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Pauwaert K, Goessaert AS, Robinson D, Cardozo L, Bower W, Calders P, Mariman A, Abrams P, Tubaro A, Dmochowski R, Weiss JP, Hervé F, Depypere H, Everaert K. Nocturia in Menopausal Women: The Link Between Two Common Problems of the Middle Age. Int Urogynecol J 2024:10.1007/s00192-024-05743-1. [PMID: 38436669 DOI: 10.1007/s00192-024-05743-1] [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: 05/06/2023] [Accepted: 12/29/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of this review is to discuss the link between menopause and nocturia and to give an overview of the increasing prevalence, risk factors, causative factors, treatment needs and options for nocturia in peri-menopausal women. METHODS This opinion article is a narrative review based on the expertise and consensus of a variety of key opinion leaders, in combination with an extensive literature review. This literature search included a thorough analysis of potential publications on both the PubMed Database and the Web of Science and was conducted between November 2022 and December 2022. The following key words were used "nocturia" and "menopause" or "nocturnal frequency and menopause." Moreover, key words including "incidence," "prevalence," "insomnia," "estrogen therapy," "metabolic syndrome," and "hot flushes" were used in combination with the aforementioned key words. Last, the reference lists of articles obtained were screened for other relevant literature. RESULTS The perimenopause can be a trigger for inducing nocturia. Typically, obesity, body mass index (BMI), and waist circumference are risk factors for developing peri-menopausal nocturia. Presumably the development of peri-menopausal nocturia is multifactorial, with interplay among bladder, sleep, and kidney problems due to estrogen depletion after the menopause. First, impaired stimulation of estrogen receptors in the urogenital region leads to vaginal atrophy and reduced bladder capacity. Moreover, menopause is associated with an increased incidence of overactive bladder syndrome. Second, estrogen deficiency can induce salt and water diuresis through blunted circadian rhythms for the secretion of antidiuretic hormone and the activation of the renin-angiotensin-aldosterone system. Additionally, an increased incidence of sleep disorders, including vasomotor symptoms and obstructive sleep apnea signs, is observed. Oral dryness and a consequent higher fluid intake are common peri-menopausal symptoms. Higher insulin resistance and a higher risk of cardiovascular diseases may provoke nocturia. Given the impact of nocturia on general health and quality of life, bothersome nocturia should be treated. Initially, behavioral therapy should be advised. If these modifications are inadequate, specific treatment should be proposed. Systemic hormone replacement is found to have a beneficial effect on nocturia, without influencing sodium and water clearance in patients with nocturnal polyuria. It is presumed that the improvement in nocturia from hormonal treatment is due to an improvement in sleep disorders.
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Affiliation(s)
- Kim Pauwaert
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - An-Sofie Goessaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Dudley Robinson
- Department of Urogynecology, King's College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynecology, King's College Hospital, London, UK
| | - Wendy Bower
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Aged Care, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Patrick Calders
- Department of General Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - An Mariman
- Department of Physical Therapy, Ghent University Hospital, Ghent, Belgium
- Department of Psychiatry, Ghent University Hospital, Ghent, Belgium
| | - Paul Abrams
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, School of Health Sciences, Sapienza University of Rome, Rome, Italy
| | - Roger Dmochowski
- Department of Urology, Vanderbilt University, Nashville, TN, USA
| | - Jeffrey P Weiss
- Department of Urology, SUNY Health Science University, Brooklyn, NY, USA
| | - Francois Hervé
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Herman Depypere
- Department of Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Verbakel I, Bou Kheir G, de Rijk M, Dhondt K, Bliwise D, Pauwaert K, Monaghan T, Hervé F, Vogelaers D, Mariman A, Everaert K. Is the insomnia phenotype the common denominator in LUTS during transition periods? An expert NOPIA research group review. Neurourol Urodyn 2024. [PMID: 38289321 DOI: 10.1002/nau.25372] [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: 09/29/2023] [Revised: 11/28/2023] [Accepted: 12/11/2023] [Indexed: 02/01/2024]
Abstract
AIMS As people age, sleep stages and characteristics transition over time, but sleep deficits can profoundly impact health and cognitive functioning. Chronic sleep deprivation is linked to impaired attention and productivity, weakened immunity, increased risk of cardiovascular disease, obesity, and mental health disorders. Insomnia, obstructive sleep apnea syndrome, hormonal changes, nocturia, neurological disorders, and life events interfere with sleep patterns and some are linked to lower urinary tract symptoms (LUTS). This NOPIA symposium on Lifelong LUTS aimed to analyze the literature on associations between sleep and LUTS, generate ideas for future research, and explore whether there is support for the concept of lifelong LUTS in relation to changes in sleep throughout the lifespan. METHODS An international panel of experts took part in an online meeting addressing the role of lifelong LUTS in relationship to sleep and the brain organized by the NOPIA research group. The manuscript summarizes existing literature, hypotheses, future research ideas, and clinical recommendations. RESULTS Insomnia, sleep fragmentation, hyperarousal, and sensory processing disorders emerged as potential factors in the relationship between sleep and LUTS. Insomnia is often a persistent factor and may have been the initial symptom; however, it is often unrecognized and/or unaddressed in healthcare settings. By recognizing insomnia as a primary driver of various health issues, including nocturia, transitional care aims to address root causes and underlying problems earlier to initiate appropriate treatment. CONCLUSIONS A multidisciplinary approach with collaboration between healthcare professionals from various disciplines, such as urology, sleep medicine, gynecology, pediatrics, and geriatrics, is needed and should include validated measurements such as the insomnia severity index and sleep and voiding diaries. Ensuring ongoing follow-up and monitoring through transitional care is crucial for individuals with persistent sleep problems and LUTS, allowing issues that arise or fluctuate over the lifespan to be addressed.
