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Mass-Lindenbaum M, Arévalo-Vega D, Aleuanlli I, Santis-Moya F, Maluenda A, Dines E, Cohen-Vaizer M, Saavedra Á, Raby T, Blumel B, Cuevas R, Pohlhammer S, Alarcon G, Albornoz MA, Pizarro-Berdichevsky J. Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2024; 46:e-rbgo11. [PMID: 38765538 PMCID: PMC11075388 DOI: 10.61622/rbgo/2024ao11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/10/2023] [Indexed: 05/22/2024] Open
Abstract
Objective To show the experience of a Latin American public hospital, with SNM in the management of either OAB, NOUR or FI, reporting feasibility, short to medium-term success rates, and complications. Methods A retrospective cohort was conducted using data collected prospectively from patients with urogynecological conditions and referred from colorectal surgery and urology services between 2015 and 2022. Results Advanced or basic trial phases were performed on 35 patients, 33 (94%) of which were successful and opted to move on Implantable Pulse Generator (GG) implantation. The average follow-up time after definitive implantation was 82 months (SD 59). Of the 33 patients undergoing, 27 (81%)reported an improvement of 50% or more in their symptoms at last follow-up. Moreover, 30 patients (90%) with a definitive implant reported subjective improvement, with an average PGI-I "much better" and 9 of them reporting to be "excellent" on PGI-I. Conclusion SNM is a feasible and effective treatment for pelvic floor dysfunction. Its implementation requires highly trained groups and innovative leadership. At a nation-wide level, greater diffusion of this therapy among professionals is needed to achieve timely referral of patients who require it.
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Affiliation(s)
- Marcelo Mass-Lindenbaum
- Centro de innovación en Piso PélvicoHospital Dr. Sótero del RíoSantiagoChileCentro de innovación en Piso Pélvico, Hospital Dr. Sótero del Río, Santiago, Chile.
- Corporación de Innovación en Piso PélvicoSantiagoChileCorporación de Innovación en Piso Pélvico, Santiago, Chile.
- Universidad de Los AndesFacultad de MedicinaSantiagoChileFacultad de Medicina, Universidad de Los Andes, Santiago, Chile.
| | - Diego Arévalo-Vega
- Centro de innovación en Piso PélvicoHospital Dr. Sótero del RíoSantiagoChileCentro de innovación en Piso Pélvico, Hospital Dr. Sótero del Río, Santiago, Chile.
- Hospital Las HiguerasTalcahuanoChileHospital Las Higueras, Talcahuano, Chile.
| | - Isidora Aleuanlli
- Pontificia Universidad Católica de ChileDepartamento de GinecologíaFacultad de MedicinaSantiagoChileDepartamento de Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Fernanda Santis-Moya
- Centro de innovación en Piso PélvicoHospital Dr. Sótero del RíoSantiagoChileCentro de innovación en Piso Pélvico, Hospital Dr. Sótero del Río, Santiago, Chile.
- Corporación de Innovación en Piso PélvicoSantiagoChileCorporación de Innovación en Piso Pélvico, Santiago, Chile.
| | - Andrea Maluenda
- Centro de innovación en Piso PélvicoHospital Dr. Sótero del RíoSantiagoChileCentro de innovación en Piso Pélvico, Hospital Dr. Sótero del Río, Santiago, Chile.
- Corporación de Innovación en Piso PélvicoSantiagoChileCorporación de Innovación en Piso Pélvico, Santiago, Chile.
- Hospital San Juan de Dios de Los AndesSantiagoChileHospital San Juan de Dios de Los Andes, Santiago, Chile.
| | - Eitan Dines
- Corporación de Innovación en Piso PélvicoSantiagoChileCorporación de Innovación en Piso Pélvico, Santiago, Chile.
| | - Miriam Cohen-Vaizer
- Universidad de ChileFacultad de MedicinaSantiagoChileFacultad de Medicina, Universidad de Chile, Santiago, Chile.
| | - Álvaro Saavedra
- Centro de innovación en Piso PélvicoHospital Dr. Sótero del RíoSantiagoChileCentro de innovación en Piso Pélvico, Hospital Dr. Sótero del Río, Santiago, Chile.
- Corporación de Innovación en Piso PélvicoSantiagoChileCorporación de Innovación en Piso Pélvico, Santiago, Chile.
- Universidad del DesarrolloFacultad de Medicina Clínica AlemanaSantiagoChileFacultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile.
| | - Trinidad Raby
- Centro de innovación en Piso PélvicoHospital Dr. Sótero del RíoSantiagoChileCentro de innovación en Piso Pélvico, Hospital Dr. Sótero del Río, Santiago, Chile.
- Corporación de Innovación en Piso PélvicoSantiagoChileCorporación de Innovación en Piso Pélvico, Santiago, Chile.
- Pontificia Universidad Católica de ChileDepartamento de GinecologíaFacultad de MedicinaSantiagoChileDepartamento de Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Bernardita Blumel
- Centro de innovación en Piso PélvicoHospital Dr. Sótero del RíoSantiagoChileCentro de innovación en Piso Pélvico, Hospital Dr. Sótero del Río, Santiago, Chile.
- Corporación de Innovación en Piso PélvicoSantiagoChileCorporación de Innovación en Piso Pélvico, Santiago, Chile.
- Clínica Santa MaríaSantiagoChileClínica Santa María, Santiago, Chile.
| | - Rodrigo Cuevas
- Centro de innovación en Piso PélvicoHospital Dr. Sótero del RíoSantiagoChileCentro de innovación en Piso Pélvico, Hospital Dr. Sótero del Río, Santiago, Chile.
- Corporación de Innovación en Piso PélvicoSantiagoChileCorporación de Innovación en Piso Pélvico, Santiago, Chile.
- Pontificia Universidad Católica de ChileDepartamento de GinecologíaFacultad de MedicinaSantiagoChileDepartamento de Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Simone Pohlhammer
- Centro de innovación en Piso PélvicoHospital Dr. Sótero del RíoSantiagoChileCentro de innovación en Piso Pélvico, Hospital Dr. Sótero del Río, Santiago, Chile.
- Corporación de Innovación en Piso PélvicoSantiagoChileCorporación de Innovación en Piso Pélvico, Santiago, Chile.
- Clinica BUPA SantiagoSantiagoChileClinica BUPA Santiago, Santiago, Chile.
| | - Gabriela Alarcon
- Centro de innovación en Piso PélvicoHospital Dr. Sótero del RíoSantiagoChileCentro de innovación en Piso Pélvico, Hospital Dr. Sótero del Río, Santiago, Chile.
- Corporación de Innovación en Piso PélvicoSantiagoChileCorporación de Innovación en Piso Pélvico, Santiago, Chile.
- Red de Clínicas y Centros Médicos RedSaludSantiagoChileRed de Clínicas y Centros Médicos RedSalud, Santiago, Chile.
| | - Marco Arellano Albornoz
- Centro de innovación en Piso PélvicoHospital Dr. Sótero del RíoSantiagoChileCentro de innovación en Piso Pélvico, Hospital Dr. Sótero del Río, Santiago, Chile.
- Corporación de Innovación en Piso PélvicoSantiagoChileCorporación de Innovación en Piso Pélvico, Santiago, Chile.
- Clínica Puerto VarasPuerto VarasChileClínica Puerto Varas, Puerto Varas, Chile.
| | - Javier Pizarro-Berdichevsky
- Centro de innovación en Piso PélvicoHospital Dr. Sótero del RíoSantiagoChileCentro de innovación en Piso Pélvico, Hospital Dr. Sótero del Río, Santiago, Chile.
- Corporación de Innovación en Piso PélvicoSantiagoChileCorporación de Innovación en Piso Pélvico, Santiago, Chile.
