Current trends in the evaluation and management of female urinary incontinence

Effectiveness of pelvic floor muscle training alone or combined with either a novel biofeedback device or conventional biofeedback for improving stress urinary incontinence: A randomized controlled pilot trial

PURPOSE

To (i) compare the acceptance of a newly developed, novel biofeedback device (PelviSense) with that of conventional biofeedback (CB) using an intravaginal probe for the treatment of stress urinary incontinence (SUI) in women, (ii) examine the feasibility and safety of using the PelviSense device as a pelvic floor muscle (PFM) training (PFMT) adjunct, and (iii) compare the PFMT adherence and effectiveness of CB, the PelviSense device, with PFMT alone for women with SUI.

METHODS

An assessor-blinded, three-arm, randomized controlled pilot trial was conducted among 51 women with SUI. Women were randomly allocated to one of three study groups (PelviSense-assisted PFMT, CB-assisted PFMT, or PFMT alone [control]). Outcome measures included the International Consultation on Incontinence Questionnaire-Short Form, the 1-h pad test, and the Modified Oxford Scale.

RESULTS

Participants in the PelviSense-assisted PFMT group expressed good device acceptance. PFMT adherence was greater in the PelviSense-assisted PFMT group than in the unassisted or CB-assisted PFMT groups. Between-groups analysis revealed significant effects on improved SUI symptoms, urine loss severity, and PFM strength for the PelviSense-assisted PFMT group compared with the CB-assisted and PFMT alone groups.

CONCLUSIONS

The pilot trial results demonstrated moderate to high PFMT adherence in the PelviSense-assisted PFMT group and supported the safety of using the PelviSense device. The preliminary results of the pilot trial showed that PelviSense-assisted PFMT was more effective for reducing SUI symptoms among women than unassisted or CB-assisted PFMT.

TRIAL REGISTRATION

This trial was registered in http://ClinicalTrials.gov (reference number: NCT04638348) before the recruitment of the first participant.

Reconstruction of the Meatus Urethrae After Oncologic Vulvectomy: Outcome of 42 Vaginal Flap Advancements in 41 Women

BACKGROUND AND AIM

Resection of the distal part of the urethra is performed in 15% to 55% of women with vulvar cancer to achieve radicality of vulvectomy. Urinary reconstruction in these women may be complicated by urethral stenosis resulting from circular inset of the meatus. We report on our experience with 2 surgical techniques of noncircular inset to prevent such stenosis.

METHODS

From January 2005 to January 2020, 42 urethral meatus reconstructions were performed in 41 women after vulvectomy for (pre)malignant skin disorders by a "limited" (n = 17) or "extended" (n = 25) anterior vaginal wall advancement technique, including V-Y insertion of part of the vaginal flap in a posterior longitudinal urethrotomy. Preoperative characteristics, procedural details, and surgical outcomes were reviewed.

RESULTS

We observed 1 neomeatal stenosis and 1 case of partial vaginal wall flap necrosis as major complications following the "limited" technique and 1 circumferential neomeatal dehiscence and occlusion as major complication after the "extended" technique. Both the neomeatal stenosis and the dehiscence/occlusion are felt to have been preventable and not caused by a flaw of design of the advancement technique.

CONCLUSIONS

We advocate applying these vaginal wall advancement techniques to prevent circular inset of the neomeatus. The "extended" technique offers a solution in cases where the periurethral vulvar defect cannot be closed by transpositioning of labial skin.

Tadalafil treatment improves cardiac, renal and lower urinary tract dysfunctions in rats with heart failure

Tadalafil, a phosphodiesterase-5 (PDE5) inhibitor, shown to exert a protection to heart failure (HF) associated damage or lower urinary tract symptoms (LUTS). Thus, we investigated the contribution of tadalafil chronic treatment in the alterations of LUTS in HF rats. Male rats were subjected to aortocaval fistula model for HF induction. Echocardiography, cystometric, renal function and redox cell balance, as well as concentration-response curves to carbachol, KCl, ATP and frequency-response curves to electrical field stimulation (EFS) were evaluated in Sham, HF, Tadalafil and HF-Tadalafil (12 weeks endpoint) groups. HF group to present increased in left-ventricle (LV) mass and in LV end-diastolic- and LV end-systolic volume, with a decreased ejection fraction. Tadalafil treatment was able to decrease in hypertrophy and improve the LV function restoring cardiac function. For micturition function (in vivo), HF animals shown an increase in basal pressure, threshold pressure, no-voiding contractions and decreased bladder capacity, being that the tadalafil treatment restored the cystometric parameters. Contractile mechanism response (in vitro) to carbachol, KCl, ATP and EFS in the detrusor muscles (DM) were increased in the HF group, when compared to Sham group. However, tadalafil treatment restored the DM hypercontractility in the HF animals. Moreover, renal function as well as the oxidative mechanism was impaired in the HF animals, and the tadalafil treatment improved all renal and oxidative parameters in HF group. Our data shown that tadalafil has potential as multi-therapeutic drug and may be used as a pharmacological strategy for the treatment of cardiovascular, renal and urinary dysfunctions associated with HF.