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Affiliation(s)
- Irina Verbakel
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - George Bou Kheir
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Mathijs de Rijk
- Department of Urology, School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Karlien Dhondt
- Department of Child and Adolescent Psychiatry, Pediatric Sleep Center, Ghent University Hospital, Ghent, Belgium
| | - Don Bliwise
- Sleep Center, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kim Pauwaert
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Thomas Monaghan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Francois Hervé
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
| | - Dirk Vogelaers
- Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, Belgium
- Department of General Internal Medicine, AZ Delta, Roeselare, Belgium
| | - An Mariman
- Center for Integrative Medicine, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, ERN Accredited Centrum, Ghent University Hospital, Ghent, Belgium
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Bravi CA, Mottaran A, Sarchi L, Piro A, Paciotti M, Nocera L, Balestrazzi E, Peraire M, Farinha R, Pauwaert K, Herwaarden MV, Vinckier MH, Backer PD, D'Hondt F, Groote RD, Naeyer GD, Mottrie A. Different approaches for bladder neck dissection during robot-assisted radical prostatectomy: the Aalst technique. Int Braz J Urol 2023; 49:521-522. [PMID: 37267619 PMCID: PMC10482447 DOI: 10.1590/s1677-5538.ibju.2023.0027] [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: 01/18/2023] [Accepted: 01/26/2022] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Bladder neck dissection is one of the most delicate surgical steps of robotic-assisted radical prostatectomy (RARP) [1, 2], and it may affect surgical margins rate and functional outcomes [3, 4]. Given the relationship between outcomes and surgical experience [5-7], it is crucial to implement a step-by-step approach for each surgical step of the procedure, especially in the most challenging part of the intervention. In this video compilation, we described the techniques for bladder neck dissection utilized at OLV Hospital (Aalst, Belgium). SURGICAL TECHNIQUE We illustrated five different techniques for bladder neck dissection during RARP. The anterior technique tackles the bladder neck from above until the urethral catheter is visualized, and then the dissection is completed posteriorly. The lateral and postero-lateral approaches involve the identification of a weakness point at the prostate-vesical junction and aim to develop the posterior plane - virtually until the seminal vesicles - prior to the opening of the urethra anteriorly. Finally, we described our techniques for bladder neck dissection in more challenging cases such as in patients with bulky middle lobes and prior surgery for benign prostatic hyperplasia. All approaches follow anatomic landmarks to minimize positive surgical margins and aim to preserve the bladder neck in order to promote optimal functional recovery. All procedures were performed with DaVinci robotic platforms using a 3-instruments configuration (scissors, fenestrated bipolar, and needle driver). As standard protocol at our Institution, urinary catheter was removed on postoperative day two [8]. CONCLUSIONS Five different approaches for bladder neck dissection during RARP were described in this video compilation. We believe that the technical details provided here might be of help for clinicians who are starting their practice with this surgical intervention.
