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van Merode NAM, Nijholt IM, Heesakkers JP, van Koeveringe GA, Steffens MG, Witte LPW. Effect of bladder outlet procedures on urodynamic assessments in men with an acontractile or underactive detrusor: A systematic review and meta-analysis. Neurourol Urodyn 2023; 42:1822-1838. [PMID: 37498009 DOI: 10.1002/nau.25253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVE To review the effect of bladder outlet procedures on urodynamic outcomes and symptom scores in males with detrusor underactivity (DU) or acontractile detrusors (AD). MATERIALS AND METHODS We performed a systematic review and meta-analysis of research publications derived from PubMed, Embase, Web of Science, and Ovid Medline to identify clinical studies of adult men with non-neurogenic DU or AD who underwent any bladder outlet procedure. Outcomes comprised the detrusor pressure at maximum flow (Pdet Qmax ), maximum flow rate (Qmax ), international prostate symptom score (IPSS), and quality of life (QoL). This study is registered under PROSPERO CRD42020215832. RESULTS We included 13 studies of bladder outlet procedures, of which 6 reported decreased and 7 reported improved Pdet Qmax after the procedure. Meta-analysis revealed an increase in the pooled mean Pdet Qmax of 5.99 cmH2 0 after surgery (95% CI: 0.59-11.40; p = 0.03; I2 95%). Notably, the Pdet Qmax improved in all subgroups with a preoperative bladder contractility index (BCI) <50 and decreased in all subgroups with a BCI ≥50. All studies reported an improved Qmax after surgery, with a pooled mean difference of 5.87 mL/s (95% CI: 4.25-7.49; I2 93%). Only three studies reported QoL, but pooling suggested significant improvements after surgery (mean, -2.41 points; 95% CI: -2.81 to -2.01; p = 0.007). All seven studies reporting IPSS demonstrated improvement (mean, -12.82; 95% CI: -14.76 to -10.88; p < 0.001). CONCLUSIONS This review shows that Pdet Qmax and Qmax increases after surgical bladder outlet procedures in men with DU and AD. Bladder outlet procedures should be discussed as part of the shared decision-making process for this group. The evidence was of low to very low certainty.
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Affiliation(s)
- Nadine A M van Merode
- Department of Urology, Isala Hospital, Zwolle, The Netherlands
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ingrid M Nijholt
- Department of Radiology, Isala Hospital, Zwolle, The Netherlands
- Department of Innovation and Science, Isala Hospital, Zwolle, The Netherlands
| | - John P Heesakkers
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Çetinkaya ŞE, Seval MM, Varlı B, Dökmeci F. The association of coital incontinence with clinical factors and single voiding cycle ambulatory urodynamic monitoring findings in women. Front Med (Lausanne) 2023; 10:1160637. [PMID: 37056730 PMCID: PMC10087523 DOI: 10.3389/fmed.2023.1160637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
IntroductionCoital incontinence (CI) is a frequent problem in women with urinary incontinence (UI) with significant impact on female sexuality and quality of life. The underlying mechanism is controversial; it has been known that CI is associated with both stress urinary incontinence (SUI) and detrusor overactivity (DO). However, recently it has been reported that CI is mainly related with SUI and urethral incompetence, but not with DO. Ambulatory urodynamic monitoring (AUM) has been shown to be a sensitive tool for the detection of DO. The aim of this study was to investigate the clinical risk factors for CI and the association of CI with urodynamic diagnoses at single voiding cycle AUM.MethodsRecords of sexually active women with urinary incontinence attending the urogynaecology unit of a university hospital, who completed the PISQ-12 were reviewed retrospectively (n = 1,005). Patients were grouped using the 6th question; patients answering “never” to this question were considered as continent during coitus (n = 591) and patients reporting any urinary leakage at coitus were considered to have CI (n = 414). Demographics, clinical examination findings, incontinence severity measured by the Sandvik Incontinence Severity Index, scores of Turkish validated questionnaires (PFDI-20, IIQ-7, OAB-V8, and PISQ-12) and single voiding cycle AUM findings were compared, and univariate and multivariate logistic regression analyses were performed.ResultsAmong all sexually active women with UI, 41.2% had CI; UI was more severe, symptom bother was higher, related quality of life (p < 0.001) and sexual function were worse (≤0.018) in these women. Younger age (OR 0.967, p < 0.001), history of vaginal delivery (OR 2.127, p = 0.019), smoking (OR 1.490, p = 0.041), postural UI (OR 2.012, p = 0.001), positive cough stress test (OR 2.193, p < 0.001), and positive SEST (OR 1.756, p = 0.01) were found as independent clinical factors associated with CI. Urodynamic SUI (OR 2.168, p = 0.001) and MUI (OR 1.874, p = 0.002) were found as significant and independent urodynamic diagnoses associated with CI, whereas no association was found with DO or UUI.ConclusionBoth clinical and AUM findings supported that CI is a more severe form of UI that it is mainly related with SUI and urethral incompetence, but not with UUI or DO.
