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Cameron AP, Chung DE, Dielubanza EJ, Enemchukwu E, Ginsberg DA, Helfand BT, Holland P, Linder BJ, Rahimi L, Reynolds WS, Rovner ES, Souter L, Suskind AM, Takacs E, Welk B, Smith AL. The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder. J Urol 2024:101097JU0000000000003985. [PMID: 38651651 DOI: 10.1097/ju.0000000000003985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE The purpose of this guideline is to provide evidence-based guidance to clinicians of all specialties on the evaluation, management, and treatment of idiopathic overactive bladder (OAB). The guideline informs the reader on valid diagnostic processes and provides an approach to selecting treatment options for patients with OAB through the shared decision-making process that will maximize symptom control and quality of life, while minimizing adverse events and burden of disease. METHODS An electronic search employing OVID was used to systematically search the MEDLINE and EMBASE databases, as well as the Cochrane Library, for systematic reviews and primary studies evaluating diagnosis and treatment of OAB from January 2013 to November 2023. Criteria for inclusion and exclusion of studies were based on the Key Questions and the populations, interventions, comparators, outcomes, timing, types of studies and settings (PICOTS) of interest. Following the study selection process, 159 studies were included and were used to inform evidence-based recommendation statements. RESULTS This guideline produced 33 statements that cover the evaluation and diagnosis of the patient with symptoms suggestive of OAB; the treatment options for patients with OAB, including non-invasive therapies, pharmacotherapy, minimally invasive therapies, invasive therapies, and indwelling catheters; and the management of patients with BPH and OAB. CONCLUSION Once the diagnosis of OAB is made, the clinician and the patient with OAB have a variety of treatment options to choose from and should, through shared decision-making, formulate a personalized treatment approach taking into account evidence-based recommendations as well as patient values and preferences.
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Shapiro K, Anger J, Cameron AP, Chung D, Daignault-Newton S, Ippolito GM, Lee U, Mourtzinos A, Padmanabhan P, Smith AL, Suskind AM, Tenggardjaja C, Van Til M, Brucker BM. Antibiotic use, best practice statement adherence, and UTI rate for intradetrusor onabotulinumtoxin-A injection for overactive bladder: A multi-institutional collaboration from the SUFU Research Network (SURN). Neurourol Urodyn 2024; 43:407-414. [PMID: 38032120 DOI: 10.1002/nau.25334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/11/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Onabotulinumtoxin A (BTX-A) is a well-established treatment for overactive bladder (OAB). The American Urological Association (AUA) 2008 Antibiotic Best Practice Statement (BPS) recommended trimethoprim-sulfamethoxazole or fluoroquinolone for cystoscopy with manipulation. The aim of the study was to evaluate concordance with antibiotic best practices at the time of BTX-A injection and urinary tract infection (UTI) rates based on antibiotic regimen. METHODS Men and women undergoing first-time BTX-A injection for idiopathic OAB with 100 units in 2016, within the SUFU Research Network (SURN) multi-institutional retrospective database were included. Patients on suppressive antibiotics were excluded. The primary outcome was concordance of periprocedural antibiotic use with the AUA 2008 BPS antimicrobials of choice for "cystoscopy with manipulation." As a secondary outcome we compared the incidence of UTI among women within 30 days after BTX-A administration. Each outcome was further stratified by procedure setting (office vs. operating room; OR). RESULTS Of the cohort of 216 subjects (175 women, 41 men) undergoing BTX-A, 24 different periprocedural antibiotic regimens were utilized, and 98 (45%) underwent BTX-A injections in the OR setting while 118 (55%) underwent BTX-A injection in the office. Antibiotics were given to 86% of patients in the OR versus 77% in office, and 8.3% of subjects received BPS concordant antibiotics in the OR versus 82% in office. UTI rates did not vary significantly among the 141 subjects who received antibiotics and had 30-day follow-up (8% BPS-concordant vs. 16% BPS-discordant, CI -2.4% to 19%, p = 0.13). A sensitivity analysis of UTI rates based on procedure setting (office vs. OR) did not demonstrate any difference in UTI rates (p = 0.14). CONCLUSIONS This retrospective multi-institutional study demonstrates that antibiotic regimens and adherence to the 2008 AUA BPS were highly variable among providers with lower rates of BPS concordant antibiotic use in the OR setting. UTI rates at 30 days following BTX-A did not vary significantly based on concordance with the BPS or procedure setting.
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Affiliation(s)
- Katherine Shapiro
- Department of Urology, New York University, New York City, New York, USA
| | - Jennifer Anger
- Department of Urology, University of California San Diego, San Diego, California, USA
| | - Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Doreen Chung
- Department of Urology, Columbia University Medical Center, New York City, New York, USA
| | | | - Giulia M Ippolito
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Una Lee
- Virginia Mason Medical Center, Seattle, Washington, District of Columbia, USA
| | - Arthur Mourtzinos
- Department of Urology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Priya Padmanabhan
- Department of Urology, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Ariana L Smith
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anne M Suskind
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | | | - Monica Van Til
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Benjamin M Brucker
- Department of Urology, New York University, New York City, New York, USA
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Smith AL, Berry A, Brubaker L, Cunningham SD, Gahagan S, Low LK, Mueller M, Sutcliffe S, Williams BR, Brady SS. The brain, gut, and bladder health nexus: A conceptual model linking stress and mental health disorders to overactive bladder in women. Neurourol Urodyn 2024; 43:424-436. [PMID: 38078701 PMCID: PMC10872494 DOI: 10.1002/nau.25356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/28/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVE A small, but growing literature links stressors and mental health disorders (MHDs) across the life course to overactive bladder (OAB) and urinary incontinence symptoms. Mechanisms by which stressors and MHDs may impact bladder health are not fully understood, limiting novel prevention and treatment efforts. Moreover, potential biopsychosocial mechanisms involving the brain and gut have not been considered in an integrated, comprehensive fashion. METHODS Members of the prevention of lower urinary tract symptoms Research Consortium developed conceptual models to inform research on biopsychosocial mechanisms through which stress and MDHs may impact bladder health among girls and women, focusing on brain and gut physiology. RESULTS Two conceptual models were developed-one to explain central (brain-based) and peripheral (gut-based) mechanisms linking stressors and MHDs to OAB and bladder health, and one to highlight bidirectional communication between the brain, gut, and bladder. Traumatic events, chronic stressors, and MHDs may lead to a maladaptive stress response, including dysregulated communication and signaling between the brain, gut, and bladder. Gut bacteria produce molecules and metabolites that alter production of neurotransmitters, amino acids, short-chain fatty acids, and inflammatory immune response molecules that mediate communication between the gut and brain. Microbiota signal neurogenesis, microglia maturation, and synaptic pruning; they also calibrate brain-gut-bladder axis communication through neurotransmission and synaptogenesis, potentially influencing bladder symptom development. Life course trajectories of risk may be prevented or interrupted by central and peripheral resources for neuropsychological resilience. CONCLUSIONS Depicted pathways, including brain-gut-bladder communication, have implications for research and development of novel prevention and treatment approaches.
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Affiliation(s)
- Ariana L. Smith
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amanda Berry
- Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Linda Brubaker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, California
| | - Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT
| | - Sheila Gahagan
- Department of Pediatrics, UC San Diego School of Medicine, University of California, San Diego CA
| | - Lisa Kane Low
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan
| | - Margaret Mueller
- Department of Ob/Gyn, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - Beverly R. Williams
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB) and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs
| | - Sonya S. Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
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Markland A, Bavendam T, Cain C, Neill Epperson C, Fitzgerald CM, Yvette LaCoursiere D, Shoham DA, Smith AL, Sutcliffe S, Rudser K. Occupational groups and lower urinary tract symptoms: A cross-sectional analysis of women in the Boston Area Community Health Study. Neurourol Urodyn 2024; 43:88-104. [PMID: 37787539 PMCID: PMC10872634 DOI: 10.1002/nau.25292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES The objective of this study is to inform our hypothesis that the workplace toileting environment may impact lower urinary tract symptoms (LUTS); we examined the prevalence of LUTS across occupational groups in the Boston Area Community Health Survey. METHODS At baseline, women (n = 3205) reported their occupation and frequency of 15 LUTS. Using the US Department of Labor's Standard Occupational Classification (SOC) system, we categorized women into 11 standard occupational groups. Prevalence ratios (PRs) were calculated by log-link generalized linear models, adjusting for age, race, education, fluid intake, and parity. Women classified in Office and Administrative Support were used as the reference group given their potential for fewer workplace toileting restrictions. RESULTS Of the 3189 women with complete data, 68% of women reported any LUTS, ranging from 57% to 82% across the SOCs. Relative to women in Office and Administrative Support (n = 576), women in Computing, Engineering, and Science (n = 64) were more likely to report any LUTS (PR = 1.2, 95% confidence interval [95% CI]: 1.0-1.4) and urinating again in <2 h (PR = 1.7, 95% CI: 1.4-2.2), and women in Education, Legal, Community Service, Arts, and Media (n = 477), as well as Healthcare Practitioner and Technical Occupations (n = 162), were less likely to report perceived frequent daytime urination (PR = 0.6, 95% CI: 0.5-0.9 and PR = 0.6, 95% CI: 0.4-0.9, respectively). CONCLUSIONS Our cross-sectional findings suggest that urination frequency varies across understudied occupational groups with various workplace toileting environments. Future studies should examine this relationship prospectively to inform the influence of workplace toileting environments on urination frequency, as well as the development and/or worsening of LUTS.
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Affiliation(s)
- Alayne Markland
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, Birmingham Geriatric Research, Education, and Clinical Center at the Birmingham VAMC, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tamara Bavendam
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Charles Cain
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Colleen M Fitzgerald
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - D Yvette LaCoursiere
- Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Diego, California, USA
| | - David A Shoham
- Department of Biostatistics and Epidemiology, East Tennessee State University College of Public Health, Johnson City, Tennessee, USA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kyle Rudser
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Fitzgerald CM, Cunningham SD, Berry A, Gahagan S, Joinson C, Lindberg S, Newman DK, Schmitz KH, Smith AL, Sutcliffe S, Shoham DA. Is there an association between physical activity and lower urinary tract symptoms in adolescent girls? Results from the Avon Longitudinal Study of Parents and Children. Int Urogynecol J 2023; 34:2995-3003. [PMID: 37715786 PMCID: PMC10962925 DOI: 10.1007/s00192-023-05639-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 07/22/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Lower urinary tract symptoms (LUTS) are common among adolescent girls. Physical activity (PA) has been implicated as both a risk (high-impact PA) and protective factor (low-impact, moderate to vigorous intensity PA) for LUTS in adult women, but its role in adolescent girls is unclear. This study investigated the prospective association between physical activity and LUTS risk in adolescent girls. METHODS The sample comprised 3,484 female participants in the Avon Longitudinal Study of Parents and Children. Multivariate logistic regression models were used to examine daily minutes of moderate to vigorous PA (MVPA) at ages 11 and 15 years in relation to LUTS at ages 14 and 19 respectively. MVPA was assessed by 7-day accelerometer data. LUTS were assessed by questionnaire. MVPA were analyzed as continuous (minutes/day) and categorical variables (<10th percentile, 10-89th percentile, ≥90th percentile). RESULTS Prevalence of LUTS ranged from 2.0% for bedwetting to 9.5% for nocturia at age 14 and from 2.0% for straining to urinate to 35.5% for interrupted urine flow at age 19. Physical activity was not associated with LUTS at either time-point. CONCLUSIONS Given the prevalence of LUTS in female adolescent populations, although this study did not find an association with accelerometer-measured MVPA, other aspects of PA that may serve as risk or protective factors deserve investigation.
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Affiliation(s)
- Colleen M Fitzgerald
- Department of Obstetrics, Gynecology and Urology, Loyola University Chicago, Chicago, IL, USA
| | - Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT, 06030, USA.
| | - Amanda Berry
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sheila Gahagan
- Department of Pediatrics, University of California San Diego, La Jolla, CA, USA
| | - Carol Joinson
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Lindberg
- Division of Biostatistics, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Diane K Newman
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kathryn H Schmitz
- Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ariana L Smith
- Division of Urology, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, and the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA
| | - David A Shoham
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN, USA
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Ostrowski DA, Logan JR, Antony M, Broms R, Weiss DA, Van Batavia J, Long CJ, Smith AL, Zderic SA, Edwins RC, Pominville RJ, Hannick JH, Woo LL, Fan Y, Tasian GE, Weaver JK. Automated Society of Fetal Urology (SFU) grading of hydronephrosis on ultrasound imaging using a convolutional neural network. J Pediatr Urol 2023; 19:566.e1-566.e8. [PMID: 37286464 DOI: 10.1016/j.jpurol.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/14/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Grading of hydronephrosis severity on postnatal renal ultrasound guides management decisions in antenatal hydronephrosis (ANH). Multiple systems exist to help standardize hydronephrosis grading, yet poor inter-observer reliability persists. Machine learning methods may provide tools to improve the efficiency and accuracy of hydronephrosis grading. OBJECTIVE To develop an automated convolutional neural network (CNN) model to classify hydronephrosis on renal ultrasound imaging according to the Society of Fetal Urology (SFU) system as potential clinical adjunct. STUDY DESIGN A cross-sectional, single-institution cohort of postnatal renal ultrasounds with radiologist SFU grading from pediatric patients with and without hydronephrosis of stable severity was obtained. Imaging labels were used to automatedly select sagittal and transverse grey-scale renal images from all available studies from each patient. A VGG16 pre-trained ImageNet CNN model analyzed these preprocessed images. Three-fold stratified cross-validation was used to build and evaluate the model that was used to classify renal ultrasounds on a per patient basis into five classes based on the SFU system (normal, SFU I, SFU II, SFU III, or SFU IV). These predictions were compared to radiologist grading. Confusion matrices evaluated model performance. Gradient class activation mapping demonstrated imaging features driving model predictions. RESULTS We identified 710 patients with 4659 postnatal renal ultrasound series. Per radiologist grading, 183 were normal, 157 were SFU I, 132 were SFU II, 100 were SFU III, and 138 were SFU IV. The machine learning model predicted hydronephrosis grade with 82.0% (95% CI: 75-83%) overall accuracy and classified 97.6% (95% CI: 95-98%) of the patients correctly or within one grade of the radiologist grade. The model classified 92.3% (95% CI: 86-95%) normal, 73.2% (95% CI: 69-76%) SFU I, 73.5% (95% CI: 67-75%) SFU II, 79.0% (95% CI: 73-82%) SFU III, and 88.4% (95% CI: 85-92%) SFU IV patients accurately. Gradient class activation mapping demonstrated that the ultrasound appearance of the renal collecting system drove the model's predictions. DISCUSSION The CNN-based model classified hydronephrosis on renal ultrasounds automatically and accurately based on the expected imaging features in the SFU system. Compared to prior studies, the model functioned more automatically with greater accuracy. Limitations include the retrospective, relatively small cohort, and averaging across multiple imaging studies per patient. CONCLUSIONS An automated CNN-based system classified hydronephrosis on renal ultrasounds according to the SFU system with promising accuracy based on appropriate imaging features. These findings suggest a possible adjunctive role for machine learning systems in the grading of ANH.
