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Shin JH, Gwak CH, Park MU, Choo MS. Effects of different types of hysterectomies on postoperative urodynamics and lower urinary tract symptoms. Investig Clin Urol 2022; 63:207-213. [PMID: 35244995 PMCID: PMC8902418 DOI: 10.4111/icu.20210393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/08/2021] [Accepted: 01/12/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate the effects of different hysterectomies—simple hysterectomy (SH) and radical hysterectomy (RH) with or without radiation therapy (RT) on urodynamics and lower urinary tract symptoms (LUTS). Materials and Methods Among patients who underwent urodynamic study between 2009 and 2019, those with RH history due to cervical cancer and SH for uterine myoma were included. Clinical parameters were compared after adjusting clinically significant baseline variables with multivariate regression. Results A total of 289 patients (RH-only, n=57; RH+RT, n=72; SH, n=160) were included. Age at hysterectomy, gap between urodynamic study and hysterectomy, body mass index, hypertension and vaginal delivery history were adjusted. Stress urinary incontinence was more likely to occur in SH group (p<0.001), while urgency urinary incontinence was more prevalent in patients with history of RH (odds ratio [OR] 6.4, 95% confidence interval 2.171–18.855; p=0.001). There was no difference in OR of mixed urinary incontinence. Higher proportion of RH patients complained of recurrent urinary tract infection and voiding symptoms requiring intermittent catheterization. On urodynamic study, RH groups had lower maximal flow rate, larger post-void residual, decreased bladder sensation and impaired detrusor contractility (all p<0.001) than SH group. Adjuvant RT resulted in decreased compliance and decrease in volume of the first sense to void. Conclusions Predominant LUTS differed among patients after different types of hysterectomy. RH resulted in inefficient bladder emptying, leading to recurrent urinary tract infection and voiding symptoms requiring intermittent catheterization. Adjuvant RT exacerbated bladder compliance and increased bladder sensation.
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Affiliation(s)
- Jung Hyun Shin
- Department of Urology, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - Chan Hoon Gwak
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Min Uk Park
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myung-Soo Choo
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Opławski M, Smoczyńska M, Grabarek BO, Boroń D. Assessment of Dysfunction in the Urinary System as Well as Comfort in the Life of Women during and after Combination Therapy Due to Ovarian and Endometrial Cancer Based on the SWL, II-Q7 and UDI-6 Scales. J Clin Med 2021; 10:jcm10061228. [PMID: 33809612 PMCID: PMC8000855 DOI: 10.3390/jcm10061228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 01/22/2023] Open
Abstract
This work aimed to assess the influence of oncological combination therapy that was done on endometrial or ovarian cancer and how the urinary system is influenced as well as the quality of life in comparison to a group of female patients after the removal of the uterus with appendages due to endometrial cancer, which did not require the supplementation of therapy after operative treatment. The study included 87 patients with endometrial cancer, where, after the removal of the uterus, there was no need for conducting adjuvant therapy (C), as well as 92 female patients with endometrial cancer or 38 patients with ovarian cancer in whom combination therapy was conducted (group A, B). The assessment of the quality of life was conducted using the questionnaires: Satisfaction Life Scale (SWLS), Incontinence Impact Questionnaire, Short Form (IIQ-7), and Urogenital Distress Inventory (UDI-6) for three, six, nine, and 12 months after the conclusion of oncological treatment. It was observed that there was a statistically significant decrease in the quality of life in female patients who underwent combination therapy in comparison to a group in whose treatment only included surgery (p < 0.05). The risk of developing urinary incontinence increases alongside an increase in the scope of the operation and in the case of supplementing treatment with brachytherapy in comparison to chemotherapy.
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Affiliation(s)
- Marcin Opławski
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Kraków, Poland; (B.O.G.); (D.B.)