Efficacy of mace (Arils of Myristica fragrans Houtt) plus PFMT on symptoms in mixed urinary incontinence: a randomized placebo-controlled trial

Background

It is not only to evaluate the efficacy and safety of mace (Arils of Myristica fragrans Houtt) but also to compare pelvic floor muscle training vs. pelvic floor muscle training (PFMT) for improving symptoms and health-related quality of life (HRQoL) of woman with mixed urinary incontinence (MUI).

Methods

A prospective, single-blind randomized controlled study was conducted. Patients (n = 60) were randomly allocated (1:1) to receive either mace powder or placebo (1.5 g) orally twice daily along with pelvic floor muscle training in both groups for three consecutive months. The primary outcomes included symptom evaluation with Patient Global Impression Index of Improvement (PGI-I) and the Patient Global Impression Index of Severity (PGI-S) for MUI. For safety, clinical examination and biochemical parameters were assessed. Secondary outcomes included Short form of Urogenital Distress Inventory Questionnaire-6 (UDI-6) and quality of life assessment with questionnaire tools such as Short form of Incontinence Impact Questionnaire-7 (IIQ-7), Short form of the Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) and ICIQ-SF. The data were statistically interpreted with 5% level of significance.

Results

After treatment (at third month), the patient reported cure for PGI-I and PGI-S was 46.66% and 90% for the mace group, whereas 0% and 16.66% for the control group, respectively (P < 0.001), statistically significant. No side effects were reported in the mace group. The mean difference noted in terms of scores, at the third month from baseline for UDI-6 (51.09 vs. 24.78), IIQ-7 (45.48 vs. 23.49), PISQ (11.33 vs. 5.40), and ICIQ-SF (8.10 vs. 2.43) scores were higher in the mace than that in the control group (P < 0.001).

Conclusion

Mace is effective and safe for the subjective improvement of mixed urinary incontinence symptoms and for the improvement of women's HRQoL than the placebo.

Clinical Trial Registry No.: CTRI/2017/04/008342

Efficacy and safety of repeated dosing of netupitant, a neurokinin-1 receptor antagonist, in treating overactive bladder

AIM

NK-1 receptors in sensory nerves, the spinal cord and bladder smooth muscle participate in complex sensory mechanisms that regulate bladder activity. This study was designed to assess the efficacy and safety of a new NK-1 receptor antagonist, netupitant, in patients with OAB.

METHODS

This was a phase II, multicenter, double-blind study in which adults with OAB symptoms >6 months were randomized to receive 1 of 3 doses of netupitant (50, 100, 200 mg) or placebo once daily for 8 weeks. The primary efficacy endpoint was percentage change from baseline in average number of daily micturitions at week 8. Urinary incontinence, urge urinary incontinence (UUI), and urgency episodes were also assessed.

RESULTS

The primary efficacy endpoint was similar in the treatment groups (-13.85 for placebo to -16.17 in the netupitant 200 mg group) with no statistically significant differences between netupitant and placebo. The same was true for most secondary endpoints although a significant difference for improvement in UUI episodes and a trend for the greatest decrease in urgency episodes were seen in the netupitant 100 mg group. Netupitant was well tolerated with most treatment emergent adverse events (AEs) being mild. While the overall incidence of AEs increased with netupitant dose, there was no evidence for this dose dependency based on relationship to treatment, intensity, or time to onset.

CONCLUSIONS

The study failed to demonstrate superiority of netupitant versus placebo in decreasing OAB symptoms, despite a trend favoring netupitant 100 mg. There were no safety concerns with daily administration of netupitant over 8 weeks.

[The translation and adaptation of the Gaudenz-Fragebogen to the Brazilian culture]

The article describes the translation and adaptation of the Gaudenz-Fragebogen, an instrument of German origin used to diagnose female urinary incontinence, to the Brazilian culture. The steps recommended by international literature were followed: translation, synthesis of translations, back translation, valuation of the synthetic version by a board of specialists and pre-test. The process of translation and adaptation was adequately accomplished, and the instrument was demonstrated to be easily understood.This instrument was used in other studies prior to the validation process, and using the instrument in other studies is crucial so that its measurement properties can be assessed.

Antipsychotics and physical attractiveness

BACKGROUND

Antipsychotics are effective in treating the symptoms of schizophrenia, but they may induce adverse effects, some of which-those that impact negatively on physical appearance-have not been sufficiently discussed in the psychiatric literature.

AIM

Through a narrative review, to catalog antipsychotic side effects that interfere with physical attractiveness and to suggest ways of addressing them.

METHOD

PubMed databases were searched for information on the association between "antipsychotic side effects" and "attractiveness" using those two search phrases plus the following terms: "weight," "teeth," "skin," "hair," "eyes," "gait," "voice," "odor." Data from relevant qualitative and quantitative articles were considered, contextualized, and summarized.