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Affiliation(s)
- David A Ostrowski
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Joseph R Logan
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Translational Research Informatics Group, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Maria Antony
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Reilly Broms
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dana A Weiss
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jason Van Batavia
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher J Long
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Stephen A Zderic
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rebecca C Edwins
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Raymond J Pominville
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jessica H Hannick
- Division of Pediatric Urology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Lynn L Woo
- Division of Pediatric Urology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Yong Fan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gregory E Tasian
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John K Weaver
- Division of Pediatric Urology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
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Wang CN, Su IW, Smith AL, Badalato GM, Chung DE. Current exposure to Female Pelvic Medicine and Reconstructive Surgery faculty during urology residency. Neurourol Urodyn 2023; 42:1569-1573. [PMID: 37449376 DOI: 10.1002/nau.25247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Contemporary US resident exposure to Female Pelvic Medicine and Reconstructive Surgery (FPMRS) faculty during urology residency is unknown. METHODS Accredited US urology residencies were identified through the American Urological Association (AUA). Accredited, urology-based FPMRS fellowships were identified through the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. The number of faculty and residency positions were obtained from program AUA profiles if they were last modified within the current application cycle; this information was obtained from program websites if AUA profiles were outdated. Data on faculty fellowship training was manually extracted from program websites. A quality control cross-check of program and faculty training characteristics was performed through direct communication with 5% of programs. RESULTS Of 139 accredited residency programs assessed, 10.8% were affiliated with an accredited, urology-based FPMRS fellowship. In total, 29.5% of residency programs, representing 25% of US urology residents, had neither a FPMRS fellowship nor any FPMRS certified faculty. The national FPMRS faculty-to-resident ratio was 1:10.8, and 7.4% of faculty at all residency programs were FPMRS certified. In comparison, faculty-to-resident ratios for other subspecialties were: 1:4.7 for pediatrics, 1:3.6 for oncology, 1:5.9 for minimally invasive surgery/endourology, 1:14.2 for trauma/reconstruction, and 1:11.8 for andrology or male sexual/reproductive health. The FPMRS faculty-to-resident ratio was 1:5.1 in programs with a urology-based FPMRS fellowship compared with 1:13.4 in programs without a FPMRS fellowship. CONCLUSIONS 30% of US urology residency programs lack FPMRS trained faculty. Even when FPMRS faculty are on staff, the field is often underrepresented relative to other urologic subspecialties. Further studies are required to ascertain if inadequate exposure to FPMRS cases and mentors during training contribute to the shortage of urology residents who choose to specialize in FPMRS. This link has important implications for the current shortage of FPMRS providers.
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Affiliation(s)
- Connie N Wang
- Columbia University Irving Medical Center Department of Urology, New York, New York, USA
| | - Irene W Su
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Ariana L Smith
- University of Pennsylvania Health System Department of Urology, Philadelphia, Pennsylvania, USA
| | - Gina M Badalato
- Columbia University Irving Medical Center Department of Urology, New York, New York, USA
| | - Doreen E Chung
- Columbia University Irving Medical Center Department of Urology, New York, New York, USA
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Gan ZS, Smith AL. Women Who Avoid or Stop Exercise Due to Lower Urinary Tract Symptoms: Prevalence, Symptom Profile, and Associated Factors. Urology 2023; 178:48-53. [PMID: 37247694 DOI: 10.1016/j.urology.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To determine the prevalence of women who report avoiding exercise or stopping a workout due to lower urinary tract symptoms (LUTS) in a community population, characterize symptoms in these women, and identify clinical and demographic factors associated with exercise cessation due to LUTS. METHODS A cross-sectional online survey was administered to community-based women. The prevalence of having avoided exercise or stopped a workout due to LUTS was calculated. Clinical and demographic variables along with comprehensive urinary symptoms assessed by the Lower Urinary Tract Research Network-Symptom Index (LURN-SI 29) were compared between women with and without the outcome. Multivariable logistic regression and random forest models were used to identify variables associated with the outcome. RESULTS Out of 1707 women who completed the survey, 18.9% reported avoiding exercising or stopping a workout due to LUTS. For these women, multiple domains of LUTS were noted, including incontinence, pain, voiding difficulty, urgency, and nocturia. Multivariable logistic regression identified LURN SI-29 score, White race, and prior vaginal delivery as significantly associated with the outcome, while the random forest model identified LURN SI-29 score, age, and body mass index (BMI) as most important. CONCLUSION In a population-based study, 1 in 5 women reported avoiding exercise or stopping a workout due to LUTS. Their reported LUTS span multiple symptom domains, and factors associated with stopping exercise include symptom severity, older age, higher BMI, White race, and prior vaginal delivery. Addressing LUTS may improve the resumption and continuation of exercise in women.
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Affiliation(s)
- Zoe S Gan
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA.
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, PA
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Smith AL, Rudser K, Harlow BL, McGwin G, Barthold J, Brady SS, Brubaker L, Cunningham SD, Griffith JW, Kenton K, Klusaritz H, Lewis CE, Lukacz ES, Maki J, Markland AD, Mueller ER, Newman DK, Nodora J, Rickey LM, Rockwood T, Simon M, Wyman JF, Sutcliffe S. RISE FOR HEALTH: Rationale and protocol for a prospective cohort study of bladder health in women. Neurourol Urodyn 2023; 42:998-1010. [PMID: 36321762 PMCID: PMC10151425 DOI: 10.1002/nau.25074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/09/2022] [Accepted: 10/16/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The spectrum of bladder health and the factors that promote bladder health and prevent lower urinary tract symptoms (LUTS) among women are not well understood. This manuscript describes the rationale, aims, study design, sampling strategy, and data collection for the RISE FOR HEALTH (RISE) study, a novel study of bladder health in women conducted by the Prevention of Lower Urinary Tract Symptom (PLUS) Research Consortium. METHODS AND RESULTS RISE is a population-based, multicenter, prospective longitudinal cohort study of community-dwelling, English- and Spanish-speaking adult women based in the United States. Its goal is to inform the distribution of bladder health and the individual factors (biologic, behavioral, and psychosocial) and multilevel factors (interpersonal, institutional, community, and societal) that promote bladder health and/or prevent LUTS in women across the life course. Key study development activities included the: (1) development of a conceptual framework and philosophy to guide subsequent activities, (2) creation of a study design and sampling strategy, prioritizing diversity, equity, and inclusion, and (3) selection and development of data collection components. Community members and cross-cultural experts shaped and ensured the appropriateness of all study procedures and materials. RISE participants will be selected by simple random sampling of individuals identified by a marketing database who reside in the 50 counties surrounding nine PLUS clinical research centers. Participants will complete self-administered surveys at baseline (mailed paper or electronic) to capture bladder health and LUTS, knowledge about bladder health, and factors hypothesized to promote bladder health and prevent LUTS. A subset of participants will complete an in-person assessment to augment data with objective measures including urogenital microbiome specimens. Initial longitudinal follow-up is planned at 1 year. DISCUSSION Findings from RISE will begin to build the necessary evidence base to support much-needed, new bladder health promotion and LUTS prevention interventions in women.
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Affiliation(s)
- Ariana L. Smith
- University of Pennsylvania, Perelman School of Medicine, Division of Urology, Philadelphia, Pennsylvania
| | - Kyle Rudser
- University of Minnesota, Division of Biostatistics, Minneapolis, Minnesota, United States
| | - Bernard L Harlow
- Boston University School of Public Health, Department of Epidemiology, Boston, Massachusetts
| | - Gerald McGwin
- University of Alabama at Birmingham, Department of Epidemiology, Birmingham, Alabama
| | - Julia Barthold
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda MD
| | - Sonya S. Brady
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
| | - Linda Brubaker
- University of California San Diego, Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, La Jolla, California
| | - Shayna D. Cunningham
- University of Connecticut, School of Medicine, Department of Public Health Sciences, Farmington, Connecticut
| | - James W. Griffith
- Northwestern University, Feinberg School of Medicine, Department of Medical Social Sciences, Chicago, Illinois
| | - Kim Kenton
- Northwestern University, Feinberg School of Medicine, Department of Obstetrics and Gynecology, Chicago, Illinois
| | - Heather Klusaritz
- University of Pennsylvania, Perelman School of Medicine, Department of Family Medicine and Community Health, Philadelphia, Pennsylvania
| | - Cora E. Lewis
- University of Alabama at Birmingham, Department of Epidemiology, Birmingham, Alabama
| | - Emily S. Lukacz
- University of California San Diego, Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, La Jolla, California
| | - Julia Maki
- Washington University in St. Louis, Division of Public Health Sciences, Department of Surgery, St. Louis, Missouri
| | - Alayne D. Markland
- University of Alabama at Birmingham, Department of Medicine, Birmingham, Alabama and Birmingham VA Medical Center Birmingham, Alabama
| | - Elizabeth R. Mueller
- Loyola University Chicago, Department of Obstetrics, Gynecology and Urology, Maywood, Illinois
| | - Diane K. Newman
- University of Pennsylvania, Perelman School of Medicine, Division of Urology, Philadelphia, Pennsylvania
| | - Jesse Nodora
- University of California San Diego, Herbert Wertheim School of Public Health & Human Longevity Science, La Jolla, California
| | | | - Todd Rockwood
- University of Minnesota, Division of Health Policy and Management, Minneapolis, Minnesota
| | - Melissa Simon
- Northwestern School of Medicine, Department of Obstetrics and Gynecology, Chicago, Illinois
| | - Jean F. Wyman
- University of Minnesota, School of Nursing, Minneapolis, Minnesota, United States
| | - Siobhan Sutcliffe
- Washington University in St. Louis, Division of Public Health Sciences, Department of Surgery, St. Louis, Missouri, United States
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Weaver JK, Martin-Olenski M, Logan J, Broms R, Antony M, Van Batavia J, Weiss DA, Long CJ, Smith AL, Zderic SA, Huang J, Fan Y, Tasian GE. Deep Learning of Videourodynamics to Classify Bladder Dysfunction Severity in Patients With Spina Bifida. J Urol 2023; 209:994-1003. [PMID: 36787376 DOI: 10.1097/ju.0000000000003267] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE Urologists rely heavily on videourodynamics to identify patients with neurogenic bladders who are at risk of upper tract injury, but their interpretation has high interobserver variability. Our objective was to develop deep learning models of videourodynamics studies to categorize severity of bladder dysfunction. MATERIALS AND METHODS We performed a cross-sectional study of patients aged 2 months to 28 years with spina bifida who underwent videourodynamics at a single institution between 2019 and 2021. The outcome was degree of bladder dysfunction, defined as none/mild, moderate, and severe, defined by a panel of 5 expert reviewers. Reviewers considered factors that increase the risk of upper tract injury, such as poor compliance, elevated detrusor leak point pressure, and detrusor sphincter dyssynergia, in determining bladder dysfunction severity. We built 4 models to predict severity of bladder dysfunction: (1) a random forest clinical model using prospectively collected clinical data from videourodynamics studies, (2) a deep learning convolutional neural network of raw data from the volume-pressure recordings, (3) a deep learning imaging model of fluoroscopic images, (4) an ensemble model averaging the risk probabilities of the volume-pressure and fluoroscopic models. RESULTS Among 306 videourodynamics studies, the accuracy and weighted kappa of the ensemble model classification of bladder dysfunction when at least 75% expected bladder capacity was reached were 70% (95% CI 66%,76%) and 0.54 (moderate agreement), respectively. The performance of the clinical model built from data extracted by pediatric urologists was the poorest with an accuracy of 61% (55%, 66%) and a weighted kappa of 0.37. CONCLUSIONS Our models built from urodynamic pressure-volume tracings and fluoroscopic images were able to automatically classify bladder dysfunction with moderately high accuracy.
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Affiliation(s)
- John K Weaver
- Department of Urology, Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Madalyne Martin-Olenski
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph Logan
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Translational Research Informatics Group, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Reiley Broms
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maria Antony
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jason Van Batavia
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dana A Weiss
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher J Long
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ariana L Smith
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen A Zderic
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jing Huang
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Tasian
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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11
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Weaver JK, Martin-Olenski M, Logan J, Broms R, Antony M, Van Batavia J, Weiss DA, Long CJ, Smith AL, Zderic SA, Huang J, Fan Y, Tasian GE. Reply By Authors. J Urol 2023; 209:1003. [PMID: 37026634 DOI: 10.1097/ju.0000000000003267.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Affiliation(s)
- John K Weaver
- Department of Urology, Rainbow Babies and Children's Hospital/Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Madalyne Martin-Olenski
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joseph Logan
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Translational Research Informatics Group, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Reiley Broms
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Maria Antony
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jason Van Batavia
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dana A Weiss
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher J Long
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Ariana L Smith
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen A Zderic
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jing Huang
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yong Fan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Tasian
- Division of Pediatric Urology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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12
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Constantine ML, Rockwood TH, Rickey LM, Bavendam T, Low LK, Lowder JL, Markland AD, McGwin G, Mueller ER, Newman DK, Putnam S, Rudser K, Smith AL, Stapleton AE, Miller JM, Lukacz ES. Validation of bladder health scales and function indices for women's research. Am J Obstet Gynecol 2023; 228:566.e1-566.e14. [PMID: 36596439 PMCID: PMC10425263 DOI: 10.1016/j.ajog.2022.12.319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Existing bladder-specific measures lack the ability to assess the full range of bladder health, from poor to optimal health. OBJECTIVE This study aimed to report evidence of validity of the self-administered, multidimensional bladder health scales and function indices for research in adult women. STUDY DESIGN A cross-sectional population-based validation study with random assignment to paper or electronic administration was conducted using national address-based probability sampling supplemented by purposive sampling of women with lower urinary tract symptoms in 7 clinical research centers. Construct validity of the bladder health scales and function indices was guided by a multitrait-multimethod approach using health and condition-specific questionnaires, bladder diaries, expert ratings of bladder health, and noninvasive bladder function testing. Internal dimensional validity was evaluated using factor analysis; internal reliability was assessed using paired t-tests and 2-way mixed-effects intraclass correlation coefficient models. Chi-square, Fisher exact, or t-tests were used for mode comparisons. Convergent validity was evaluated using Pearson correlations with the external construct measures, and known-group validity was established with comparison of women known and unknown to be symptomatic of urinary conditions. RESULTS The sample included 1072 participants. Factor analysis identified 10 scales, with Cronbach's alpha ranging from 0.74 to 0.94. Intraclass correlation coefficients of scales ranged from 0.55 to 0.94. Convergent validity of the 10 scales and 6 indices ranged from 0.52 to 0.83. Known-group validity was confirmed for all scales and indices. Item distribution was similar by mode of administration. CONCLUSION The paper and electronic forms of the bladder health scales and function indices are reliable and valid measures of bladder health for use in women's health research.
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Affiliation(s)
- Melissa L Constantine
- Division of Biostatistics, University of Minnesota, Minneapolis, MN; Patient Centered Research, Evidera, Bethesda, MD.
| | - Todd H Rockwood
- Department of Health Policy, University of Minnesota, Minneapolis, MN
| | - Leslie M Rickey
- Departments of Urology and Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT
| | - Tamara Bavendam
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | - Lisa Kane Low
- School of Nursing, University of Michigan, Ann Arbor, MI
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - Alayne D Markland
- Division of Gerontology, Geriatrics and Palliative Care, Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Gerald McGwin
- School of Public Health, The University of Alabama at Birmingham, Birmingham, AL
| | - Elizabeth R Mueller
- Departments of Urology and Obstetrics and Gynecology, Loyola University Medical Center, Loyola University Chicago, Chicago, IL
| | - Diane K Newman
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sara Putnam
- Division of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Kyle Rudser
- Division of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Ariana L Smith
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ann E Stapleton
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Janis M Miller
- School of Nursing, University of Michigan, Ann Arbor, MI
| | - Emily S Lukacz
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, La Jolla, CA.