- Pontificia Universidad Católica de ChileDepartamento de GinecologíaFacultad de MedicinaSantiagoChileDepartamento de Ginecología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Parodi S, Kendall HJ, Terrone C, Heesakkers JPFA. What Is in the Pipeline on Investigational Neuromodulation Techniques for Lower Urinary Tract Dysfunction: A Narrative Review. Neuromodulation 2024; 27:267-272. [PMID: 37865890 DOI: 10.1016/j.neurom.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/10/2023] [Accepted: 09/18/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVES Overactive bladder (OAB) affects millions of patients worldwide. Its treatment is challenging but improves the patient's quality of life. Besides standard techniques for neuromodulation (sacral and pudendal neuromodulation and posterior tibial nerve stimulation), several new techniques have been investigated to treat symptoms of refractory OAB. The purpose of the present review is to outline the state of the art of new neuromodulation techniques for lower urinary tract dysfunction (LUTD). MATERIALS AND METHODS In March 2023, a comprehensive MEDLINE, EMBASE, and Scopus search was carried out (keywords: LUTD, new technologies, neuromodulation, LUTS, OAB, painful bladder syndromes, etc). Articles were included according to inclusion (randomized controlled trials, prospective trials, large retrospective studies) and exclusion (case reports, outcomes not clearly expressed in full text, animal studies) criteria. The reference lists of the included studies also were scanned. Both adult and pediatric populations were included, in addition to both neurogenic and nonneurogenic OAB. A narrative review was then performed. RESULTS Peroneal neuromodulation, transcutaneous electrical nerve stimulation, magnetic nerve stimulation, and parasacral transcutaneous neuromodulation are the most studied investigative techniques and were shown to yield promising results in treating OAB symptoms. Most studies showed promising results even in the complex scenarios of patients with OAB refractory to standard treatments. Comparing investigational techniques with standard of care and their respective clinical outcomes and safety profiles, and confronting their pros and cons, we reasonably believe that once such treatment modalities are further developed, they could play a role in the OAB treatment algorithm. CONCLUSIONS Although the described neuromodulation techniques are being intensely studied, the available results are not yet sufficient for any guidelines to recommend their use.
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Affiliation(s)
- Stefano Parodi
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; University Medical Center, Maastricht, The Netherlands.
| | | | - Carlo Terrone
- Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Pavčnik M, Antić A, Lukanović A, Krpan Ž, Lukanović D. Evaluation of Possible Side Effects in the Treatment of Urinary Incontinence with Magnetic Stimulation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1286. [PMID: 37512097 PMCID: PMC10383588 DOI: 10.3390/medicina59071286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Magnetic stimulation is a type of conservative treatment of urinary incontinence. Our aim was to evaluate the possible side effects of this method. Materials and Methods: We conducted a systematic literature review. The key search terms were urinary incontinence, magnetic stimulation, and female. All known synonyms were used. Results: 255 titles and abstracts were retrieved, and 28 articles met our inclusion criteria. Out of 28 studies, 15 reported no side effects, five reported side effects, and eight did not report anything. There was no significant difference in the incidence of side effects between the sham and active treatment groups. Conclusions: Side effects of magnetic stimulation in comparison to other active treatments are minimal and transient. Among the conservative UI treatment methods, magnetic stimulation is one of the safest methods for the patient and as such a suitable first step in treating UI.
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Affiliation(s)
- Maja Pavčnik
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Anja Antić
- Ljubljana University Medical Center, 1000 Ljubljana, Slovenia
| | - Adolf Lukanović
- Division of Gynecology and Obstetrics, Ljubljana University Medical Center, 1000 Ljubljana, Slovenia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Žan Krpan
- Independent Researcher, Zanzna s.p., 1000 Ljubljana, Slovenia
| | - David Lukanović
- Division of Gynecology and Obstetrics, Ljubljana University Medical Center, 1000 Ljubljana, Slovenia
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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Filippini M, Biordi N, Curcio A, Comito A, Pennati BM, Farinelli M. A Qualitative and Quantitative Study to Evaluate the Effectiveness and Safety of Magnetic Stimulation in Women with Urinary Incontinence Symptoms and Pelvic Floor Disorders. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050879. [PMID: 37241111 DOI: 10.3390/medicina59050879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023]
Abstract
Background and objectives: Involuntary loss of urine owed to dysfunction of the detrusor muscle or muscles of the pelvic floor is known as urinary incontinence (UI). In this study, ultrasound monitoring was employed for the first time to measure the usefulness and safety of electromagnetic stimulation for women with Stress or Urge UI. Materials and Methods: A total of 62 women were enrolled, with a mean age of 55.1 (±14.5); 60% of them were menopausal and presented with urinary incontinence (UI). Eight validated questionnaires were used to evaluate Stress UI, prolapse, overactive bladder urge, faecal incontinence, and quality of life, and the whole study population was tested with ultrasounds at the beginning and at the end of the treatment cycle. The device used was a non-invasive electromagnetic therapeutic system composed of a main unit and an adjustable chair applicator shaped for deep pelvic floor area stimulation. Results: Ultrasound measurements and validated questionnaires revealed a consistent and statistically significant (p < 0.01) improvement of the mean scores when pre- and post-treatment data were considered. Conclusions: Study results showed that the proposed treatment strategy led to a significant improvement in Pelvic Floor Muscle (PFM) tone and strength in patients with UI and pelvic floor disorders, without discomfort or side effects. The demonstration was qualitatively carried out with validated questionnaires and quantitatively with ultrasounds exams. Thus, the "chair" device we used represents valuable and effective support that could be widely employed in the gynaecological field for patients affected by different pathologies.
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Affiliation(s)
- Maurizio Filippini
- Department of Obstetrics and Gynaecology, Hospital State of Republic of San Marino, 47893 San Marino, San Marino
| | - Nicoletta Biordi
- Department of Obstetrics and Gynaecology, Hospital State of Republic of San Marino, 47893 San Marino, San Marino
| | - Antonella Curcio
- Misericordia Bagno a Ripoli, Gynaecology Unit, 50012 Florence, Italy
| | - Alessandra Comito
- El. En. Group, Clinical Research & Practice Department, 50041 Calenzano, Italy
| | | | - Miriam Farinelli
- Department of Obstetrics and Gynaecology, Hospital State of Republic of San Marino, 47893 San Marino, San Marino
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Krhut J, Rejchrt M, Slovak M, Dvorak RV, Grepl M, Zvara P. Peroneal electrical transcutaneous neuromodulation in the home treatment of the refractory overactive bladder. Int Urogynecol J 2022:10.1007/s00192-022-05359-3. [PMID: 36125509 DOI: 10.1007/s00192-022-05359-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/25/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this prospective, open-label, multicenter, noncomparative study was to evaluate the efficacy and safety of peroneal electrical transcutaneous neuromodulation (peroneal eTNM®) using the URIS® neuromodulation system as a home treatment for refractory overactive bladder (OAB). METHODS The patients were treated with daily peroneal eTNM® for 30 min over a 6-week period. The primary endpoint was defined as the proportion of responders, i.e., participants with ≥ 50% reduction in the average daily sum of severe urgency episodes (defined as "I could not postpone voiding but had to rush to the toilet in order not to wet myself") and urgency incontinence episodes. In addition, bladder diary variables, symptom severity (OAB V8 questionnaire), treatment satisfaction (visual analog scale), and pain perception (visual analog scale) were evaluated at baseline (BL), at week 4 (W4), and at the end of treatment (EoT). Safety evaluations included monitoring of the incidence and severity of adverse events (AEs). Changes in time were analyzed using the nonparametric one-way ANOVA Friedman test for categorical variables and the Wilcoxon rank-sum test for the noncategorical variables. RESULTS In total, 40 subjects were screened and 29 were included in the full analysis set. The proportion of responders was 86% at W4 and 79% at EoT. There was a significant reduction in frequency (p<0.001), number of severe urgency episodes (p< 0.001), number of urgency incontinence episodes (p=0.001), and number of nocturia episodes (p=0.002). There was a significant improvement in the OAB V8 score and treatment satisfaction (both p<0.001). Two mild treatment-related AEs were recorded. Both patients recovered without sequelae and completed the study. CONCLUSIONS Peroneal eTNM® proved to be a highly effective and safe method for the home treatment of OAB, providing a therapeutic response in approximately 80% of patients.