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Affiliation(s)
- Carlo A. Bravi
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
- IRCCS Ospedale San RaffaeleUnit of UrologyDivision of OncologyMilanItalyDivision of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Angelo Mottaran
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
- IRCCS Azienda Ospedaliero-Universitaria di BolognaDivision of UrologyBolognaItalyDivision of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luca Sarchi
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
| | - Adele Piro
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
- University of Modena and Reggio EmiliaDepartment of UrologyModenaItalyDepartment of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Paciotti
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
- IRCCSHumanitas Research HospitalDepartment of UrologyMilanRozzanoItalyDepartment of Urology, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Luigi Nocera
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
- IRCCS Ospedale San RaffaeleUnit of UrologyDivision of OncologyMilanItalyDivision of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Eleonora Balestrazzi
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
- IRCCS Azienda Ospedaliero-Universitaria di BolognaDivision of UrologyBolognaItalyDivision of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Maria Peraire
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
| | - Rui Farinha
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
| | - Kim Pauwaert
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Manoe Van Herwaarden
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Marie-Hélène Vinckier
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | | | - Frederiek D'Hondt
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
| | - Ruben De Groote
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
| | - Geert De Naeyer
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
| | - Alexandre Mottrie
- Onze-Lieve-Vrouwziekenhuis HospitalDepartment of UrologyAalstBelgiumDepartment of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI AcademyGhentBelgiumORSI Academy, Ghent, Belgium
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4
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Van der Jeugt J, Umari P, Mottaran A, Ribeiro L, Lambert E, Vollemaere J, Develtere D, Veys R, Goossens M, Scarcella S, Pauwaert K, Van Praet C, Pauwels E, De Groote R, Dhondt F, Naeyer G, Mottrie A, Schatteman P. Holmium Laser Enucleation of the Prostate versus Robotic Assisted Simple Prostatectomy for lower urinary tract symptoms in patients with extremely large prostates ≧200 ml: A comparative analysis. J Endourol 2023. [PMID: 37335047 DOI: 10.1089/end.2022.0851] [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] [Indexed: 06/21/2023] Open
Abstract
Introduction and objectives Robot-Assisted Simple Prostatectomy (RASP) and Holmium Laser Enucleation of the prostate (HoLEP) are both well-established, minimally-invasive surgical treatment options for lower urinary tract symptoms caused by benign prostatic enlargement. We have reported the first comparative analysis of both techniques in patients with prostates of 200ml. Materials & methods Between 2009 and 2020 a total of 53 patients with a prostate volume of 200ml were surgically treated at OLV Hospital Aalst (Belgium): 31 underwent RASP and 22 underwent HoLEP. Preoperative and postoperative assessments included uroflowmetry with maximum urinary flow rate (Qmax) and post-void residual volume (PVR), as well as the International Prostate Symptom Score (IPSS) and quality of life (IPSS-QoL). The complication rates were evaluated according to the Clavien-Dindo Classification. Results Patients treated with RASP had significantly larger prostate volumes compared to HoLEP (median 226 vs. 204.5 ml, p=0.004). After a median follow-up of 14 months, both groups showed a significant improvement in the maximum flow rate (+10.60 vs. +10.70 ml/s, p=0.724) and a reduction of the IPSS score (-12.50 vs. -9, p=0.246) as well as improvement of the QoL (-3 vs. -3, p=0.880). Median operative time was similar in both groups (150 vs. 132.5 min, p=0.665). The amount of resected tissue was lower in the RASP group (134.5 vs. 180 g, p=0.029) and there was no significant difference in postoperative PSA (1.2 vs. 0.8 ng/ml, p=0,112). Despite a similar median catheterization time (3 vs. 2 days, p=0.748), the median hospitalization time was shorter in the HoLEP group (4 vs. 3 days, p=0.052). Complication rates were similar in both groups (32% vs. 36%, p=0.987). Conclusion Our results suggest similar outcomes for RASP and HoLEP in patients with very large prostates 200ml. These findings will require external validation at other high-volume centers.
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Affiliation(s)
| | - Paolo Umari
- St. George's University Hospital, Department of Urology, London, United Kingdom of Great Britain and Northern Ireland
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Angelo Mottaran
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, 18508, Department of Urology, Bologna, Emilia-Romagna, Italy
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Luis Ribeiro
- St. George's University Hospital, urology, London, United Kingdom of Great Britain and Northern Ireland;
| | - Edward Lambert
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | | | - Dries Develtere
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Ralf Veys
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Marijn Goossens
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Simone Scarcella
- Polytechnic University of Marche Region, Department of Urology, Ancona, Italy
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Kim Pauwaert
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Charles Van Praet
- University Hospital Ghent, 60200, urology, Gent, Oost-Vlaanderen, Belgium;
| | | | - Ruben De Groote
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | | | - Geert Naeyer
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
| | - Alex Mottrie
- OLV Ziekenhuis Campus Aalst, 74840, urology, Aalst, Belgium;
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Bravi C, Mottaran A, Sarchi L, Piro A, Paciotti M, Nocera L, Balestrazzi E, Peraire Lores M, Piramide F, Pauwaert K, Van Herwaarden M, Vinckier M, De Backer P, D’Hondt F, De Groote R, De Naeyer G, Mottrie A. Robot-assisted radical prostatectomy in large (≥100 gr) prostate glands: Results and different techniques for bladder neck dissection. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01462-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Peraire Lores M, Domínguez J, Bravi CA, Mottaran A, Sarchi L, Paciotti M, Piro A, Nocera L, Balestrazzi E, Farinha R, Pauwaert K, Van Herwaarden M, Vinckier MH, De Backer P, De Groote R, D'Hondt F, De Naeyer G, Mottrie A. Robot-assisted sutureless partial nephrectomy for the treatment of fifteen bilateral renal masses in a patient with Von Hippel-Lindau syndrome: a case report from a high-volume robotic center. CEN Case Rep 2023:10.1007/s13730-022-00770-7. [PMID: 36611089 PMCID: PMC10393926 DOI: 10.1007/s13730-022-00770-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/23/2022] [Accepted: 12/13/2022] [Indexed: 01/09/2023] Open
Abstract
Renal cell carcinoma is among major causes of death in patients with Von Hippel-Lindau (VHL) syndrome, and it usually presents with multiple and bilateral lesions that may require multiple renal surgeries. This, in turn, may compromise renal function, resulting in end-stage renal disease. To minimize renal function impairment in these patients, great importance is given to the preservation of functional parenchyma with the use of nephron-sparing techniques. Furthermore, new techniques such as off-clamp surgery, selective suturing or sutureless techniques may improve long-term functional outcomes. We described the case of a 27-year-old male patient with a family history of VHL disease affected by multiple, bilateral renal masses. He received bilateral, metachronous robot-assisted partial nephrectomies (RAPN) for a total of 15 renal lesions. No intra- or post-operative complications occurred, and the patient was discharged on the second postoperative day after both procedures. Serum creatinine after the second RAPN was 0.99 mg/dl (baseline value was 1.11 mg/dl). In patients with VHL syndrome and multiple renal lesions, robot-assisted partial nephrectomy, especially with the use of clampless and sutureless techniques, helps minimizing renal function impairment and should be performed when anatomically and technically feasible.