- Correspondence:
| | - Magdalena Smoczyńska
- Department of Rehabilitation Psychology, Ludwik Rydygier Collegium Medium, Mikołaj Kopernik’s University CM UMK, 30-835 Bydgoszcz, Poland;
| | - Beniamin Oskar Grabarek
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Kraków, Poland; (B.O.G.); (D.B.)
- Department of Histology, Cytophysiology and Embryology in Zabrze, Faculty of Medicine in Zabrze, University of Technology in Katowice, 41-800 Zabrze, Poland
- District Hospital in Chrzanów, 32-500 Chrzanów, Poland
- Department of Nursing and Maternity, High School of Strategic Planning in Dąbrowa Górnicza, 41-300 Dąbrowa Górnicza, Poland
| | - Dariusz Boroń
- Department of Gynecology and Obstetrics with Gynecologic Oncology, Ludwik Rydygier Memorial Specialized Hospital, 31-826 Kraków, Poland; (B.O.G.); (D.B.)
- Department of Histology, Cytophysiology and Embryology in Zabrze, Faculty of Medicine in Zabrze, University of Technology in Katowice, 41-800 Zabrze, Poland
- District Hospital in Chrzanów, 32-500 Chrzanów, Poland
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Vilos GA, Reyes-MuÑoz E, Riemma G, Kahramanoglu I, Lin LT, Chiofalo B, Lordelo P, Della Corte L, Vitagliano A, Valenti G. Gynecological cancers and urinary dysfunction: a comparison between endometrial cancer and other gynecological malignancies. Minerva Med 2021; 112:96-110. [PMID: 32700863 DOI: 10.23736/s0026-4806.20.06770-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this paper is to provide a narrative overview of the available literature about voiding dysfunction in women with gynecological cancer before and after surgical, chemo- and radiotherapy treatments. Radical surgery, radiotherapy, and chemotherapy may cause lower urinary tract dysfunction such as stress and urge urinary incontinence, and voiding difficulties. However, nerve-sparing radical hysterectomy may be a valid surgical approach in order to reduce bladder innervation impairment and maintain normal urinary function. Also, newer radiotherapy techniques significantly reduce the number of adverse effects, including bladder dysfunction. Pelvic floor muscle physiotherapy and training with biofeedback and urethral bulking agents represent some additional therapies that can be used in oncologically treated patients with urinary symptoms in order to improve a significant aspect of their quality of life. Considering the important impact on the patients' quality of life, a full urogynecological evaluation should be considered as an important part of oncological treatment and follow-up.
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Affiliation(s)
- George A Vilos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada -
| | - Enrique Reyes-MuÑoz
- Department of Endocrinology, Isidro Espinosa de los Reyes National Institute of Perinatology, Mexico City, Mexico
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
- Division of Gynecologic Oncology, Department of Women's and Children's Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Ilker Kahramanoglu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, University of Instanbul, Istanbul, Turkey
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Benito Chiofalo
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Patricia Lordelo
- Centro de Atenção ao Piso Pélvico (CAAP), Division of Physiotherapy, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Amerigo Vitagliano
- Department of Women and Children's Health, University of Padua, Padua, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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4
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Stabholz Y, Sandhu JS. Management of voiding dysfunction associated with pelvic malignancies. Int J Urol 2020; 28:17-24. [PMID: 33159341 DOI: 10.1111/iju.14405] [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: 07/06/2020] [Accepted: 09/14/2020] [Indexed: 11/27/2022]
Abstract
Voiding dysfunction is common after surgical and radiation treatments in patients diagnosed with non-urological pelvic malignancies. Presentation might vary with lower urinary tract symptoms and/or overactive bladder, urinary retention, or incontinence. We reviewed the most recent literature with the aim of describing various types of urinary dysfunction that manifest after radical treatments for non-urological pelvic malignancies. Radical surgical or radiation treatment adversely affect other adjacent pelvic organ function, including viscera, pelvic musculature and the peripheral nervous system. This results in direct organ and indirect functional damage to the genitourinary tract. Multiple surgical and radiation modifications are available nowadays, allowing urologists to offer various treatments for better functional lower urinary tract outcomes. Diagnosing and understanding the type and severity of voiding dysfunction plays a key role in tailoring an appropriate treatment plan. The objective to better functional results relies on maintaining adequate bladder compliance and capacity while permitting volitional emptying, ideally through voiding. Management should routinely start with conservative measures, including pelvic floor muscle training with or without a combination of oral medication for urgency incontinence and clean intermittent catheterization for the management of urinary retention. Concomitant or isolated urinary incontinence can be further managed through multiple established surgical approaches. We attempted to address various treatment available for known lower urinary tract symptoms that might have been caused secondary to non-urological pelvic surgery or radiation. We discuss different diagnostic and treatment modalities individualized for patients with various entities, to help achieve optimal urinary function and improve quality of life.