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Affiliation(s)
- Jan Krhut
- Department of Urology, University Hospital, Tř. 17. Listopadu 1790, 708 52, Ostrava, Czech Republic. .,Department of Surgical Studies, Medical Faculty, Ostrava University, Ostrava, Czech Republic.
| | - Michal Rejchrt
- Department of Urology, 2nd Faculty of Medicine of Charles University and Motol University Hospital, Prague, Czech Republic
| | | | | | - Michal Grepl
- Department of Urology, University Hospital, Tř. 17. Listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Surgical Studies, Medical Faculty, Ostrava University, Ostrava, Czech Republic
| | - Peter Zvara
- Biomedical Laboratory and Research Unit of Urology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Urology, Odense University Hospital, Odense, Denmark
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Vecchio M, Chiaramonte R, DI Benedetto P. Management of bladder dysfunction in multiple sclerosis: a systematic review and meta-analysis of studies regarding bladder rehabilitation. Eur J Phys Rehabil Med 2022; 58:387-396. [PMID: 35102733 PMCID: PMC9980558 DOI: 10.23736/s1973-9087.22.07217-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The aim of the study was to investigate the efficacy of rehabilitation programs for bladder disorders in patients with multiple sclerosis (MS) and to guide physicians in delineating therapeutic tools and programs for physiatrists, using the best current strategies. EVIDENCE ACQUISITION A search was conducted on PubMed, EMBASE, the Cochrane Library and Web of Science. Studies were eligible if they included adults with bladder disorders related to MS and described specific treatments of rehabilitation interest. The search identified 190,283 articles using the key words "multiple sclerosis" AND "rehabilitation" AND "urinary" OR "bladder," of which the reviewers analyzed 81 full-texts; 21 publications met the criteria and were included in the systematic review. EVIDENCE SYNTHESIS The systematic review identified the specific rehabilitation treatments reported in the current literature. The meta-analysis compared the scores and scales used to quantify bladder disorders due to MS, both before and after rehabilitation or in a comparison with a control group. CONCLUSIONS The present study suggests the need of a specific therapeutic protocol, based on the degree of disability and symptom complexity in patients with MS-related neurogenic lower urinary tract dysfunction (NLUTD). Particularly, the meta-analysis shows the effectiveness of peripheral tibial nerve stimulation (PTNS) and pelvic floor muscle training (PFMT) for neurogenic detrusor overactivity (NDO). However, the goal of physiotherapy is to treat incontinence without making urinary retention worse and vice-versa, reducing the loss of urine urgency, while ensuring the emptying of the bladder.
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Affiliation(s)
- Michele Vecchio
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy - .,Unit of Rehabilitation, Vittorio Emanuele Polyclinic, Catania, Italy -
| | - Rita Chiaramonte
- Section of Pharmacology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
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Zhao Y, Wang D, Zou L, Mao L, Yu Y, Zhang T, Bai B, Chen Z. Comparison of the efficacy and safety of sacral root magnetic stimulation with transcutaneous posterior tibial nerve stimulation in the treatment of neurogenic detrusor overactivity: an exploratory randomized controlled trial. Transl Androl Urol 2022; 11:821-831. [PMID: 35812198 PMCID: PMC9262733 DOI: 10.21037/tau-22-249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/27/2022] [Indexed: 11/06/2022] Open
Abstract
Background Both repetitive sacral root magnetic stimulation (rSMS) and transcutaneous posterior tibial nerve stimulation (TTNS) have demonstrated clinical benefits for lower urinary tract dysfunction. However it still remains unclear that which method is more effective and safer to treat neurogenic detrusor overactivity (NDO). Methods From December 2020 to December 2021, 50 patients (31 men and 19 women, aged 47.9±12.4 years) with NDO secondary to suprasacral spinal cord injury (SCI) were enrolled and randomly allocated to the rSMS or TTNS group based on a computer-generated random numbers table. The stimulation was applied continuously 5 times per week for 20 sessions. Urodynamic test was conducted at baseline and the day after the final 20th treatment session. The primary outcome was the individual change (Δ) in maximum cystometric capacity (MCC) from baseline to post-treatment. Secondary outcomes included changes (Δ) for the following parameters: volume at 1st involuntary detrusor contraction (1st IDCV), maximal detrusor pressure (Pdetmax), bladder compliance (BC), postvoid residual (PVR) volume, and bladder voiding efficiency (BVE). Additionally, adverse reactions including pain and skin irritation during stimulation were observed and recorded as safety outcomes. Results Finally 47 patients completed the study (23 in rSMS and 24 in TTNS group). A per-protocol (PP) analysis was performed, and Mann-Whitney U test and unpaired t-test were used for statistical analysis. Compared with the efficacy of TTNS, rSMS showed statistically greater ΔMCC [median +43 mL (IQR, 22–62 mL) vs. +20 mL (IQR, 15–25 mL), P=0.001, with a between-group difference of +22 mL (95% CI: +7 to +35 mL)] and ΔBVE [median +10.0% (IQR, 3.8–15.7%) vs. +3.5% (IQR, 0.0–7.8%), P=0.003, with a between-group difference of +5.9% (95% CI: +1.2% to +9.7%)]. No significant differences were found in Δ1st IDCV (P=0.40), ΔPdetmax (P=0.67), ΔBC (P=0.79) and ΔPVR (P=0.92) between the two groups. Meanwhile, patients exhibited high tolerance to both protocols, and no adverse reactions were observed. Conclusions RSMS may be more effective to improve urodynamics in the treatment for NDO than TTNS, cause it led to a statistical improvement in bladder capacity and voiding efficiency, without any side effects. RSMS is thus worthy of further clinical promotion. Trial Registration Chinese Clinical Trial Registry ChiCTR2100050663.
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Affiliation(s)
- Yifan Zhao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Daming Wang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Liliang Zou
- Department of Rehabilitation Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Lin Mao
- Department of Rehabilitation Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ying Yu
- Department of Rehabilitation Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Tianfang Zhang
- Department of Rehabilitation Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Bing Bai
- Department of Rehabilitation Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zuobing Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Tezer T, Yıldız N, Sarsan A, Alkan H. Short-term effect of magnetic stimulation added to bladder training in women with idiopathic overactive bladder: A prospective randomized controlled trial. Neurourol Urodyn 2022; 41:1380-1389. [PMID: 35593007 DOI: 10.1002/nau.24957] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/16/2022] [Accepted: 05/10/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate the efficacy of magnetic stimulation (MStim) added to bladder training (BT) on incontinence-related quality of life (QoL) and clinical parameters in women with idiopathic overactive bladder (OAB). MATERIAL AND METHODS Seventy-six women with idiopathic OAB were randomized into two groups using the random numbers generator as follows: Group 1 received BT alone (n: 38), and Group 2 received BT + MStim (n: 38). MStim was performed with MStim therapy armchair (Novamag NT60), 2 days a week, 20 min a day, a total of 12 sessions for 6 weeks. Women were evaluated in terms of incontinence severity (24-h pad test), 3-day voiding diary (frequency of voiding, incontinence episodes, nocturia, and number of pads), symptom severity (OAB-V8), QoL (IIQ-7), positive response and cure-improvement rates, and treatment satisfaction (Likert scale) at the baseline and the end of treatment (sixth week). RESULTS A statistically significant improvement was found in incontinence severity, frequency of voiding, incontinence episodes, nocturia, number of pads, symptom severity, and QoL parameters for two groups at the end of the treatment compared to the baseline values (p < 0.05). At the end of treatment; incontinence severity, incontinence episodes, nocturia, number of pads, symptom severity, and QoL were significantly improved in Group 2 compared to Group 1 (p < 0.05). No difference was found between the two groups in terms of frequency of voiding (p > 0.05). The positive response and cure-improvement rates, and treatment satisfaction were significantly higher in Group 2 than in Group 1 (p < 0.05). CONCLUSION MStim added to BT is more effective than BT alone in women with idiopathic OAB.