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Affiliation(s)
- Maria Peraire Lores
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium. .,ORSI Academy, Ghent, Belgium.
| | - Jesús Domínguez
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium
| | - Carlo A Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium.,Division of Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Angelo Mottaran
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium.,Division of Urology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Luca Sarchi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium
| | - Marco Paciotti
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium.,Department of Urology, Humanitas Research Hospital, IRCCS, Rozzano, Milan, Italy
| | - Adele Piro
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium.,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Luigi Nocera
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium.,Division of Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Eleonora Balestrazzi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium.,Division of Urology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Rui Farinha
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium
| | - Kim Pauwaert
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | | | | | | | - Ruben De Groote
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium
| | - Frederiek D'Hondt
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium
| | - Geert De Naeyer
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium
| | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium.,ORSI Academy, Ghent, Belgium
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Mottaran A, Paciotti M, Bravi CA, Sarchi L, Nocera L, Piro A, Farinha R, DE Backer P, Piazza P, Pauwaert K, van Herwaarden M, DE Groote R, Mottrie A, De Naeyer G. Robot-assisted simple prostatectomy with the novel HUGO™ RAS System: feasibility, setting, and perioperative outcomes. Minerva Urol Nephrol 2022; 75:235-239. [PMID: 36094389 DOI: 10.23736/s2724-6051.22.05031-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Robot-assisted simple prostatectomy (RASP) has demonstrated better peri-operative outcomes as compared to open simple prostatectomy. However, RASP is still limited by platform availability and cost-effectiveness issues. The new surgical robots increasing competition may spread the robotic approach also in non-oncological fields. We reported the first RASP executed in Europe at OLV Hospital (Aalst, Belgium) performed with the novel HUGO™ Robot-Assisted Surgery (RAS) System. The platform consists of four independent carts, an open console, and a system tower equipped for both laparoscopic and robotic surgery. Our main goal was to demonstrate the technical feasibility of RASP with the novel HUGO™ RAS along with its safety in terms of perioperative outcomes and complications. We also aimed to describe our surgical setup. We collected patient's baseline characteristics, intraoperative and perioperative complications, postoperative outcomes, docking time, operative time, clashing of the instruments, or technical errors of the system. The procedure was performed in a 72-year-old male with a prostate volume of 155 g at preoperative imaging. No need for conversion to open/laparoscopic surgery and/or for additional port placement was required. No intraoperative complications, instrument clashes, or failure of the system that compromised the completion of the surgery were recorded. Docking, operative, and console times were 9, 150, and 120 minutes, respectively. The catheter was removed on the second postoperative day. No postoperative complications occurred. The postoperative uroflowmetry revealed a maximum flow of 26.2 mL/s, without postvoid residual volume. Robot-assisted simple prostatectomy with the HUGO™ RAS System is a feasible and safe procedure in terms of perioperative outcomes and complications. Our setup allowed for a rapid docking procedure and a smoothly completion of the surgery.