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Vahabi B, Jabr R, Fry C, McCloskey K, Everaert K, Agudelo CW, Monaghan TF, Rahnama'i MS, Panicker JN, Weiss JP. ICI-RS 2019 nocturia think tank: How can experimental science guide us in understanding the pathophysiology of nocturia? Neurourol Urodyn 2020; 39 Suppl 3:S88-S95. [PMID: 31922620 DOI: 10.1002/nau.24274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/30/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The following is a report on the proceedings of the 2019 International Consultation on Incontinence-Research Society nocturia think tank (NTT). OBJECTIVES The objectives of the 2019 NTT were as follows: (a) to evaluate the role of urothelium in the pathophysiology of nocturia; (b) to determine whether nocturia is a circadian disorder; (c) to discuss the role of melatonin in nocturia; (d) to consider ambulatory urodynamic monitoring in evaluating patients with nocturia; (e) to explore studies of water handling in human compartments utilizing heavy water; and (f) to explore whether basic science is the key to understanding the treatment options for diminished bladder capacity in patients with nocturia. METHODS A compendium of discussions of the role of experimental science in understanding the pathophysiology of nocturia is described herein. RESULTS AND CONCLUSIONS Translational science will play an increasing role in understanding the pathophysiology of nocturia, which may result in improved treatment strategies.
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Affiliation(s)
- Bahareh Vahabi
- Department of Applied Sciences, School of Physiology, Pharmacology, and Neuroscience, University of Bristol, Bristol, UK
| | - Rita Jabr
- Department of Cardiac Electrophysiology, University of Surrey, Guildford, Surrey, UK
| | - Chris Fry
- Department of Applied Sciences, School of Physiology, Pharmacology, and Neuroscience, University of Bristol, Bristol, UK
| | - Karen McCloskey
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Christina W Agudelo
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Mohammad S Rahnama'i
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jalesh N Panicker
- Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, New York
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Wireless intravesical device for real-time bladder pressure measurement: Study of consecutive voiding in awake minipigs. PLoS One 2019; 14:e0225821. [PMID: 31790475 PMCID: PMC6886791 DOI: 10.1371/journal.pone.0225821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 11/13/2019] [Indexed: 12/16/2022] Open
Abstract
Traditional urodynamics have poor correlation with urological symptoms. Ambulatory urodynamics may improve this correlation but the need for a transurethral catheter and the time-consuming nature of this examination limits its use. Therefore, the objective of this study was to develop a wireless real-time bladder pressure measurement device for repeated and prolonged-term measurement of bladder behavior in awake pigs. The Bladder Pill is an intravesical device with a pressure microsensor and a 3-dimensional inductive coupling coil for energy supply. A corresponding external coil provides wireless power transmission and real-time communication of bladder pressure data. To test the correlation between the pressure data measured by the device and by standard methods, we compared static water column pressures with this device and water-filled urodynamic catheter systems. In vivo assessment of awake voiding by the pill was done by introducing the bladder pill into the bladder of Göttingen minipigs. An air-charged urodynamic catheter was introduced transurethrally as control for pressure measurements. The optimal physical configuration of the pill was investigated to maximize the containment in the bladder. We used two versions of external signal receivers (one waistband and one rectangular frame) to test the optimal external signal capture. Next to that, we performed short-term and medium-term comparative pressure studies. The in vitro static pressure measurement demonstrated a mean difference of less than 1 cm H2O between the methods. The optimal design of the pill for maximal retainment in the bladder proved to be a pigtail configuration. The bending of the device during bladder contractions caused offset of 2.7 +/- 1.4 cm H2O (mean +/- SD) on the pressure measurements. The rectangular frame performed signal capture during 5 consecutive voids with a good correlation of the pressure measurements. The device can be inserted through the urethra and is retrieved using string or endoscopic extraction. In conclusion, wireless long-term measurement of bladder pressure is demonstrated and yields comparable results to current available catheter methods of measurement in a pig model.
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Osman NI, Pang KH, Martens F, Atunes-Lopes T, Geavlete B, Husch T, Tutolo M, Rahnama’i MS, Marcelissen T. Detrusor Underactivity and Underactive Bladder in Women: What Is New? CURRENT BLADDER DYSFUNCTION REPORTS 2019. [DOI: 10.1007/s11884-019-00531-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Abstract
Purpose of Review
Detrusor underactivity (DU) and its symptom-based correlation, the underactive bladder (UAB), are common problems encountered in urological practice. Whilst DU has been defined for many years, only recently has UAB received a formal definition and there is now accumulating literature based on this condition. In this article, we reviewed the recent literature on the aetiology, pathogenesis, diagnosis and management of DU/UAB in women.
Recent Findings
Detrusor underactivity is diagnosed on urodynamic studies but there still remains a lack of widely recognised and accepted diagnostic criteria. Commencing treatment based on the diagnosis of UAB, with or without a PVR measurement, is perhaps feasible due to the lower occurrence of BOO in women and specific clinical features that may distinguish this group. Prospective studies attempting to correlate UAB with the underlying DU are needed before this approach could be considered.
Summary
Detrusor underactivity/UAB in women requires a separate consideration from men due to the anatomical and functional differences in the lower urinary tracts between both genders and consequent differences in pathologies affecting them. The aetiology of DU remains largely unknown, but is probably multifactorial, including myogenic, neurogenic and vasculogenic factors. There remains a lack of any simple effective drug treatments, whilst apart from sacral neuromodulation for the specific subgroup with non-obstructive urinary retention, no safe and effective surgical treatment is currently available. Often, permanent or intermittent bladder drainage with a catheter is the final solution.