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Affiliation(s)
- Tevfik Tezer
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Necmettin Yıldız
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Ayşe Sarsan
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, Turkey
| | - Hakan Alkan
- Department of Physical Medicine and Rehabilitation, Pamukkale University Faculty of Medicine, Denizli, Turkey
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Al-Shenqiti AM, Ragab WM, Rostum EH, Emara HA, Khaled OA. Effects of behavioural therapy versus interferential current on bladder dysfunction in multiple sclerosis patients; a randomised clinical study. J Taibah Univ Med Sci 2021; 16:812-818. [PMID: 34899124 PMCID: PMC8626809 DOI: 10.1016/j.jtumed.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/28/2021] [Accepted: 08/01/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives This study examines the effect of behavioural therapy (biofeedback) and interferential current on bladder dysfunction in multiple sclerosis patients. Methods Fifty patients with secondary progressive type multiple sclerosis (SPMS) suffering from bladder dysfunction were divided equally into two groups randomly. Group A (GA) received behavioural therapy (biofeedback training), while Group B (GB) received interferential current training. Both groups were assessed by urodynamics for detrusor pressure and maximum flow rate before and after eight weeks of behavioural therapy and interferential training. Results Both groups, GA and GB, showed significant increase in the detrusor pressure and maximum flow rate after eight weeks of training. There was no significant difference between both methods. However, GA showed more improvement by close observation. Conclusions Both behavioural therapy and interferential current training effectively managed bladder dysfunction in patients with SPMS, with more evident effects in behavioural therapy patients by close observation.
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Affiliation(s)
- Abdullah M Al-Shenqiti
- Department of Physical Therapy, Faculty of Medical Rehabilitation, Taibah University, Almadinah Almunawwarah, KSA
| | - Walaa M Ragab
- Department of Neurology, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Esraa H Rostum
- Department of Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Hatem A Emara
- Department of Physical Therapy for Growth and Developmental Disorders in Children and its Surgery, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
| | - Osama A Khaled
- Department of Basic Science, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
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10
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Yang E, Yang SH, Huang WC, Yeh SC, Yang JM. Association of Baseline Pelvic Floor Muscle Activities With Sexual and Urinary Functions In Female Stress Urinary Incontinence. J Sex Med 2021; 18:1698-1704. [PMID: 37057501 DOI: 10.1016/j.jsxm.2021.07.013] [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: 05/09/2021] [Revised: 07/18/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The presence of reactive and strong pelvic floor muscle (PFM) activities is supposed to be associated with better urinary and sexual functions in female stress urinary incontinence (SUI). AIM This study was to explore the association of baseline PFM activities, both volitional and reflex, with urinary and sexual functions in women with SUI but who had no experience of PFM training programs before. METHODS Secondary analysis of a prospectively maintained database identified 125 sexually active women with SUI who had met the eligibility criteria. All patients had undergone intravaginal digital examination and pelvic ultrasound to detect volitional and reflex PFM activities, respectively, and responded to questionnaire surveys, including short forms of the urogenital distress inventory, incontinence impact questionnaire-7, and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire. On pelvic ultrasound, an inward clitoral motion and an anorectal lift preceding or during coughing were regarded as the presence of reflex activities of the PFM. OUTCOMES The relationship of volitional and reflex PFM activities with pelvic floor dysfunction relating questionnaires and urethral function on urodynamic studies was analyzed. RESULT Of the 125 women studied, 30 (24.0%) had volitional PFM contraction strength less than grade 2, 74 (59.2%) grade 2 to 3, and 21 (16.8%) greater than grade 3 based on the modified Oxford grading scale. During or preceding coughing, an inward clitoral motion was not observed on ultrasound in 9 (7.2%) women and an anorectal lift was not observed in 8 (6.4%) women. The strength of volitional PFM contraction and the presence or absence of anorectal lift reflex was not associated with urethral and sexual function. In contrast, the absence of reflex inward clitoral motion was significantly associated with lower maximum urethral closure pressure (P = .042) and higher scores of urogenital distress inventory-6 (P = .006) and incontinence impact questionnaire-7 (P = .029). CLINICAL IMPLICATIONS Higher volitional PFM contraction strength was not associated with better sexual and urinary functions; however, loss of one reflex PFM activity was associated with poorer urinary function. STRENGTHS & LIMITATION To our knowledge, this is the first study that evaluates the association of baseline PFM activities with sexual and urinary functions in female SUI. Nevertheless, the cross-sectional design of this study cannot well support the cause-effect relationship CONCLUSION: Besides PFM physiotherapy for enhancing sexual and urinary functions in female SUI, additional treatment strategies such as neuromodulation should take into consideration for those who had absent reflex PFM activities. Yang E, Yang SH, Huang WC, et al. Association of Baseline Pelvic Floor Muscle Activities With Sexual and Urinary Functions In Female Stress Urinary Incontinence. J Sex Med 2021;18:1698-1704.
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Affiliation(s)
- Evelyn Yang
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan; Research Center of Geriatric Nutrition, College of Nutrition, Taipei Medical University, Taipei, Taiwan; Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Wen-Chen Huang
- Department of Obstetrics and Gynecology, Cathay General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Su-Chen Yeh
- Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
| | - Jenn-Ming Yang
- Department of Obstetrics and Gynecology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Obstetrics and Gynecology, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan.
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11
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Sun K, Zhang D, Wu G, Wang T, Wu J, Ren H, Cui Y. Efficacy of magnetic stimulation for female stress urinary incontinence: a meta-analysis. Ther Adv Urol 2021; 13:17562872211032485. [PMID: 34345251 PMCID: PMC8283222 DOI: 10.1177/17562872211032485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/25/2021] [Indexed: 11/21/2022] Open
Abstract
Aim: This meta-analysis aimed to evaluate the efficacy of magnetic stimulation (MS) in treating female stress urinary incontinence (SUI) and providing an alternative treatment for patients who are unwilling to undergo surgery. Methods: Randomized controlled trials (RCTs) that evaluated MS as a remedy for female SUI were retrieved from various electronic databases, including MEDLINE, EMBASE, and the Cochrane Controlled Trial Registry system. Moreover, reference lists for related papers were carefully screened for relevant studies. Results: A total of six RCTs evaluating the effect of MS in treating female SUI were included in this study. Compared with the placebo group, the MS group exhibited higher quality-of-life scores [mean difference (MD) 0.59, 95% credibility interval (CI) 0.23–0.95; p = 0.001] and lower International Consultation on Incontinence Questionnaire scores (MD −3.93, 95% CI −5.85 to −2.01; p < 0.0001). Moreover, they exhibited a higher objective cure rate (odds ratio 8.49, 95% CI 3.08–23.37). In addition, MS treatment reduced the number of episodes of urinary incontinence (MD −1.42, 95% CI −2.24 to −0.59; p = 0.0007) and urine loss on pad test (MD −4.67, 95% CI −8.05 to −1.28; p = 0.007). There were no significant treatment-related adverse reactions. Conclusion: This study evaluated the efficacy and safety of MS in the treatment of female SUI. The results have important implications for patients who do not wish to undergo surgical therapy. We found that MS treatment for SUI has positive outcomes, however, future studies should aim at establishing the best protocol for optimizing the therapeutic effect.
