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Birder LA, Wolf-Johnston AS, Zabbarova I, Ikeda Y, Robertson AM, Cardozo R, Azari F, Kanai AJ, Kuchel GA, Jackson EK. Hypoxanthine Induces Signs of Bladder Aging With Voiding Dysfunction and Lower Urinary Tract Remodeling. J Gerontol A Biol Sci Med Sci 2024; 79:glad171. [PMID: 37463319 PMCID: PMC11083631 DOI: 10.1093/gerona/glad171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Lower urinary tract syndrome (LUTS) is a group of urinary tract symptoms and signs that can include urinary incontinence. Advancing age is a major risk factor for LUTS; however, the underlying biochemical mechanisms of age-related LUTS remain unknown. Hypoxanthine (HX) is a purine metabolite associated with generation of tissue-damaging reactive oxygen species (ROS). This study tested the hypothesis that exposure of the adult bladder to HX-ROS over time damages key LUT elements, mimicking qualitatively some of the changes observed with aging. METHODS Adult 3-month-old female Fischer 344 rats were treated with vehicle or HX (10 mg/kg/day; 3 weeks) administered in drinking water. Targeted purine metabolomics and molecular approaches were used to assess purine metabolites and biomarkers for oxidative stress and cellular damage. Biomechanical approaches assessed LUT structure and measurements of LUT function (using custom-metabolic cages and cystometry) were also employed. RESULTS HX exposure increased biomarkers indicative of oxidative stress, pathophysiological ROS production, and depletion of cellular energy with declines in NAD+ levels. Moreover, HX treatment caused bladder remodeling and decreased the intercontraction interval and leak point pressure (surrogate measure to assess stress urinary incontinence). CONCLUSIONS These studies provide evidence that in adult rats chronic exposure to HX causes changes in voiding behavior and in bladder structure resembling alterations observed with aging. These results suggest that increased levels of uro-damaging HX were associated with ROS/oxidative stress-associated cellular damage, which may be central to age-associated development of LUTS, opening up potential opportunities for geroscience-guided interventions.
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Affiliation(s)
- Lori A Birder
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Amanda S Wolf-Johnston
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Irina Zabbarova
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Youko Ikeda
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ricardo Cardozo
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fatemeh Azari
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anthony J Kanai
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - George A Kuchel
- UConn Center on Aging, University of Connecticut, Farmington, Connecticut, USA
| | - Edwin K Jackson
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Hamidi Alamdari D, Douzandeh A, Keshvari Shirvan M, Narouie B, Radpour N. Mixed treatment for same-severe mixed urinary incontinence: A novel method. Clin Case Rep 2024; 12:e8579. [PMID: 38464568 PMCID: PMC10920305 DOI: 10.1002/ccr3.8579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/12/2024] Open
Abstract
Key Clinical Message Innovative mixed treatment offers hope for persistent mixed urinary incontinence (MUI): PRP-Fibrin Glue-Stem Cell injection, Botox, and TVT in a single session. Successful case study reveals promising outcomes, emphasizing the need for further research. Abstract Mixed urinary incontinence is a complaint of stress and urge incontinence which affects patients' quality of life and dramatic changes in patients' physical, mental, and socioeconomic status. The treatment is challenging and depends on the dominance of one of the complaints to the other. The progress in the method of treatment is still under discussion. This study reports treatment of a MUI case in a 56-year-old, with a history of MUI of 7-year duration, which was persistent to pharmacological treatment, pelvic muscle training, biofeedback, and anti-incontinence surgery (Burch Colposuspension). PRP-Fibrin Glue-Stem Cell injection, Botox injection, and TVT were performed in a one surgery session. Patient was discharged with ability to urinate with acceptable amount of post void residue. After 3-month follow-up, patient was completely satisfied and happy. Further research is needed to substantiate the efficacy of these mixed treatments for MUI.