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13
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Camenga DR, Wang Z, Chu H, Lindberg S, Sutcliffe S, Brady SS, Coyne-Beasley T, Fitzgerald CM, Gahagan S, Low LK, LaCoursiere DY, Lavender M, Smith AL, Stapleton A, Harlow BL. Sexual Health Behaviors by Age 17 and Lower Urinary Tract Symptoms at Age 19: PLUS Research Consortium Analysis of ALSPAC Data. J Adolesc Health 2023; 72:737-745. [PMID: 36781327 PMCID: PMC10826680 DOI: 10.1016/j.jadohealth.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 02/13/2023]
Abstract
PURPOSE We examined how antecedent sexual health factors affect lower urinary tract symptoms (LUTS) in adolescent women. METHODS We analyzed 1,941 adolescent women from the Avon Longitudinal Study of Parents and Children at age 19. At ages 15 and 17, participants reported use of oral contraceptives (OCs), history of sexual intercourse, number of sexual partners, and condom use. At age 19, The Bristol Female Lower Urinary Tract Symptoms questionnaire quantified the frequency over the past month: stress incontinence, any incontinence, urgency, sensation of incomplete emptying, bladder pain, and urinary tract infection. Multivariable regression models examined associations between sexual health behaviors reported at ages 15 and 17 and six LUTS reported at age 19, after controlling for covariates. RESULTS Commonly reported LUTS at age 19 were past-month stress incontinence (26.8%), bladder pain (26.3%), any urine leakage (22.1%), and urinary tract infection (15.4%). OC use by age 17 was associated with urgency (odds ratio [OR] = 1.62, 95% confidence interval [CI] 1.19-2.20), incomplete emptying (OR = 1.62, 95% CI = 1.17-2.26), bladder pain (OR = 1.45, 95% CI = 1.15-1.83), and urinary tract infections (OR = 1.68, 95% CI = 1.28-2.21) at age 19 after adjustment for covariates. However, associations were attenuated after adjustment for condom use and number of sexual partners. Sexual intercourse by age 17 was associated with 1.53-2.65 increased odds of LUTs categories except incontinence, with lower confidence interval boundaries > 1.0. Associations were stronger among women with ≥ 3 sexual partners (vs. 0) by age 17. DISCUSSION We found longitudinally assessed associations between OC use, sexual intercourse, and number of sexual partners during adolescence and LUTS at age 19.
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Affiliation(s)
- Deepa R Camenga
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Zhenxun Wang
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneaspolis, Minnesota
| | - Haitao Chu
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneaspolis, Minnesota
| | - Sarah Lindberg
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneaspolis, Minnesota
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Tamera Coyne-Beasley
- Division of Adolescent Medicine, Departments of Pediatrics and Internal Medicine, University of Alabama at Birmingham Medical School, Birmingham, Alabama
| | - Colleen M Fitzgerald
- Department of Obstetrics and Gynecology, Loyola University Chicago Stritch School of Medicine, Chicago, Illinois
| | - Sheila Gahagan
- Division of Academic General Pediatrics, University of California San Diego School of Medicine, San Diego, California
| | - Lisa Kane Low
- Department Obstetrics and Gynecology, University of Michigan School of Nursing, Women's and Gender Studies, Ann Arbor, Michigan
| | - D Yvette LaCoursiere
- Department of Obstetrics and Gynecology, University of California San Diego, La Jolla, California
| | | | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Ann Stapleton
- Division of Allergy & Infectious Disease, Department of Medicine, University of Washington, Seattle, Washington
| | - Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts.
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14
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Koch RL, Soler-Alfonso C, Kiely BT, Asai A, Smith AL, Bali DS, Kang PB, Landstrom AP, Akman HO, Burrow TA, Orthmann-Murphy JL, Goldman DS, Pendyal S, El-Gharbawy AH, Austin SL, Case LE, Schiffmann R, Hirano M, Kishnani PS. Diagnosis and management of glycogen storage disease type IV, including adult polyglucosan body disease: A clinical practice resource. Mol Genet Metab 2023; 138:107525. [PMID: 36796138 DOI: 10.1016/j.ymgme.2023.107525] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 01/26/2023]
Abstract
Glycogen storage disease type IV (GSD IV) is an ultra-rare autosomal recessive disorder caused by pathogenic variants in GBE1 which results in reduced or deficient glycogen branching enzyme activity. Consequently, glycogen synthesis is impaired and leads to accumulation of poorly branched glycogen known as polyglucosan. GSD IV is characterized by a remarkable degree of phenotypic heterogeneity with presentations in utero, during infancy, early childhood, adolescence, or middle to late adulthood. The clinical continuum encompasses hepatic, cardiac, muscular, and neurologic manifestations that range in severity. The adult-onset form of GSD IV, referred to as adult polyglucosan body disease (APBD), is a neurodegenerative disease characterized by neurogenic bladder, spastic paraparesis, and peripheral neuropathy. There are currently no consensus guidelines for the diagnosis and management of these patients, resulting in high rates of misdiagnosis, delayed diagnosis, and lack of standardized clinical care. To address this, a group of experts from the United States developed a set of recommendations for the diagnosis and management of all clinical phenotypes of GSD IV, including APBD, to support clinicians and caregivers who provide long-term care for individuals with GSD IV. The educational resource includes practical steps to confirm a GSD IV diagnosis and best practices for medical management, including (a) imaging of the liver, heart, skeletal muscle, brain, and spine, (b) functional and neuromusculoskeletal assessments, (c) laboratory investigations, (d) liver and heart transplantation, and (e) long-term follow-up care. Remaining knowledge gaps are detailed to emphasize areas for improvement and future research.
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Affiliation(s)
- Rebecca L Koch
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
| | - Claudia Soler-Alfonso
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Bridget T Kiely
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Akihiro Asai
- Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, OH, USA; Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Deeksha S Bali
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Peter B Kang
- Paul and Sheila Wellstone Muscular Dystrophy Center, Department of Neurology, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Andrew P Landstrom
- Division of Cardiology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA; Department of Cell Biology, Duke University School of Medicine, Durham, NC, USA
| | - H Orhan Akman
- Department of Neurology, Columbia University Irving Medical Center, New York City, NY, USA
| | - T Andrew Burrow
- Section of Genetics and Metabolism, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | | | - Deberah S Goldman
- Adult Polyglucosan Body Disease Research Foundation, Brooklyn, NY, USA
| | - Surekha Pendyal
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Areeg H El-Gharbawy
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Stephanie L Austin
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Laura E Case
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA; Doctor of Physical Therapy Division, Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | | | - Michio Hirano
- Department of Neurology, Columbia University Irving Medical Center, New York City, NY, USA
| | - Priya S Kishnani
- Division of Medical Genetics, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
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15
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Newman DK, Lowder JL, Meister M, Low LK, Fitzgerald CM, Fok CS, Geynisman-Tan J, Lukacz ES, Markland A, Putnam S, Rudser K, Smith AL, Miller JM. Comprehensive pelvic muscle assessment: Developing and testing a dual e-Learning and simulation-based training program. Neurourol Urodyn 2023. [PMID: 36626146 DOI: 10.1002/nau.25125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/04/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The Prevention of Lower Urinary Tract Symptoms (PLUS) research consortium launched the RISE FOR HEALTH (RISE) national study of women's bladder health which includes annual surveys and an in-person visit. For the in-person exam, a standardized, replicable approach to conducting a pelvic muscle (PM) assessment was necessary. The process used to develop the training, the products, and group testing results from the education and training are described. METHODS A comprehensive pelvic muscle assessment (CPMA) program was informed by literature view and expert opinion. Training materials were prepared for use on an electronicLearning (e-Learning) platform. An in-person hands-on simulation and certification session was then designed. It included a performance checklist assessment for use by Clinical Trainers, who in collaboration with a gynecology teaching assistant, provided an audit and feedback process to determine Trainee competency. RESULTS Five discrete components for CPMA training were developed as e-Learning modules. These were: (1) overview of all the clinical measures and PM anatomy and examination assessments, (2) visual assessment for pronounced pelvic organ prolapse, (3) palpatory assessment of the pubovisceral muscle to estimate muscle integrity, (4) digital vaginal assessment to estimate strength, duration, symmetry during PM contraction, and (5) pressure palpation of both myofascial structures and PMs to assess for self-report of pain. Seventeen Trainees completed the full CPMA training, all successfully meeting the a priori certification required pass rate of 85% on checklist assessment. CONCLUSIONS The RISE CPMA training program was successfully conducted to assure standardization of the PM assessment across the PLUS multicenter research sites. This approach can be used by researchers and healthcare professionals who desire a standardized approach to assess competency when performing this CPMA in the clinical or research setting.
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Affiliation(s)
- Diane K Newman
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Melanie Meister
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas, USA
| | - Lisa K Low
- School of Nursing, University of Michigan, Ann Arbor Michigan, USA
| | - Colleen M Fitzgerald
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois, USA
| | - Cynthia S Fok
- Department of Urology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Julia Geynisman-Tan
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Emily S Lukacz
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Alayne Markland
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama, USA
| | - Sara Putnam
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kyle Rudser
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ariana L Smith
- Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Janis M Miller
- School of Nursing, University of Michigan, Ann Arbor Michigan, USA
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16
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Brubaker L, Barthold J, Fitzgerald CM, Kenton K, Lewis CE, Lowder J, Lukacz ES, Markland A, Meister M, Miller J, Mueller ER, Rudser K, Smith AL, Newman DK. The RISE FOR HEALTH study: Methods for in-person assessment and biospecimen collection. Neurourol Urodyn 2022. [PMID: 36573845 DOI: 10.1002/nau.25108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/15/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To describe the methods for the in-person assessment of the RISE FOR HEALTH (RISE) study, a population-based multicenter prospective cohort study designed to identify factors that promote bladder health and/or prevent lower urinary tract symptoms in adult women, conducted by the Prevention of Lower Urinary Tract Symptoms Research Consortium (PLUS). METHODS AND RESULTS A subset of RISE participants who express interest in the in-person assessment will be screened to ensure eligibility (planned n = 525). Eligible consenting participants are asked to complete 15 physical assessments in addition to height and weight, to assess pelvic floor muscle function, musculoskeletal (MSK) status, and pain, and to provide urogenital microbiome samples. Pelvic floor muscle assessments include presence of prolapse, strength, levator attachment integrity (tear) and myofascial pain. MSK tests evaluate core stability, lumbar spine, pelvic girdle and hip pain and function. Participants are asked to complete the Short Physical Performance Battery to measure balance, lower extremity strength, and functional capacity. All participants are asked to provide a voided urine sample and a vaginal swab for microbiome analyses; a subset of 100 are asked to contribute additional samples for feasibility and validation of a home collection of urinary, vaginal, and fecal biospecimens. RESULTS Online and in-person training sessions were used to certify research staff at each clinical center before the start of RISE in-person assessments. Standardized protocols and data collection methods are employed uniformly across sites. CONCLUSIONS The RISE in-person assessment is an integral portion of the overall population-based RISE study and represents an innovative approach to assessing factors hypothesized to promote bladder health and/or prevent lower urinary tract symptoms. Data collected from this assessment will be used to prioritize future research questions and prevention strategies and interventions. This description of the assessment methods is intended to provide methodologic transparency and inform other researchers who join efforts to understand and improve bladder health.
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Affiliation(s)
- Linda Brubaker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Julia Barthold
- Division of Kidney, Urologic and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA
| | - Colleen M Fitzgerald
- Department of Obstetrics, Gynecology and Urology, Loyola University Chicago, Chicago, Illinois, USA
| | - Kimberly Kenton
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Cora E Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jerry Lowder
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Emily S Lukacz
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Alayne Markland
- Department of Medicine, School of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, Alabama, USA
| | - Melanie Meister
- Department of Obstetrics and Gynecology, University of Kansas, Kansas City, Kansas, USA
| | - Janis Miller
- Department of Obstetrics, Gynecology and Urology, Loyola University Chicago, Chicago, Illinois, USA.,School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth R Mueller
- Department of Obstetrics, Gynecology and Urology, Loyola University Chicago, Chicago, Illinois, USA
| | - Kyle Rudser
- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ariana L Smith
- Perelman School of Medicine, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diane K Newman
- Perelman School of Medicine, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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- School of Public Health, Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
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17
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Wyman JF, Cain CH, Epperson CN, Fitzgerald CM, Gahagan S, Newman DK, Rudser K, Smith AL, Vaughan CP, Sutcliffe S. Urination Frequency Ranges in Healthy Women. Nurs Res 2022; 71:341-352. [PMID: 35319538 PMCID: PMC9420750 DOI: 10.1097/nnr.0000000000000595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Limited information on the normal range of urination frequencies in women is available to guide bladder health promotion efforts. OBJECTIVES This study used data from the Boston Area Community Health (BACH) Survey to (a) estimate normative reference ranges in daytime and nighttime urination frequencies in healthy women based on two operational definitions of "healthy" and (b) compare urination frequencies by age, race/ethnicity, and fluid intake. METHODS A secondary analysis of cross-sectional interview data collected from female participants was performed using less restrictive ("healthy") and strict ("elite healthy") inclusion criteria. All analyses were weighted to account for the BACH sampling design. Normative reference values corresponding to the middle 95% of the distribution of daytime and nighttime urination frequencies were calculated overall and stratified by age, race/ethnicity, and fluid intake. Generalized linear regression with a log-link was used to estimate rate ratios of daytime and nighttime urination frequencies by age, race/ethnicity, and fluid intake. RESULTS Of the 2,534 women who completed the BACH follow-up interviews, 1,505 women met healthy eligibility criteria, and 300 met elite healthy criteria. Overall, reference ranges for urination frequencies were 2-10 times/day and 0-4 times/night in healthy women and 2-9 times/day and 0-2 times/night in elite healthy women. Women ages 45-64 years, but not 65+ years, reported a greater number of daytime urination than those aged 31-44 years, whereas women 65+ years reported a greater number of nighttime urination. Black women reported fewer daytime urination and more nighttime urinations than White women. Women who consumed less than 49 oz daily reported fewer daytime and nighttime urinations than those who drank 50-74 oz; drinking 75+ oz had only a small effect on urination frequencies. DISCUSSION Normative reference values for daytime and nighttime urination frequencies were similar in women using strict and relaxed definitions of health. These results indicate a wide range of "normal" urination frequencies, with some differences by age, race/ethnicity, and fluid intake. Future research is needed to examine urination frequencies in minority women and whether fluid intake amount and type influence the development of lower urinary tract symptoms.