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Cantu H, Sharaf A, Bevan W, Hassine A, Hashim H. Ambulatory urodynamics in clinical practice: A single centre experience. Neurourol Urodyn 2019; 38:2077-2082. [DOI: 10.1002/nau.24153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/05/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Hector Cantu
- Bristol Urological InstituteSouthmead Hospital Bristol United Kingdom
| | - Ala'a Sharaf
- Bristol Urological InstituteSouthmead Hospital Bristol United Kingdom
| | - Wendy Bevan
- Bristol Urological InstituteSouthmead Hospital Bristol United Kingdom
| | - Anna Hassine
- Bristol Urological InstituteSouthmead Hospital Bristol United Kingdom
| | - Hashim Hashim
- Bristol Urological InstituteSouthmead Hospital Bristol United Kingdom
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Drossaerts J, Rademakers KLJ, Rahnama'i SM, Marcelissen T, Van Kerrebroeck P, van Koeveringe G. The Value of Ambulatory Urodynamics in the Evaluation of Treatment Effect of Sacral Neuromodulation. Urol Int 2019; 102:299-305. [PMID: 30612126 DOI: 10.1159/000493988] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/21/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To assess the improvement of symptoms by sacral neuromodulation (SNM) in an objective way by carrying out an ambulatory urodynamic study (ambulatory-UDS). Until now, successful treatment has been defined as a ≥50% improvement recorded on voiding diaries. Voiding diaries are a patient reported outcome tool. A tool with less bias is desired to evaluate the treatment results before an expensive permanent system is implanted. METHODS Between 2002 and 2015, a total of 334 patients with lower urinary tract symptoms were included consecutively in an ambulatory-UDS database. From this database, a subgroup of patients was selected which underwent SNM. RESULTS In 51 patients, an ambulatory-UDS was performed both at baseline and during the SNM test period. A positive treatment outcome after test stimulation based on the patients' voiding diary, correlated (p < 0.0001) with an improvement on ambulatory-UDS. Twenty-six of the 30 patients, who have showed improvement of more than 50% on voiding diary parameters and who had subjective improvement of their symptoms, showed an early improvement on ambulatory-UDS. CONCLUSIONS Ambulatory-UDS can be used in clinical decision making, as it is associated with voiding diary improvement during the SNM test period. Using ambulatory-UDS to confirm success could in the future justify the shortening of the test period.
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Affiliation(s)
- Jamie Drossaerts
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands, .,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands,
| | - Kevin L J Rademakers
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Sajjad M Rahnama'i
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.,School of Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands.,Pelvic Care Centre Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands
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Basu AS, Majerus S, Ferry L, Makovey I, Zhu H, Damaser MS. Is submucosal bladder pressure monitoring feasible? Proc Inst Mech Eng H 2019; 233:100-113. [PMID: 30799738 PMCID: PMC6391733 DOI: 10.1177/0954411918754925] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There has been recent interest in placing pressure-sensing elements beneath the bladder mucosa to facilitate chronic bladder pressure monitoring. Wired submucosal sensors with the wires passed through detrusor have been demonstrated in vivo, with limited chronic retention, potentially due to the cable tethering the detrusor. Published studies of submucosal implants have shown that high correlation coefficients between submucosal and lumen pressures can be obtained in caprine, feline, and canine models. We have developed a wireless pressure monitor and surgical technique for wireless submucosal implantation and present our initial chronic implantation study here. Pressure monitors were implanted (n = 6) in female calf models (n = 5). Five devices were implanted cystoscopically with a 25-French rigid cystoscope. One device was implanted suprapubically to test device retention with an intact mucosa. Wireless recordings during anesthetized cystometry simultaneous with catheter-based reference vesical pressure measurements during filling and manual bladder compressions were recorded. Individual analysis of normalised data during bladder compressions (n = 12) indicated high correlation (r = 0.85-0.94) between submucosal and reference vesical pressure. The healing response was robust over 4 weeks; however, mucosal erosion occurred 2-4 weeks after implantation, leading to device migration into the bladder lumen and expulsion during urination. Wireless pressure monitors may be successfully placed in a suburothelial position. Submucosal pressures are correlated with vesical pressure, but may differ due to biomechanical forces pressing on an implanted sensor. Fully wireless devices implanted beneath the mucosa have risk of erosion through the mucosa, potentially caused by disruption of blood flow to the urothelium, or an as-yet unstudied mechanism of submucosal regrowth. Further investigation into device miniaturisation, anchoring methods, and understanding of submucosal pressure biomechanics may enable chronic submucosal pressure monitoring. However, the risk of erosion with submucosal implantation highlights the need for investigation of devices designed for chronic intravesical pressure monitoring.