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Affiliation(s)
- Yariv Stabholz
- Department of Surgery/Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jaspreet S Sandhu
- Department of Surgery/Urology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Urodynamic assessment of bladder storage function after radical hysterectomy for cervical cancer. Chin Med J (Engl) 2020; 133:2274-2280. [PMID: 32925291 PMCID: PMC7546844 DOI: 10.1097/cm9.0000000000001014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND After radical hysterectomy for cervical cancer, the most common complication is lower urinary tract symptoms. Post-operatively, bladder capacity can alter bladder function for a prolonged period. This study aimed to identify factors affecting bladder storage function. METHODS A multicenter, retrospective cohort study was conducted. Information of patients with stages IA2 to IIB cervical cancer with urodynamic study results were retrospectively collected from nine hospitals between June 2013 and June 2018 according to the inclusion criteria. Demographic, surgical, and oncological data were collected. The univariate and multivariate logistic regression was used to identify clinical factors associated with bladder storage function. RESULTS Two hundred and three patients with cervical cancer had urodynamic testing post-operatively. Ninety-five (46.8%) patients were diagnosed with stress urinary incontinence (SUI). The incidence of low bladder compliance (LBC) was 23.2%. Twenty-seven (13.3%) patients showed detrusor overactivity (DO). Fifty-seven patients (28.1%) presented with a decreased maximum cystometric capacity (DMCC). The probability of composite bladder storage dysfunction was 68.0%. Multivariate analysis confirmed that laparoscopy represents a protective factor for SUI with an odds ratio of 0.498 (P = 0.034). Patients who underwent a nerve-sparing procedure were less odds to experience SUI (P = 0.014). A significant positive correlation between LBC and DO was observed (P < 0.001). A greater length of the resected vagina and chemoradiotherapy were common risk factors for LBC and DO, while radiotherapy exerted a stronger effect than chemotherapy. Additionally, patients who received chemoradiotherapy frequently developed a DMCC. The follow-up time was not correlated with bladder storage function. CONCLUSION A nerve-sparing procedure without longer resected vagina is recommended for protecting the bladder storage function.