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18
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Watts C, Spillane A, Henderson MA, Cust A, Braithwaite J, Gyorki DE, Hong AM, Kelly JW, Long GV, Mar VJ, Menzies AM, Morton RL, Rapport F, Saw RPM, Schmid H, Scolyer RA, Smith AL, Winder A, Mann GJ. Sentinel lymph node biopsy rates in Victoria, 2018 and 2019. Med J Aust 2022. [DOI: 10.5694/mja2.51424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Caroline Watts
- Daffodil Centre University of Sydney and Cancer Council NSW Sydney NSW
- The Kirby Institute UNSW Sydney NSW
| | - Andrew Spillane
- Melanoma Institute Australia University of Sydney Sydney NSW
- Sydney Medical School University of Sydney Sydney NSW
- Royal North Shore Hospital Sydney NSW
- Mater Hospital Sydney NSW
| | - Michael A Henderson
- Peter MacCallum Cancer Centre Melbourne VIC
- The University of Melbourne Melbourne VIC
| | - Anne Cust
- Daffodil Centre University of Sydney and Cancer Council NSW Sydney NSW
- Melanoma Institute Australia University of Sydney Sydney NSW
| | - J Braithwaite
- Australian Institute of Health Innovation Macquarie University Sydney NSW
| | - DE Gyorki
- Peter MacCallum Cancer Centre Melbourne VIC
| | - AM Hong
- Melanoma Institute Australia University of Sydney Sydney NSW
| | - JW Kelly
- Victorian Melanoma Service Alfred Hospital Melbourne VIC
| | - GV Long
- Melanoma Institute Australia University of Sydney Sydney NSW
- Sydney Medical School University of Sydney Sydney NSW
- Royal North Shore Hospital Sydney NSW
- Mater Hospital Sydney NSW
| | - VJ Mar
- Victorian Melanoma Service Alfred Hospital Melbourne VIC
| | - AM Menzies
- Melanoma Institute Australia University of Sydney Sydney NSW
- Sydney Medical School University of Sydney Sydney NSW
- Royal North Shore Hospital Sydney NSW
- Mater Hospital Sydney NSW
| | - RL Morton
- Melanoma Institute Australia University of Sydney Sydney NSW
- NHMRC Clinical Trials Centre University of Sydney Sydney NSW
| | - F Rapport
- Australian Institute of Health Innovation Macquarie University Sydney NSW
| | - RPM Saw
- Melanoma Institute Australia University of Sydney Sydney NSW
- Sydney Medical School University of Sydney Sydney NSW
- Mater Hospital Sydney NSW
| | - H Schmid
- Daffodil Centre University of Sydney and Cancer Council NSW Sydney NSW
| | - RA Scolyer
- Melanoma Institute Australia University of Sydney Sydney NSW
- Sydney Medical School University of Sydney Sydney NSW
- Royal Prince Alfred Hospital and New South Wales Health Pathology Sydney NSW
| | - AL Smith
- Daffodil Centre University of Sydney and Cancer Council NSW Sydney NSW
| | - A Winder
- Melanoma Institute Australia University of Sydney Sydney NSW
| | - GJ Mann
- Melanoma Institute Australia University of Sydney Sydney NSW
- The John Curtin School of Medical Research Australian National University Canberra ACT
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19
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Gan ZS, Roberson DS, Smith AL. Role of Hysteropexy in the Management of Pelvic Organ Prolapse. Curr Urol Rep 2022; 23:175-183. [PMID: 35789456 DOI: 10.1007/s11934-022-01101-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW To discuss considerations for hysteropexy for apical pelvic organ prolapse (POP) and summarize available literature comparing various hysteropexy techniques to analogous procedures involving hysterectomy. RECENT FINDINGS Hysteropexy for apical POP has increased in popularity in recent years, although anatomic factors and gynecologic cancer risk must be taken into account. Native tissue hysteropexy options include the LeFort colpocleisis, sacrospinous hysteropexy, and uterosacral hysteropexy. Although vaginal mesh was banned by the Food and Drug Administration in 2019, abdominal mesh sacrohysteropexy done either open or laparoscopically remains an option in the USA. Overall, short-term prolapse outcomes appear to be comparable between uterus-sparing approaches and hysterectomy, with less blood loss and shorter operating room time observed with the uterine-sparing approaches, although long-term outcome data remains variable and limited. Uterine-sparing apical POP repair may be offered to appropriate patients without certain risk factors, although longer-term data will be required to evaluate durability.
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Affiliation(s)
- Zoe S Gan
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, PCAM 3-334W, Philadelphia, PA, 19104, USA.
| | - Daniel S Roberson
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, PCAM 3-334W, Philadelphia, PA, 19104, USA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, PCAM 3-334W, Philadelphia, PA, 19104, USA
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20
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Giugale L, Sridhar A, Ferrante KL, Komesu YM, Meyer I, Smith AL, Myers D, Visco AG, Paraiso MFR, Mazloomdoost D, Gantz M, Zyczynski HM. Long-term Urinary Outcomes After Transvaginal Uterovaginal Prolapse Repair With and Without Concomitant Midurethral Slings. Female Pelvic Med Reconstr Surg 2022; 28:142-148. [PMID: 35272320 PMCID: PMC8928054 DOI: 10.1097/spv.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Many health care providers place concomitant midurethral slings during pelvic organ prolapse repair, yet growing evidence supports staged midurethral sling placement. OBJECTIVES The aim of this study was to compare urinary function after transvaginal uterovaginal prolapse repair with and without midurethral sling. STUDY DESIGN Secondary analysis of the Study of Uterine Prolapse Procedures Randomized Trial (hysterectomy with uterosacral ligament suspension vs mesh hysteropexy). Our primary outcome was Urinary Distress Inventory score (UDI-6) through 5 years compared between women with and without a concomitant sling within prolapse repair arms. Sling effect was adjusted for select clinical variables and interaction terms (α = .05). RESULTS The sling group included 90 women (43 hysteropexy, 47 hysterectomy), and the no-sling group included 93 women (48 hysteropexy, 45 hysterectomy). At baseline, the sling group reported more bothersome stress (66% vs 36%, P < 0.001) and urgency incontinence (69% vs 48%, P = 0.007). For hysteropexy, there were no significant long-term differences in UDI-6 scores or bothersome urine leakage between sling groups. For hysterectomy, women with sling had better UDI-6 scores across time points (adjusted mean difference, -5.1; 95% confidence interval [CI], -9.9 to -0.2); bothersome stress and urgency leakage were less common in the sling group (stress adjusted odds ratio, 0.1 [95% CI, 0.0-0.4]; urge adjusted odds ratio, 0.5 [95% CI, 0.2-1.0]). Treatment for stress incontinence over 5 years was similar in the sling (7.9%) versus no-sling (7.6%) groups. CONCLUSIONS Five-year urinary outcomes of concomitant midurethral sling may vary by type of transvaginal prolapse surgery, with possible benefit of midurethral sling at the time of vaginal hysterectomy with apical suspension but not after mesh hysteropexy.
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Affiliation(s)
- Lauren Giugale
- University of Pittsburgh, Magee-Womens Research Institute, Pittsburgh PA
| | | | | | | | - Isuzu Meyer
- University of Alabama at Birmingham, Birmingham AL
| | - Ariana L. Smith
- Department of Surgery, Division of Urology, University of Pennsylvania Philadelphia PA
| | - Deborah Myers
- Brown University/Women & Infants Hospital, Providence RI
| | | | | | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health
| | - Marie Gantz
- RTI International, Research Triangle Park NC
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21
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Reynolds WS, Suskind AM, Anger JT, Brucker BM, Cameron AP, Chung DE, Daignault-Newton S, Lane GI, Lucioni A, Mourtzinos AP, Padmanabhan P, Reyblat PX, Smith AL, Tenggardjaja CF, Lee UJ. Incomplete bladder emptying and urinary tract infections after botulinum toxin injection for overactive bladder: Multi-institutional collaboration from the SUFU research network. Neurourol Urodyn 2022; 41:662-671. [PMID: 35019167 PMCID: PMC8891079 DOI: 10.1002/nau.24871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/08/2021] [Accepted: 12/05/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Onabotulinumtoxin A (BTX-A) is an effective therapy for overactive bladder (OAB), however, adverse events may prevent patients from initiating therapy. The study objective was to report real-world rates of incomplete emptying and urinary tract infection (UTI) in men and women undergoing BTX-A for OAB. METHODS Eleven clinical sites performed a retrospective study of adults undergoing first-time BTX-A injection (100 units) for idiopathic OAB in 2016. Exclusions included: postvoid residual (PVR) > 150 ml, prior BTX-A, pelvic radiation, or need for preprocedure catheterization. Primary outcomes at 6 months were incomplete emptying (clean intermittent catheterization [CIC] or PVR ≥ 300 ml without the need for CIC); and UTI (symptoms with either positive culture or urinalysis or empiric treatment). We compared rates of incomplete emptying and UTI within and between sexes, using univariate and multivariable models. RESULTS 278 patients (48 men and 230 women) met inclusion criteria. Mean age was 65.5 years (range: 24-95). 35% of men and 17% of women had incomplete emptying. Men had 2.4 (95% CI: 1.04-5.49) higher odds of incomplete emptying than women. 17% of men and 23.5% of women had ≥1 UTI, the majority of which occurred within the first month following injection. The strongest predictor of UTI was a history of prior UTI (OR: 4.2 [95% CI: 1.7-10.3]). CONCLUSIONS In this multicenter retrospective study, rates of incomplete emptying and UTI were higher than many previously published studies. Men were at particular risk for incomplete emptying. Prior UTI was the primary risk factor for postprocedure UTI.
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Affiliation(s)
- William Stuart Reynolds
- Division of Reconstructive Urology and Pelvic Health, Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anne M. Suskind
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Jennifer T. Anger
- Department of Urology, UC San Diego Health, San Diego, California, USA
| | - Benjamin M. Brucker
- Department of Urology, New York University, Langone Health, New York, New York, USA
| | - Anne P. Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Doreen E. Chung
- Department of Urology, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Giulia I. Lane
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Arthur P. Mourtzinos
- Department of Urology, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Priya Padmanabhan
- Department of Urology, Beaumont Health, Farmington Hills, Michigan, USA
| | | | - Ariana L. Smith
- Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Una J. Lee
- Virginia Mason Medical Center, Seattle, Washington, USA
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22
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Smith AL, Chen J, Wyman JF, Newman DK, Berry A, Schmitz K, Stapleton AE, Klusaritz H, Lin G, Stambakio H, Sutcliffe S. Survey of lower urinary tract symptoms in United States women using the new lower urinary tract dysfunction research Network-Symptom Index 29 (LURN-SI-29) and a national research registry. Neurourol Urodyn 2022; 41:650-661. [PMID: 35032354 DOI: 10.1002/nau.24870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/17/2021] [Accepted: 12/25/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE An online bladder health survey was administered to national registry volunteers to: (1) determine the feasibility of using ResearchMatch for studying lower urinary tract symptoms (LUTS); (2) pilot the new, comprehensive Lower Urinary Tract Dysfunction Research Network Symptom Index-29 (LURN-SI-29) and determine its ability to detect known associations with LUTS; and (3) explore novel areas of bladder health in community-based women. METHODS A cross-sectional web-based survey was administered to a random sample of ResearchMatch adult female, transgender and non-binary volunteers. Participant demographics, health characteristics, the LURN-SI-29, and LUTS-related experiences were collected. RESULTS A total of 1725 ReseachMatch volunteers with a mean age of 44.0 years completed the study and were eligible for the analysis. Participants were primarily white, cisgendered, highly educated, nulliparous, and premenopausal. The median LURN-SI-29 score was 17 (interquartile range: 11-26). More than half the sample reported urinary urgency (71.0%), nocturia (65.7%), and stress incontinence (52.3%) a "few times" or more in the last 7 days. Approximately half reported sensation of incomplete bladder emptying (49.6%) with one-third reporting urgency incontinence (37.6%); notably, 52.6% of respondents reported being at least "somewhat" bothered by LUTS. LURN-SI-29 scores increased with age, body mass index, decrements in self-reported health, medical comorbidity, parity, menopausal status, and urinary symptom bother, providing evidence of convergent validity. LURN-SI-29 scores varied by race and education, with the lowest scores in Asian and highly educated women. CONCLUSION Overall, the prevalence and spectrum of LUTS in an online research registry of women volunteers were high and comparable to other population-based samples. The new LURN-SI-29 demonstrated its ability to detect expected associations with demographic and health characteristics in a nonclinical population.
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Affiliation(s)
- Ariana L Smith
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jingwen Chen
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jean F Wyman
- Division of Nursing Research, University of Minnesota School of Nursing, Minneapolis, Minnesota, USA
| | - Diane K Newman
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia, Pennsylvania, USA
| | - Amanda Berry
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kathryn Schmitz
- Division of Public Health Sciences, Penn State University State College, State College, Pennsylvania, USA
| | - Ann E Stapleton
- Division of Infectious Disease, University of Washington Seattle, Seattle, Washington, USA
| | - Heather Klusaritz
- Department of Family Medicine and Community Health, University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - George Lin
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia, Pennsylvania, USA
| | - Hanna Stambakio
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania Philadelphia, Philadelphia, Pennsylvania, USA
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri, USA
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Hendrickson WK, Xie G, Rahn DD, Amundsen CL, Hokanson JA, Bradley M, Smith AL, Sung VW, Visco AG, Luo S, Jelovsek JE. Predicting outcomes after intradetrusor onabotulinumtoxina for non-neurogenic urgency incontinence in women. Neurourol Urodyn 2022; 41:432-447. [PMID: 34859485 PMCID: PMC9014828 DOI: 10.1002/nau.24845] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/14/2021] [Accepted: 11/18/2021] [Indexed: 01/03/2023]
Abstract
AIMS Develop models to predict outcomes after intradetrusor injection of 100 or 200 units of onabotulinumtoxinA in women with non-neurogenic urgency urinary incontinence (UUI). METHODS Models were developed using 307 women from two randomized trials assessing efficacy of onabotulinumtoxinA for non-neurogenic UUI. Cox, linear and logistic regression models were fit using: (1) time to recurrence over 12 months, (2) change from baseline daily UUI episodes (UUIE) at 6 months, and (3) need for self-catheterization over 6 months. Model discrimination of Cox and logistic regression models was calculated using c-index. Mean absolute error determined accuracy of the linear model. Calibration was demonstrated using calibration curves. All models were internally validated using bootstrapping. RESULTS Median time to recurrence was 6 (interquartile range [IQR]: 2-12) months. Increasing age, 200 units of onabotulinumtoxinA, higher body mass index (BMI) and baseline UUIE were associated with decreased time to recurrence. The c-index was 0.63 (95% confidence interval [CI]: 0.59, 0.67). Median change in daily UUIE from baseline at 6 months was -3.5 (IQR: -5.0, -2.3). Increasing age, lower baseline UUIE, 200 units of onabotulinumtoxinA, higher BMI and IIQ-SF were associated with less improvement in UUIE. The mean absolute error predicting change in UUIE was accurate to 1.6 (95% CI: 1.5, 1.7) UUI episodes. The overall rate of self-catheterization was 17.6% (95% CI: 13.6%-22.4%). Lower BMI, 200 units of onabotulinumtoxinA, increased baseline postvoid residual and maximum capacity were associated with higher risk of self-catheterization. The c-index was 0.66 (95% CI: 0.61, 0.76). The three calculators are available at http://riskcalc.duke.edu. CONCLUSIONS After external validation, these models will assist clinicians in providing more accurate estimates of expected treatment outcomes after onabotulinumtoxinA for non-neurogenic UUI in women.