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Affiliation(s)
- Daryoush Hamidi Alamdari
- Vascular and Endovascular Surgery Research CenterMashhad University of Medical SciencesMashhadIran
| | - Armina Douzandeh
- Department of Health and BiomedicineVictoria UniversityMelbourneVictoriaAustralia
| | - Maliheh Keshvari Shirvan
- Department of UrologyImam Reza Academic Hospital, Mashhad University of Medical SciencesMashhadIran
| | - Behzad Narouie
- Department of UrologyZahedan University of Medical SciencesZahedanIran
| | - Negar Radpour
- Urology and Nephrology Research CenterShahid Beheshti University of Medical SciencesTehranIran
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Hașegan A, Mihai I, Teodoru CA, Matacuta IB, Dura H, Todor SB, Ichim C, Tanasescu D, Grigore N, Bolca CN, Mohor CI, Mohor CI, Bacalbașa N, Bratu DG, Boicean A. Exploring the Challenges of Using Minimal Invasive Surgery to Treat Stress Urinary Incontinence: Insights from a Retrospective Case-Control Study. Diagnostics (Basel) 2024; 14:323. [PMID: 38337839 PMCID: PMC10855614 DOI: 10.3390/diagnostics14030323] [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: 12/19/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
Stress urinary incontinence (SUI) is a significant global health issue that particularly affects females, leads to notable societal and economic challenges and significantly affects the quality of life. This study focuses on the comparative analysis of two established surgical interventions, tension-free vaginal tape (TVT) and transobturator tape (TOT), at a single center and applied to 455 women suffering from SUI, with a mean follow-up period of 102 ± 30 months for TVT and 80.4 ± 13 months for TOT. Our findings indicate that, in comparison to TVT, the TOT procedure demonstrates fewer early and late post-operative complications in patient outcomes (1.41% vs. 17.64% and; 5.66% vs. 12.74%, both respectively). However, the TVT procedure shows a modestly favorable outcome in the risk of recurrence of SUI, compared to TOT (0% vs. 3.7%); the TOT procedure has also proven to be more effective in alleviating of urgency symptoms, although not at a statistically significant level (p = 0.072). Univariable and multivariable analysis of factors that predict late complications showed that only obesity can predict a worse outcome [OR]: 1.125 CI 95%: 1.105-1.533, p = 0.037), when adjustments are made for symptoms presented before surgery and procedure type. While both methods are safe and effective, the choice between them should be based on the specific characteristics of each case.
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Affiliation(s)
- Adrian Hașegan
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Ionela Mihai
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Cosmin Adrian Teodoru
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Ioana Bogdan Matacuta
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Horațiu Dura
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Samuel Bogdan Todor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Cristian Ichim
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Denisa Tanasescu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Nicolae Grigore
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | | | - Cosmin Ioan Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Călin Ilie Mohor
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Nicolae Bacalbașa
- Surgery Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, 020021 Bucharest, Romania;
| | - Dan Georgian Bratu
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
| | - Adrian Boicean
- Faculty of Medicine, Lucian Blaga University of Sibiu, 550169 Sibiu, Romania; (A.H.); (I.M.); (C.A.T.); (I.B.M.); (H.D.); (S.B.T.); (C.I.); (D.T.); (N.G.); (C.I.M.); (C.I.M.); (A.B.)
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MacNevin W, Bitcon C, Cox A. Social Disparities in the Diagnosis and Care of Lower Urinary Tract Dysfunction. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00673-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Birder LA, Wolf-Johnston A, Wein AJ, Grove-Sullivan M, Stoltz D, Watkins S, Newman D, Dmochowski RR, Jackson EK. A uro-protective agent with restorative actions on urethral and striated muscle morphology. World J Urol 2021; 39:2685-2690. [PMID: 33078215 PMCID: PMC8053723 DOI: 10.1007/s00345-020-03492-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/07/2020] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Aging increases oxidative stress, which can have delirious effects on smooth and striated muscle resulting in bladder dysfunction. Consequently, in women aged over 60 years, urinary incontinence (UI) is a prevalent health problem. Despite the prevalence and consequences, UI continues to be undertreated simply because there are few therapeutic options. METHODS Here we investigated whether 8-aminoguanine (8-AG), a purine nucleoside phosphorylase (PNPase inhibitor), would restore urethra and external sphincter (EUS) muscle morphology in the aged rat. Aged (> 25 months) female Fischer 344 rats were randomized to oral treatment with 8-AG (6 weeks) or placebo, and the urethra and EUS were evaluated by electron microscopy and protein expression (western immunoblotting). RESULTS Aging was associated with mitochondrial degeneration in smooth and striated muscle cells as compared to young rats. We also observed a significant increase in biomarkers such as PARP, a downstream activator of oxidative/nitrosative stress. Treatment of aged rats with 8-AG normalized all abnormalities to that of a younger state. CONCLUSIONS 8-AG, a potent inhibitor of PNPase, reverses age-related lower urinary tract morphological and biochemical changes. Our observations support the concept that 8-AG will reverse age-induced lower urinary tract disorders such as UI. These initial findings could have therapeutic implications for the prevention and treatment of age-related UI.
