separately from other injectable procedures. Neuromodulation has a growing role in UI treatment, and ongoing trends will be important to examine.
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Affiliation(s)
- Una J Lee
- Section of Urology, Virginia Mason Medical Center, Seattle, WA
| | | | | | - Brian R Matlaga
- Johns Hopkins Brady Urological Institute, Department of Urology, Baltimore, MD
| | | | - Tamara Bavendam
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
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Bels J, de Vries P, de Beij J, Marcelissen T, van Koeveringe G, Rademakers K. Long-term Follow-up of Intravesical Onabotulinum Toxin-A Injections in Male Patients with Idiopathic Overactive Bladder: Comparing Surgery-naïve Patients and Patients After Prostate Surgery. Eur Urol Focus 2020; 7:1424-1429. [PMID: 32919951 DOI: 10.1016/j.euf.2020.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 08/06/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Evidence regarding long-term results in male idiopathic overactive bladder (iOAB) patients is limited and rarely focuses on the effects of prior prostatic surgery. OBJECTIVE This study aims to identify the long-term treatment persistency and occurrence of adverse events of intravesical onabotulinum toxin-A (BoNT-A) injections in male iOAB patients after prostatic surgery (ie, transurethral resection of the prostate [TURP] or radical prostatectomy [RP]) compared with surgery-naïve patients. DESIGN, SETTING, AND PARTICIPANTS In this retrospective, single-centre study, data from 477 patients treated with intravesical BoNT-A injections were collected. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcome data of 120 male patients with iOAB, with collectively 207 BoNT-A injections, were analysed and presented in this study. RESULTS AND LIMITATIONS At the last point of follow-up, 35 patients (29.2%) were still on active treatment. Twenty patients (16.7%) required de novo clean intermittent self-catheterisation (CISC). Three groups were identified: 56 patients without prostate surgery, 40 patients with TURP, and 24 patients with RP prior to treatment. Discontinuation rates and patient-reported outcomes of BoNT-A treatment (none, insufficient, or satisfactory) were similar, but a significant difference was seen in de novo CISC (p=0.004): 28.6% in the group without prior surgery, 7.5% in the TURP subgroup, and 4.2% in the RP subgroup. Odds of de novo CISC was significantly higher for the group without prior surgery than for both the TURP subgroup (odds ratio [OR] 4.9; 95% confidence interval [CI]: 1.33-18.31; p=0.017) and the RP subgroup (OR 9.2; 95% CI: 1.14-73.96; p= 0.037). CONCLUSIONS The data of this retrospective, single-centre cohort suggest that BoNT-A treatment leads to lower CISC rates in male patients after prior desobstructive surgery than in surgery-naïve patients. PATIENT SUMMARY This study describes the results of onabotulinum toxin-A (BoNT-A) injections in the bladder of male patients with idiopathic overactive bladder after initial prostate surgery compared with surgery-naïve patients. The results showed that BoNT-A treatment leads to lower catheterisation rates in patients after prior prostate surgery than in men without prior prostate surgery.
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Affiliation(s)
- Julia Bels
- Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands.
| | - Peter de Vries
- Department of Urology, Zuyderland Medisch Centrum, Sittard/Heerlen, The Netherlands
| | - Jeltje de Beij
- Department of Urology, Zuyderland Medisch Centrum, Sittard/Heerlen, The Netherlands
| | - Tom Marcelissen
- Department of Urology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Gommert van Koeveringe
- Department of Urology, Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands
| | - Kevin Rademakers
- Department of Urology, Zuyderland Medisch Centrum, Sittard/Heerlen, The Netherlands
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Soligo M, Torella M, Balzarro M, Matarazzo MG, Braga A, Serati M. An innovative device in the management of female urodynamic stress incontinence: a perception survey. MINERVA GINECOLOGICA 2020; 72:219-228. [PMID: 33000935 DOI: 10.23736/s0026-4784.20.04675-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Urinary incontinence significantly affects daily life of suffering women. Minimally invasive solutions to cope with urine leakage would be of great interest. METHODS A survey to investigate efficacy and compliance of an innovative intravaginal device (Diveen®) to reduce the risk of urine leakage was performed in 5 Urogynecological Centers across Italy. Women with urodynamic diagnosis of stress incontinence, included mixed conditions, underwent the survey. RESULTS The device was effective (60%) independently from severity of Incontinence or the presence of concomitant detrusor overactivity (mixed forms) with a positive impact on quality of life in more than half of the women. Also compliance with the device was satisfactory (up to 73%). Clinically symptomatic prolapse and age >65 years are the only limiting factors in terms of efficacy and compliance, while the menopausal status would not seem to affect these aspects. CONCLUSIONS Despite global satisfactory outcomes, 46% of the surveyed women declare their propensity to use the device. This data deserves further investigation.