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Affiliation(s)
- Anisha S. Basu
- Dept of Biomedical Engineering, Case Western Reserve University, Cleveland, OH USA
- Dept of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH USA
| | - Steve Majerus
- Dept of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH USA
- Dept of Electrical Engineering and Computer Science, Case Western Reserve University, Cleveland, OH USA
- Advanced Platform Technology Center, Louis Stokes Cleveland Dept. of Veterans Affairs Medical Center, Cleveland, OH USA
| | - Liz Ferry
- Department of Urology, SUNY Upstate Medical University, Syracuse, NY USA
| | - Iryna Makovey
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH USA
| | - Hui Zhu
- Advanced Platform Technology Center, Louis Stokes Cleveland Dept. of Veterans Affairs Medical Center, Cleveland, OH USA
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH USA
| | - Margot S. Damaser
- Dept of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH USA
- Advanced Platform Technology Center, Louis Stokes Cleveland Dept. of Veterans Affairs Medical Center, Cleveland, OH USA
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH USA
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Hüsch T, Reitz A, Ulm K, Haferkamp A. Ice water test in multiple sclerosis: A pilot trial. Int J Urol 2018; 25:938-943. [PMID: 30103278 DOI: 10.1111/iju.13786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/18/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the significance of the ice water test in patients with multiple sclerosis and to evaluate a novel ice water test nomogram in a large patient cohort. METHODS A total of 201 ice water tests of patients with multiple sclerosis were retrospectively evaluated. Incontinence episodes in 24 h and sex were correlated with the ice water test. Furthermore, an ice water test nomogram was developed in order to categorize the detrusor overactivity in severity degrees. Descriptive statistics were carried out for population characteristics. Correlations of categorical variables were calculated by the χ2 -test. The independent t-test was carried out for correlations of continuous variables. Furthermore, the data were evaluated in the novel ice water test nomogram. RESULTS The patient population consisted of 141 (70.1%) women and 60 (39.9%) men. A clinically positive ice water test (maximum detrusor pressure >15 cmH2 O) was identified in 75 patients (37.3%). Significantly more men presented a clinically positive ice water test (P = 0.006). In 16.5%, the ice water test unmasked an involuntary detrusor contraction, although routine cystometry did not show any detrusor overactivity. The ice water test nomogram could be successfully applied. The incontinence episodes and maximum detrusor pressure correlated positively with a higher categorization in the nomogram. Therapeutic interventions and follow-up controls could be successfully illustrated by the nomogram. CONCLUSIONS The ice water test is a simple tool for unmasking non-identified detrusor overactivity in neurogenic bladder dysfunction. A severity categorization of the detrusor overactivity can be facilitated by the use of the ice water test nomogram. After further validation, the ice water test could be ultimately used in future as objective assessment for bladder dysfunction.
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Affiliation(s)
- Tanja Hüsch
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
| | - André Reitz
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany.,KontinenzZentrum Hirslanden, Zurich, Switzerland
| | - Kurt Ulm
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, Munich, Germany
| | - Axel Haferkamp
- Department of Urology and Pediatric Urology, University Medical Center of Johannes Gutenberg University, Mainz, Germany
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Colaco M, Osman NI, Karakeçi A, Artibani W, Andersson KE, Badlani GH. Current concepts of the acontractile bladder. BJU Int 2018; 122:195-202. [PMID: 29633516 DOI: 10.1111/bju.14236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The acontractile bladder (AcB) is a urodynamic-based diagnosis wherein the bladder is unable to demonstrate any contraction during a pressure flow study. Although it is often grouped with underactive bladder, it is a unique phenomenon and should be investigated independently. The purpose of the present review was to examine the current literature on AcB regarding its pathology, diagnosis, current management guidelines, and future developments. We performed a review of the PubMed database, classifying the evidence for AcB pathology, diagnosis, treatment, and potential future treatments. Over the 67 years covered in our review period, 42 studies were identified that met our criteria. Studies were largely poor quality and mainly consisted of retrospective review or animal models. The underlying pathology of AcB is variable with both neurological and myogenic aetiologies. Treatment is largely tailored for renal preservation and reduction of infection. Although future developments may allow more functional restorative treatments, current treatments mainly focus on bladder drainage. AcB is a unique and understudied bladder phenomenon. Treatment is largely based on symptoms and presentation. While cellular therapy and neuromodulation may hold promise, further research is needed into the underlying neuro-urological pathophysiology of this disease so that we may better develop future treatments.
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Affiliation(s)
- Marc Colaco
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nadir I Osman
- Academic Urology Unit, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Walter Artibani
- Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Dokmeci F, Cetinkaya SE, Seval MM, Dai O. Ambulatory urodynamic monitoring of women with overactive bladder syndrome during single voiding cycle. Eur J Obstet Gynecol Reprod Biol 2017; 212:126-131. [DOI: 10.1016/j.ejogrb.2017.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/28/2017] [Accepted: 03/14/2017] [Indexed: 11/17/2022]
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12
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Urodynamic Evaluation Following Bladder Reconstruction. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0395-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Abstract
The inability to generate a voiding contraction sufficient to allow efficient bladder emptying within a reasonable time frame is a common problem seen in urological practice. Typically, the symptoms that arise are voiding symptoms, such as weak and slow urinary flow. These symptoms can cause considerable bother to patients and impact upon quality of life. The urodynamic finding of inadequate detrusor contraction has been termed detrusor underactivity (DUA). Although a definition is available for this entity, there are no widely accepted diagnostic criteria. Drawing parallels to detrusor overactivity and the overactive bladder, the symptoms arising from DUA have been referred to as the “underactive bladder” (UAB), while attempts to crystallize the definition of UAB are now ongoing. In this article, we review the contemporary literature pertaining to the epidemiology and etiopathogenesis of DUA as well as discuss the definitional aspects that are currently under consideration.
