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de Carvalho MDSR, Pellino G, Pereira AMG, Bray-Beraldo F, Lopes RGC, Di Saverio S. Prevalence of urinary dysfunction after minimally invasive surgery for deep rectosigmoid endometriosis. Langenbecks Arch Surg 2023; 408:83. [PMID: 36773124 DOI: 10.1007/s00423-023-02831-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE This study aimed to assess the prevalence and progression of lower urinary tract symptoms following laparoscopic surgery for deep-infiltrating endometriosis of the rectosigmoid and identify preoperative factors associated with worse postoperative outcomes. METHODS Prospective, observational study. SETTINGS single-center, referral hospital for endometriosis. Patients undergoing laparoscopic surgery for deep-infiltrating endometriosis of the rectosigmoid colon between October 2016 and October 2018. MAIN OUTCOME MEASURES urinary function was assessed with the validated Portuguese language version of the International Prostate Symptom Score, which is also used in women. The score was collected before and after surgery. The Wilcoxon signed-rank test was used to compare pre and postoperative scores and the chi-square test compared symptoms categorized by severity. RESULTS Fifty-three patients were assessed and 44 were included. Concerning urinary symptoms after surgery, the irritative symptoms prevailed over the obstructive ones. Additionally, 58.8% and 54.5% of the women reported moderate or severe symptoms at pre and postoperative, respectively. In at least one questionnaire category, the postoperative questionnaire scores increased in ten (22.7%) participants. A statistically significant difference was found comparing the changes from absent/mild to moderate/severe IPSS categories (P = 0.039). No significant changes were identified in any of the International Prostate Symptom Score pre and postoperatively (P = 0.876). CONCLUSIONS There was a high prevalence of pre and postoperative urinary symptoms. Patients with preoperative moderate/severe International Prostate Symptom Score are at risk of persisting urinary dysfunction after surgery for rectosigmoid deep endometriosis.
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Affiliation(s)
- Mariana de Sousa Ribeiro de Carvalho
- Department of Gynecology, Hospital do Servidor Público Estadual de São Paulo, Pedro de Toledo Street, 1800, São Paulo, Vila Clementino, CEP 04039-004, Brazil.
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università Studi della Campania "Luigi Vanvitelli", Naples, Italy
- Colorectal Surgery, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona UAB, Barcelona, Spain
| | - Ana Maria Gomes Pereira
- Department of Gynecology, Hospital do Servidor Público Estadual de São Paulo, Pedro de Toledo Street, 1800, São Paulo, Vila Clementino, CEP 04039-004, Brazil
| | - Fernando Bray-Beraldo
- Department of Digestive Surgery and Coloproctology, Hospital do Servidor Público Estadual de São Paulo, São Paulo, Brazil
| | - Reginaldo Guedes Coelho Lopes
- Department of Gynecology, Hospital do Servidor Público Estadual de São Paulo, Pedro de Toledo Street, 1800, São Paulo, Vila Clementino, CEP 04039-004, Brazil
| | - Salomone Di Saverio
- Cambridge Endometriosis & Endoscopic Surgery Unit (CEESU) and Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
- Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Italy
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2
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Serati M, Giammò A, Carone R, Ammirati E, Gubbiotti M, Ruffolo A, Salvatore S, Scancarello C, Castronovo F, Caccia G, Braga A. Bulking agents for the treatment of recurrent stress urinary incontinence: a suitable option? Minerva Urol Nephrol 2022; 74:747-754. [PMID: 33949184 DOI: 10.23736/s2724-6051.21.04269-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND The management of recurrent female stress urinary incontinence (SUI) still needs worldwide standardization. Few data on the role of urethral bulking agents (UBA) for the treatment of recurrent stress urinary incontinence exist. The aim of this study is to assess the efficacy and safety of urethral bulking agents for the treatment of recurrent SUI. METHODS A multicenter, prospective study was conducted in four tertiary referral centers in two countries. All consecutive women with urodynamically-proven recurrent SUI, and with a history of previous failed anti-incontinence