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Affiliation(s)
- Whitney K. Hendrickson
- Department of OBGYN, Division of Urogynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - Gongbo Xie
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina, USA
| | - David D. Rahn
- Department of OBGYN, Division of Female Pelvic Medicine and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cindy L. Amundsen
- Department of OBGYN, Division of Urogynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - James A. Hokanson
- Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Megan Bradley
- Department of Obstetrics, Gynecology and Reproductive Services, Division of Urogynecology and Pelvic Reconstructive Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ariana L. Smith
- Department of Surgery, Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vivian W. Sung
- Department of OBGYN, Division of Urogynecology and Pelvic Reconstructive Surgery, Women and Infants Hospital, Brown University, Providence, Rhode Island, USA
| | - Anthony G. Visco
- Department of OBGYN, Division of Urogynecology, Duke University Medical Center, Durham, North Carolina, USA
| | - Sheng Luo
- Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina, USA
| | - J. Eric Jelovsek
- Department of OBGYN, Division of Urogynecology, Duke University Medical Center, Durham, North Carolina, USA
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24
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Sutcliffe S, Cain C, Bavendam T, Fitzgerald CM, Gahagan S, Markland AD, Shoham DA, Smith AL, Rudser K. Changes in Bladder Health Over Time: A Longitudinal Analysis of Adult Women in the Boston Area Community Health Survey. J Urol 2021; 207:1086-1095. [PMID: 34968151 PMCID: PMC9020460 DOI: 10.1097/ju.0000000000002393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe changes in bladder health, defined as "a complete state of physical, mental, and social well-being related to bladder function that permits daily activities, adapts to short-term stressors, and allows optimal well-being," in women over time. MATERIALS AND METHODS We used data on 15 lower urinary tract symptoms (LUTS) and interference from urinary experiences assessed at the baseline and five-year follow-up interviews of the Boston Area Community Health (BACH) Survey to estimate changes in bladder health over time in women. Associations between baseline and follow-up bladder health (defined as the maximum frequency of LUTS or interference at each time point) were calculated by ordinal logistic regression and generalized linear models. RESULTS 2,526 women provided complete information on bladder health at baseline and follow-up. Over the five-year follow-up, 6.5% of women maintained optimal bladder health (no LUTS or interference), 33.6% developed worse bladder health (including 10.4% who transitioned from optimal to less than optimal health), 31.4% maintained their less than optimal bladder health status, and 28.7% improved. Despite these changes, women with poorer bladder health at baseline were still more likely to have poorer bladder health five years later (eg, multivariable-adjusted relative risk=3.27, 95% confidence interval: 2.49-4.29 for severe LUTS/interference at follow-up among those with severe LUTS/interference at baseline). CONCLUSIONS Findings from our large secondary analysis of BACH Survey data suggest considerable variability in bladder health over time, and underscore the importance of bladder health promotion to prevent the initial onset and progression of poor bladder health in women.
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Affiliation(s)
- Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery; Department of Obstetrics and Gynecology; and the Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Charles Cain
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota.,Medtronic, Minneapolis, Minnesota
| | - Tamara Bavendam
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Colleen M Fitzgerald
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Sheila Gahagan
- Division of Child Development and Community Health, University of California, San Diego, California
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine at the University of Alabama at Birmingham and the Birmingham Geriatric Research, Education, and Clinical Center at the Birmingham VAMC, Birmingham, Alabama
| | - David A Shoham
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, Tennessee
| | - Ariana L Smith
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kyle Rudser
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Newman DK, Burgio KL, Cain C, Hebert-Beirne J, Low LK, Palmer MH, Smith AL, Rickey L, Rudser K, Gahagan S, Harlow BL, James AS, Lacoursiere DY, Hardacker CT, Wyman JF. Toileting behaviors and lower urinary tract symptoms: A cross-sectional study of diverse women in the United States. International Journal of Nursing Studies Advances 2021; 3. [DOI: 10.1016/j.ijnsa.2021.100052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Gilham D, Smith AL, Fu L, Moore DY, Muralidharan A, Reid SPM, Stotz SC, Johansson JO, Sweeney M, Wong NCW, El-Gamal D, Kulikowski E. Bromodomain and extraterminal (BET) protein inhibitor, apabetalone, reduces ACE2 expression and attenuates SARS-CoV-2 infection in vitro. Eur Heart J 2021. [PMCID: PMC8767620 DOI: 10.1093/eurheartj/ehab724.3267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/Introduction SARS-CoV-2 causes life threatening COVID-19 complications including acute coronary syndrome, venous thromboembolism, hyperinflammation and damage in multiple tissues. The SARS-CoV-2 “spike protein” binds cell surface receptors including angiotensin-converting enzyme 2 (ACE2) for entry into host cells to initiate infection. Host cell dipeptidyl peptidase-4 (DPP4 / CD26) is implicated as a cofactor in uptake. Recent evidence indicates expression of factors involved in SARS-CoV-2 uptake into host cells is regulated by BET proteins, epigenetic readers modulating gene expression. Apabetalone, the most clinically advanced BET inhibitor (BETi), is in phase 3 trials for cardiovascular disease (CVD) (a,b). In cultured human cardiomyocytes, apabetalone suppressed infection with SARS-CoV-2 and prevented dysfunction of cardiac organoids induced by the cytokine-storm that arises in patients with severe symptoms (c). However, anti-viral properties of apabetalone in other cell types are not known. Purpose To examine effects of apabetalone on SARS-CoV-2 infection in cell culture via downregulated expression of cell surface receptors involved in viral entry. Cell systems used mimic initial sites of infection in the lung as well as cell types contributing to complications in late stages of infection. Methods Gene expression was measured by real-time PCR, protein levels by immunoblot or flow cytometry, and binding of recombinant SARS-CoV-2 spike protein by flow cytometry. Infection with SARS-CoV-2 was determined in a BSL3 facility. Infectivity was quantified by determining levels of viral spike protein amongst total cells via imaging on an Operetta CLS. Results In Calu-3, a human bronchial epithelial cell line, apabetalone dose-dependently downregulated ACE2 gene expression (up to 98%), reduced ACE2 protein levels (up to 84%) and diminished binding of SARS-CoV-2 spike protein (up to 77%, p<0.001 for all parameters). Further, apabetalone abolished infection of Calu-3 cells with live SARS-CoV-2, which was comparable to other antiviral agents. Apabetalone-driven ACE2 downregulation was also observed in extrapulmonary cell types including HepG2, Huh-7 or primary hepatocytes (up to 90%, p<0.001 for all cell types), and Vero E6, a monkey kidney epithelial cell line (up to 38%, p<0.05). DPP4/CD26, a potential cofactor for SARS-CoV-2 uptake, was also downregulated by apabetalone in Calu-3 cells (mRNA ∼65% and protein ∼40%, p<0.001), which may be synergistic with ACE2 reductions to impede SARS-CoV-2 infection. Conclusions Apabetalone, an investigational drug for CVD, reduced cell surface receptors (ACE2 and DPP4) involved in SARS-CoV-2 uptake into host cells and dramatically attenuated SARS-CoV-2 infection/propagation in vitro. Our results suggest apabetalone can mitigate SARS-CoV-2 replication in multiple organs, which together with an established safety profile supports clinical evaluation of apabetalone to treat Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): COVID-19 Rapid Response Grant from the College of Medicine at the University of Nebraska Medical Center (to DE and SPMR), and by University of Nebraska Medical Center start-up funds (to DE).
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Affiliation(s)
- D Gilham
- Resverlogix Corp., Calgary, Canada
| | - A L Smith
- University of Nebraska Medical Center, Eppley Institute for Research in Cancer and Allied Diseases, Omaha, United States of America
| | - L Fu
- Resverlogix Corp., Calgary, Canada
| | - D Y Moore
- University of Nebraska Medical Center, Eppley Institute for Research in Cancer and Allied Diseases, Omaha, United States of America
| | - A Muralidharan
- University of Nebraska Medical Center, Department of Pathology and Microbiology, Omaha, United States of America
| | - S P M Reid
- University of Nebraska Medical Center, Department of Pathology and Microbiology, Omaha, United States of America
| | | | - J O Johansson
- Resverlogix Inc., San Francisco, United States of America
| | - M Sweeney
- Resverlogix Inc., San Francisco, United States of America
| | | | - D El-Gamal
- University of Nebraska Medical Center, Eppley Institute for Research in Cancer and Allied Diseases, Omaha, United States of America
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Roberson D, Newman DK, Ziemba JB, Wein A, Stambakio H, Hamilton RG, Callender L, Holderbaum L, King T, Jackson A, Tran T, Lin G, Smith AL. Results of the patient report of intermittent catheterization experience (PRICE) study. Neurourol Urodyn 2021; 40:2008-2019. [PMID: 34516673 DOI: 10.1002/nau.24786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 02/02/2023]
Abstract
AIMS Patient satisfaction is paramount to health-related quality of life (HR-QoL) outcomes. High quality, quantitative data from the US describing patients' actual experiences, difficulties, and HR-QoL while on an intermittent self-catheterization (ISC) regimen is very scarce. Our objective was to better understand patient practices with and attitudes towards ISC. METHODS This is a cross-sectional, multi-centered, clinical study of adult men and women performing ISC in the United States. Data collected included demographics, medical history, catheter characteristics, specific self-catheterization habits and two validated HR-QoL questionnaires: The Intermittent Self-Catheterization Questionnaire (ISC-Q) and the Intermittent Catheterization Difficulty Questionnaire (ICDQ). RESULTS Two hundred participants were recruited from six sites; 70.0% were male, 73.5% were Caucasian with a median age was 51.0 years (range 19-90 years). The ISC-Q showed that the vast majority of participants reported ease with ISC (82.0% satisfaction score) had confidence in their ability to perform ISC (91.9% satisfaction score); yet, many felt self-conscious about doing so (58.3% satisfaction score) and had concerns about long-term adverse effects (58.1% satisfaction score). The ICDQ indicated little to no difficulty for most participants with all routine ISC practices. A small minority of participants reported some difficulty with a "blocking sensation" during initiation of catheterization, leg spasticity, and painful catheterization. Multivariate linear regression results are also reported. DISCUSSION/CONCLUSION Participants are confident with ISC and have little overall difficulty, which may be a product of successful education and/or catheter design. urinary tract infections (UTIs) were common (yet variable) and may contribute to the noted long-term ISC concerns. Limitations exist including various selection biases leading to concerns of external validity. Future educational interventions in this population may further improve HR-QoL, optimize UTIs prevention, and diminish concerns with long-term ISC.
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Affiliation(s)
- Daniel Roberson
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Diane K Newman
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justin B Ziemba
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alan Wein
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hanna Stambakio
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rita G Hamilton
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA
| | - Librada Callender
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA
| | - Leah Holderbaum
- Baylor Scott & White Institute for Rehabilitation, Dallas, Texas, USA
| | - Tamara King
- Shepherd Multispecialty Clinic, Shepherd Center, Inc., Atlanta, Georgia, USA
| | - Angela Jackson
- Department of Urology, University of South Florida, Tampa, Florida, USA
| | - Thanh Tran
- Department of Urology, University of South Florida, Tampa, Florida, USA
| | - George Lin
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Rogers RG, Meyer I, Smith AL, Ackenbom M, Barden L, Korbly N, Mazloomdoost D, Thomas S, Nager C. Improved body image after uterovaginal prolapse surgery with or without hysterectomy. Int Urogynecol J 2021; 33:115-122. [PMID: 34432089 DOI: 10.1007/s00192-021-04954-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/15/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to compare body image and sexual activity and function changes up to 3 years after sacrospinous ligament fixation with graft hysteropexy or vaginal hysterectomy with uterosacral ligament suspension (hysterectomy). METHODS This was a planned secondary analysis of a multi-center randomized trial of women undergoing prolapse repair with mesh hysteropexy versus hysterectomy. Women were masked to intervention. The modified Body Image Scale (BIS), sexual activity status, and Pelvic Organ Prolapse/Incontinence Sexual Questionnaire, IUGA-Revised (PISQ-IR) scores were reported at baseline and 1.5, 6, 12, 18, 24, and 36 months after surgery. We compared mean BIS and PISQ-IR scores, the proportion of women whose BIS scores met a distribution-based estimate of the minimally important difference (MID), and sexual activity status. Comparisons were analyzed with linear and logistic repeated measures models adjusted for site, intervention, visit, and intervention by visit interaction. RESULTS Eighty-eight women underwent mesh hysteropexy; 87 underwent hysterectomy. Women were similar with regard to baseline characteristics, mean age 65.9 ± 7.3 years, and most had stage III or IV prolapse (81%). Baseline mean BIS scores were not significantly different, improved in both groups by 1.5 months, and were sustained through 36 months with no differences between groups (all p > 0.05). The estimated BIS MID was 3; and by 36 months, more women in the mesh hysteropexy group achieved the MID than in the hysterectomy group (62% vs 44%, p = 0.04). The makeup of the sexually active cohort changed throughout the study, making function comparisons difficult. CONCLUSIONS Body image improves following prolapse surgery whether or not hysterectomy is performed or transvaginal mesh is used at the time of repair; sexual activity status changes over time following prolapse surgery.
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Affiliation(s)
- Rebecca G Rogers
- Albany Medical College, Albany NY and University of New Mexico, Albuquerque, NM, USA. .,, 391 Myrtle Avenue, Suite 200, Albany, NY, 12208, USA.
| | - Isuzu Meyer
- Albany Medical College, Albany NY and University of New Mexico, Albuquerque, NM, USA.,, 391 Myrtle Avenue, Suite 200, Albany, NY, 12208, USA
| | - Ariana L Smith
- Albany Medical College, Albany NY and University of New Mexico, Albuquerque, NM, USA.,, 391 Myrtle Avenue, Suite 200, Albany, NY, 12208, USA
| | - Mary Ackenbom
- Albany Medical College, Albany NY and University of New Mexico, Albuquerque, NM, USA.,, 391 Myrtle Avenue, Suite 200, Albany, NY, 12208, USA
| | - Lindsey Barden
- Albany Medical College, Albany NY and University of New Mexico, Albuquerque, NM, USA.,, 391 Myrtle Avenue, Suite 200, Albany, NY, 12208, USA
| | - Nicole Korbly
- Albany Medical College, Albany NY and University of New Mexico, Albuquerque, NM, USA.,, 391 Myrtle Avenue, Suite 200, Albany, NY, 12208, USA
| | - Donna Mazloomdoost
- Albany Medical College, Albany NY and University of New Mexico, Albuquerque, NM, USA.,, 391 Myrtle Avenue, Suite 200, Albany, NY, 12208, USA
| | - Sonia Thomas
- Albany Medical College, Albany NY and University of New Mexico, Albuquerque, NM, USA.,, 391 Myrtle Avenue, Suite 200, Albany, NY, 12208, USA
| | - Charles Nager
- Albany Medical College, Albany NY and University of New Mexico, Albuquerque, NM, USA.,, 391 Myrtle Avenue, Suite 200, Albany, NY, 12208, USA
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Yeguez AC, Yeguez CE, Smith AL. Lost in Translation: Misconceptions and Miscommunications Among Spanish-Speaking Latinas with Pelvic Floor Disorders. Urology 2021; 163:34-43. [PMID: 34015394 DOI: 10.1016/j.urology.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 03/19/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
This review sought to identify impediments to disease understanding among Spanish-speaking Latinas with pelvic floor disorders (PFDs). Five databases were queried and reference lists were searched for relevant articles, 14 were included. Thematic analysis identified 10 themes composed of 52 findings. Three synthesized findings were established: patient-related, provider-related, and system-related barriers to care. We identified that Spanish-speaking Latinas with PFDs face multiple, interacting healthcare barriers related to language and culture at the level of the patient, provider, and healthcare system. Emerging themes identified in this review provide insights for clinical practice as well as hypotheses and directions for future research.
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Affiliation(s)
- Andrea C Yeguez
- Perelman School of Medicine, University Pennsylvania, Philadelphia, PA.
| | - Carlos E Yeguez
- Department of Psychology and Center for Children and Families, Florida International University, Miami, FL.
| | - Ariana L Smith
- Perelman School of Medicine, University Pennsylvania, Philadelphia, PA.