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Affiliation(s)
- Nadir Osman
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Altaf Mangera
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Christopher Hillary
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Richard Inman
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Christopher Chapple
- Department of Urology, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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14
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Urodynamics in the Elderly. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-014-0115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Rademakers KLJ, Drossaerts JMAFL, Rahnama'i MS, van Koeveringe GA. Differentiation of lower urinary tract dysfunctions: The role of ambulatory urodynamic monitoring. Int J Urol 2015; 22:503-7. [PMID: 25711671 DOI: 10.1111/iju.12723] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/24/2014] [Accepted: 12/29/2014] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To determine the value of ambulatory urodynamic monitoring in the assessment of patients with lower urinary tract symptoms. METHODS This was a cross-sectional study including patients who underwent both conventional urodynamic and ambulatory urodynamic assessment at our Center between December 2002 and February 2013. The ambulatory urodynamic studies were interpreted in a standardized way by a resident experienced with urodynamic measurements, and one staff member who specialized in incontinence and urodynamics. RESULTS A total of 239 patients (71 male and 168 female) were included in the present study. The largest subgroup of patients, 79 (33%), underwent ambulatory urodynamic monitoring based on suspicion of an acontractile bladder. However, 66 of these patients (83.5%) still showed contractions on ambulatory urodynamics. Other groups that were analyzed were patients with suspected storage dysfunction (47 patients), inconclusive conventional urodynamic studies (68 patients) and incontinence of unclear origin (45 patients). Particularly in this last group, ambulatory urodynamics appeared to be useful for discrimination between different causes of incontinence. CONCLUSIONS Ambulatory urodynamic monitoring is a valuable discriminating diagnostic tool in patients with lower urinary tract symptoms who have already undergone conventional urodynamics, particularly in the case of patients with suspected bladder acontractility and incontinence of unclear origin during ambulatory urodynamics. Further study is required to determine the clinical implications of the findings and their relationship with treatment outcome.
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Affiliation(s)
- Kevin L J Rademakers
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
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Drossaerts J, Rademakers K, van Koeveringe G, Van Kerrebroeck P. The value of urodynamic tools to guide patient selection in sacral neuromodulation. World J Urol 2015; 33:1889-95. [PMID: 25680936 PMCID: PMC4617837 DOI: 10.1007/s00345-015-1479-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/03/2015] [Indexed: 12/01/2022] Open
Abstract
Purpose
The aim of this study is to explore whether urodynamics, with the addition of ambulatory urodynamic study (ambulatory-UDS), will be able to better predict and assess sacral neuromodulation (SNM) treatment outcome. Selection of patients is a critical element in achieving optimal outcome in SNM. Quantitative and qualitative results of urodynamic tests are used to justify surgical therapy and to evaluate treatment for lower urinary tract dysfunction. Therefore, these tests should be representative and subsequently offer a correct prognosis.
Methods Between December 2002 until May 2013 selected patients with lower urinary tract symptoms (storage and/or voiding dysfunction) were included in an ambulatory urodynamic measurement database. From this database, the total subgroup of patients that underwent a sacral neuromodulation test evaluation was selected. Results A total of 98 patients were included. Success rate of SNM in patients with storage dysfunction was around 70 %, according to either conventional-UDS or ambulatory-UDS diagnosis. Based on conventional-UDS, success rate of SNM in patients with hypocontractility was 67 % and in acontractile patients 35 %. According to ambulatory-UDS diagnosis, success rates were 32 and 17 %, respectively. Conclusions This study shows that conventional-UDS overestimates the amount of patients diagnosed with hypocontractile or acontractile bladder. Patients with reduced contractility on ambulatory-UDS have a lower chance of SNM success. Hence, ambulatory-UDS allows us to select patients with a real acontractile bladder and predict SNM failure. In patients with storage dysfunction, additional ambulatory-UDS does not seem to contribute in predicting SNM outcome.
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Affiliation(s)
- Jamie Drossaerts
- Department of Urology, Maastricht University Medical Centre (MUMC+), The Netherlands and School of Mental Health and Neuroscience (MHeNS), Maastricht University, P. Debyelaan 25, POB 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Kevin Rademakers
- Department of Urology, Maastricht University Medical Centre (MUMC+), The Netherlands and School of Mental Health and Neuroscience (MHeNS), Maastricht University, P. Debyelaan 25, POB 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre (MUMC+), The Netherlands and School of Mental Health and Neuroscience (MHeNS), Maastricht University, P. Debyelaan 25, POB 5800, 6202 AZ, Maastricht, The Netherlands.
| | - Philip Van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre (MUMC+), The Netherlands and School of Mental Health and Neuroscience (MHeNS), Maastricht University, P. Debyelaan 25, POB 5800, 6202 AZ, Maastricht, The Netherlands.