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Affiliation(s)
- Angelo Mottaran
- ORSI Academy, Ghent, Belgium -
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium -
- Department of Urology, IRCCS AOU Bologna, Bologna, Italy -
- University of Bologna, Bologna, Italy -
| | - Marco Paciotti
- ORSI Academy, Ghent, Belgium
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- Department of Urology, IRCCS Humanitas Clinic, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Carlo A Bravi
- ORSI Academy, Ghent, Belgium
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Luca Sarchi
- ORSI Academy, Ghent, Belgium
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Luigi Nocera
- ORSI Academy, Ghent, Belgium
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- Unit of Urology, Division of Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Adele Piro
- ORSI Academy, Ghent, Belgium
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Pietro Piazza
- ORSI Academy, Ghent, Belgium
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- Department of Urology, IRCCS AOU Bologna, Bologna, Italy
- University of Bologna, Bologna, Italy
| | - Kim Pauwaert
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | | | - Ruben DE Groote
- ORSI Academy, Ghent, Belgium
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Alexandre Mottrie
- ORSI Academy, Ghent, Belgium
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
| | - Geert De Naeyer
- ORSI Academy, Ghent, Belgium
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
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Pauwaert K, Bodé S, Alwis US, Mylle T, Boeckx P, Delanghe J, Everaert K, Roggeman S. Observing the water handling in humans to resolve the role of the interstitium: preliminary results of the usability of deuterium oxide and bio-impedance analysis - a pilot analysis. Isotopes Environ Health Stud 2022; 58:99-110. [PMID: 35072572 DOI: 10.1080/10256016.2022.2026349] [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] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 12/02/2021] [Indexed: 06/14/2023]
Abstract
The aim of this research was to evaluate the relevance of using deuterium oxide (2H2O) and bio-impedance analysis (BIA) to assess size and function of the interstitium for urological research. Nineteen volunteers were recruited to this prospective trial combining ingestion of 2H2O and BIA. Blood samples were obtained every 10 min after ingestion of 2H2O. Urine was collected before and after the experiment. BIA was performed every 5 min. Body position was alternated to study the effect on fluid distribution. First order kinetics were assumed for the uptake of 2H2O from the gastrointestinal tract to the blood. Sex seemed to have an influence with a significantly slower exchange for women (p = 0.041, men: 0.052 min-1, women: 0.038 min-1). Impedance measured in legs (men: p = 0.012, women: p = 0.008) and trunk (both p < 0.001) decreased significantly with posture change. These changes probably reflect the orthostatic redistribution of fluid with an increase of fluid in both trunk and legs. Both methods were tested and found to be useful for further urological research. Significant gender differences in 2H2O uptake dynamics from the gastrointestinal pool were observed. An impact of posture changes on the electrical impedance measured was observed.
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Affiliation(s)
- Kim Pauwaert
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Samuel Bodé
- Isotope Bioscience Laboratory - ISOFYS, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | | | - Toon Mylle
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Pascal Boeckx
- Isotope Bioscience Laboratory - ISOFYS, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Joris Delanghe
- Department of Diagnostic Sciences, University Hospital Ghent, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Saskia Roggeman
- Department of Urology, University Hospital Ghent, Ghent, Belgium
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Pauwaert K, Muysoms F, Dewulf M. Incidental finding of a congenital unilateral absence of the vas deferens during robotic inguinal hernia repair: missing a crucial landmark. A case report. Acta Chir Belg 2022:1-4. [PMID: 35098883 DOI: 10.1080/00015458.2022.2035920] [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: 11/01/2022]
Abstract
INTRODUCTION We report on a case of congenital unilateral atresia of the vas deferens encountered during a robotic-assisted transabdominal preperitoneal (TAPP) inguinal hernia repair. CASE REPORT Our 65-years-old male patient was scheduled for a bilateral robotic-assisted TAPP inguinal hernia repair because of bilateral symptomatic groin hernia. Standard intraoperative dissection obtaining a critical view of the myopectineal orifice did not allow for an identification of the vas deferens (VD) on the left side. On the right side, a normal VD was identified. There was no suspicion of an intraoperative lesion or ligation of the VD. Both gonadal and inferior epigastric vessels were present on both sides. Upon clinical evaluation, no VD was palpable in the scrotum on the left side. The diagnosis of a congenital unilateral absence of the vas deferens was made. Additional abdominal computed tomography scan revealed a congenital agenesis of the left kidney, ureter, vesicula seminalis and vas deferens. DISCUSSION The accidental finding of a congenital absence of the vas deferens during inguinal hernia repair is rare. However, surgeons performing inguinal hernia repair should be aware of this condition and the clinical implications it poses, as this could prevent unnecessary exploration and missed diagnosis of associated underlying conditions.