surgical procedure (mid-urethral sling or single incision sling), treated by UBAs were included. We evaluated only patients who completed at least a 3-year follow-up. Data regarding subjective outcomes (International Consultation on Incontinence Questionnaire-Short Form, Patient Global Impression of Improvement, Urogenital Distress Inventory score and patient satisfaction score), objective cure (stress test) rates, and adverse events were collected during follow-up. Univariable and multivariable analyses was performed to investigate outcomes. RESULTS Forty-seven consecutive patients were enrolled. At 3-year follow-up, all women were available for the evaluation. At 3 years after surgery, 38 of 47 patients (81%) declared themselves cured. Similarly, at 3-year evaluation, 39 of 47 patients (83%) were objectively cured. Only five patients (10.6%) required re-operation for UBA failure. The urodynamic diagnosis of preoperative detrusor overactivity and the PDet Max filling phase ≥15 cmH<inf>2</inf>O (hazard ratio: 2.74; 95% CI, 1.64-10.7; P=0.009 and 1.62; 95% CI, 1.11-3.42; P=0.04, respectively) were the only predictors of failure. Only four complications were reported (8.5%). CONCLUSIONS The 3-year results of this study showed that bulking agents is an appropriately effective and safe option for the treatment of recurrent SUI. The presence of preoperative concomitant detrusor overactivity is associated with a significant decrease of the efficacy of this procedure.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy.,European Urogynecological Association (EUGA), Piacenza, Italy
| | - Alessandro Giammò
- Department of Neuro-Urology, Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Roberto Carone
- Department of Neuro-Urology, Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Enrico Ammirati
- Department of Neuro-Urology, Unipolar Spinal Cord Unit, AOU Città della Salute e della Scienza, Turin, Italy
| | - Marilena Gubbiotti
- Department of Urology, San Donato Hospital, Arezzo, Italy.,InVita Research Center, Serafico Institute, Assisi, Perugia, Italy
| | - Alessandro Ruffolo
- Department of Obstetrics and Gynecology, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Salvatore
- Department of Obstetrics and Gynecology, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Fabiana Castronovo
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland - .,Faculty of Biomedical Sciences, University of Italian Switzerland, Lugano, Switzerland
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3
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Serati M, Braga A, Rosier PFWM, de Wachter S, Uren A, Finazzi-Agrò E. Acceptability and perceived value of urodynamics from the patient perspective: A narrative review. Neurourol Urodyn 2022; 41:1065-1073. [PMID: 35419867 PMCID: PMC9322284 DOI: 10.1002/nau.24932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/12/2022] [Accepted: 03/22/2022] [Indexed: 11/10/2022]
Abstract
Background The value and application of urodynamic evaluation (UDS) have been a controversial topic in recent years. Gaining robust data on the patient viewpoint in this area is important since, even when UDS findings do not change the management plan, the objective diagnostic information gained from UDS may be valued by patients. Moreover, insights from UDS may empower treating physicians to counsel patients more effectively and manage their expectations regarding treatment outcomes. Objective This expert narrative review aims to analyze the findings of published studies in this area, looking at two topics in turn: (a) the tolerability and acceptability of the UDS procedure itself from the patient perspective and (b) patient perceptions of the clinical value of insights provided by UDS. Design, Setting, Participants, and Outcome Measurements An evidence assessment was conducted using selected articles from the literature reporting data on patients' perspectives on the tolerability, acceptability, utility, and value of the urodynamic investigation. Results and Limitations Although pain, discomfort, and infection risks are frequently used as a rationale to skip UDS when initial management fails, there is good evidence that, from the patients' perspective, the procedure is very well tolerated in most cases. There are only a few articles available that assess patient perceptions of the usefulness of UDS, but those that do exist appear to demonstrate that the insights