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17
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Qu CY, Xu DF. Comprehensive urodynamics: Being devoted to clinical urologic practice. World J Clin Urol 2014; 3:96-112. [DOI: 10.5410/wjcu.v3.i2.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/12/2014] [Accepted: 06/16/2014] [Indexed: 02/06/2023] Open
Abstract
As a combined electrophysiological system for evaluating the lower urinary tract (LUT), comprehensive urodynamics (UDS) aims at duplicating patient’s micturition process, either normal or abnormal, and further seeking for possible causative origin, either neurogenic or non-neurogenic, in order to guide treatment. Through thorough analysis, some so-called cut-off values, for example, bladder outlet obstruction (BOO) degree or dyssynergic degree between the detrusor and sphincter, could be gained; however, in most cases, their qualitative description, such as stress urinary incontinence, idiopathic detrusor underactivity (DUA), detrusor overactivity (IDO), low compliance, and idiopathic sphincter overactivity (ISO), is more preferable and important. In aged neurologically intact male patients with symptoms of the LUT (LUTS) including benign prostatic hyperplasia, a combined UDS system, which coupled BOO with compliance, was constructed. The patients may be categorized into one of the seven subgroups, including equivocal or mild BOO with sphincter synergia with or without IDO (pattern A), equivocal or mild BOO with ISO (B), classic BOO with sphincter synergia (C) or ISO (D), BOO with only low compliance (E), BOO with both DUA and low compliance (F), and potential BOO with DUA (G). This new system can be used to optimize diagnosis and treatment according to a derived guideline diagram.
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Drake MJ, Williams J, Bijos DA. Voiding dysfunction due to detrusor underactivity: an overview. Nat Rev Urol 2014; 11:454-64. [PMID: 25002201 DOI: 10.1038/nrurol.2014.156] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Detrusor underactivity (DUA) is defined as a voiding contraction of reduced strength and/or duration, which prolongs urination and/or prevents complete emptying of the bladder within a 'normal' period of time. This issue is associated with voiding and postmicturition urinary symptoms, and can predispose to urinary infections and acute urinary retention. The aetiology of DUA is influenced by multiple factors, including ageing, bladder outlet obstruction, neurological disease, and autonomic denervation. The true prevalence of this condition remains unknown, as most data come from referral populations. Urodynamic testing is used to diagnose the condition, either by assessing the relationship between bladder pressures and urinary flow, or by interrupting voiding to measure detrusor pressure change under isovolumetric conditions. Current treatments for DUA have poor efficacy and tolerability, and often fail to improve quality of life; muscarinic receptor agonists, in particular, have limited efficacy and frequent adverse effects. Bladder emptying might be achieved through Valsalva straining, and intermittent or indwelling catheterization, although sacral nerve stimulation can reduce dependency on catheterization. Novel stem-cell-based therapies have been attempted; however, new drugs that increase contractility are currently largely conceptual, and the complex pathophysiology of DUA, difficulty achieving organ specificity of treatment, the limited availability of animal models, and the subjective nature of current outcome measures must be addressed to facilitate the development of such agents.
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Affiliation(s)
- Marcus J Drake
- Urology Department, University of Bristol and Bristol Urological Institute, Southmead Hospital, Bristol, Avon BS10 5NB, UK
| | - Jonathan Williams
- Urology Department, University of Bristol and Bristol Urological Institute, Southmead Hospital, Bristol, Avon BS10 5NB, UK
| | - Dominika A Bijos
- Urology Department, University of Bristol and Bristol Urological Institute, Southmead Hospital, Bristol, Avon BS10 5NB, UK
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Osman NI, Chapple CR, Abrams P, Dmochowski R, Haab F, Nitti V, Koelbl H, van Kerrebroeck P, Wein AJ. Detrusor underactivity and the underactive bladder: a new clinical entity? A review of current terminology, definitions, epidemiology, aetiology, and diagnosis. Eur Urol 2013; 65:389-98. [PMID: 24184024 DOI: 10.1016/j.eururo.2013.10.015] [Citation(s) in RCA: 235] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/12/2013] [Indexed: 12/12/2022]
Abstract
CONTEXT Detrusor underactivity (DU) is a common cause of lower urinary tract symptoms (LUTS) in both men and women, yet is poorly understood and underresearched. OBJECTIVE To review the current terminology, definitions, and diagnostic criteria in use, along with the epidemiology and aetiology of DU, as a basis for building a consensus on the standardisation of current concepts. EVIDENCE ACQUISITION The Medline and Embase databases were searched for original articles and reviews in the English language pertaining to DU. Search terms included underactive bladder, detrusor underactivity, impaired detrusor contractility, acontractile detrusor, detrusor failure, detrusor areflexia, raised PVR [postvoid residual], and urinary retention. Selected studies were assessed for content relating to DU. EVIDENCE SYNTHESIS A wide range of terminology is applied in contemporary usage. The only term defined by the standardisation document of the International Continence Society (ICS) in 2002 was the urodynamic term detrusor underactivity along with detrusor acontractility. The ICS definition provides a framework, considering the urodynamic abnormality of contraction and how this affects voiding; however, this is necessarily limited. DU is present in 9-48% of men and 12-45% of older women undergoing urodynamic evaluation for non-neurogenic LUTS. Multiple aetiologies are implicated, affecting myogenic function and neural control mechanisms, as well as the efferent and afferent innervations. Diagnostic criteria are based on urodynamic approximations relating to bladder contractility such as maximum flow rate and detrusor pressure at maximum flow. Other estimates rely on mathematical formulas to calculate isovolumetric contractility indexes or urodynamic "stop tests." Most methods have major disadvantages or are as yet poorly validated. Contraction strength is only one aspect of bladder voiding function. The others are the speed and persistence of the contraction. CONCLUSIONS The term detrusor underactivity and its associated symptoms and signs remain surrounded by ambiguity and confusion with a lack of accepted terminology, definition, and diagnostic methods and criteria. There is a need to reach a consensus on these aspects to allow standardisation of the literature and the development of optimal management approaches.