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Affiliation(s)
- Lori A Birder
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, A 1217 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA.
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA.
| | - Amanda Wolf-Johnston
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, A 1217 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
| | - Alan J Wein
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Mara Grove-Sullivan
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA
| | - Donna Stoltz
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA
| | - Simon Watkins
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA
| | - Diane Newman
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Roger R Dmochowski
- Department of Urology, Vanderbilt Medical Center, Nashville, TN, 37240, USA
| | - Edwin K Jackson
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15261, USA
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Three-Dimensional Urethral Profilometry-A Global Urethral Pressure Assessment Method. Diagnostics (Basel) 2021; 11:diagnostics11040687. [PMID: 33921357 PMCID: PMC8070236 DOI: 10.3390/diagnostics11040687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background: To present a new method of urethral pressure examination, and to evaluate diagnostic capabilities of three-dimensional profilometry, as an alternative to classical urethral profile (UPP). Using five channel catheters and dedicated software, a global urethral pressure image is obtained. The method eliminates the main limitation of classical urethral profilometry, where the catheter orientation determines the pressure picture limited to only one point in the urethral circumference; we observed up to 50% differences in pressure measures depending on the point of urethral circumference where the measurement was taken. Methods: This is a preliminary study containing a method presentation and analysis of the use in varied clinical cases of either healthy patients or patients with lower urinary tract symptoms (LUTS). The article includes a technique and equipment description and a full evaluation of selected cases, including three-dimensional urethral pressure distribution graphics. Results and Conclusions: Three-dimensional profilometry compared to the classical technique is comparable regarding the time, cost, technical difficulty and patient discomfort. At the same time, we obtained much more data on the urethral pressure and its distribution. The results are easy to interpret due to the 3D movable graphics created automatically by the dedicated software.
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Birder LA, Wolf-Johnston A, Wein AJ, Cheng F, Grove-Sullivan M, Kanai AJ, Watson AM, Stoltz D, Watkins SC, Robertson AM, Newman D, Dmochowski RR, Jackson EK. Purine nucleoside phosphorylase inhibition ameliorates age-associated lower urinary tract dysfunctions. JCI Insight 2020; 5:140109. [PMID: 32910805 PMCID: PMC7605521 DOI: 10.1172/jci.insight.140109] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/04/2020] [Indexed: 12/29/2022] Open
Abstract
In the aging population, lower urinary tract (LUT) dysfunction is common and often leads to storage and voiding difficulties classified into overlapping symptom syndromes. Despite prevalence and consequences of these syndromes, LUT disorders continue to be undertreated simply because there are few therapeutic options. LUT function and structure were assessed in aged (>25 months) male and female Fischer 344 rats randomized to oral treatment with a purine nucleoside phosphorylase (PNPase inhibitor) 8-aminoguanine (8-AG) or vehicle for 6 weeks. The bladders of aged rats exhibited multiple abnormalities: tactile insensitivity, vascular remodeling, reduced collagen-fiber tortuosity, increased bladder stiffness, abnormal smooth muscle morphology, swelling of mitochondria, and increases in urodamaging purine metabolites. Treatment of aged rats with 8-AG restored all evaluated histological, ultrastructural, and physiological abnormalities toward that of a younger state. 8-AG is an effective treatment that ameliorates key age-related structural and physiologic bladder abnormalities. Because PNPase inhibition blocks metabolism of inosine to hypoxanthine and guanosine to guanine, likely uroprotective effects of 8-AG are mediated by increased bladder levels of uroprotective inosine and guanosine and reductions in urodamaging hypoxanthine and xanthine. These findings demonstrate that 8-AG has translational potential for treating age-associated LUT dysfunctions and resultant syndromes in humans.