gained from UDS are widely welcomed by patients in the interest of receiving a more tailored and personalized treatment approach. Conclusion From the patient perspective, UDS appears to be a well‐accepted and well‐tolerated diagnostic tool in patients with lower urinary tract symptoms, particularly when an appropriate explanation is provided before the examination. Our review also highlights that patients value the objective information provided by UDS and that this outweighs the temporary invasiveness of the test. This information is particularly relevant in light of the relative lack of evidence in the literature about patient expectations of specialist care in functional urology, which may have hindered progress with quality of care.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Andrea Braga
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.,Department of Obstetrics and Gynaecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | - Peter F W M Rosier
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan de Wachter
- Department of Urology, Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - Alan Uren
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Enrico Finazzi-Agrò
- Urology Unit, Department of Surgical Sciences, Tor Vergata University Hospital, University of Rome Tor Vergata, Rome, Italy
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4
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DE Cillis S, Geretto P, Cancrini F, Phé V. Uncomplicated overactive bladder: do we need urodynamics testing for better etiologic evaluation? Minerva Urol Nephrol 2022; 73:868-869. [PMID: 35144375 DOI: 10.23736/s2724-6051.21.04823-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sabrina DE Cillis
- Division of Urology, Department of Oncology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy -
| | - Paolo Geretto
- Division of Neuro-Urology, Department of Surgical Sciences, Città della Salute e della Scienza, Turin, Italy
| | - Fabiana Cancrini
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy
| | - Véronique Phé
- Division of Urology, Tenon Hospital, Sorbonne University, Paris, France
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5
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Iacovelli V, Serati M, Bianchi D, Braga A, Turbanti A, Agrò EF. Preoperative abdominal straining in uncomplicated stress urinary incontinence: is there a correlation with voiding dysfunction and de novo overactive bladder after mid-urethral sling procedures? Ther Adv Urol 2021; 13:17562872211058243. [PMID: 34868350 PMCID: PMC8637698 DOI: 10.1177/17562872211058243] [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: 08/06/2021] [Accepted: 10/20/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives: To evaluate the role of preoperative abdominal straining in predicting
de novo overactive bladder (OAB) and voiding
dysfunction in female patients undergoing suburethral taping by
trans-obturator approach (TVT-O) for uncomplicated stress urinary
incontinence (SUI). Methods: Data from patients who underwent TVT-O surgery for SUI were retrospectively
analyzed. Inclusion criteria included: history of pure SUI. Exclusion
criteria included previous surgery for urinary incontinence, pelvic
radiation, pelvic surgery within the last 3 months, and anterior or apical
pelvic organ prolapse (POP) ⩾ +1 cm. Voiding dysfunction has been defined
through symptoms and or urodynamics (UDS) signs. Accordingly, patients were
divided into group A and group B according to the presence of abdominal
straining during UDS. Patients were observed clinically and with UDS at a
3-year follow-up. Results: A total of 192 patients underwent TVT-O surgery for uncomplicated SUI.
Preoperative abdominal straining was identified in 60/192 patients (Group A:
31.2% vs Group B: 68.8%). Qmax was not different in the two
groups (Group A: 19.5 vs Group B: 20.5 mL/s,
p = 0.76). Demographics was similar for the two groups
regarding age, parity. At 3-year follow-up, voiding dysfunction was reported
in Group A: 9 and Group B: 8 patients (p = 0.056),
de novo OAB was significantly reported in Group A: 23
and Group B: 26 patients (p = 0.007). Conclusion: Preoperative abdominal straining was found to be related to a significant
incidence of de novo OAB. A significant correlation was not
assessed for postoperative voiding dysfunction. Further studies may better
define the impact of preoperative abdominal straining.