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Affiliation(s)
- Nadir I Osman
- Department of Urology, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Paul Abrams
- Department of Urology, University of Bristol, Bristol, UK
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Victor Nitti
- Department of Urology, NYU Langone Medical Center, New York, NY, USA
| | - Heinz Koelbl
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Vienna, Austria
| | - Philip van Kerrebroeck
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Alan J Wein
- Division of Urology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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20
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van Koeveringe G, Rademakers K, Stenzl A. Latissimus dorsi detrusor myoplasty to restore voiding in patients with an acontractile bladder - fact or fiction? Curr Urol Rep 2013; 14:426-34. [PMID: 23775469 DOI: 10.1007/s11934-013-0349-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Multiple causes at any level between the brain and the bladder can lead to diminished voiding efficiency and bladder acontractility. Treatment options for patients with an acontractile bladder have been limited as most patients were forced to perform lifelong self-catheterization at the moment. The latissimus dorsi detrusor myoplasty (LDDM) is a recent and promising therapeutic surgical option to restore adequate bladder emptying on demand. This article critically reviews the available literature on LDDM and focuses particularly on the preoperative diagnostic evaluation and patient selection, treatment outcome and the postoperative contractility measurement.
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Affiliation(s)
- Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Centre, P. Debyelaan 25, POB 5800, 6202, AZ, Maastricht, The Netherlands,
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21
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Jeong SJ, Kim HJ, Lee YJ, Lee JK, Lee BK, Choo YM, Oh JJ, Lee SC, Jeong CW, Yoon CY, Hong SK, Byun SS, Lee SE. Prevalence and Clinical Features of Detrusor Underactivity among Elderly with Lower Urinary Tract Symptoms: A Comparison between Men and Women. Korean J Urol 2012; 53:342-8. [PMID: 22670194 PMCID: PMC3364474 DOI: 10.4111/kju.2012.53.5.342] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 01/14/2012] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To identify the prevalence and clinical features of detrusor underactivity (DU) in elderly men and women presenting with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS We reviewed 1,179 patients aged over 65 years who had undergone a urodynamic study for LUTS with no neurological or anatomical conditions. DU was defined as a bladder contractility index <100 and a maximal flow rate (Qmax) ≤12 ml/s combined with a detrusor pressure at Qmax ≤10 cmH(2)O for men and women, respectively. RESULTS Of the patients, 40.2% of men and 13.3% of women were classified as having DU (p<0.001). Types of clinical symptoms were not significantly different between patients with and without DU. In men, whereas the prevalence of bladder outlet obstruction (BOO) was constant across the age spectrum, the prevalence of DU and detrusor overactivity (DO) increased with age, and 46.5% of men with DU also had DO or BOO. In women, the prevalence of DU also increased with age, and the trend was more remarkable in women aged over 70 years. DU was accompanied by DO or urodynamic stress urinary incontinence (USUI) in 72.6% of the women with DU. Women with DU were found to have lower cystometric capacity and exhibited a greater incidence of reduced compliance than did women without DU. CONCLUSIONS DU was a common mechanism underlying LUTS in the elderly population, especially in men. One half of the men and three quarters of the women with DU also had other pathologies such as DO, BOO, or USUI.
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Affiliation(s)
- Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
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Gakis G, Ninkovic M, Stenzl A. Bladder hypocontractility--extending the indication for LDDM. Nat Rev Urol 2012; 9:231. [PMID: 22450607 DOI: 10.1038/nrurol.2011.27-c1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Low-frequency electrotherapy for female patients with detrusor underactivity due to neuromuscular deficiency. Int Urogynecol J 2012; 23:1007-15. [PMID: 22441580 PMCID: PMC3396337 DOI: 10.1007/s00192-012-1714-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Accepted: 02/09/2012] [Indexed: 02/06/2023]
Abstract
Introduction and hypothesis The aim of the study was to assess the efficacy of low-frequency electrotherapy (LFE) for female patients with early-stage detrusor underactivity (DUA) due to neuromuscular deficiency. Methods A total of 102 female patients were divided randomly into four groups: LFE-NC (normal compliance), LFE-LC (low compliance), CON (control)-NC and CON-LC. Patients in the LFE-NC and LFE-LC groups received LFE, and those in the CON-NC and CON-LC groups received conservative treatment. Urodynamic evaluation was performed before and after treatment. Results After treatment, 82 % of the LFE-NC regained detrusor contractility, whereas only 2 (8 %) of the CON-NC had normal detrusor contraction. None of LFE-LC or CON-LC regained detrusor contractility (p < 0.01). The per cent of LFE-NC who relied on catheterization for bladder emptying decreased by 43 % (p < 0.01). Those in the LFE-LC, CON-NC and CON-LC groups decreased by only 4, 12 or 0 % (p > 0.05). Conclusions LFE was more effective for DUA patients with normal compliance; these patients benefited from LFE, but DUA patients with low compliance did not.