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Affiliation(s)
- Marco Soligo
- Unit of Urogynecology, Department of Woman, Mother, and Neonate, Buzzi Children's Hospital, ASST Fatebenefratelli-Sacco, University of Milan, Milan, Italy -
| | - Marco Torella
- Department of Gynecology, Obstetric and Reproductive Science, Second University of Naples, Naples, Italy
| | - Matteo Balzarro
- Department of Urology, University Hospital of Verona, Verona, Italy
| | - Maria G Matarazzo
- Gynecological Clinic, University Polyclinic of Catania, Catania, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
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Enoka RM, Amiridis IG, Duchateau J. Electrical Stimulation of Muscle: Electrophysiology and Rehabilitation. Physiology (Bethesda) 2020; 35:40-56. [DOI: 10.1152/physiol.00015.2019] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The generation of action potentials in intramuscular motor and sensory axons in response to an imposed external current source can evoke muscle contractions and elicit widespread responses throughout the nervous system that impact sensorimotor function. The benefits experienced by individuals exposed to several weeks of treatment with electrical stimulation of muscle suggest that the underlying adaptations involve several physiological systems, but little is known about the specific changes elicited by such interventions.
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Affiliation(s)
- Roger M. Enoka
- Department of Integrative Physiology, University of Colorado Boulder, Colorado
| | - Ioannis G. Amiridis
- Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jacques Duchateau
- Laboratory of Applied Biology and Neurophysiology, ULB Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
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Yamashiro J, de Riese W, de Riese C. New Implantable Tibial Nerve Stimulation Devices: Review of Published Clinical Results in Comparison to Established Neuromodulation Devices. Res Rep Urol 2019; 11:351-357. [PMID: 31921712 PMCID: PMC6934123 DOI: 10.2147/rru.s231954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 11/26/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of this review is to offer an update for medical providers practicing general urology and urogynecology in evolving and new promising technologies for neuromodulation in patients with OAB. Patients and Methods A focused literature search for the years 2015 through 2019 was conducted on PubMed/Medline for the terms: “new techniques” AND “neuromodulation” AND “tibial nerve stimulation” AND “overactive bladder”. We limited our search to publications in English, for the last five years and with patient follow-up of at least 3 months. Results Clinical success, safety based on adverse events, and quality of life improvement criteria were evaluated and compared to sacral nerve stimulation (SNS) devices and older, non-implantable percutaneous tibial nerve stimulation (PTNS) treatment devices. Considering the limited number of participants with up to 6 months follow-up data currently available, overall the clinical response rates suggest that the new implantable devices stimulating the tibial nerve have a promising clinical outlook, are less invasive upon implantation than SNS, less expensive, and less of a burden on patients compared to the older non-implantable PTNS devices. Conclusion Practicing urologists should be aware of this new treatment option when counseling their patients regarding treatment for OAB.
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Affiliation(s)
- Justine Yamashiro
- School of Medicine, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Werner de Riese
- Department of Urology, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Cornelia de Riese
- Department of Obstetrics and Gynecology, Texas Tech University Health Science Center, Lubbock, TX, USA
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Development and Validation of a Machine Learning Algorithm for Predicting Response to Anticholinergic Medications for Overactive Bladder Syndrome. Obstet Gynecol 2019; 134:946-957. [DOI: 10.1097/aog.0000000000003517] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Clinical outcomes of intravesical injections of botulinum toxin type A in patients with refractory idiopathic overactive bladder. Pharmacol Rep 2018; 70:1133-1138. [DOI: 10.1016/j.pharep.2018.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/22/2018] [Accepted: 08/01/2018] [Indexed: 12/12/2022]
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Transcutaneous stimulation of the posterior tibial nerve for treating refractory urge incontinence of idiopathic and neurogenic origin. Actas Urol Esp 2017; 41:465-470. [PMID: 28325529 DOI: 10.1016/j.acuro.2017.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 01/23/2017] [Accepted: 01/24/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To assess the efficacy of treatment with transcutaneous posterior tibial nerve stimulation (TPTNS) in patients with urge urinary incontinence, of neurogenic or nonneurogenic origin, refractory to first-line therapeutic options. MATERIAL AND METHODS We included 65 patients with urge urinary incontinence refractory to medical treatment. A case history review, a urodynamic study and a somatosensory evoked potentials (SEP) study were conducted before the TPTNS, studying the functional urological condition by means of a voiding diary. The treatment consisted of 10 weekly sessions of TPTNS lasting 30minutes. RESULTS Some 57.7% of the patients showed abnormal tibial SEPs, and 42% showed abnormal pudendal SEPs. A statistically significant symptomatic improvement was observed in all clinical parameters after treatment with TPTNS, and 66% of the patients showed an overall improvement, regardless of sex, the presence of underlying neurological disorders, detrusor hyperactivity in the urodynamic study or SEP disorders. There were no adverse effects during the treatment. CONCLUSIONS TPTNS is an effective and well tolerated treatment in patients with urge incontinence refractory to first-line therapies and should be offered early in the treatment strategy. New studies are needed to identify the optimal parameters of stimulation, the most effective treatment protocols and long-term efficacy, as well as its applicability to patients with a neurogenic substrate.