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Affiliation(s)
- Kai Sun
- Urology Department, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Dongxu Zhang
- Urology Department, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Gang Wu
- Urology Department, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Tianqi Wang
- Urology Department, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - JiTao Wu
- Urology Department, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong, China
| | - Hongxu Ren
- Operation Department, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20 East Yuhuangding Road, Yantai, Shandong 264000, China
| | - Yuanshan Cui
- Urology Department, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, No. 20 East Yuhuangding Road, Yantai, Shandong 264000, China
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Russo E, Caretto M, Giannini A, Bitzer J, Cano A, Ceausu I, Chedraui P, Durmusoglu F, Erkkola R, Goulis DG, Kiesel L, Lambrinoudaki I, Hirschberg AL, Lopes P, Pines A, Rees M, van Trotsenburg M, Simoncini T. Management of urinary incontinence in postmenopausal women: An EMAS clinical guide. Maturitas 2020; 143:223-230. [PMID: 33008675 DOI: 10.1016/j.maturitas.2020.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 09/21/2020] [Accepted: 09/21/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The prevalence of urinary incontinence and of other lower urinary tract symptoms increases after the menopause and affects between 38 % and 55 % of women aged over 60 years. While urinary incontinence has a profound impact on quality of life, few affected women seek care. AIM The aim of this clinical guide is to provide an evidence-based approach to the management of urinary incontinence in postmenopausal women. MATERIALS AND METHODS Literature review and consensus of expert opinion. SUMMARY RECOMMENDATIONS Healthcare professionals should consider urinary incontinence a clinical priority and develop appropriate diagnostic skills. They should be able to identify and manage any relevant modifiable factors that could alleviate the condition. A wide range of treatment options is available. First-line management includes lifestyle and behavioral modification, pelvic floor exercises and bladder training. Estrogens and other pharmacological interventions are helpful in the treatment of urgency incontinence that does not respond to conservative measures. Third-line therapies (e.g. sacral neuromodulation, intravesical onabotulinum toxin-A injections and posterior tibial nerve stimulation) are useful in selected patients with refractory urge incontinence. Surgery should be considered in postmenopausal women with stress incontinence. Midurethral slings, including retropubic and transobturator approaches, are safe and effective and should be offered.
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Affiliation(s)
- Eleonora Russo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Marta Caretto
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Andrea Giannini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy
| | - Johannes Bitzer
- Department of Obstetrics and Gynecology, University Hospital, Basel, Switzerland
| | - Antonio Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia and INCLIVA, Valencia, Spain
| | - Iuliana Ceausu
- Department of Obstetrics and Gynecology I, "Dr. I. Cantacuzino" Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Peter Chedraui
- Instituto de Investigación e Innovación de Salud Integral (ISAIN), Facultad de Ciencias Médicas, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
| | - Fatih Durmusoglu
- İstanbul Medipol International School of Medicine, Istanbul, Turkey
| | - Risto Erkkola
- Department of Obstetrics and Gynecology, University Central Hospital, Turku, Finland
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Ludwig Kiesel
- Department of Gynecology and Obstetrics, University of Münster, Münster, Germany
| | - Irene Lambrinoudaki
- Second Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Greece
| | - Angelica Lindén Hirschberg
- Department of Women's and Children's Health, Karolinska Institutet and Department of Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Patrice Lopes
- Nantes, France Polyclinique de l'Atlantique Saint Herblain. F 44819 St Herblain France, Université de Nantes F, 44093, Nantes, Cedex, France
| | - Amos Pines
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
| | - Margaret Rees
- Women's Centre, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Mick van Trotsenburg
- Department of Obstetrics and Gynecology, University Hospital St. Poelten, Lilienfeld, Austria
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56100, Pisa, Italy.
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13
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Lee J, Park E, Kang W, Kim Y, Lee KS, Park SM. An Efficient Noninvasive Neuromodulation Modality for Overactive Bladder Using Time Interfering Current Method. IEEE Trans Biomed Eng 2020; 68:214-224. [PMID: 32746006 DOI: 10.1109/tbme.2020.2995841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The present study aimed to evaluate a new tibial nerve stimulation (TNS) modality, which uses interferential currents, in terms of the stimulation electric field penetration efficiency into the body and physiological effectiveness. METHODS In silico experiments were performed to analyze the penetration efficiency of proposed interferential current therapy (ICT). Based on this, we performed in vivo experiments to measure excitation threshold of ICT for the tibial nerve, which is related to stimulation field near the nerve. Regarding analysis of the physiological effectiveness, in vivo ICT-TNS was performed, and changes in bladder contraction frequency and voiding volume were measured. The penetration efficiency and physiological effectiveness of ICT were evaluated by comparison with those of conventional TNS using transcutaneous electrical nerve stimulation (TENS). RESULTS Simulation results showed that ICT has high penetration efficiency, thereby generating stronger field than TENS. These results are consistent with the in vivo results that nerve excitation threshold of ICT is lower than that of TENS. Moreover, ICT-TNS decreased contraction frequency and increased voiding volume, and its performance was profound compared with that of TENS-TNS. CONCLUSION The proposed ICT is more efficient in inducing the stimulation field near the tibial nerve placed deep inside the body compared with conventional TENS and shows a good clinical effectiveness for TNS. SIGNIFICANCE The high efficiency of ICT increases the safety of noninvasive neurostimulation; therefore, it has clinical potential to become a promising modality for TNS to treat OAB and other peripheral neurostimulations.
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14
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Urinary Incontinence in Women: Modern Methods of Physiotherapy as a Support for Surgical Treatment or Independent Therapy. J Clin Med 2020; 9:jcm9041211. [PMID: 32340194 PMCID: PMC7230757 DOI: 10.3390/jcm9041211] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022] Open
Abstract
Urinary incontinence (UI) is a common health problem affecting quality of life of nearly 420 million people, both women and men. Pelvic floor muscle (PFM) training and other physiotherapy techniques play an important role in non-surgical UI treatment, but their therapeutic effectiveness is limited to slight or moderate severity of UI. Higher UI severity requires surgical procedures with pre- and post-operative physiotherapy. Given that nearly 30%–40% of women without dysfunction and about 70% with pelvic floor dysfunction are unable to perform a correct PFM contraction, therefore, it is particularly important to implement physiotherapeutic techniques aimed at early activation of PFM. Presently, UI physiotherapy focuses primarily on PFM therapy and its proper cooperation with synergistic muscles, the respiratory diaphragm, and correction of improper everyday habits for better pelvic organ support and continence. The purpose of this work is a systematic review showing the possibilities of using physiotherapeutic techniques in the treatment of UI in women with attention to the techniques of PFM activation. Evidence of the effectiveness of well-known (e.g., PFM training, biofeedback, and electrostimulation) and less-known (e.g., magnetostimulation, vibration training) techniques will be presented here regarding the treatment of symptoms of urinary incontinence in women.