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Heeringa R, van Koeveringe GA, Winkens B, van Kerrebroeck PEV, de Wachter SGG. Degree of urge, perception of bladder fullness and bladder volume--how are they related? J Urol 2011; 186:1352-7. [PMID: 21855937 DOI: 10.1016/j.juro.2011.05.050] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE We evaluated the reliability of the degree of urge and perception of bladder fullness scales, the relationship between the scales and bladder volume, and possible differences between bladder sensations experienced in a controlled or an uncontrolled setting. MATERIALS AND METHODS Volunteers and patients with overactive bladder symptoms participated in the protocols. They were asked to grade bladder sensation on a 4-point urge scale of no sensation to need to void now and assess the perception of fullness on a visual analog scale of empty to full bladder. This was assessed in a 3-day bladder diary and during controlled, noninvasive bladder filling. RESULTS Each scale was reliable and significantly related to bladder volume (p <0.001). Agreement between the scales and voided volume was poor. Patients and volunteers grade bladder fullness and degree of urge higher in an uncontrolled than in a controlled setting. CONCLUSIONS The perception of bladder fullness and the degree of urge have a significant relation to bladder volume in controlled and uncontrolled settings. Due to poor agreement between the scales and actual voided volume these scales cannot replace measuring voided volume. The perception of bladder sensation depends on the setting. Bladder sensation at the hospital might underestimate the bother of symptoms experienced by a patient in daily life.
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Affiliation(s)
- Rhea Heeringa
- Department of Urology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
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25
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van Koeveringe GA, Vahabi B, Andersson KE, Kirschner-Herrmans R, Oelke M. Detrusor underactivity: a plea for new approaches to a common bladder dysfunction. Neurourol Urodyn 2011; 30:723-8. [PMID: 21661020 DOI: 10.1002/nau.21097] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AIMS Detrusor underactivity (DU) is defined by the International Continence Society as a contraction of reduced strength and/or duration resulting in prolonged or incomplete emptying of the bladder but has yet received only little attention. The purpose of this report is to summarize the ICI-RS meeting in Bristol in 2010 exploring current knowledge on DU and outline directions for future research. METHODS A think tank discussion was held and the summary of discussions was presented to all ICI-RS participants. This report is based on the final discussions. RESULTS The understanding of the pathophysiology, epidemiology, assessment, and treatment of DU remains rudimentary. DU is defined by pressure-flow analysis but no consensus exists regarding which of the available formulae should be used for quantification of detrusor work. DU is likely to be multifactorial. Aging causes a decay in detrusor activity but other concomitant causes, either myogenic or neurogenic, may aggravate the problem resulting in decrease of detrusor contractility. No effective pharmacotherapy for the condition exists. Only a few surgical therapeutic strategies have been explored, such as neuromodulation and skeletal muscle myoplasties. Consequently, the management of affected individuals remains unsatisfactory. CONCLUSIONS Future directions recommended by the ICI-RS panel include assessment of pathogenesis by developing novel animal models in addition to new non-invasive tests allowing longitudinal trials. Furthermore, optimizing the existing evaluation algorithms to support standard testing for DU and further epidemiological studies to quantify the size of the problem are required for the development of future treatment modalities.
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Affiliation(s)
- G A van Koeveringe
- Department of Urology and Pelvic care Center Maastricht, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Abstract
Patients with bladder acontractility often rely on clean intermittent catheterization (CIC) for bladder emptying. A recent study has reported that successful latissimus dorsi detrusor myoplasty (LDDM) allows volitional voiding and removes the need for long-term CIC.
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Affiliation(s)
- David A Ginsberg
- University of Southern California Institute of Urology, 1441 Eastlake Avenue, Suite 7416, Los Angeles, CA 90033, USA.
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27
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Gakis G, Ninkovic M, van Koeveringe GA, Raina S, Sturtz G, Rahnama'i MS, Sievert KD, Stenzl A. Functional Detrusor Myoplasty for Bladder Acontractility: Long-Term Results. J Urol 2011; 185:593-9. [DOI: 10.1016/j.juro.2010.09.112] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2010] [Indexed: 10/18/2022]
Affiliation(s)
- Georgios Gakis
- Department of Urology, Eberhard-Karls University, Tuebingen, Germany
| | - Milomir Ninkovic
- Department of Plastic and Reconstructive Surgery, Hospital Munich-Bogenhausen, Munich, Germany
| | | | - Shailesh Raina
- Department of Urology, Jaslok Hospital & Research Centre, Mumbai, India
| | - Gustavo Sturtz
- Department of Plastic and Reconstructive Surgery, Hospital Munich-Bogenhausen, Munich, Germany
| | - Mohammad S. Rahnama'i
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls University, Tuebingen, Germany
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