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Affiliation(s)
- Kim Pauwaert
- Department of Urology, Gent University Hospital, Gent, Belgium
| | - Filip Muysoms
- Department of General Surgery, Maria Middelares Hospital, Gent, Belgium
| | - Maxime Dewulf
- Department of General Surgery, Maria Middelares Hospital, Gent, Belgium
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Pauwaert K, Bruneel E, Van Laecke E, Depypere H, Everaert K, Goessaert AS. The bladder or the kidney: Who is affected the most by hormonal therapy in postmenopausal women with and without nocturnal polyuria? Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00524-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Pauwaert K, Bruneel E, Van Laecke E, Depypere H, Everaert K, Goessaert AS. Does hormonal therapy affect the bladder or the kidney in postmenopausal women with and without nocturnal polyuria? Results of a pilot trial. Maturitas 2022; 160:61-67. [DOI: 10.1016/j.maturitas.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 11/08/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022]
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Alwis US, Verbakel I, Pauwaert K, Delanghe J, Dossche L, Van Camp J, Roggeman S, Everaert K. The Influence of Salt Sensitivity Phenotype on Sodium Excretion and Diuresis: A Chrononutrition Pilot Study. Int J Clin Pract 2022; 2022:9608962. [PMID: 35685516 PMCID: PMC9159230 DOI: 10.1155/2022/9608962] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chrononutrition studies on interaction of diet/nutrients on endogenous circadian clocks and meal timing on metabolic homeostasis may be of importance in the management of nocturnal polyuria (NP), owing to loss of circadian rhythm in nighttime urination. Dietary salt restriction is an increasingly popular lifestyle recommendation for NP patients. AIM This study aims to evaluate the effect of an acute salt load on diuresis and to study the phenomenon of salt sensitivity. Methodology. Young, healthy men (n = 21, fasted and sober) ingested 500 ml of water on the control day and 8 g and 12 g of salt with water (500 ml) on two other days. Blood and urine samples were collected at 0 hrs, 2 hrs, and 4 hrs and voided volumes were recorded. Diuresis, serum and urine osmolality, sodium, potassium, urea, and creatinine were measured. Salt sensitivity was determined based on the rate of sodium excretion. RESULTS Compared to 8 g, ingestion of 12 g of salt significantly increased diuresis after 4 hrs. Pure water load induced fast diuresis, whereas salt and water load initially reduced diuresis and promoted late increase in diuresis. The total voided volume was significantly lower in the salt sensitive individuals. CONCLUSION Taken together, salt sensitivity profile and type and time of fluid intake are important considerations to build effective personalized lifestyle recommendations for NP patients, which needs further investigation.
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Affiliation(s)
| | - Irina Verbakel
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Kim Pauwaert
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
| | - Joris Delanghe
- Department of Diagnostic Sciences, Ghent University, 9000 Ghent, Belgium
| | - Lien Dossche
- Department of Internal Medicine and Pediatrics, Ghent University, 9000 Ghent, Belgium
- Department of Pediatric Nephrology, Ghent University, 9000 Ghent, Belgium
| | - John Van Camp
- Department of Food Technology, Safety and Health, Ghent University, 9000 Ghent, Belgium
| | - Saskia Roggeman
- Research and Policy Department, Psychiatric Center Sint-Jan-Baptist, 9060 Zelzate, Belgium
| | - Karel Everaert
- Department of Human Structure and Repair, Ghent University, 9000 Ghent, Belgium
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Ghijselings L, Pauwaert K, Verla W, Beeckman D, Van de Putte D, Pattyn P, Everaert K. Primary care providers' knowledge about the therapeutic management of refractory pelvic floor dysfunctions in Flanders, Belgium: a cross-sectional study. Acta Chir Belg 2021; 121:386-393. [PMID: 32644014 DOI: 10.1080/00015458.2020.1794338] [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] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pelvic floor dysfunctions (PFD) are prevalent conditions in primary care practice. Basic knowledge of second-line therapies among primary care providers (PCPs) is indispensable to well-inform refractory patients and improve their access to specialized care. OBJECTIVES Getting insight into the extent of knowledge about second-line therapies for refractory PFD among PCPs in Flanders, Belgium. METHODS From January to March 2019 Flemish PCPs participated in the OptiLUTS trial - Part A (EC/2018/0244), by the completion of a 22-item online Dutch questionnaire. Prevalence of PCPs having awareness about sacral neuromodulation (SNM), intradetrusor botulinum toxin injections (BTX) and percutaneous tibial nerve stimulation (PTNS) was explored. Descriptive statistics, univariate analyses, and multiple logistic regression analyses were performed. RESULTS Sixty PCPs, 55% GPs, 45% GP trainees, median age 29 years, participated. Respectively, 90, 73 and 5% had ever heard about BTX, SNM and PTNS. The profession was an independent predictive factor for never having heard of SNM therapy, GPs being more likely to have a lack of knowledge than trainees (OR = 29, 95%CI [1.9-442.5]). Ninety-three percent want to learn more about these therapies. CONCLUSION There is a margin for improvement in the knowledge of PCPs regarding therapies for refractory PFD. Awareness among PCPs should be increased for the optimization of patient care.