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15
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Yokoyama O, Honda M, Yamanishi T, Sekiguchi Y, Fujii K, Nakayama T, Mogi T. OnabotulinumtoxinA (botulinum toxin type A) for the treatment of Japanese patients with overactive bladder and urinary incontinence: Results of single-dose treatment from a phase III, randomized, double-blind, placebo-controlled trial (interim analysis). Int J Urol 2020; 27:227-234. [PMID: 31957922 PMCID: PMC7154639 DOI: 10.1111/iju.14176] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/01/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of onabotulinumtoxinA (botulinum toxin type A) 100 U in patients with overactive bladder and urinary incontinence. METHODS This was a phase III, randomized, double-blind, placebo-controlled trial in Japanese patients who were inadequately managed with overactive bladder medications (anticholinergics and/or β3 -adrenergic receptor agonists). Eligible patients were randomized 1:1 to receive a single dose of either onabotulinumtoxinA or placebo into the detrusor muscle (n = 124 each). The primary end-point was the change in the number of daily urinary incontinence episodes at week 12 from baseline. Secondary end-points included volume voided per micturition, other symptomatic measures (urinary urgency incontinence, micturition, urgency and nocturia) and patient-reported outcomes. RESULTS In the onabotulinumtoxinA group, there was a significantly greater decrease from baseline in the mean number of daily urinary incontinence episodes compared with the placebo group (2.16; P < 0.001), and significantly greater improvement for all secondary end-points (P < 0.05). Urinary tract infection, dysuria, urinary retention and post-void residual urine volume increased represented adverse events occurring at a higher rate in the onabotulinumtoxinA group. The majority of these were mild or moderate in severity. CONCLUSIONS Statistically significant and clinically relevant improvements in symptoms and patient-reported outcomes, and tolerability were seen in patients with overactive bladder and urinary incontinence who had been inadequately managed with overactive bladder medications after using onabotulinumtoxinA.
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Affiliation(s)
- Osamu Yokoyama
- Department of Urology, Faculty of Medical Science, University of Fukui, Fukui, Japan
| | - Masashi Honda
- Department of Urology, Tottori University Faculty of Medicine, Tottori, Japan
| | | | | | - Kenji Fujii
- Medicines Development, Japan Development Division, GlaxoSmithKline, Tokyo, Japan
| | - Takashi Nakayama
- Biomedical Data Sciences Department, Japan Development Division, GlaxoSmithKline, Tokyo, Japan
| | - Takao Mogi
- Medicines Development, Japan Development Division, GlaxoSmithKline, Tokyo, Japan
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16
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A Controlled Clinical Trial on the Effects of Exercise on Lower Urinary Tract Symptoms in Women With Multiple Sclerosis. Am J Phys Med Rehabil 2019; 98:777-782. [DOI: 10.1097/phm.0000000000001189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Patel DN, Zhao HH, Houman J, Ackerman AL, Eilber KS, Anger JT. Comparative effectiveness of one versus two‐stage sacral neurostimulation device placement. Neurourol Urodyn 2019; 38:734-739. [DOI: 10.1002/nau.23908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/30/2018] [Accepted: 11/24/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Devin N. Patel
- Cedars Sinai Medical CenterDivision of Urology Los AngelesLos AngelesCalifornia
| | - Hanson H. Zhao
- Cedars Sinai Medical CenterDivision of Urology Los AngelesLos AngelesCalifornia
| | - Justin Houman
- Cedars Sinai Medical CenterDivision of Urology Los AngelesLos AngelesCalifornia
| | - A. Lenore Ackerman
- Cedars Sinai Medical CenterDivision of Urology Los AngelesLos AngelesCalifornia
| | - Karyn S. Eilber
- Cedars Sinai Medical CenterDivision of Urology Los AngelesLos AngelesCalifornia
| | - Jennifer T. Anger
- Cedars Sinai Medical CenterDivision of Urology Los AngelesLos AngelesCalifornia
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Zhang AY, Xu X. Prevalence, Burden, and Treatment of Lower Urinary Tract Symptoms in Men Aged 50 and Older: A Systematic Review of the Literature. SAGE Open Nurs 2018; 4:2377960818811773. [PMID: 33415211 PMCID: PMC7774430 DOI: 10.1177/2377960818811773] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 10/17/2018] [Indexed: 11/18/2022] Open
Abstract
We conducted a systematic review of literature from the years 2000 through 2017 on the prevalence and burden of lower urinary tract symptoms (LUTS) in men aged 50 and older, and medical treatments of and alternative nonmedical approaches to LUTS. EBSCOhost (Medline with Full Text) was searched for observational, experimental, and review studies in peer-reviewed journals in the English language. Our review found that LUTS were highly prevalent in the world and estimated to affect 2.3 billion people in 2018, with 44.7% being men. Men with LUTS suffer from not only burdensome symptoms such as nocturia and urgency but also adverse psychological consequences (e.g., anxiety and depression) and financial burden. Current medical treatments are clinically effective, but their efficacy is compromised by side effects and low compliance rates. Alternative nonmedical treatments for LUTS were also sought worldwide. There is evidence that lifestyle modifications such as pelvic muscle exercises and bladder training, physical activity, dietary modification, and nutritional supplements can alleviate LUTS and improve patient quality of life; however, evidence based on rigorous methodology remains minimal and cannot be generalized across populations. Evidence of effectiveness of weight loss programs to reduce LUTS is inconclusive. We conclude that although behavioral treatment is a promising approach to alleviating LUTS, especially when combined with medical treatments, well-designed randomized controlled and longitudinal clinical trials on behavioral treatments of LUTS are still needed. Minimally invasive procedures and neuromodulation therapy also show positive results of alleviating LUTS but require further research as well.
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Affiliation(s)
- Amy Y Zhang
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Xinyi Xu
- University Hospitals Cleveland Medical Center Seidman Cancer Center, Cleveland, OH, USA
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Lasak AM, Jean-Michel M, Le PU, Durgam R, Harroche J. The Role of Pelvic Floor Muscle Training in the Conservative and Surgical Management of Female Stress Urinary Incontinence: Does the Strength of the Pelvic Floor Muscles Matter? PM R 2018; 10:1198-1210. [PMID: 29753829 DOI: 10.1016/j.pmrj.2018.03.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 01/06/2018] [Accepted: 03/02/2018] [Indexed: 01/23/2023]
Abstract
The purpose of this review is to provide an in-depth overview of the role of pelvic floor muscle (PFM) training in the management of stress urinary incontinence (SUI). The definition, epidemiology, and pathogenesis of SUI are described. We review the anatomy of the PFM and the importance of PFM strength in maintaining urinary continence and establishing normal voiding function. A brief description of the surgical options currently available for SUI and the existing data regarding the role of perioperative PFM training for SUI are included. Critical research questions to better evaluate and assess PFM training during the perioperative period are proposed. Promising novel approaches in the treatment of SUI are also presented. This review is useful for physiatrists, urogynecologists, female urologists, and nurse practitioners who specialize in the management and treatment of women with SUI. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Anna Maria Lasak
- Department of Rehabilitation Medicine, Montefiore Medical Center, The University Hospital For Albert Einstein College of Medicine, Bronx, NY(∗)
| | | | - Phuong Uyen Le
- Department of Rehabilitation Medicine, Montefiore Medical Center, The University Hospital For Albert Einstein College of Medicine, 150 East 210(th) Street, 2(nd) floor, Bronx, NY 10467(‡).