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Affiliation(s)
- Lori A Birder
- Department of Medicine, Renal-Electrolyte Division, and.,Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Alan J Wein
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fangzhou Cheng
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mara Grove-Sullivan
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anthony J Kanai
- Department of Medicine, Renal-Electrolyte Division, and.,Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alan M Watson
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Donna Stoltz
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Simon C Watkins
- Department of Cell Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Diane Newman
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roger R Dmochowski
- Department of Urology, Vanderbilt Medical Center, Nashville, Tennessee, USA
| | - Edwin K Jackson
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Wang W, Liu Y, Su T, Sun Y, Liu Z. Comparing the effect of electroacupuncture treatment on obese and non-obese women with stress urinary incontinence or stress-predominant mixed urinary incontinence: A secondary analysis of two randomised controlled trials. Int J Clin Pract 2019; 73:e13435. [PMID: 31621982 DOI: 10.1111/ijcp.13435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 09/19/2019] [Accepted: 10/13/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To explore whether obesity patients with a body mass index (BMI) of ≥25 kg/m2 who suffer from stress urinary incontinence (SUI) or stress-predominant mixed urinary incontinence (S-MUI) show less improvement in urinary incontinence (UI) symptoms after electroacupuncture (EA) treatment compared with non-obese counterparts. METHODS This study was a secondary analysis of existing data. About 252 SUI patients and 250 S-MUI patients treated with the same EA regimen were assigned to one of the two groups: the obesity group for BMI ≥25 kg/m2 and the non-obesity group for BMI <25 kg/ m2 . The primary outcome was the proportion of treatment responders, defined as patients exhibiting a ≥50% reduction in 72-hours incontinence episode frequency, as measured by a 72-hours bladder diary at week 6 compared with baseline. RESULTS Of the 1004 randomised women, 129 obese women (86 SUI and 43 S-MUI) and 255 non-obese women (166 SUI and 89 S-MUI) treated with EA were included in a secondary analysis. The primary outcome was that 58.3% (74/127) of patients in the obesity group and 60.7% (150/247) of patients in the non-obesity group (difference 0.55%; 95% confidence interval, -10.01 to 11.11; P = .919) responded to treatment. CONCLUSION This study suggests that EA treatment may safely improve UI symptoms in both obese and non-obese patients, regardless of BMI category. Additionally, obesity status may not affect the efficacy of EA treatment on SUI or S-MUI among Chinese women.
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Affiliation(s)
- Weiming Wang
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yan Liu
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tongsheng Su
- Shaanxi Province Hospital of Traditional Chinese Medicine, Xi'an, China
| | - Yuanjie Sun
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhishun Liu
- Guang'an Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Najeeya AGF, Sultana A. Efficacy of mace (Arils of Myristica fragrans Houtt) plus PFMT on symptoms in mixed urinary incontinence: a randomized placebo-controlled trial. Integr Med Res 2018; 7:307-315. [PMID: 30519527 PMCID: PMC6260249 DOI: 10.1016/j.imr.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 05/01/2018] [Accepted: 10/12/2018] [Indexed: 11/26/2022] Open
Abstract
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
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Affiliation(s)
| | - Arshiya Sultana
- Department of Amraze Niswan wa Ilmul Qabalat (Gynecology and Obstetrics), National Institute of Unani Medicine, Bengaluru, India
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Influence of the Short-term Intake of High Doses of Solifenacin and Trospium on Cognitive Function and Health-Related Quality of Life in Older Women With Urinary Incontinence. Int Neurourol J 2018; 22:41-50. [PMID: 29609422 PMCID: PMC5885132 DOI: 10.5213/inj.1834996.498] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/27/2018] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of this study was to investigate the safety and the effects of elevated doses of solifenacin and trospium on cognitive function and health-related quality of life (HRQoL) in elderly women receiving treatment for urinary incontinence. Methods The study included 312 women aged 60–83 years (mean age, 69.4 years). All participants had scored at least 24 points on the Mini-Mental State Examination (MMSE) scale, and all of them had been diagnosed with urge urinary incontinence (UUI) or mixed urinary incontinence (MUI). The women were randomly assigned to 3 groups: group A, individuals who were simultaneously administered solifenacin at a high dosage of 20 mg per day and trospium at a high dosage of 60 mg per day; group B, persons taking solifenacin and trospium at the usual dosage of 10 and 30 mg per day, respectively; and group C, persons who received a placebo. Participants’ cognitive status was assessed by the MMSE, Controlled Oral Word Association Test, Wechsler Adult Intelligence Scale-Revised, Wechsler Memory Scale III, Colour Trails Test, and California Verbal Learning Test scales. The HRQoL assessment was performed using the Medical Outcomes Study 36-Item Health Survey. Results The cognitive function parameters did not differ at the start and end of the study across the groups (P>0.05). Additionally, the cognitive function parameters did not differ significantly within each group between the start and end of the study (P>0.05). The values of most HRQoL parameters regarding the functional state of the lower urinary tract (LUT) after the termination of treatment significantly improved in groups A and B (P<0.05). A significant correlation between cognitive status and HRQoL or LUT parameters was absent (r<0.3), while the correlations between HRQoL and LUT parameters were r=0.31–0.83, P<0.05. Conclusions The use of elevated doses of solifenacin and trospium did not increase the risk of cognitive impairment in women with UUI and MUI. The combination of solifenacin and trospium at a double dosage may be recommended to elderly women with treatment-resistant symptoms of UUI and MUI. However, the safety of combining antimuscarinic drugs in women with an increased volume of residual urine requires further study.