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Affiliation(s)
- Valerio Iacovelli
- Department of Surgical Sciences, Urology Unit, San Carlo di Nancy Hospital, GVM Care and Research, University of Rome Tor Vergata, Via Aurelia 275, 00165 Rome, Italy
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Daniele Bianchi
- Department of Surgical Sciences, Urology Unit, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland
| | | | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Urology Unit, University of Rome Tor Vergata, Rome, Italy
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6
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Cancrini F, DE Cillis S, Phe V. Urodynamics in healthy volunteer: the limit of the use of the study. Minerva Urol Nephrol 2021; 73:694-695. [PMID: 34847657 DOI: 10.23736/s2724-6051.21.04741-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Fabiana Cancrini
- Department of Medical and Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza University, Rome, Italy.,Sorbonne University, Tenon Hospital, Paris, France.,Functional Urology Working Group of the EAU Young Academic Urologists, Rome, Italy
| | - Serena DE Cillis
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
| | - Veronique Phe
- Sorbonne University, Tenon Hospital, Paris, France.,Functional Urology Working Group of the EAU Young Academic Urologists, Rome, Italy
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7
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Swavely NR, Speich JE, Klausner AP. Artifacts and abnormal findings may limit the use of asymptomatic volunteers as controls for studies of multichannel urodynamics. Minerva Urol Nephrol 2021; 73:655-661. [PMID: 32638575 PMCID: PMC9112542 DOI: 10.23736/s2724-6051.20.03838-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Multichannel urodynamics is the gold standard for the evaluation of lower urinary tract symptoms (LUTS). When performing studies to validate new adjuncts to urodynamic testing with control patients undergoing urodynamic investigation, there is difficulty in the interpretation of urodynamic results in the asymptomatic patient due to artifacts and the invasive nature of the procedure. The purpose of this investigation was to examine urodynamics in asymptomatic volunteers in order to better understand the role of control participants in urodynamic research studies. METHODS Asymptomatic volunteers with no LUTS were recruited to undergo standard urodynamic testing as a comparison group in a study evaluating novel urodynamic techniques. To be eligible, participants had to report no LUTS, score ≤1 on all symptom questions of the International Consultation on Incontinence Questionnaire Overactive Bladder Module (ICIq-OAB) survey, have no medical conditions or to undergo any medications that affect bladder function. The urodynamics was done according to ICS standards. All tracings were evaluated by an expert neuro-urologist. Data were analyzed categorically for the presence or absence of low compliance (<30 mL/cmH20), detrusor overactivity, bladder outlet obstruction (Bladder Outlet Obstruction Index [BOOI]>40), weak contractility (bladder contractility index [BCI]<100), straining to void, poorly sustained detrusor contraction, uncoordinated EMG activity, and intermittent flow. RESULTS A total of 24 participants completed the study including 10 men and 14 women. All participants had at least 1 urodynamic abnormality/artifact with an average of 4.43±1.28 abnormalities/participant. The most common abnormalities included uncoordinated electromyography (EMG) activity (87.50%), straining to void (79.17%), and intermittent flow (70.83%). There were no significant differences for sex, age, Body Mass Index. CONCLUSIONS This study demonstrated that healthy, asymptomatic volunteers have high rates of abnormal urodynamic findings, suggesting that asymptomatic participants are not the ideal controls in research studies that involve urodynamic testing.
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Affiliation(s)
- Natalie R Swavely
- Virginia Commonwealth University School of Medicine, Division of Urology, Department of Surgery, Richmond, VA, USA
| | - John E Speich
- Virginia Commonwealth University School of Engineering, Department of Mechanical and Nuclear Engineering, Richmond, VA, USA
| | - Adam P Klausner
- Virginia Commonwealth University School of Medicine, Division of Urology, Department of Surgery, Richmond, VA, USA -
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8
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Gomes CM, de Bessa J, Nunes RV, Prezotti J, Bruschini H, Gomes MM. Impact of a 1-day urodynamic course on knowledge, perceptions, and attitudes of urology residents. Neurourol Urodyn 2020; 40:443-450. [PMID: 33205844 DOI: 10.1002/nau.24581] [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: 09/04/2020] [Revised: 10/21/2020] [Accepted: 11/04/2020] [Indexed: 11/08/2022]
Abstract
AIMS No evidence-informed educational curriculum is available for designing urodynamics (UDS) courses. We evaluated the learning outcomes of a short-lasting urodynamic course for urology residents. METHODS Urology residents of postgraduate years 4 and 5 (n = 13 and n = 1316, respectively) attended a 1-day urodynamic course. Learning objectives included patient preparation, indication and technique, terminology, trace interpretation, and impact on patient management. Instructional methods consisted of short lectures (3 h) and case-based discussions (7.5 h). Learners' reactions, modifications of perceptions and attitudes, and acquisition of knowledge and skills were assessed by three written tests with a single group, pretest, posttest 1, and posttest 2 design. Tests were conducted precourse, 1 week after, and 4 months after the course. RESULTS All participants felt more confident in several urodynamic competencies after the course, including patient preparation, urodynamic indication and technique, terminology, trace interpretation, and impact for patient management. These perceptions remained unchanged after 4 months. Most became stricter in the indication of UDS, including 20 (87.0%) at posttest 1 and 8 (66.7%) at posttest 2. The mean number of correct answers in the knowledge evaluation was 52.2% versus 61.4% versus 56.7%, respectively at pretest, posttest 1, and posttest 2; p = 0.535). All participants rated the course as very useful or useful in both posttest evaluations. CONCLUSIONS Our study demonstrates that a 1-day urodynamic course can promote lasting improvements in self-reported perceptions, attitudes, and urodynamic-related competencies of urology residents. Further studies using evidence-informed educational principles are needed to determine the effect of specific educational interventions on urodynamic competencies in different contexts.