| | - Roshni Durgam
- Department of Rehabilitation Medicine, Montefiore Medical Center, The University Hospital For Albert Einstein College of Medicine, Bronx, NY(§)
| | - Jessica Harroche
- Montefiore Medical Center, The University Hospital For Albert Einstein College of Medicine, Bronx, NY(¶)
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Abello A, Das AK. Electrical neuromodulation in the management of lower urinary tract dysfunction: evidence, experience and future prospects. Ther Adv Urol 2018; 10:165-173. [PMID: 29623108 DOI: 10.1177/1756287218756082] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/23/2017] [Indexed: 11/16/2022] Open
Abstract
Lower urinary tract dysfunction (LUTD) is common and causes a spectrum of morbidity and decreased quality of life (QoL) for patients. LUTD can range from urinary retention to urge incontinence, and includes a variety of syndromes, with the most common and widely recognized being overactive bladder (OAB). The classic treatments of LUTD and OAB comprise different strategies including behavioral therapies, medications and minimally invasive or invasive surgical procedures. Generally, once patients have tried behavioral modifications and oral medical therapy, and have not experienced adequate relief of their symptoms, the next step is to consider minimally invasive therapies. In the last two decades since FDA approval, sacral nerve stimulation (SNS) has become an accepted intervention, with increasing use and evidence of effectiveness for LUTD, specifically OAB and non-obstructive urinary retention. SNS has shown both objective and subjective improvement in voiding symptoms in several randomized controlled trials (RCTs) when compared to sham or standard medical therapy. The main limitations for more extensive use include relatively high cost, implantation of a device and possibly reoperation secondary to adverse events (AE). Percutaneous tibial nerve stimulation (PTNS) is a less invasive, less direct and less expensive method for neuromodulation, which has also shown effectiveness in several randomized and non-randomized trials, including comparable improvement rates to anticholinergics in OAB management. However, the efficacy of PTNS is only maintained for a short period after the stimulation is delivered. This technique has a much lower rate of AE compared to SNS, but with the inconvenience of weekly visits for stimulation, although implantable devices are on the horizon. In this article we review the mechanism of action, indications, effectiveness and complications related to SNS and PTNS therapy for LUTD.
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Affiliation(s)
- Alejandro Abello
- Division of Urology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anurag K Das
- Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston MA 02215, USA
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Rydningen MB, Riise S, Wilsgaard T, Lindsetmo RO, Norderval S. Sacral neuromodulation for combined faecal and urinary incontinence following obstetric anal sphincter injury. Colorectal Dis 2018; 20:59-67. [PMID: 28727899 DOI: 10.1111/codi.13820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 06/13/2017] [Indexed: 02/08/2023]
Abstract
AIM The aim of this study was to investigate the efficacy of sacral neuromodulation (SNM) in the treatment of faecal incontinence and concomitant urinary incontinence in women with a history of obstetric anal sphincter injury (OASIS). METHOD In this prospective study, consecutive women with faecal incontinence following OASIS accepted for SNM were screened for concomitant urinary incontinence. The primary outcome was the change in urinary incontinence score on the International Consultation on Incontinence Questionnaire for Urinary Incontinence, Short Form (ICIQ-UI-SF), between baseline and 12 months. Secondary outcomes included the change in St Mark's score, sexual function and quality of life, change in grade of urinary incontinence and disappearance of urgency. RESULTS From March 2012 to September 2014, 39 women with combined faecal incontinence and urinary incontinence received SNM. Thirty-seven women were available for analysis after 12 months. The mean reduction in the ICIQ-UI-SF score between the baseline and 12 months was 5.8 (95% CI 3.7-8.0, P < 0.001). ICIQ-UI-SF was reduced in 29 (78%) women, urinary incontinence resolved in 13/37 (35%, 95% CI 20%-50%) patients, and urgency disappeared in 14/33 (42%, 95% CI 26%-59%). The mean reduction in the St Mark's score was 10.6 (95% CI 8.6-12.7, P < 0.001). Disease-specific quality of life, Euroqual 5-dimension visual analogue scale (EQ-5D VAS) and several areas of sexual function changed significantly for the better. CONCLUSION More than three-quarters of the women with combined faecal and urinary incontinence following OASIS reported a successful outcome with reduction in ICIQ-UI-SF at 12 months after SNM.
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Affiliation(s)
- M B Rydningen
- Department of Gastroenterological Surgery, University Hospital of North Norway, Tromsø, Norway
| | - S Riise
- Department of Gastroenterological Surgery, University Hospital of North Norway, Tromsø, Norway
| | - T Wilsgaard
- Department of Community Medicine, Arctic University of Norway, Tromsø, Norway
| | - R O Lindsetmo
- Department of Gastroenterological Surgery, University Hospital of North Norway, Tromsø, Norway.,Institute of Clinical Medicine, Arctic University of Norway, Tromsø, Norway
| | - S Norderval
- Department of Gastroenterological Surgery, University Hospital of North Norway, Tromsø, Norway.,Institute of Clinical Medicine, Arctic University of Norway, Tromsø, Norway.,National Advisory Board of Continence and Pelvic Floor Health of Norway, University Hospital of North Norway, Tromsø, Norway
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22
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Liu X, Liu K, Zhi M, Mo Q, Gao X, Liu Z. Effects of electroacupuncture at BL33 on detrusor smooth muscle activity in a rat model of urinary retention. Acupunct Med 2017; 35:437-444. [PMID: 29109130 PMCID: PMC5738530 DOI: 10.1136/acupmed-2016-011355] [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] [Accepted: 10/26/2017] [Indexed: 01/25/2023]
Abstract
Background Detrusor smooth muscle (DSM) underactivity may lead to urinary retention (UR). Electroacupuncture (EA) at BL33 may be effective in improving DSM contractions. Objectives This study aimed to investigate: (1) the effect of EA at BL33; and (2) the effect of different manipulation methods at BL33 on the modulation of DSM contractions in UR rats. Methods 30 male Sprague-Dawley rats were anaesthetised with urethane and modelled by urethral outlet obstruction. First, 2 Hz EA at BL33, SP6 and LI4 wasrandomly applied to the UR rats for 5 min to observe the immediate effects (n=10); second, manual acupuncture (MA) (n=10) and 100 Hz EA (n=10) were applied with the same programme. DSM electromyography (EMG) and cystometrogram data were evaluated. Results (1) 2 Hz EA at BL33 and SP6 significantly increased DSM discharging frequency (0.80±0.10 Hz, P<0.001, and 0.22±0.14 Hz, P=0.038), shortened micturation intervals (65.67±20.65 s, P=0.008, and 35.62±15.84 s, P=0.042), prolonged the duration of voiding (2.13±0.61 s, P=0.005, and 0.47±0.16 s, P=0.015), and reduced residual pressure (−0.91±0.31 mmHg, P=0.019, and −0.66±0.27 mmHg, P=0.046). EA at LI4 was not associated with any functional effects (P>0.05). Compared with SP6, EA at BL33 had greater positive effects on DSM discharging frequency, duration of discharging, and duration of voiding (all P<0.05). (2) No statistically significant differences were shown between MA, 2 Hz EA and 100 Hz EA interventions when stimulating at BL33, SP6 or LI4. Conclusions EA at BL33 improved DSM contractions to a greater degree than EA at SP6 or LI4. There were no differences in effect when stimulating using 2 Hz EA, 100 Hz EA and MA.
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Affiliation(s)
- Xiaoxu Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Kun Liu
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Mujun Zhi
- Changchun University of Chinese Medicine, Changchun, Jilin, China
| | - Qian Mo
- Guiyang University of Chinese Medicine, Guiyang, Guizhou, China
| | - Xinyan Gao
- Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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23
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Yamanishi T, Suzuki T, Sato R, Kaga K, Kaga M, Fuse M. Effects of magnetic stimulation on urodynamic stress incontinence refractory to pelvic floor muscle training in a randomized sham-controlled study. Low Urin Tract Symptoms 2017; 11:61-65. [PMID: 28961380 DOI: 10.1111/luts.12197] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 06/06/2017] [Accepted: 07/11/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of the present study was to evaluate the effect of magnetic stimulation on urodynamic stress incontinence refractory to pelvic floor muscle training in a randomized sham-controlled study. METHODS Female patients with urodynamic stress incontinence who had not been cured by pelvic floor muscle training were randomly assigned at a ratio of 2 : 1 to either active treatment or sham treatment for 10 weeks. The randomization was made using magnetic cards for individuals indicating active or sham stimulation. The primary endpoint was changes in the number of incontinence episodes/week, with secondary endpoints of the degree of incontinence (in g/day; determined using the pad test), the total score on the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF), the ICIQ quality of life (QOL) score, and the abdominal leak point pressure (ALPP) on urodynamic study. RESULTS Although 39 patients were enrolled in the study, 9 dropped out, leaving a total patients for analysis (18 in the active treatment group, 12 in the sham treatment group). The number of incontinence episodes/week, the degree of incontinence, total ICIQ-SF score, ICIQ-QOL score, and ALPP were significantly improved after active treatment compared with baseline (all P < .05), but did not change significantly after sham treatment. There was a significant intergroup difference with regard to changes from baseline in the ICIQ-SF and ALPP in favor of the active treatment group (P < .05). There were no significant differences in any other parameters between the 2 groups. Treatment-related adverse events were not found in both groups. CONCLUSION Magnetic stimulation was effective in treating urodynamic stress incontinence.