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Ocádiz-Flores JA, Gheribi AE, Vlieland J, de Haas D, Dardenne K, Rothe J, Konings RJM, Smith AL. Examination of the short-range structure of molten salts: ThF 4, UF 4, and related alkali actinide fluoride systems. Phys Chem Chem Phys 2021; 23:11091-11103. [PMID: 33949518 DOI: 10.1039/d1cp00566a] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The short-range structures of LiF-ThF4, NaF-AnF4, KF-AnF4, and Cs-AnF4 (An = Th, U), were probed using in situ high temperature Extended X-ray Absorption Fine Structure (EXAFS) spectroscopy. Signally, the EXAFS spectra of pure molten ThF4 and UF4 were measured for the first time. The data were interpreted with the aid of Molecular Dynamics (MD) and standard fitting of the EXAFS equation. As in related studies, a speciation distribution dominated by [AnFx]4-x (x = 7, 8, 9) coordination complexes was observed. The average coordination number was found to decrease with the increasing size of the alkali cation, and increase with AnF4 content. An average coordination number close to 6, which had not been detected before in melts of alkali actinide fluorides, was seen when CsF was used as solvent.
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Affiliation(s)
- J A Ocádiz-Flores
- Delft University of Technology, Faculty of Applied Sciences, Radiation Science & Technology Department, Mekelweg 15, 2629 JB Delft, The Netherlands
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Shoham DA, Wang Z, Lindberg S, Chu H, Brubaker L, Brady SS, Coyne-Beasley T, Fitzgerald CM, Gahagan S, Harlow BL, Joinson C, Low LK, Markland AD, Newman DK, Smith AL, Stapleton A, Sutcliffe S, Berry A. School Toileting Environment, Bullying, and Lower Urinary Tract Symptoms in a Population of Adolescent and Young Adult Girls: Preventing Lower Urinary Tract Symptoms Consortium Analysis of Avon Longitudinal Study of Parents and Children. Urology 2021; 151:86-93. [PMID: 32679271 PMCID: PMC8074340 DOI: 10.1016/j.urology.2020.06.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/22/2020] [Accepted: 06/28/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To examine whether the school toilet environment at age 13, including bullying at toilets, is associated with female lower urinary tract symptoms (LUTS) at ages 13 and 19, as little is known about the association among school toilet environment, voiding behaviors, and LUTS in adolescent girls. METHODS The sample comprised 3962 female participants from the Avon Longitudinal Study of Parents and Children. At age 13, participants reported on 7 school toilet environment characteristics and a range of LUTS items. At age 19, participants completed the Bristol Female Lower Urinary Tract Symptoms questionnaire. RESULTS All toilet environmental factors were associated with at least 1 LUTS outcome at age 13. Holding behavior was associated with all school toilet environmental factors, with odds ratios ranging from 1.36 (95% confidence interval [CI]: 1.05, 1.76) for dirty toilets to 2.38 (95% CI: 1.60, 3.52) for feeling bullied at toilets. Bullying was associated with all daytime LUTS symptoms and nocturia; odds ratios ranged from 1.60 (95% CI: 1.04, 2.07) for nocturia to 2.90 (95% CI: 1.77, 4.75) for urgency. Associations between age 13 school toilets and age 19 LUTS were in the same direction as age 13 LUTS. CONCLUSION This is the first examination of associations between school toilets and LUTS. Toileting environments were cross-sectionally associated with LUTS in adolescent girls. While further work is needed to determine whether these associations are causal, school toilet environments are modifiable and thus a promising target for LUTS prevention.
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Affiliation(s)
- David A Shoham
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL.
| | - Zhenxun Wang
- Department of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Sarah Lindberg
- Department of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Haitao Chu
- Department of Biostatistics, University of Minnesota, Minneapolis, MN
| | - Linda Brubaker
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Diego, San Diego, CA
| | - Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Tamera Coyne-Beasley
- Division of Adolescent Medicine, University of Alabama at Birmingham Medical School, Birmingham, AL
| | - Colleen M Fitzgerald
- Department of Obstetrics and Gynecology, Loyola University Chicago Stritch School of Medicine, Chicago, IL
| | - Sheila Gahagan
- Division of Academic General Pediatrics, University of California San Diego School of Medicine, San Diego, CA
| | | | | | - Lisa Kane Low
- University of Michigan School of Nursing, Women's Studies, Dept. Obstetrics and Gynecology, Ann Arbor, MI
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham School of Medicine and Birmingham VA Medical Center, Birmingham, AL
| | - Diane K Newman
- Department of Surgery, Division of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ariana L Smith
- Department of Surgery, Division of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Ann Stapleton
- Department of Medicine, University of Washington, Seattle, WA
| | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
| | - Amanda Berry
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA; Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, University of Minnesota, Minneapolis, MN
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Affiliation(s)
- Ariana L Smith
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Affiliation(s)
- Ariana L Smith
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Lane GI, Gracely A, Uberoi P, Lee U, Smith AL, Anger JT, Theva D, DeLong J, Kowalik C, Padmanabhan P, Powell CR, Carmel ME, Clemens JQ, Cameron AP, Gupta P. Changes in patient reported outcome measures after treatment for female urethral stricture. Neurourol Urodyn 2021; 40:986-993. [PMID: 33719145 DOI: 10.1002/nau.24653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/07/2022]
Abstract
INTRODUCTION There is a paucity of patient reported outcome measure (PROM) data for women with urethral strictures. To address this gap, we aim to evaluate change in PROM among women who underwent surgery for a stricture. METHODS American Urological Association Symptom Index (AUA-SI) and Urogenital Distress Inventory (UDI-6) data from a multi-institutional retrospective cohort study of women treated for urethral stricture was assessed. RESULTS Fifty-seven women had either AUA-SS or UDI-6 and 26 had baseline and postoperative data for either. Most women underwent urethroplasty (77%) and the majority (73%) remained stricture free at median follow-up of 21 months (interquartile range [IQR] 7-37). The median baseline AUA-SI was 21 (IQR 12-28) and follow-up was 10 (IQR 5-24). After treatment, there was a median decrease of 12 (IQR -18 to -2) in AUA-SI (p = 0.003). The median AUA Quality of life (QOL) score at baseline and follow-up were 6 (IQR 4-6) and 3 (IQR 2-5), respectively. There was a median AUA-QOL improvement of 2 points (-5,0; p = 0.007) from a baseline 5 (unhappy) to 3 (mixed). Median UDI-6 scores were 50 (IQR 33-75) at baseline and 17 (IQR 0-39), at follow-up. After treatment, there was a median decrease of 19 (-31 to -11; p = 0.01). CONCLUSION Women with urethral strictures have severe lower urinary tract symptoms which improved after surgery. This study substantiates the claims that recognizing and treating women with urethral stricture disease greatly improves lower urinary tract symptoms and QOL.
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Affiliation(s)
- Giulia I Lane
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alyssa Gracely
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Una Lee
- Virginia Mason, Seattle, Washington, USA
| | - Ariana L Smith
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Didi Theva
- Memorial Hospital Miramar, Miramar, Florida, USA
| | | | - Casey Kowalik
- Kansas University Medical Center, Kansas City, Kansas, USA
| | - Priya Padmanabhan
- Kansas University Medical Center, Kansas City, Kansas, USA.,Beaumont Hospital, Royal Oak, Michigan, USA
| | | | - Maude E Carmel
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - J Quentin Clemens
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne P Cameron
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
| | - Priyanka Gupta
- Department of Urology, University of Michigan, Ann Arbor, Michigan, USA
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Hendrickson WK, Amundsen CL, Rahn DD, Meyer I, Bradley MS, Smith AL, Myers DL, Jelovsek JE, Lukacz ES. Comparison of 100 U With 200 U of Intradetrusor OnabotulinumToxinA for Nonneurogenic Urgency Incontinence. Female Pelvic Med Reconstr Surg 2021; 27:140-146. [PMID: 33620895 PMCID: PMC8117667 DOI: 10.1097/spv.0000000000001020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to compare efficacy and adverse events between 100 U and 200 U of onabotulinumtoxinA for 6 months in women with nonneurogenic urgency incontinence. METHODS This is a secondary analysis of 2 multicenter randomized controlled trials assessing efficacy of onabotulinumtoxinA in women with nonneurogenic urgency incontinence; one compared 100 U to anticholinergics and the other 200 U to sacral neuromodulation. Of 307 women who received onabotulinumtoxinA injections, 118 received 100 U, and 189 received 200 U. The primary outcome was mean adjusted change in daily urgency incontinence episodes from baseline over 6 months, measured on monthly bladder diaries. Secondary outcomes included perceived improvement, quality of life, and adverse events. The primary outcome was assessed via a multivariate linear mixed model. RESULTS Women receiving 200 U had a lower mean reduction in urgency incontinence episodes by 6 months compared with 100 U (-3.65 vs -4.28 episodes per day; mean difference, 0.63 episodes per day [95% confidence interval (CI), 0.05-1.20]). Women receiving 200 U had lower perceptions of improvement (adjusted odds ratio, 0.32 [95% CI, 0.14-0.75]) and smaller improvement in severity score (adjusted mean difference, 12.0 [95% CI, 5.63-18.37]). Upon subanalysis of only women who were treated with prior anticholinergic medications, these differences between onabotulinumtoxinA doses were no longer statistically significant. There was no statistically significant difference in adverse events in women receiving 200 U (catheterization, 32% vs 23%; adjusted odds ratio, 1.4 [95% CI, 0.8-2.4]; urinary tract infection, 37% vs 27%; adjusted odds ratio, 1.5 [95% CI, 0.9-2.6]). CONCLUSIONS A higher dose of onabotulinumtoxinA may not directly result in improved outcomes, but rather baseline disease severity may be a more important prediction of outcomes.
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Affiliation(s)
- Whitney K Hendrickson
- From the Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
| | - Cindy L Amundsen
- From the Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
| | - David D Rahn
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, UT Southwestern Medical Center, Dallas, TX
| | - Isuzu Meyer
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL
| | - Megan S Bradley
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Services, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Deborah L Myers
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Brown University, Providence, RI
| | - J Eric Jelovsek
- From the Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC
| | - Emily S Lukacz
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, UC San Diego, San Diego, CA
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Williams BR, Vargo K, Newman DK, Yvette Lacoursiere D, Mueller ER, Connett J, Low LK, James AS, Smith AL, Schmitz KH, Burgio KL. It's About Time: The Temporal Burden of Lower Urinary Tract Symptoms Among Women. Urol Nurs 2020; 40:10.7257/1053-816x.2020.40.6.277. [PMID: 33642840 PMCID: PMC7906293 DOI: 10.7257/1053-816x.2020.40.6.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This secondary analysis studied 50 transcripts of women who shared day-to-day experiences of lower urinary tract symptoms (LUTS) and characterized temporal (time-associated) features of living with LUTS. Findings revealed two overarching time-associated themes: The Complexity of LUTS and The Quest for Empowerment over LUTS. Findings suggest that the temporal burden of LUTS is the accumulated impact of symptoms and symptom management on women's daily lives within multiple contexts across the life course. Increasing nurses' knowledge of the temporal context of LUTS may heighten awareness and improve symptom detection and management.
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Affiliation(s)
- Beverly Rosa Williams
- University of Alabama at Birmingham School of Medicine, Department of Veterans Affairs, Birmingham, AL
| | - Keith Vargo
- University of Minnesota School of Public Health
| | - Diane K Newman
- Division of Urology, Department of Surgery, University of Pennsylvania, Perelman School of Medicine
| | | | | | | | | | - Aimee S James
- Washington University in St. Louis School of Medicine
| | | | | | - Kathryn L Burgio
- University of Alabama at Birmingham School of Medicine, Department of Veterans Affairs, Birmingham, AL
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Lane GI, Smith AL, Stambakio H, Lin G, Al Hussein Alawamlh O, Anger JT, Brandes ER, Carmel ME, Chung DE, Cox L, DeLong J, Elliott CS, Eltahawy E, Aparecido França W, Gousse A, Gupta P, Hagedorn JC, High RA, Khan A, Kowalik C, Lee RK, Lee UJ, Lucioni A, MacDonald S, Malaeb B, McKay S, Padmanabhan P, Powell CR, Sajadi KP, Sutherland SE, Theva D, Vollstedt A, Welk B, Zheng Y, Cameron AP. Treatment of urethral stricture disease in women: A multi‐institutional collaborative project from the SUFU research network. Neurourol Urodyn 2020; 39:2433-2441. [PMID: 32926460 DOI: 10.1002/nau.24507] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/11/2020] [Accepted: 08/27/2020] [Indexed: 01/18/2023]
Abstract
AIM Female urethral stricture disease is rare and has several surgical approaches including endoscopic dilations (ENDO), urethroplasty with local vaginal tissue flap (ULT) or urethroplasty with free graft (UFG). This study aims to describe the contemporary management of female urethral stricture disease and to evaluate the outcomes of these three surgical approaches. METHODS This is a multi-institutional, retrospective cohort study evaluating operative treatment for female urethral stricture. Surgeries were grouped into three categories: ENDO, ULT, and UFG. Time from surgery to stricture recurrence by surgery type was analyzed using a Kaplan-Meier time to event analysis. To adjust for confounders, a Cox proportional hazard model was fit for time to stricture recurrence. RESULTS Two-hundred and ten patients met the inclusion criteria across 23 sites. Overall, 64% (n = 115/180) of women remained recurrence free at median follow-up of 14.6 months (IQR, 3-37). In unadjusted analysis, recurrence-free rates differed between surgery categories with 68% ENDO, 77% UFG and 83% ULT patients being recurrence free at 12 months. In the Cox model, recurrence rates also differed between surgery categories; women undergoing ULT and UFG having had 66% and 49% less risk of recurrence, respectively, compared to those undergoing ENDO. When comparing ULT to UFG directly, there was no significant difference of recurrence. CONCLUSION This retrospective multi-institutional study of female urethral stricture demonstrates that patients undergoing endoscopic management have a higher risk of recurrence compared to those undergoing either urethroplasty with local flap or free graft.