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Miguel TP, Laurienzo CE, Faria EF, Sarri AJ, Castro IQ, Júnior RJA, da Cunha Andrade CEM, Vieira MDA, dos Reis R. Chemoradiation for cervical cancer treatment portends high risk of pelvic floor dysfunction. PLoS One 2020; 15:e0234389. [PMID: 32530941 PMCID: PMC7292417 DOI: 10.1371/journal.pone.0234389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 05/26/2020] [Indexed: 12/09/2022] Open
Abstract
Goal To assess the impact of chemoradiation on pelvic floor (PF) muscle function after the treatment of cervical cancer (CC). Methods We performed a prospective cohort study of women between the ages of 20 and 70 years old who had a diagnosis of CC. Patients were treated with chemoradiation at the Barretos Cancer Hospital (BCH), between August 2016 and July 2017. We performed three evaluations at different time points after chemoradiation treatment to compare changes in muscle function. Pelvic floor muscle function was assessed through perineometry (PNM) and surface electromyography (EMG) at the following time points: Pretreatment Moment 1 (M1): evaluated before chemoradiation; Moment 2 (M2): at the first follow-up medical visit (usually 3 to 4 months after treatment); and Moment 3 (M3): at the second follow-up medical visit (usually after 6 to 9 months after treatment). Mean vaginal squeeze pressure levels were determined by PNM and muscle electromyographic activity by EMG and the results were evaluated by Generalized Linear Model comparisons. Results Forty-nine patients were evaluated at M1; 35 at M2; and 32 at M3, so that 32 patients had all three muscle evaluations performed. There was a statistically significant increase in the frequency of women with urgency urinary incontinence at the M2 evaluation time (41.9%), compared to pretreatment M1 (18.6%), p<0.001. The means of the vaginal squeeze pressures reduced through M1 to M3 in the phasic (M1: 17.7 mmHg; M3: 11.27mmHg) and tonic contractions (M1: 10.56 mmHg; M3: 7.52mmHg), p = 0.01 and p = 0.03 respectively. There was no difference in pelvic floor function in the three evaluations M1-M3, measured by EMG. The pelvic floor strength assessed by PMN and their interactions with anthropometric, parity and hormonal status variables, showed that a high body mass index (BMI) significantly influenced decreases in pelvic floor muscle function before and after treatment. Conclusion These results show that chemoradiation causes reduction of muscle function of the pelvic floor, especially in the late phase after the end of treatment. Both the high BMI and urgent urinary incontinence symptoms were related to decreased muscle strength.
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Affiliation(s)
- Taís Pereira Miguel
- Department of Physiotherapy, Barretos Cancer Hospital, São Paulo, Brazil
- * E-mail:
| | | | | | - Almir José Sarri
- Department of Physiotherapy, Barretos Cancer Hospital, São Paulo, Brazil
| | - Isabela Queiroz Castro
- Department of Epidemiology and Biostatistics, Barretos Cancer Hospital, São Paulo, Brazil
| | | | | | | | - Ricardo dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, São Paulo, Brazil
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7
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Sakuragi N, Murakami G, Konno Y, Kaneuchi M, Watari H. Nerve-sparing radical hysterectomy in the precision surgery for cervical cancer. J Gynecol Oncol 2020; 31:e49. [PMID: 32266799 PMCID: PMC7189083 DOI: 10.3802/jgo.2020.31.e49] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/11/2019] [Accepted: 01/05/2020] [Indexed: 12/24/2022] Open
Abstract
Precision cancer surgery is a system that integrates the accurate evaluation of tumor extension and aggressiveness, precise surgical maneuvers, prognosis evaluation, and prevention of the deterioration of quality of life (QoL). In this regard, nerve-sparing radical hysterectomy has a pivotal role in the personalized treatment of cervical cancer. Various types of radical hysterectomy can be combined with the nerve-sparing procedure. The extent of parametrium and vagina/paracolpium excision and the nerve-sparing procedure are tailored to the tumor status. Advanced magnetic resonance imaging technology will improve the assessment of the local tumor extension. Validated risk factors for perineural invasion might guide selecting treatment for cervical cancer. Type IV Kobayashi (modified Okabayashi) radical hysterectomy combined with the systematic nerve-sparing procedure aims to both maximize the therapeutic effect and minimize the QoL impairment. Regarding the technical aspect, the preservation of vesical nerve fibers is essential. Selective transection of uterine nerve fibers conserves the vesical nerve fibers as an essential piece of the pelvic nervous system comprising the hypogastric nerve, pelvic splanchnic nerves, and inferior hypogastric plexus. This method is anatomically and surgically valid for adequate removal of the parametrial and vagina/paracolpium tissues while preserving the total pelvic nervous system. Local recurrence after nerve-sparing surgery might occur due to perineural invasion or inadequate separation of pelvic nerves cutting through the wrong tissue plane between the pelvic nerves and parametrium/paracolpium. Postoperative management for long-term maintenance of bladder function is as critical as preserving the pelvic nerves.