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Affiliation(s)
- Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Mibu, Japan
| | - Tsuneki Suzuki
- Department of Urology, Dokkyo Medical University, Koshigaya Hospital, Koshigaya, Japan
| | - Ryo Sato
- Department of Urology, Dokkyo Medical University, Koshigaya Hospital, Koshigaya, Japan
| | - Kanya Kaga
- Department of Urology, Continence Center, Dokkyo Medical University, Mibu, Japan
| | - Mayuko Kaga
- Department of Urology, Continence Center, Dokkyo Medical University, Mibu, Japan
| | - Miki Fuse
- Department of Urology, Continence Center, Dokkyo Medical University, Mibu, Japan
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24
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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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25
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Homma Y, Gotoh M, Kawauchi A, Kojima Y, Masumori N, Nagai A, Saitoh T, Sakai H, Takahashi S, Ukimura O, Yamanishi T, Yokoyama O, Yoshida M, Maeda K. Clinical guidelines for male lower urinary tract symptoms and benign prostatic hyperplasia. Int J Urol 2017; 24:716-729. [DOI: 10.1111/iju.13401] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/23/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Yukio Homma
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Momokazu Gotoh
- Department of Urology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | | | - Yoshiyuki Kojima
- Department of Urology; Fukushima Prefectural University of Medicine; Fukushima Japan
| | - Naoya Masumori
- Department of Urology; Sapporo Medical University School of Medicine; Sapporo Japan
| | - Atsushi Nagai
- Department of Urology; Kawasaki Medical School; Kurashiki Japan
| | | | - Hideki Sakai
- Department of Urology; Nagasaki University; Nagasaki Japan
| | | | - Osamu Ukimura
- Department of Urology; Kyoto Prefectural University of Medicine; Kyoto Japan
| | | | | | - Masaki Yoshida
- Department of Urology; National Center of Geriatrics and Gerontology; Obu Japan
| | - Kenji Maeda
- Department of Urology; Maeda Clinic of Internal Medicine; Ageo Japan
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26
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Tamam Y, Özdemir HH, Gedik A, Tamam C, Nazlıkul H. Efficacy of peripheral lidocaine application (neural therapy) in the treatment of neurogenic detrusor overactivity in multiple sclerosis patients. Neurourol Urodyn 2017; 36:1832-1838. [PMID: 28084625 DOI: 10.1002/nau.23191] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 11/15/2016] [Indexed: 12/28/2022]
Abstract
AIMS Many agents and treatments are used in the treatment of neurogenic detrusor overactivity (NDO) in MS patients, but no study has been conducted on the use of peripheric lidocaine (neural therapy-NT) on MS patients. We evaluated the effects of local administration of lidocaine on NDO in Multiple Sclerosis (MS) patients. METHODS For each patient local anesthetic lidocaine was injected at each session. Sessions were held once a week for 5 weeks. At each session, Th 10-L1, urogenital segment intradermal injections, Frankenhauser, and sacral epidural injections were given. The patients had clinical and urodynamic assessment 1 month before and 3, 9, and 12 months after NT. In addition, multiple sclerosis quality of life inventory (MSQL-54) and bladder control scale (BLCS) was performed for patients. RESULTS Twenty-eight patients were included in the study (8 males, 20 females). The patients' average age was 31.7 ± 8.1 years. The injection therapy significantly improved volume at first involuntary bladder contraction (FCV), maximal detrusor pression during filling (P det. max.), maximal cystometric bladder capacity (MCC) after 3 months. Also, the MSQL-54 and BLCS scores were improved with treatment. However, these improvements reached a maximum 3 months after treatment, but from the 9 month a regression was seen in the parameters, and after 12 months the findings were seen to be slightly above their basal levels. CONCLUSIONS These results suggest that NDO treatment in MS patients could be an effective treatment which is easy and has very few side effects, and is cost effective.
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Affiliation(s)
- Yusuf Tamam
- Department of Neurology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
| | | | - Abdullah Gedik
- Department of Urology, Dicle University Faculty of Medicine, Diyarbakir, Turkey
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27
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La disfunción del tracto urinario inferior en el paciente mayor. Med Clin (Barc) 2016; 147:455-460. [DOI: 10.1016/j.medcli.2016.03.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 03/17/2016] [Accepted: 03/21/2016] [Indexed: 11/18/2022]
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28
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Ray A, Morgan H, Wilkes A, Carter K, Carolan-Rees G. The Urolift System for the Treatment of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia: A NICE Medical Technology Guidance. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2016; 14:515-26. [PMID: 26832146 PMCID: PMC5025508 DOI: 10.1007/s40258-015-0218-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
As part of its Medical Technologies Evaluation Programme (MTEP), the National Institute for Health and Care Excellence (NICE) invited Neotract (manufacturer) to submit clinical and economic evidence for their prostatic urethral lift device, Urolift, for the relief of lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS BPH). The Urolift System uses implants to retract the prostatic lobe away from the urethral lumen. The clinical evidence used in the manufacturer's submission shows that Urolift is effective for the treatment of BPH. Urolift delivers a weighted mean International Prostate Symptom Score (IPSS) improvement of between 9.22 and 11.82 points. These Urolift improvements are greater than a published 'marked improvement' in IPSS score of 8.80. Comparison with randomised controlled trials (RCTs) of TURP (Transurethral Resection of Prostate) and HoLEP (Holmium Laser Enucleation of Prostate) show that Urolift does not yield better clinical outcomes from baseline compared to TURP and HoLEP in terms of IPSS, QoL (Quality of Life) and Qmax (maximum urinary flow). However, Urolift appears to have the advantage in terms of minimal and mild complications, and this may be of interest to patients and urologists. The economic case for Urolift was made using a very detailed and thorough de novo cost model. The base case posed by the manufacturer placed Urolift at almost cost-neutral (£3 cost incurring, based on 2014 prices) compared to TURP, and £418 cost incurring compared to HoLEP. In an additional scenario comparing day-case Urolift with in-patient TURP, the estimated per-patient savings with Urolift were £286 compared with monopolar TURP (mTURP) and £159 compared with bipolar TURP (BiTURP). NICE guidance MTG26 recommends that the case for adoption of Urolift was supported by the evidence, when implemented in a day-case setting.
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Affiliation(s)
| | | | - Antony Wilkes
- Cardiff and Vale University Health Board, Cardiff, Wales, UK
| | - Kimberley Carter
- National Institute for Health and Care Excellence, Manchester, UK
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29
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Carr DJ. In this Issue. Acupunct Med 2016. [DOI: 10.1136/acupmed-2016-011059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- David John Carr
- Institute for Medical and Biomedical Education, St George's University of London, London, UK
- Royal London Hospital for Integrated Medicine, University College London Hospitals NHS Trust, London, UK
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