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Mota RL. Female urinary incontinence and sexuality. Int Braz J Urol 2017; 43:20-28. [PMID: 28124522 PMCID: PMC5293379 DOI: 10.1590/s1677-5538.ibju.2016.0102] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 12/04/2022] Open
Abstract
Urinary incontinence is a common problem among women and it is estimated that between 15 and 55% of them complain of lower urinary symptoms. The most prevalent form of urinary incontinence is associated with stress, followed by mixed urinary incontinence and urge urinary incontinence. It is a symptom with several effects on quality of life of women mainly in their social, familiar and sexual domains. Female reproductive and urinary systems share anatomical structures, which promotes that urinary problems interfere with sexual function in females. This article is a review of both the concepts of female urinary incontinence and its impact on global and sexual quality of life. Nowadays, it is assumed that urinary incontinence, especially urge urinary incontinence, promotes anxiety and several self-esteem damages in women. The odour and the fear of incontinence during sexual intercourse affect female sexual function and this is related with the unpredictability and the chronicity of incontinence, namely urge urinary incontinence. Female urinary incontinence management involves conservative (pelvic floor muscle training), surgical and pharmacological treatment. Both conservative and surgical treatments have been studied about its benefit in urinary incontinence and also the impact among female sexual function. Unfortunately, there are sparse articles that evaluate the benefits of female sexual function with drug management of incontinence.
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Affiliation(s)
- Renato Lains Mota
- Departamento de Urologia, Centro Hospitalar de Lisboa Ocidental, EPE e
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Juszczak K, Maciukiewicz P, Drewa T, Thor PJ. Cajal-like interstitial cells as a novel target in detrusor overactivity treatment: true or myth? Cent European J Urol 2014; 66:413-7. [PMID: 24757530 PMCID: PMC3992455 DOI: 10.5173/ceju.2013.04.art5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 11/18/2013] [Accepted: 11/25/2013] [Indexed: 11/22/2022] Open
Abstract
Introduction The Cajal–like intestitial cells (ICCs) act as a pacemaker and are responsible for generating smooth muscle activity in the gastrointestinal tract (GI). Interstitial cells that resemble ICCs in the GI have been identified in the urinary bladder. Materials and methods This review is based on a systemic literature research. The medline/pubmed, scopus, embase, and Web of Science databases were browsed in order to identify original and review articles, as well as editorials relating to cajal–like cells, urinary bladder, detrusor overactivity, overactive bladder, glivec, etc. The controlled vocabulary of the Medical Subject Headings (MeSH) database was used to ensure the sensitivity of the searches. 40 papers met the criteria and were used for this review. Results Cajal cells lie in close proximity to the muscle cells, autonomic nerve endings, and urothelial cells. There is increasing evidence that ICCs play role in urinary tract dysfunction development (e.g. detrusor overactivity, primary obstructive megaureter, congenital ureteropelvic junction obstruction, etc.). ICCs may be responsible for generating electrical potentials and induction of detrusor muscle contractions. Novel pathomechanisms of detrusor overactivity development have been postulated, as follows: 1) the disturbance of spontaneous contractility caused by altered signal transduction of ICCs between nerves and detrusor muscle cells, and 2). the alteration in signal transduction between urothelium and afferent nerve endings via suburothelial ICCs. The c–kit receptor is not only a detection marker of these cells, but may also play a crucial role in the control of bladder function. Conclusions Cajal cells in urinary bladder suggest that the c–kit receptor may provide a novel target for treating detrusor overactivity. The review presents the current knowledge of ICCs, its role in urinary bladder function, and potential novel therapeutic strategy.
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Affiliation(s)
- Kajetan Juszczak
- Department of Pathophysiology, Jagiellonian University, Medical College, Cracow, Poland ; Department of Urology, Memorial Rydygier Hospital, Cracow, Poland
| | | | - Tomasz Drewa
- Department of Tissue Engineering, Medical College, Nicolaus Copernicus University, Toruń, Poland ; Department of Urology, Nicolaus Copernicus University, Toruń, Poland
| | - Piotr J Thor
- Department of Pathophysiology, Jagiellonian University, Medical College, Cracow, Poland
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