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Affiliation(s)
- Cristiano M Gomes
- Division of Urology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Jose de Bessa
- Department of Surgery, State University of Feira de Santana, Feira de Santana, Bahia, Brazil
| | - Ricardo V Nunes
- Clinic of Urology, Military Hospital of Sao Paulo Area, Sao Paulo, Brazil
| | - Jose Prezotti
- Division of Urology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Homero Bruschini
- Division of Urology, School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Marcio M Gomes
- Department of Pathology and Laboratory Medicine, Royal College of Physicians and Surgeons of Canada, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
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9
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Serati M, Cantaluppi S, Coluccia AC, Scancarello C, Cimmino C, Braga A, Salvatore S, Finazzi Agrò E, Ghezzi F. Is urodynamic evaluation able to change and improve the management of women with idiopathic overactive bladder? Minerva Urol Nephrol 2020; 73:823-830. [PMID: 32573171 DOI: 10.23736/s2724-6051.20.03801-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND For women with overactive bladder (OAB), current guidelines recommend the use of urodynamic studies (UDS) only in complicated cases. This study aimed to investigate whether UDS can also be helpful in uncomplicated cases. Specific aims of the study were: 1) to evaluate objective benefit and subjective patient satisfaction with tailored treatment based on the UDS diagnosis compared to the outcomes of the pharmacological treatment only based on the symptoms; 2) to investigate the correlation between symptoms and UDS findings in women with uncomplicated idiopathic OAB symptoms; 3) to assess the ability of UDS to modify management decisions in these patients. METHODS Women presenting to our clinic with a history of uncomplicated OAB symptoms for the past three months or more, and who completed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), were considered for this study. We proposed UDS to all participants. In women who accepted UDS (group 1), management decisions were made on the basis of urodynamic findings and post-treatment evaluation was scheduled at three months. The outcomes of treatments in these patients were compared to the results in women who did not accept UDS and who received pharmacological treatment symptoms-based (group 2). Objective outcomes were based on completion of a 3-day micturition diary. Subjective outcomes were captured using the Overactive Bladder Questionnaire Short Form (OABq-SF), the Patient Global Impression of Improvement (PGI-I) scale, and a patient satisfaction scale. RESULTS A total of 680 women were enrolled in the study; 478 underwent UDS and 202, at the contrary, declined UDS. In 53.6% of cases, UDS led to modification of the proposed management approach. At the 3-month follow-up, the overall patient satisfaction rate in group 1 and group 2 was 77% and 65.8%, respectively (P=0.003). CONCLUSIONS We showed that OAB management tailored according to the UDS diagnosis results in higher subjective satisfaction if compared with a pharmacological treatment symptoms-based. Our study confirmed a lack of correlation between OAB symptoms and the urodynamically proven diagnosis of detrusor overactivity (DO). It also suggested that UDS can determine the underlying pathophysiology of every woman with OAB syndrome, whether complicated or uncomplicated, allowing treatment to be appropriately tailored with better results.