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Affiliation(s)
- Giulia I. Lane
- Department of Urology University of Michigan Ann Arbor Michigan USA
| | - Ariana L. Smith
- Division of Urology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Hanna Stambakio
- Division of Urology University of Pennsylvania Philadelphia Pennsylvania USA
| | - George Lin
- Division of Urology University of Pennsylvania Philadelphia Pennsylvania USA
| | | | | | - Eileen R. Brandes
- Section of Urology Dartmouth Hitchcock Medical Center Lebanon New Hampshire USA
| | - Maude E. Carmel
- Department of Urology University of Texas Southwestern Medical Center Dallas Texas USA
| | | | - Lindsey Cox
- Department of Urology Medical University of South Carolina Charleston South Carolina USA
| | - Jessica DeLong
- Department of Urology Eastern Virginia Medical School Norfolk Virginia USA
| | | | - Ehab Eltahawy
- Department of Urology University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Wagner Aparecido França
- Department of Urology Hospital do Servidor Público Estadual de São Paulo ‐ IAMSPE São Paulo Brazil
| | - Angelo Gousse
- Department of Urology Memorial Hospital Miramar Miramar Florida USA
| | - Priyanka Gupta
- Department of Urology University of Michigan Ann Arbor Michigan USA
| | | | - Rachel A. High
- Department of Urology Baylor Scott and White Health Temple Texas USA
| | - Aqsa Khan
- Department of Urology Mayo Clinic Phoenix Arizona USA
| | - Casey Kowalik
- Department of Urology Kansas University Medical Center Kansas City Kansas USA
| | - Richard K. Lee
- Department of Urology Weill Cornell Medicine NYC New York USA
| | - Una J. Lee
- Department of Urology Virginia Mason Seattle Washington USA
| | - Alvaro Lucioni
- Department of Urology Virginia Mason Seattle Washington USA
| | - Susan MacDonald
- Division of Urology Penn State Hershey Medical Center Hershey Pennsylvania USA
| | - Bahaa Malaeb
- Department of Urology University of Michigan Ann Arbor Michigan USA
| | - Scotty McKay
- Department of Urology University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | | | | | - Kamran P. Sajadi
- Department of Urology Oregon Health & Science University Portland Oregon USA
| | | | - Didi Theva
- Department of Urology Memorial Hospital Miramar Miramar Florida USA
| | - Annah Vollstedt
- Division of Urology University of Pennsylvania Philadelphia Pennsylvania USA
| | - Blayne Welk
- Division of Urology Western University London Ontario Canada
| | - Yu Zheng
- Department of Urology Medical University of South Carolina Charleston South Carolina USA
| | - Anne P. Cameron
- Department of Urology University of Michigan Ann Arbor Michigan USA
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Sutcliffe S, Cain C, Bavendam T, Epperson CN, Fitzgerald CM, Gahagan S, Markland AD, Shoham DA, Smith AL, Rudser K. Revisiting the Spectrum of Bladder Health: Relationships Between Lower Urinary Tract Symptoms and Multiple Measures of Well-Being. J Womens Health (Larchmt) 2020; 29:1077-1090. [PMID: 32831001 DOI: 10.1089/jwh.2019.8167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Little research to date has investigated the spectrum of bladder health in women, including both bladder function and well-being. Therefore, we expanded our previous baseline analysis of bladder health in the Boston Area Community Health (BACH) Survey to incorporate several additional measures of bladder-related well-being collected at the 5-year follow-up interview, including one developed specifically for women. Methods: At follow-up, participants reported their frequency of 15 lower urinary tract symptoms (LUTS), degree of life impact from and thought related to urinary symptoms or pelvic/bladder pain/discomfort, and perception of their bladder condition. Prevalence ratios were calculated by generalized linear models with robust variance estimation, adjusting for LUTS risk factors and individual LUTS. The BACH Survey was approved by the New England Research Institutes Institutional Review Board and all participants provided written informed consent. Results: Generally similar findings were observed in the 5-year cross-sectional analysis as at baseline, irrespective of how we categorized LUTS or measured bladder-related well-being. Approximately one in five women (16.2%-18.0% of 2527 eligible women) reported no LUTS and no diminished bladder-related well-being, the majority (55.8%-65.7%) reported some LUTS and/or diminished well-being, and a further one in five (16.9%-26.6%) reported the maximum frequency, number, or degree of LUTS and/or diminished well-being. Measures of storage function (urinating again after <2 hours, perceived frequency, nocturia, incontinence, and urgency) and pain were independently associated with bladder-related well-being. Conclusions: Our similar distribution of bladder health and consistent associations between LUTS and bladder-related well-being across multiple measures of well-being, including a female-specific measure, lend confidence to the concept of a bladder health spectrum and reinforce the bothersome nature of storage dysfunction and pain.
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Affiliation(s)
- Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.,Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, Missouri, USA.,The Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Charles Cain
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tamara Bavendam
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - C Neill Epperson
- Department of Psychiatry, University of Colorado School of Medicine-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Colleen M Fitzgerald
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Sheila Gahagan
- Division of Child Development and Community Health, University of California, San Diego, California, USA
| | - Alayne D Markland
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine at the University of Alabama at Birmingham and the Birmingham Geriatric Research, Education, and Clinical Center at the Birmingham VAMC, Birmingham, Alabama, USA
| | - David A Shoham
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, USA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kyle Rudser
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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Smith AL, Weissbart SJ. Gynecologic Considerations for the Urologic Surgeon. Urology 2020; 150:116-124. [PMID: 32739307 DOI: 10.1016/j.urology.2020.05.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/17/2020] [Accepted: 05/25/2020] [Indexed: 11/17/2022]
Abstract
While gynecologic malignancy is uncommon in women with conditions such as pelvic organ prolapse and bladder cancer, urologists should be acquainted with the relevant gynecologic literature as it pertains to their surgical care of female patients. While taking the patient history, urologists should be aware of prior cervical cancer screening and ask about vaginal bleeding, which can be a sign of uterine cancer. Urologic surgeons should also discuss the role of concomitant prophylactic oophorectomy and/or salpingectomy for ovarian cancer risk reduction at the time of pelvic surgery. An understanding of basic tests, such as a transvaginal sonogram, can help urologists provide comprehensive care.
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Affiliation(s)
- Ariana L Smith
- Department of Surgery, University of Pennsylvania's Perelman School of Medicine, Philadelphia, PA.
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40
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Cruz AP, Chelluri R, Ramchandani P, Guzzo TJ, Smith AL. Post-cystectomy Enterocele: A Case Series and Review of the Literature. Urology 2020; 150:180-187. [PMID: 32512108 DOI: 10.1016/j.urology.2020.03.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/08/2020] [Accepted: 03/22/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To present a case series and literature review on post radical cystectomy (RC) pelvic organ prolapse (POP) to heighten awareness of the symptoms, imaging findings, and risk factors associated with this complication and discuss opportunities for prevention. Women with muscle invasive bladder cancer undergo RC with anterior exenteration, significantly disrupting the pelvic floor. These women are at risk for POP. METHODS We present 4 cases of high-grade POP in women who underwent RC for bladder cancer. We reviewed the literature by conducting a Boolean search in PubMed with the terms "("radical cystectomy") AND ("enterocele" OR "pelvic organ prolapse" OR "rectocele" OR "vaginal vault prolapse")." RESULTS All 4 women reported a bulge sensation in the vagina and physical exam confirmed POP. Three had radiographic findings consistent with high-grade enterocele at rest. Three experienced prolonged intra-abdominal pressure rise post-RC that may have further weakened pelvic floor support, while the fourth had a history of surgery for high-grade POP. Nine articles on POP following RC were identified. Four focused on treatment and 3 focused on prevention. CONCLUSION Administration of a single validated question would have identified all 4 cases of postoperative enterocele and is sensitive to detect most women who are experiencing POP. Attention to the pelvic floor on cross-sectional imaging with identification of features that indicate POP, such as herniation of intestinal contents below the pubo-coccygeal line, will identify and/or confirm high-grade enterocele. Familiarity with risk factors for POP and identification of weakened vaginal wall support opens up the opportunity for prevention.
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Affiliation(s)
- Alan P Cruz
- University of Michigan Medical School, Ann Arbor, MI
| | - Raju Chelluri
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Parvati Ramchandani
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Thomas J Guzzo
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ariana L Smith
- Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Brady SS, Berry A, Camenga DR, Fitzgerald CM, Gahagan S, Hardacker CT, Harlow BL, Hebert-Beirne J, LaCoursiere DY, Lewis JB, Low LK, Lowder JL, Markland AD, McGwin G, Newman DK, Palmer MH, Shoham DA, Smith AL, Stapleton A, Williams BR, Sutcliffe S. Applying concepts of life course theory and life course epidemiology to the study of bladder health and lower urinary tract symptoms among girls and women. Neurourol Urodyn 2020; 39:1185-1202. [PMID: 32119156 PMCID: PMC7659467 DOI: 10.1002/nau.24325] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/23/2020] [Indexed: 01/18/2023]
Abstract
AIMS Although lower urinary tract symptoms (LUTS) may occur at different periods during the life course of women, a little research on LUTS has adopted a life course perspective. The purpose of this conceptual paper is to demonstrate how life course theory and life course epidemiology can be applied to study bladder health and LUTS trajectories. We highlight conceptual work from the Prevention of Lower Urinary Tract Symptoms Research Consortium to enhance the understanding of life course concepts. METHODS Consortium members worked in transdisciplinary teams to generate examples of how life course concepts may be applied to research on bladder health and LUTS in eight prioritized areas: (a) biopsychosocial ecology of stress and brain health; (b) toileting environment, access, habits, and techniques; (c) pregnancy and childbirth; (d) physical health and medical conditions; (e) musculoskeletal health; (f) lifestyle behaviors; (g) infections and microbiome; and (h) hormonal status across the life span. RESULTS Life course concepts guided consortium members' conceptualization of how potential risk and protective factors may influence women's health. For example, intrapartum interventions across multiple pregnancies may influence trajectories of bladder health and LUTS, illustrating the principle of life span development. Consortium members also identified and summarized methodologic and practical considerations in designing life course research. CONCLUSIONS This paper may assist researchers from a variety of disciplines to design and implement research identifying key risk and protective factors for LUTS and bladder health across the life course of women. Results from life course research may inform health promotion programs, policies, and practices.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Amanda Berry
- Department of Surgery, Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Deepa R Camenga
- Department of Emergency Medicine and Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Colleen M Fitzgerald
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Sheila Gahagan
- Department of Pediatrics, Division of Academic General Pediatrics, University of California San Diego School of Medicine, San Diego, California
| | | | - Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Jeni Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - D Yvette LaCoursiere
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, San Diego, California
| | - Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Lisa K Low
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Alayne D Markland
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama, Birmingham, Alabama
- Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - Diane K Newman
- Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary H Palmer
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - David A Shoham
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois
| | - Ariana L Smith
- Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann Stapleton
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, Washington
| | - Beverly R Williams
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama, Birmingham, Alabama
| | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri
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Smith AL, Rickey LM, Brady SS, Fok CS, Lowder JL, Markland AD, Mueller ER, Sutcliffe S, Bavendam TG, Brubaker L. Laying the Foundation for Bladder Health Promotion in Women and Girls. Urology 2020; 150:227-233. [PMID: 32197984 DOI: 10.1016/j.urology.2020.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 02/27/2020] [Accepted: 03/05/2020] [Indexed: 01/03/2023]
Abstract
Prevention strategies have been effective in many areas of human health, yet have not been utilized for lower urinary tract symptoms (LUTS) or bladder health (BH). This commentary outlines LUTS prevention research initiatives underway within the NIH-sponsored Prevention of Lower Urinary Tract Symptoms Research Consortium (PLUS). Prevention science involves the systematic study of factors associated with health and health problems, termed protective and risk factors, respectively. PLUS is enhancing traditional prevention science approaches through use of: (1) a transdisciplinary team science approach, (2) both qualitative and quantitative research methodology (mixed methodology), and (3) community engagement. Important foundational work of PLUS includes development of clear definitions of both BH and disease, as well as a BH measurement instrument that will be validated for use in the general population, adolescents, and Latinx and Spanish-speaking women.1 The BH measurement instrument will be used in an upcoming nationally-representative cohort study that will measure BH and investigate risk and protective factors. PLUS investigators also developed a conceptual framework to guide their research agenda; this framework organizes a broad array of candidate risk and protective factors that can be studied across the life course of girls and women.1 As PLUS begins to fill existing knowledge gaps with new information, its efforts will undoubtedly be complemented by outside investigators to further advance the science of LUTS prevention and BH across additional populations. Once the BH community has broadened its understanding of modifiable risk and protective factors, intervention studies will be necessary to test LUTS prevention strategies and support public health efforts. LUTS providers may be able to translate this evolving evidence for individual patients under their care and act as BH advocates in their local communities.
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Affiliation(s)
- Ariana L Smith
- Department of Surgery, University of Pennsylvania's Perelman School of Medicine, Philadelphia, PA.
| | - Leslie M Rickey
- Department of Urology, Yale University School of Medicine, New Haven, CT
| | - Sonya S Brady
- Department of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Cynthia S Fok
- Department of Urology, University of Minnesota, Minneapolis MN
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Washington University, St Louis, MO
| | - Alayne D Markland
- Department of Medicine, University of Alabama at Birmingham and the Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Birmingham, AL
| | - Elizabeth R Mueller
- Departments of Obstetrics and Gynecology & Urology, Stritch School of Medicine, Loyola University Chicago, Chicago IL
| | | | | | - Linda Brubaker
- Department of Obstetrics, Gynecology and Reproductive Sciences, UC San Diego, San Diego, CA
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Meyer I, Whitworth RE, Lukacz ES, Smith AL, Sung VW, Visco AG, Ackenbom MF, Wai CY, Mazloomdoost D, Gantz MG, Richter HE. Outcomes of native tissue transvaginal apical approaches in women with advanced pelvic organ prolapse and stress urinary incontinence. Int Urogynecol J 2020; 31:2155-2164. [PMID: 32146521 DOI: 10.1007/s00192-020-04271-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 02/18/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Limited data exist comparing different surgical approaches in women with advanced vaginal prolapse. This study compared 2-year surgical outcomes of uterosacral ligament suspension (ULS) and sacrospinous ligament fixation (SSLF) in women with advanced prolapse (stage III-IV) and stress urinary incontinence. METHODS This was a secondary analysis of a multicenter 2 × 2 factorial randomized trial comparing (1) ULS versus SSLF and (2) behavioral therapy with pelvic floor muscle training versus usual care. Of 374 subjects, 117/188 (62.7%) in the ULS and 113/186 (60.7%) in the SSLF group had advanced prolapse. Two-year surgical success was defined by the absence of (1) apical descent > 1/3 into the vaginal canal, (2) anterior/posterior wall descent beyond the hymen, (3) bothersome bulge symptoms, and (4) retreatment for prolapse. Secondary outcomes included individual success outcome components, symptom severity measured by the Pelvic Organ Prolapse Distress Inventory, and adverse events. Outcomes were also compared in women with advanced prolapse versus stage II prolapse. RESULTS Success did not differ between groups (ULS: 58.2% [57/117] versus SSLF: 58.5% [55/113], aOR 1.0 [0.5-1.8]). No differences were detected in individual success components (p > 0.05 for all components). Prolapse symptom severity scores improved in both interventions with no intergroup differences (p = 0.82). Serious adverse events did not differ (ULS: 19.7% versus SSLF: 16.8%, aOR 1.2 [0.6-2.4]). Success was lower in women with advanced prolapse compared with stage II (58.3% versus 73.2%, aOR 0.5 [0.3-0.9]), with no retreatment in stage II. CONCLUSIONS Surgical success, symptom severity, and overall serious adverse events did not differ between ULS and SSLF in women with advanced prolapse. ClinicalTrials.gov Identifier: NCT01166373.