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Affiliation(s)
- Lynn Ghijselings
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Kim Pauwaert
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Wesley Verla
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Dirk Van de Putte
- Colorectal Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Piet Pattyn
- Colorectal Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
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14
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Pauwaert K, Goessaert AS, Ghijselings L, Bower W, Mariman A, Vogelaers D, Depypere H, Everaert K. Hormone therapy as a possible solution for postmenopausal women with nocturia: results of a pilot trial. Menopause 2021; 28:502-510. [PMID: 33739310 DOI: 10.1097/gme.0000000000001741] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To observe the impact of different hormonal treatment options on nocturia, its causative factors and bother in postmenopausal women. METHODS This prospective study recruited 245 postmenopausal women and divided them into four treatment groups based on patient's choice: Estrogen + Progesterone (E+P), Estrogen-only in patients with a prior hysterectomy, tissue-selective estrogen complex (TSEC) and no treatment. Nocturia and its causative factors were observed using two standardized questionnaires before and after treatment: the International Consultation on Incontinence Questionnaire Nocturia Module and the Targeting the individual's Aetiology of Nocturia to Guide Outcomes (TANGO). The results of the Targeting the individual's Aetiology of Nocturia to Guide Outcomes were divided in four influencing topics of which the sum score was calculated. RESULTS A significant reduction in prevalence of nocturia ≥ twice per night was seen after treatment, as the prevalence decreased from 27.7% (59/213) to 16.4% (35/213). Specified per therapy, a significant reduction in nocturnal voiding frequency was observed in patients treated with E+P and TSEC (P = 0.018 and P = 0.018, respectively). This improvement could be explained by a significant reduction in SLEEP sum score in patients treated with E+P and TSEC (P < 0.001, P = 0.013, respectively). Estrogen-only led to a significant change in URINARY TRACT sum score, which is the result of a reduction in urgency prevalence (P = 0.039). CONCLUSIONS E+P and TSEC treatment led to a significant reduction in nocturia prevalence and bother in women with ≥ 2 nocturnal voids. This effect is mainly the result of improvement in sleep disorders, however an improvement in bladder disorders can be suggested as well. More research is necessary to confirm these findings.
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Affiliation(s)
- Kim Pauwaert
- Department of Urology, Ghent University Hospital, Belgium
- Faculty of Medicine and Health Science, Department of Human Structure and Repair, Ghent University, Belgium
| | - An-Sofie Goessaert
- Faculty of Medicine and Health Science, Department of Human Structure and Repair, Ghent University, Belgium
| | - Lynn Ghijselings
- Department of Urology, Ghent University Hospital, Belgium
- Faculty of Medicine and Health Science, Department of Human Structure and Repair, Ghent University, Belgium
| | - Wendy Bower
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - An Mariman
- Department of General Internal Medicine, Ghent University Hospital, Belgium
| | - Dirk Vogelaers
- Department of General Internal Medicine, Ghent University Hospital, Belgium
| | - Herman Depypere
- Department of Gynecology, Ghent University Hospital, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Belgium
- Faculty of Medicine and Health Science, Department of Human Structure and Repair, Ghent University, Belgium
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15
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Pauwaert K, Goessaert AS, Ghijselings L, Monaghan TF, Depypere H, Everaert K. Nocturia through the menopausal transition and beyond: a narrative review. Int Urogynecol J 2021; 32:1097-1106. [PMID: 33439278 DOI: 10.1007/s00192-020-04640-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/14/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Nocturia, defined as the act of waking to pass urine during sleeping, is a common problem in older women and is associated with significant morbidity and impairments in health-related quality of life. The aim of this review was to synthesize the current evidence regarding the incidence, impact, pathophysiology, and specific diagnostic approach of nocturia in the postmenopausal population. METHODS We searched PubMed and Web of Science databases to identify relevant studies published through June 2020. Reference lists of the reviews obtained were screened for other articles deemed pertinent by the authors. RESULTS Genitourinary symptoms attributed to the menopause have been reported to occur in nearly 90% of postmenopausal women, and nocturia is one of the most common. The relative deficiency in endogenous estrogen production after the menopause is thought to exacerbate all major pathophysiological mechanisms that may underlie nocturia, including reduced bladder capacity, nocturnal polyuria, global polyuria, and sleep disorders. Diminished estrogen may induce anatomical and physiological bladder changes, contributing to a reduction in functional bladder capacity. Excess nocturnal urine production can also be provoked by estrogen depletion, either via free water-predominant diuresis by an impaired secretion of antidiuretic hormone, or a salt-predominant diuresis owing to diminished activation of the renin-angiotensin-aldosterone axis. Additionally, a relationship between the transition to menopause and impaired sleep has been described, mediated by increased incidence in vasomotor symptoms and obstructive sleep apnea signs during the menopause. CONCLUSION Further research is necessary to better characterize and manage nocturia in postmenopausal women.