RESULTS

Antipsychotics, as a group, increase weight and may lead to dry mouth and bad breath, cataracts, hirsutism, acne, and voice changes; they may disturb symmetry of gait and heighten the risk for tics and spasms and incontinence, potentially undermining a person's attractiveness.

CONCLUSIONS

Clinicians need to be aware of the impact of therapeutic drugs on appearance and how important this issue is to patients. Early in treatment, they need to plan preventive and therapeutic strategies.

Better short-term outcomes with the U-method compared with the Hammock technique for the implantation of the TVT-SECUR under local anesthesia

OBJECTIVES

To observe the satisfaction of local anesthesia during the implantation of the tension-free vaginal tape (TVT)-SECUR (Gynecare, Ethicon, Somerville, NJ) for the treatment of stress urinary incontinence, using questionnaires completed by the patients, and to evaluate the short-term safety and efficacy of the sling.

METHODS

Forty-eight women were operated between January 2007 and October 2008. The implantation of the TVT-SECUR was done under local anesthesia by 1 surgeon. The "Hammock" technique was used in the first 23 patients and the "U-Method" in the last 25 patients.

RESULTS

Mean patient age was 61 years (range, 38-85). Visual analogue scale for pain immediately and 1 week after surgery showed a mean score of 19/100 and 29/100, respectively. Overall, 93% (43/46) of the patients would recommend this type of anesthesia. At 1 week, 2 months, and 6 months after surgery, the improvement in incontinence symptoms rate was 82% (18/22), 76% (16/21), and 69% (11/16) for the Hammock technique, compared with 75% (18/24), 92% (22/24), and 100% (22/22) for the U-Method. At 6 months, the difference was statistically significant (P = .0087). Postoperative complications included 6 partial tape exposures, all with the Hammock technique.

CONCLUSIONS

Local anesthesia with light sedation represents an appropriate choice for the implantation of this new sling. The TVT-SECUR using the U-Method appears to be relatively safe, and the short-term efficacy rates seem to compare with traditional midurethral slings, with long-term efficacy still to be determined. This is the first report showing better outcomes of one technique over the other.

Urinary incontinence management in geriatric patients

OBJECTIVE

To review prevalence, causes, types, and appropriate therapy to treat urinary incontinence (UI) in geriatric patients.

DATA SOURCES

Selection and extraction from a PubMed/MEDLINE, English-language literature search from 2000 to the present using the search terms urinary incontinence and geriatrics.

DATA SYNTHESIS

UI is a prevalent condition in geriatric patients. Unmanaged UI decreases quality of life and increases the risk of perineal skin breakdown, which can lead to painful skin irritation and pressure sores. Identifying the type of UI, and treating or eliminating transient causes as a result of acute conditions or medications, are initial steps in appropriate management. Health professionals can identify medication-related causes by reviewing the patient history, diagnoses, symptoms, and medication regimen. Chronic UI is often caused by physiological changes in the bladder; increasing age also can result in changes in bladder and urethral compliance. Other UI risk factors include impaired function, cognition, mobility, and dexterity as well as neurodegenerative damage that affect the patient's ability to toilet or recognize the need to toilet. Chronic or persistent UI is classified as stress, urge, overflow, functional, or mixed. Treatment options for chronic UI are discussed in detail.

CONCLUSION

Pharmacists can have a positive impact on this condition by recommending appropriate medication changes and pharmacologic and nonpharmacologic treatments.

The potential of hormones and selective oestrogen receptor modulators in preventing voiding dysfunction in rats

OBJECTIVE

To investigate whether oestrogen, selective oestrogen receptor modulators (SERMs), and growth hormone (GH) can prevent the development of voiding dysfunction in a postpartum postmenopausal rat model of voiding dysfunction.

MATERIALS AND METHODS

Immediately after spontaneous delivery, nine primiparous Sprague-Dawley rats served as uninjured controls (sham group) and 54 underwent intravaginal balloon dilation. On day 7, the 54 subject rats underwent bilateral ovariectomy. A week later, six treatment groups of nine rats were randomized to receive: normal saline (injured control group), 17beta-oestradiol (E(2)), raloxifene, levormeloxifene, GH, or GH + E(2). The treatment groups received daily subcutaneous injections for 3 weeks. The effects of hormone treatment were examined by conscious cystometry at the end of the study. Voiding dysfunction was defined to include overactive bladder and sphincter deficiency.

RESULTS

The sham rats had a mean (sd) voiding frequency of 3 (0.87) times in 10 min and a bladder capacity of 0.43 (0.13) mL with smooth cystometry curves. The number of rats in each treatment group (each group contained nine rats) that had voiding dysfunction was as follows: E(2), three; raloxifene, six; levormeloxifene, four; and controls, four (P > 0.05 among the groups). Only one rat in the GH-treated group and no rats in the GH + E(2)-treated group had voiding dysfunction, which was significantly less in the GH + E(2)-treated group than in the controls (P = 0.041).

CONCLUSION

This functional data suggest that the development of voiding dysfunction can be prevented by short-term administration of GH and GH + E(2) in our rat model. SERMs and E(2) alone seem to have no therapeutic effect.