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Affiliation(s)
- Maurizio Serati
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Simona Cantaluppi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Anna C Coluccia
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Chiara Scancarello
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Chiara Cimmino
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland -
| | - Stefano Salvatore
- Unit of Obstetrics and Gynecology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy.,Unit of Urology, Tor Vergata University Hospital, Rome, Italy
| | - Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
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10
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Amparore D, Campi R, Checcucci E, Sessa F, Pecoraro A, Minervini A, Fiori C, Ficarra V, Novara G, Serni S, Porpiglia F. Forecasting the Future of Urology Practice: A Comprehensive Review of the Recommendations by International and European Associations on Priority Procedures During the COVID-19 Pandemic. Eur Urol Focus 2020; 6:1032-1048. [PMID: 32553544 PMCID: PMC7261455 DOI: 10.1016/j.euf.2020.05.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/24/2020] [Indexed: 01/17/2023]
Abstract
Context The unprecedented health care scenario caused by the coronavirus disease 2019 (COVID-19) pandemic has revolutionized urology practice worldwide. Objective To review the recommendations by the international and European national urological associations/societies (UASs) on prioritization strategies for both oncological and nononcological procedures released during the current emergency scenario. Evidence acquisition Each UAS official website was searched between April 8 and 18, 2020, to retrieve any document, publication, or position paper on prioritization strategies regarding both diagnostic and therapeutic urological procedures, and any recommendations on the use of telemedicine and minimally invasive surgery. We collected detailed information on all urological procedures, stratified by disease, priority (higher vs lower), and patient setting (outpatient vs inpatient). Then, we critically discussed the implications of such recommendations for urology practice in both the forthcoming “adaptive” and the future “chronic” phase of the COVID-19 pandemic. Evidence synthesis Overall, we analyzed the recommendations from 13 UASs, of which four were international (American Urological Association, Confederation Americana de Urologia, European Association of Urology, and Urological Society of Australia and New Zealand) and nine national (from Belgium, France, Germany, Italy, Poland, Portugal, The Netherlands, and the UK). In the outpatient setting, the procedures that are likely to impact the future burden of urologists’ workload most are prostate biopsies and elective procedures for benign conditions. In the inpatient setting, the most relevant contributors to this burden are represented by elective surgeries for lower-risk prostate and renal cancers, nonobstructing stone disease, and benign prostatic hyperplasia. Finally, some UASs recommended special precautions to perform minimally invasive surgery, while others outlined the potential role of telemedicine to optimize resources in the current and future scenarios. Conclusions The expected changes will put significant strain on urological units worldwide regarding the overall workload of urologists, internal logistics, inflow of surgical patients, and waiting lists. In light of these predictions, urologists should strive to leverage this emergency period to reshape their role in the future. Patient summary Overall, there was a large consensus among different urological associations/societies regarding the prioritization of most urological procedures, including those in the outpatient setting, urological emergencies, and many inpatient surgeries for both oncological and nononcological conditions. On the contrary, some differences were found regarding specific cancer surgeries (ie, radical cystectomy for higher-risk bladder cancer and nephrectomy for larger organ-confined renal masses), potentially due to different prioritization criteria and/or health care contexts. In the future, the outpatient procedures that are likely to impact the burden of urologists’ workload most are prostate biopsies and elective procedures for benign conditions. In the inpatient setting, the most relevant contributors to this burden are represented by elective surgeries for lower-risk prostate and renal cancers, nonobstructing stone disease, and benign prostatic hyperplasia.
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Affiliation(s)
- Daniele Amparore
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Enrico Checcucci
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Sessa
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Angela Pecoraro
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Andrea Minervini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Cristian Fiori
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy
| | - Vincenzo Ficarra
- Department of Human and Pediatric Pathology "Gaetano Barresi", Urology Section, University of Messina, Messina, Italy
| | - Giacomo Novara
- Urologic Unit, Department of Oncologic, Surgical and Gastrointestinal Sciences, University of Padua, Padua, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, School of Medicine, San Luigi Hospital, University of Turin, Orbassano, Turin, Italy.
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11
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Braga A, Caccia G, Soligo M. Re: Urodynamics Useless in Female Stress Urinary Incontinence? Time for Some Sense-A European Expert Consensus. Eur Urol 2019; 76:873. [PMID: 31350068 DOI: 10.1016/j.eururo.2019.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/10/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland.
| | - Giorgio Caccia
- Department of Obstetrics and Gynecology, EOC-Beata Vergine Hospital, Mendrisio, Switzerland
| | - Marco Soligo
- Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
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