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Affiliation(s)
- Isuzu Meyer
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL, 35249, USA.
| | - Ryan E Whitworth
- RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC, USA
| | - Emily S Lukacz
- Department of Reproductive Medicine, University of California-San Diego Health Systems, San Diego, CA, USA
| | - Ariana L Smith
- Department of Surgery, Division of Urology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Vivian W Sung
- Division of Urogynecology and Reconstructive Pelvic Surgery, Alpert Medical School of Brown University, Providence, RI, USA
| | - Anthony G Visco
- Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Mary F Ackenbom
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Clifford Y Wai
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Donna Mazloomdoost
- The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Marie G Gantz
- RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC, USA
| | - Holly E Richter
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham, 619 19th Street South, Birmingham, AL, 35249, USA
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Williams BR, Nodora J, Newman DK, Kane Low L, James AS, Camenga DR, Hebert-Beirne J, Brady SS, Hardacker CT, Smith AL, Cunningham SD, Burgio KL, Prevention Of Lower Urinary Tract Symptoms Plus Research Consortium. I never knew anyone who peed on themselves on purpose: Exploring adolescent and adult women's lay language and discourse about bladder health and function. Neurourol Urodyn 2020; 39:225-236. [PMID: 31578778 PMCID: PMC8126963 DOI: 10.1002/nau.24174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/09/2019] [Indexed: 11/06/2022]
Abstract
AIMS This analysis explored and characterized adolescent and adult women's lay language and discourse related to bladder health/function. METHODS Forty-four focus groups were conducted across seven United States research centers with 360 adolescents and adult women, organized by six age categories. Multilevel content analyses classified emergent themes. A transdisciplinary lens and inductive approach guided data interpretation. Interpretive insights were validated by a community engagement panel. RESULTS A repertoire of bladder function terms emerged, including explicit functional terms, formal and polite euphemistic terms, and informal familiar terms, as well as cultural and regional metaphors and idioms. Terminology usage was historically grounded, developmental, and cumulative across the life course. Lay discourse was contextual and affectively valent, suggesting unspoken, commonly understood, situation-based "rules" for talking about bladder function. Discourse appeared to be siloed within family and friendship circles. Adolescents and adult women often described, rather than named, bladder sensations or problems. Terminology for bladder issues tended to minimize severity and frequency, with medical language only relevant to extreme examples and not applicable to mild episodes. CONCLUSIONS A definitional discordance between medical and lay views of bladder problems was identified, signifying a need to clarify the meaning of medical terms for lay persons. Adolescents and adult women do not have or use standardized precise terminology for bladder health and function, relying instead on social convention and interpersonal context. Findings can be used to foster shared understandings between lay persons and health professionals, informing development of clinical, research, and public health initiatives to promote bladder health.
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Affiliation(s)
- Beverly Rosa Williams
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB), Alabama
| | - Jesse Nodora
- Department of Family Medicine and Public Health, University of California-San Diego Moores Cancer Center, San Diego, California
| | - Diane K Newman
- Adjunct Professor of Urology in Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Pennsylvania
| | - Lisa Kane Low
- Women's Studies and Department of Obstetrics and Gynecology, University of Michigan, Michigan
| | - Aimee S James
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Washington
| | - Deepa R Camenga
- Department of Emergency Medicine (Pediatrics), Section of Research, Yale School of Medicine, Connecticut
| | - Jeni Hebert-Beirne
- Community Health Sciences, School of Public Health, University of Illinois at Chicago, Illinois
| | - Sonya S Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minnesota
| | - Cecilia T Hardacker
- Department of Education, Center for Education, Research and Advocacy, Howard Brown Health, Chicago, Illinois
- Adjunct Instructor, Rush University College of Nursing, Illinois
| | - Ariana L Smith
- Division of Urology, Department of Surgery, University of Pennsylvania Health System, Pennsylvania
| | - Shayna D Cunningham
- Social and Behavioral Sciences Department, Yale School of Public Health, Connecticut
| | - Kathryn L Burgio
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, Geriatric Research, Education and Clinical Center, Department of Veterans Affairs, University of Alabama at Birmingham (UAB) and Birmingham/Atlanta, Alabama
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Smith AL, Weissbart SJ, Hartigan SM, Bilello M, Newman DK, Wein AJ, Malykhina AP, Erus G, Fan Y. Association between urinary symptom severity and white matter plaque distribution in women with multiple sclerosis. Neurourol Urodyn 2019; 39:339-346. [PMID: 31691357 DOI: 10.1002/nau.24206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/01/2019] [Indexed: 12/12/2022]
Abstract
AIMS Multiple sclerosis (MS) is characterized by demyelinated white matter plaque throughout the central nervous system. Plaque involvement in regions that regulate micturition may be associated with urinary symptom severity in patients with MS. The aim of this prospective study is to investigate the relationship between cerebral plaque volume (PV), location, and urinary symptoms in women with MS. METHODS We conducted a case-control pilot study of women with MS undergoing routine yearly brain MRI. Women were administered the American Urologic Association-Symptom Index (AUA-SI) and divided into two groups: severe urinary symptoms (AUA-SI ≥20) and mild symptoms (AUA-SI ≤7). PV and location in the brain were determined using a validated automated white matter lesion segmentation algorithm. RESULTS This study of 36 women found that the median total PV did not differ between groups. Women with severe urinary symptoms had larger median PV in the left frontal lobe (LFL) and right limbic lobe (RLL) compared with women with mild urinary symptoms. Within the RLL, women with severe symptoms had a larger median PV in the right cingulate gyrus (RCG). There was a moderate correlation between LFL lesion volume and RLL lesion volume with the AUA emptying subscore; however, these regions did not correlate with the storage subscore. CONCLUSIONS This preliminary study found urinary symptom severity in women with MS is associated with PV in the RCG and LFL, and not total cerebral PV. These findings may explain why disease burden alone is not a predictor of severity or type of voiding dysfunction in patients with MS.
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Affiliation(s)
- Ariana L Smith
- Division of Urology, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Steven J Weissbart
- Department of Urology, School of Medicine, Stony Brook University, New York, New York
| | | | - Michel Bilello
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Diane K Newman
- Division of Urology, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Alan J Wein
- Division of Urology, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| | - Anna P Malykhina
- Division of Urology, University of Colorado Denver, Aurora, Colorado
| | - Guray Erus
- Department of Radiology, Center for Biomedical Image Computing and Analytics (CBICA), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yong Fan
- Department of Radiology, Center for Biomedical Image Computing and Analytics (CBICA), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Sung VW, Borello-France D, Newman DK, Richter HE, Lukacz ES, Moalli P, Weidner AC, Smith AL, Dunivan G, Ridgeway B, Nguyen JN, Mazloomdoost D, Carper B, Gantz MG. Effect of Behavioral and Pelvic Floor Muscle Therapy Combined With Surgery vs Surgery Alone on Incontinence Symptoms Among Women With Mixed Urinary Incontinence: The ESTEEM Randomized Clinical Trial. JAMA 2019; 322:1066-1076. [PMID: 31529007 PMCID: PMC6749544 DOI: 10.1001/jama.2019.12467] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Mixed urinary incontinence, including both stress and urgency incontinence, has adverse effects on a woman's quality of life. Studies evaluating treatments to simultaneously improve both components are lacking. OBJECTIVE To determine whether combining behavioral and pelvic floor muscle therapy with midurethral sling is more effective than sling alone for improving mixed urinary incontinence symptoms. DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial involving women 21 years or older with moderate or severe stress and urgency urinary incontinence symptoms for at least 3 months, and at least 1 stress and 1 urgency incontinence episode on a 3-day bladder diary. The trial was conducted across 9 sites in the United States, enrollment between October 2013 and April 2016; final follow-up October 2017. INTERVENTIONS Behavioral and pelvic floor muscle therapy (included 1 preoperative and 5 postoperative sessions through 6 months) combined with midurethral sling (n = 209) vs sling alone (n = 207). MAIN OUTCOMES AND MEASURES The primary outcome was change between baseline and 12 months in mixed incontinence symptoms measured by the Urogenital Distress Inventory (UDI) long form; range, 0 to 300 points; minimal clinically important difference, 35 points, with higher scores indicating worse symptoms. RESULTS Among 480 women randomized (mean [SD] age, 54.0 years [10.7]), 464 were eligible and 416 (86.7%) had postbaseline outcome data and were included in primary analyses. The UDI score in the combined group significantly decreased from 178.0 points at baseline to 30.7 points at 12 months, adjusted mean change -128.1 points (95% CI, -146.5 to -109.8). The UDI score in the sling-only group significantly decreased from 176.8 to 34.5 points, adjusted mean change -114.7 points (95% CI, -133.3 to -96.2). The model-estimated between-group difference (-13.4 points; 95% CI, -25.9 to -1.0; P = .04) did not meet the minimal clinically important difference threshold. Related and unrelated serious adverse events occurred in 10.2% of the participants (8.7% combined and 11.8% sling only). CONCLUSIONS AND RELEVANCE Among women with mixed urinary incontinence, behavioral and pelvic floor muscle therapy combined with midurethral sling surgery compared with surgery alone resulted in a small statistically significant difference in urinary incontinence symptoms at 12 months that did not meet the prespecified threshold for clinical importance. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01959347.
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Affiliation(s)
- Vivian W. Sung
- The Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Diane Borello-France
- Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania
| | - Diane K. Newman
- The Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Holly E. Richter
- Division of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Alabama at Birmingham
| | - Emily S. Lukacz
- The Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Diego, La Jolla
| | - Pamela Moalli
- Women’s Center for Bladder and Pelvic Health, Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alison C. Weidner
- Division of Urogynecology, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina
| | - Ariana L. Smith
- The Division of Urology, Department of Surgery, Perelman School of Medicine, University of Pennsylvania Health System, Philadelphia
| | - Gena Dunivan
- The Division of Urogynecology, Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque
| | - Beri Ridgeway
- Center for Urogynecology and Reconstructive Pelvic Surgery, Obstetrics, Gynecology and Women’s Health Institute, Cleveland Clinic, Cleveland, Ohio
| | - John N. Nguyen
- The Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics & Gynecology, Kaiser Permanente, Downey, California
| | - Donna Mazloomdoost
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
| | - Benjamin Carper
- Social, Statistical, & Environmental Sciences, RTI International, Research Triangle Park, North Carolina
| | - Marie G. Gantz
- Social, Statistical, & Environmental Sciences, RTI International, Research Triangle Park, North Carolina
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Sutcliffe S, Bavendam T, Cain C, Epperson CN, Fitzgerald CM, Gahagan S, Markland AD, Shoham DA, Smith AL, Townsend MK, Rudser K. The Spectrum of Bladder Health: The Relationship Between Lower Urinary Tract Symptoms and Interference with Activities. J Womens Health (Larchmt) 2019; 28:827-841. [PMID: 31058573 PMCID: PMC6590721 DOI: 10.1089/jwh.2018.7364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background: Little research to date has focused on lower urinary tract symptom (LUTS) prevention and bladder health promotion in women. To address this gap, the Prevention of LUTS Research Consortium developed the following working bladder health definition: "A complete state of physical, mental, and social well-being related to bladder function [that] permits daily activities [and] allows optimal well-being." To begin to inform and quantify this definition, we used data from the Boston Area Community Health Survey, drawing upon its rare collection of information on LUTS and LUTS-specific interference with activities. Methods: At baseline, participants reported their frequency of 15 LUTS and interference with 7 activities. Prevalence ratios (PRs) were calculated by generalized linear models with robust variance estimation, adjusting for LUTS risk factors and individual LUTS. Results: Of the 3169 eligible participants, 17.5% reported no LUTS or interference, whereas the remaining 82.5% reported some frequency of LUTS/interference: 15.1% rarely; 21.7% a few times; 22.6% fairly often/usually; and 22.9% almost always. LUTS independently associated with interference were urgency incontinence, any incontinence, urgency, nocturia, perceived frequency, and urinating again after <2 hours (PRs = 1.2-1.5, all p < 0.05). Conclusions: Our findings suggest that bladder health exists on a continuum, with approximately one in five women considered to have optimal bladder health (no LUTS/interference), the majority to have intermediate health (LUTS/interference rarely to usually), and a further one in five to have worse or poor health (LUTS/interference almost always). These findings underscore the need for LUTS prevention and bladder health promotion.
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Affiliation(s)
- Siobhan Sutcliffe
- Address correspondence to: Siobhan Sutcliffe, PhD, Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO 63110
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Abstract
PURPOSE OF REVIEW The purpose of this paper is to review (1) the epidemiology and pathophysiology of pelvic organ prolapse (POP) and occult stress urinary incontinence (SUI), (2) examine the data on combined operative management of POP and occult SUI, (3) discuss the approaches to clinical decision making, and (4) present future therapies. RECENT FINDINGS Prospective data on many approaches to concomitant treatment of prolapse and occult stress urinary incontinence, such as minimally invasive sacrocolpopexy and midurethral sling, or older approaches that have regained favor among patients and clinicians wishing to avoid synthetic mesh, such as native tissue prolapse repair and pubovaginal sling, are limited. Safe durable treatments with absorbable graft materials that promote a beneficial host response are intriguing but may be far from clinical implementation. Stem cell therapy for the treatment of stress urinary incontinence has demonstrated benefit in phase I/II trials but has not been studied in the setting of concomitant treatment of occult SUI with POP surgery and remains in the preclinical phase for the treatment of POP. A personalized approach to concomitant SUI surgery that incorporates individual risk assessment as well as informed patient preferences likely optimizes the risk/benefit ratio and patient satisfaction. Novel therapies, including graft materials and cellular therapies that stimulate a regenerative response, may improve or maintain continence outcomes while mitigating risk and alter the approach to both POP and SUI surgery.
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Affiliation(s)
- Joshua A Cohn
- Department of Urology, Einstein Healthcare Network, 50 E. Township Line Road, Suite 202, Elkins Park, Philadelphia, PA, 19027, USA. .,Fox Chase Cancer Center, Philadelphia, PA, USA.
| | - Ariana L Smith
- University of Pennsylvania Health System and Perelman School of Medicine, Philadelphia, PA, USA
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Abstract
Understanding the pathophysiologic mechanisms responsible for overactive bladder (OAB) and urgency urinary incontinence (UUI) is critical to advancing the treatment options available to men and women with this prevalent and bothersome condition. Development of novel technologies and advanced functional neuroimaging modalities has provided us with new information to support and refine existing mechanistic theories. Emerging research on central pathophysiologic mechanisms of OAB from functional magnetic resonance imaging may provide new targets for therapeutic interventions and opens the door for novel treatment strategies. Several regions of interest—specifically the anterior cingulate gyrus, insula, and frontal cortices—have been implicated as areas of activation in women with OAB, suggesting a neural correlate of the experience of urgency. The cerebellum and parietal lobe have demonstrated increased activation during inhibition of voiding, and increased connectivity between the cerebellum and parietal lobe and the right insula and anterior cingulate gyrus has been demonstrated in women with UUI compared with controls. Evolving literature is beginning to shed light on the prerequisite effective connections between regions of interest in the healthy bladder and negative connectivity in OAB and UUI. Precision medicine with individualized care pathways may better select available treatment modalities for rightful recipients, thus improving efficacy with prescribed treatment approaches and adherence to therapy.
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Affiliation(s)
- Ariana L Smith
- Division of Urology, University of Pennsylvania , Philadelphia, PA, USA
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50
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Smith AL, Kolon TF, Canning DA, Weissbart SJ. Partially Obstructed Longitudinal Vaginal Septum Presenting in Adulthood With Complaint of Urinary Incontinence. Urology 2018; 124:302-305. [PMID: 30471368 DOI: 10.1016/j.urology.2018.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 11/05/2018] [Accepted: 11/13/2018] [Indexed: 11/26/2022]
Abstract
A longitudinal vaginal septum can be obstructive or nonobstructive. We report on an adult woman who presented with involuntary fluid loss per vagina and had a partially obstructive longitudinal vaginal septum. A 36-year-old nulliparous female presented with malodorous, clear, leakage per vagina that she described as "urinary incontinence." Examination revealed a fluid-filled fluctuant anterior vaginal wall with a draining sinus. Imaging revealed a solitary right kidney with duplicated ectopic fluid-filled ureters inserting into a partially obstructed left hemivagina with a longitudinal vaginal septum. A longitudinal vaginal septum may present in adulthood with the complaint of urinary incontinence.
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Affiliation(s)
- Ariana L Smith
- University of Pennsylvania, Division of Urology, Philadelphia, PA.
| | - Thomas F Kolon
- University of Pennsylvania, Division of Urology, Philadelphia, PA
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