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Affiliation(s)
- Noriaki Sakuragi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Gynecology, Otaru General Hospital, Otaru, Japan.
| | - Gen Murakami
- Department of Anatomy II, Sapporo Medical University, Sapporo, Japan
- Division of Internal Medicine, Jikou-kai Clinic of Home Visits, Sapporo, Japan
| | - Yosuke Konno
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | | | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Novackova M, Pastor Z, Chmel R, Brtnicky T, Chmel R. Urinary tract morbidity after nerve-sparing radical hysterectomy in women with cervical cancer. Int Urogynecol J 2019; 31:981-987. [DOI: 10.1007/s00192-019-04083-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/06/2019] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW To present the available literature pertaining to the management of lower urinary tract symptoms (LUTS) after pelvic radiation (RT) in female patients treated for pelvic malignancy. RECENT FINDINGS Recent publications have focused on isolating de novo RT-induced LUTS in women from other contributors to urinary symptoms such as pelvic surgery and chemotherapy. There is a paucity of literature on the treatment of RT-related changes to urinary function. The treatment of pelvic malignancies in women alters voiding function. RT contributes to the deterioration of voiding function. More study is needed to evaluate the efficacy of available therapies.
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Affiliation(s)
- Laura S Leddy
- Memorial Sloan-Kettering Cancer Center, 353 East 68th Street, New York, NY, 10065, USA.
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10
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Ervandian M, Djurhuus JC, Høyer M, Graugaard-Jensen C, Borre M. Long-term urodynamic findings following radical prostatectomy and salvage radiotherapy. Scand J Urol 2017; 52:20-26. [DOI: 10.1080/21681805.2017.1354067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Maria Ervandian
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Morten Høyer
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Michael Borre
- Department of Urology, Aarhus University Hospital, Aarhus, Denmark
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11
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Solomon E, Veeratterapillay R, Malde S, Harding C, Greenwell TJ. Can filling phase urodynamic parameters predict the success of the bulbar artificial urinary sphincter in treating post-prostatectomy incontinence? Neurourol Urodyn 2016; 36:1557-1563. [PMID: 27673430 DOI: 10.1002/nau.23147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 09/02/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To evaluate whether filling phase urodynamic parameters can predict the success of the artificial urinary sphincter (AUS) in treating post-prostatectomy incontinence (PPI). MATERIALS AND METHODS We reviewed the pre-AUS urodynamics of 99 patients with PPI at two tertiary referral centers. We documented the peak DO pressure (Pdet ), capacity, and compliance (C). We defined success as patient-reported continence or only using one safety pad. Patients' perception of improvement was assessed using the PGI-I score. RESULTS Sixty-eight percent (n = 68) of patients had a successful outcome. The mean compliance for the "success" and "failure" group was 112.3 mL/cmH2 O (±119.7) and 34.1 mL/cmH2 O (±36.2), respectively. Fifty-five percent (17/31) of patients in the "failure" group demonstrated DO(Pdet = 36.2 ± 18.2 cmH2 O) compared to 18% (12/68) in the success group. The differences between the two groups in Pdet and compliance were statistically significant (all P < 0.01). There was, however, no statistical difference between the mean cystometric capacities of patients in the two outcome groups. Thirteen out of 18 (72%) patients who had radiotherapy had a poor outcome ("success" group only 15% [9/59]). These results were used to develop a nomogram for the probability of AUS success. A good inverse correlation (r = -0.65) was demonstrated between the probability of AUS success as deduced from the nomogram and PGI-I score post-AUS implantation CONCLUSION: Compliance and Pdet are predictors of outcome following AUS implantation for PPI. We have developed and internally validated a nomogram that may be used to determine an individualized likelihood of AUS success. This nomogram may be used as a counseling tool to objectively set realistic expectations of continence post-AUS implantation.