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Crook JJ, Lovick TA. High Frequency Stimulation of the Pelvic Nerve Inhibits Urinary Voiding in Anesthetized Rats. Front Physiol 2017; 8:623. [PMID: 28970803 PMCID: PMC5609575 DOI: 10.3389/fphys.2017.00623] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 08/11/2017] [Indexed: 01/01/2023] Open
Abstract
Urge Urinary Incontinence: “a sudden and uncontrollable desire to void which is impossible to defer” is extremely common and considered the most bothersome of lower urinary tract conditions. Current treatments rely on pharmacological, neuromodulatory, and neurotoxicological approaches to manage the disorder, by reducing the excitability of the bladder muscle. However, some patients remain refractory to treatment. An alternative approach would be to temporarily suppress activity of the micturition control circuitry at the time of need i.e., urgency. In this study we investigated, in a rat model, the utility of high frequency pelvic nerve stimulation to produce a rapid onset, reversible suppression of voiding. In urethane-anesthetized rats periodic voiding was induced by continuous infusion of saline into the bladder whilst recording bladder pressure and electrical activity from the external urethral sphincter (EUS). High frequency (1–3 kHz), sinusoidal pelvic nerve stimulation initiated at the onset of the sharp rise in bladder pressure signaling an imminent void aborted the detrusor contraction. Urine output was suppressed and tone in the EUS increased. Stimulating the right or left nerve was equally effective. The effect was rapid in onset, reversible, and reproducible and evoked only minimal “off target” side effects on blood pressure, heart rate, respiration, uterine pressure, or rectal pressure. Transient contraction of abdominal wall was observed in some animals. Stimulation applied during the filling phase evoked a small, transient rise in bladder pressure and increased tonic activity in the EUS, but no urine output. Suppression of micturition persisted after section of the contralateral pelvic nerve or after ligation of the nerve distal to the electrode cuff on the ipsilateral side. We conclude that high frequency pelvic nerve stimulation initiated at the onset of an imminent void provides a potential means to control urinary continence.
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Affiliation(s)
- Jonathan J Crook
- Physiology, Pharmacology and Neuroscience, University of BristolBristol, United Kingdom
| | - Thelma A Lovick
- Physiology, Pharmacology and Neuroscience, University of BristolBristol, United Kingdom
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Drake M. Editorial Comment. J Urol 2017; 198:209-210. [DOI: 10.1016/j.juro.2017.01.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Marcus Drake
- Department of Physiological Urology, University of Bristol, Bristol, United Kingdom
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Fontaine CL, Rudd I, Pakzad M, Hamid R, Ockrim JL, Greenwell TJ. Patient treatment preferences for symptomatic refractory urodynamic idiopathic detrusor overactivity. Urol Ann 2017; 9:249-252. [PMID: 28794591 PMCID: PMC5532892 DOI: 10.4103/ua.ua_172_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/27/2017] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION There is a multiplicity of treatments currently available for patients with symptomatic refractory urodynamic idiopathic detrusor overactivity (SRU IDO). We have assessed patient treatment preferences and their outcomes over a 12-month period from January 1 2009 to December 31 2009. PATIENTS AND METHODS A retrospective database of all patients with SRU IDO was reviewed for patient demographics, treatment preference, and outcome. All patients attending for treatment in the time period were offered: no further treatment, repeat bladder training ± antimuscarinic (BT ± AM), acupuncture, intravesical botulinum toxin injection, sacral neuromodulation (SNM), clam cystoplasty ± Mitrofanoff channel formation, and ileal conduit. STATISTICAL ANALYSIS USED Statistical analysis of outcomes was done by Chi-square test, and statistical significance was determined as P < 0.05. RESULTS A total of 217 patients with SRU IDO underwent primary treatment in this time period, with a median age of 56 years and follow-up for a minimum of 12 months' posttreatment to determine outcome. No patients opted for any further treatment or an ileal conduit. The majority of patients opted for intravesical botulinum toxin injections and SNM with similar success rates (approximately 70%). A small number of patients decided to have nonsurgical interventions (BT ± AM or acupuncture) and had a broadly similar success rate (50%). A minority opted for clam cystoplasty ± Mitrofanoff channel formation - this group reported the highest success rate at 86%. CONCLUSIONS Treatment options in SRU IDO are diverse, with the majority of patients opting for minimally invasive surgery. Clinicians should be familiar with all treatment options for management of SRU IDO.
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Affiliation(s)
| | - Ian Rudd
- Department of Urology, University College London Hospital, London, W1G 8PH, UK
| | - Mahreen Pakzad
- Department of Urology, University College London Hospital, London, W1G 8PH, UK
| | - Rizwan Hamid
- Department of Urology, University College London Hospital, London, W1G 8PH, UK
| | - Jeremy L. Ockrim
- Department of Urology, University College London Hospital, London, W1G 8PH, UK
| | - Tamsin J. Greenwell
- Department of Urology, University College London Hospital, London, W1G 8PH, UK
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Apostolidis A, Averbeck MA, Sahai A, Rahnama'i MS, Anding R, Robinson D, Gravas S, Dmochowski R. Can we create a valid treatment algorithm for patients with drug resistant overactive bladder (OAB) syndrome or detrusor overactivity (DO)? Results from a think tank (ICI-RS 2015). Neurourol Urodyn 2017; 36:882-893. [DOI: 10.1002/nau.23170] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/29/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
| | | | - Arun Sahai
- Department of Urology; Guy's and St.Thomas’ Hospitals; London UK
| | | | - Ralf Anding
- Department of Neurourology; University Hospital Bonn; Bonn Germany
| | - Dudley Robinson
- Department of Urogynaecology; King's College Hospital; NHS Foundation Trust; London UK
| | - Stavros Gravas
- Department of Urology; University of Thessaly; Larissa Greece
| | - Roger Dmochowski
- Department of Urology; Vanderbilt University; Nashville Tennesse
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Abstract
: Overactive bladder is a term used to describe a group of lower urinary tract symptoms that are prevalent in women, particularly as they age. Those with overactive bladder often experience related physical and psychological symptoms or conditions and report a poorer quality of life than other women. Many factors that increase the risk of developing overactive bladder are modifiable; therefore, lifestyle and behavioral interventions are first-line treatments. More treatment options are becoming available to women as research provides new information about the underlying pathophysiology of overactive bladder. Nurses play a major role in its screening, assessment, and management in women, many of whom do not seek help and try to self-manage symptoms, leading to a continuing cycle of unpredictable urgency and incontinence.
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Rodrigues RF, Silva EBD. Intracavitary electrical stimulation as treatment for overactive bladder: systematic review. FISIOTERAPIA EM MOVIMENTO 2016. [DOI: 10.1590/1980-5918.029.004.ao18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Introduction: Overactive bladder (OAB) is a clinical diagnosis of irritating urinary symptoms that influence on sufferers' life quality. There are effective treatments described in literature, but most of them present adverse effects. One way of treatment is the use of electrical stimulation, which has been widely used, but studies show varying results. Objective: To verify if intracavitary electrical stimulation can be effective in patients with OAB. Methods: online databases were searched with specific descriptors to find randomized clinical trials on overactive bladder treated with intracavitary electrical stimulation. Only articles with score equal or higher than 5 in methodological PEDro scale were used and those that described intra and / or inter-group P-value. Results: 217 articles were found, but only 6 were analyzed by the selection criteria. The studies show that electrical stimulation promotes the reduction of urinary frequency, urinary incontinence, nocturia, urgency and the number of protectors used, and improvements in maximum cystometric bladder capacity, symptoms of OAB and quality of life. Conclusion: Electrical stimulation was effective in patients with OAB and can be used before any invasive treatment due to none side effects.