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Affiliation(s)
| | | | - Sachin Malde
- University College London Hospital, London, United Kingdom
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12
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Sun MJ, Sun R, Chen LJ. The therapeutic efficiency of extracorporeal magnetic innervation treatment in women with urinary tract dysfunction following radical hysterectomy. J OBSTET GYNAECOL 2014; 35:74-8. [PMID: 25153935 DOI: 10.3109/01443615.2014.935721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Data on 32 consecutive women with demonstrable urinary tract dysfunction for at least 6 months following radical hysterectomy (RH) for uterine cervical cancer, who received 24 sessions of extracorporeal magnetic innervation (ExMI) treatment twice-weekly were collected. The 1-h pad test weight decreased from 27.2 g pre-treatment to 12.1 g post-treatment (p < 0.05). Both the median UDI-6 and IIQ-7 scores showed statistically significant improvements (p < 0.001) at every stage of the ExMI treatment and in the 24.2 months mean follow-up duration after treatment. The symptoms of frequency, stress incontinence, urge incontinence and voiding difficulty showed statistically significant improvements (p < 0.001) after 8 and 24 sessions of ExMI treatment. The urodynamic parameters between pre-treatment and post-treatment after 24 sessions revealed no statistically significant changes. Based on the objective and subjective measures observed in this study, 24 sessions of twice-weekly ExMI treatment is an additional non-invasive therapy option for patients with the symptoms of lower urinary tract following RH.
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Affiliation(s)
- M-J Sun
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Changhua Christian Hospital
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13
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Yi WM, Chen Q, Liu CH, Hou JY, Chen LD, Wu WK. Acupuncture for preventing complications after radical hysterectomy: a randomized controlled clinical trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2014; 2014:802134. [PMID: 24839455 PMCID: PMC4009289 DOI: 10.1155/2014/802134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 03/25/2014] [Indexed: 12/21/2022]
Abstract
We aimed to investigate the preventive effects of acupuncture for complications after radical hysterectomy. A single-center randomized controlled single-blinded trial was performed in a western-style hospital in China. One hundred and twenty patients after radical hysterectomy were randomly allocated to two groups and started acupuncture from sixth postoperative day for five consecutive days. Sanyinjiao (SP6), Shuidao (ST28), and Epangxian III (MS4) were selected with electrical stimulation and Zusanli (ST36) without electrical stimulation for thirty minutes in treatment group. Binao (LI14) was selected as sham acupuncture point without any stimulation in control group. The main outcome measures were bladder function and prevalence of postoperative complications. Compared with control group, treatment group reported significantly improved bladder function in terms of maximal cystometric capacity, first voiding desire, maximal flow rate, residual urine, and bladder compliance, and decreased bladder sensory loss, incontinence, and urinary retention on fifteenth and thirtieth postoperative days. Treatment group showed significant advantage in reduction of urinary tract infection on thirtieth postoperative day. But no significant difference between groups was observed for lymphocyst formation. By improving postoperative bladder function, early intervention of acupuncture may provide a valuable alternative method to prevent bladder dysfunctional disorders and urinary tract infection after radical hysterectomy.
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Affiliation(s)
- Wei-min Yi
- Department of Traditional Chinese Medicine and Acupuncture, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
- Department of Traditional Chinese Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510635, China
| | - Qing Chen
- Department of Gynecology Oncology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Chang-hao Liu
- Department of Gynecology Oncology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Jia-yun Hou
- Department of Traditional Chinese Medicine and Acupuncture, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Liu-dan Chen
- Department of Traditional Chinese Medicine and Acupuncture, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
| | - Wei-kang Wu
- Department of Traditional Chinese Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510635, China
- Institute of Integrated Traditional Chinese and Western Medicine, Sun Yat-sen University, Guangzhou 510080, China
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