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Marcelissen TAT, Rahnama'i MS, Snijkers A, Schurch B, De Vries P. Long-term follow-up of intravesical botulinum toxin-A injections in women with idiopathic overactive bladder symptoms. World J Urol 2016; 35:307-311. [PMID: 27272312 DOI: 10.1007/s00345-016-1862-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 05/18/2016] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Intravesical botulinum toxin (BoNT-A) is a safe and effective treatment for overactive bladder syndrome. There are many reports on the clinical experience with BoNT-A, especially in patients with neurogenic detrusor overactivity. The US Food and Drug Administration has recently approved its use for idiopathic overactive bladder (iOAB). Various studies have reported positive results for iOAB in the short-term. Yet little is known about the results after repeated BoNT-A injections. In this study, we evaluated the long-term results of botulinum toxin (BoNT-A) in women with iOAB. METHODS Patients treated with BoNT-A from 2004 until 2009 were evaluated in a non-academic teaching hospital (Zuyderland MC, Heerlen, the Netherlands). All female patients with a follow-up of >5 years with idiopathic bladder dysfunction were included. All patients received 200 U of onabotulinum toxin-A in 20 intradetrusor injections. In some patients, we applied a dose adjustment for repeated injections. Patients were instructed how to use clean intermittent self-catheterization (CISC) before the treatment. We advised patients to commence CISC if post-void residual exceeded 150 ml. RESULTS A total of 128 women were included. All patients had at least 5-year follow-up after their first injection. The mean follow-up was 97 (60-125) months. The mean age was 67 (46-88) years. Of all patients, 30 % were still on BoNT-A treatment at the last follow-up visit. Of the 70 % that discontinued treatment, 27 % had insufficient effect and 43 % had tolerability issues. Most patients discontinued treatment after the first (79 %) and second (19 %) injections. Only 2 % of patients discontinued treatment after more than two injections during follow-up. CONCLUSION Intravesical BoNT-A is an effective treatment for women with idiopathic OAB. However, in time, almost two-thirds of patients in our study discontinued therapy. Most patients discontinue treatment after one or two injections and mainly due to tolerability issues.
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Affiliation(s)
- T A T Marcelissen
- Department of Urology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - M S Rahnama'i
- Department of Urology, Zuyderland Medical Centre, Heerlen, The Netherlands.
- Maastricht University, Maastricht, The Netherlands.
| | - A Snijkers
- Maastricht University, Maastricht, The Netherlands
| | - B Schurch
- Service de neuroréhabilitation, CHUV, Lausanne, Switzerland
| | - P De Vries
- Department of Urology, Zuyderland Medical Centre, Heerlen, The Netherlands
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Kelly SL, Radley SC, Brown SR. Does percutaneous tibial nerve stimulation improve global pelvic function in women with faecal incontinence? Colorectal Dis 2016; 18:O158-63. [PMID: 26970061 DOI: 10.1111/codi.13329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/11/2016] [Indexed: 02/08/2023]
Abstract
AIM Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive treatment for faecal incontinence. Many patients with faecal incontinence have coexisting pelvic floor disorders such as urinary incontinence and vaginal symptoms. We utilized a pelvic floor assessment tool to analyse any effect of PTNS on global pelvic floor function. METHODS Patients with faecal incontinence attending our institution who had failed to respond sufficiently to biofeedback were offered a course of PTNS. Patients underwent pre- and post-stimulation assessment with a validated electronic Personal Assessment Questionnaire - Pelvic Floor (ePAQ-PF) for pelvic floor disorders. Scores were compared to assess the effect of treatment on global pelvic floor function. RESULTS During the study period pre- and post-stimulation ePAQ-PF data were available for 60 patients (55% of all patients starting PTNS). In this cohort there was a significant improvement in bowel continence, bowel related quality of life, irritable bowel syndrome and bowel evacuation with a large effect size for continence and bowel related quality of life. There was also a significant improvement in non-bowel related symptoms, including urinary pain and stress incontinence, urinary related quality of life and bowel related sexual function. Sixty-five per cent of those who answered the question reported improvement in global health after stimulation. CONCLUSION For patients presenting with faecal incontinence, PTNS appears to have a positive effect on bowel related function in approximately two-thirds of patients. However, for treatment responders, improvement appears to relate mainly to improvement in bowel related function rather than a global pelvic floor effect.
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Affiliation(s)
- S L Kelly
- Northern General Hospital, Sheffield, UK
| | - S C Radley
- Royal Hallamshire Hospital, Sheffield, UK
| | - S R Brown
- Northern General Hospital, Sheffield, UK
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