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Affiliation(s)
- Kim Pauwaert
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - An-Sofie Goessaert
- Faculty of Medicine and Health Science, Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Lynn Ghijselings
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Herman Depypere
- Department of Gynecology, Ghent University Hospital, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Monaghan TF, Delanghe JR, Agudelo CW, Alwis US, Pauwaert K, Weiss JP, Vande Walle J. Toward a dry tomorrow: Novel technologies in the treatment of nocturnal enuresis. J Pediatr Urol 2020; 16:733-734. [PMID: 32736861 DOI: 10.1016/j.jpurol.2020.06.034] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Thomas F Monaghan
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Joris R Delanghe
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Christina W Agudelo
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Upeksha S Alwis
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Kim Pauwaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Jeffrey P Weiss
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA; Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
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Pauwaert K, Goessaert AS, Ghijselings L, Bower W, Depypere H, Everaert K. Characterizing nocturia among Belgian healthy postmenopausal women: Prevalence, degree of bother, etiology and risk factors for nocturia. Maturitas 2020; 143:41-46. [PMID: 33308635 DOI: 10.1016/j.maturitas.2020.08.008] [Citation(s) in RCA: 2] [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: 06/11/2020] [Revised: 07/16/2020] [Accepted: 08/17/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Limited literature concerning nocturia in early postmenopausal women is available. However, due to the lack of endogenous estrogen in these women, an increased prevalence of nocturia is expected. MATERIAL AND METHODS This prospective observational trial recruited 210 'early' postmenopausal women consulting the Ghent University menopause clinic. Postmenopausal status was biochemically confirmed. Women completed 3 questionnaires: the ICI questionnaire on nocturia (ICIQ-N); 'Targeting the individual's Aetiology of Nocturia to Guide Outcomes' (TANGO) and the Perceived Stress Scale (PSS). Moreover, information concerning women's age, anthropometrics and lifestyle was collected. Nocturia was defined as two or more nocturnal voids. RESULTS Nocturia was reported in 24.8% (52/210) of the postmenopausal women. Bother increased with every nocturnal void. Women with two or more nighttime voids were found to have significantly increased prevalence of urgency compared with women with only one (p < 0.001; 38.5% versus 22.7%). Trouble initiating sleep at the start of the night and insomnia during the night were significantly different in women with a different nocturnal frequency (initiating sleep p = 0.09, no voids 34.4 %, 1 void 39.2 %, ≥ 2 voids 53.8 %; insomnia p < 0.001; no voids 1.6%, 1 void 22.7 %, ≥ 2 voids 53.8 %). In addition to bladder and sleep dysfunctions, waist circumference was a risk factor for nocturia (OR 1.04; 95 % CI: 1.01-1.08). CONCLUSION Nocturia is an important problem in early postmenopausal women, affecting a quarter of the questioned women. Etiology of nocturia in this population is multifactorial as estrogen withdrawal is accompanied by bladder and sleep dysfunctions.
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Affiliation(s)
- Kim Pauwaert
- Department of Urology, Ghent University Hospital, Belgium; Faculty of Medicine and Health Science, Department of Human Structure and Repair, Ghent University, Belgium.
| | - An-Sofie Goessaert
- Faculty of Medicine and Health Science, Department of Human Structure and Repair, Ghent University, Belgium
| | - Lynn Ghijselings
- Department of Urology, Ghent University Hospital, Belgium; Faculty of Medicine and Health Science, Department of Human Structure and Repair, Ghent University, Belgium
| | - Wendy Bower
- Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Herman Depypere
- Department of Gynecology, Ghent University Hospital, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Belgium; Faculty of Medicine and Health Science, Department of Human Structure and Repair, Ghent University, Belgium
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Pauwaert K, Goessaert AS, Bruneel E, Ghijselings L, Depypere H, Everaert K. Can hormonal replacement therapy be a solution for postmenopausal women with nocturia? EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)32744-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ghijselings L, Hervé F, Van der Aa F, De Wachter S, Pauwaert K, Haddad R, Beeckman D, Pattyn P, Everaert K. Development of a flowchart reflecting the current attitude and approach towards idiopathic overactive bladder treatment in Belgium: A Delphi study. Neurourol Urodyn 2020; 39:1781-1795. [PMID: 32531082 DOI: 10.1002/nau.24421] [Citation(s) in RCA: 2] [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: 03/09/2020] [Accepted: 05/25/2020] [Indexed: 11/07/2022]
Abstract
AIMS Idiopathic overactive bladder syndrome (iOAB) is a prevalent condition in urological practice. The variability in management between specialists and between centers remains high. Even existing guidelines contain inconsistencies. We aimed to develop a treatment algorithm for iOAB for use in daily clinical practice. METHODS From October 2018 till November 2019, a Delphi study was conducted to obtain expert consensus on the management of iOAB. Members from the Belgian Working Group of Functional Urology were asked to rate online statements, based on gaps and variabilities between the American Urology Association (AUA), European Association of Urology (EAU) and International Consultation on Incontinence (ICI) guidelines on iOAB. The consensus was reached if ≥75% of the panel agreed on the level of appropriateness. Two Delphi rounds and an open discussion session were held. RESULTS Twenty out of 49 members completed the first round and 18 completed the second round. The consensus was reached on 44/143 statements and 15/56 statements in the first and second round, respectively. The consensus was reached on criteria by which to phenotype OAB patients, the terminology relating to the first-, second- and third-line treatment, the duration of therapies, the chronological order, and the choice between therapies. No consensus was reached on the role of percutaneous tibial nerve stimulation (PTNS) in the treatment algorithm. CONCLUSIONS A flowchart reflecting the current attitude and approach of a Delphi expert panel towards the treatment of iOAB was developed. We propose its use in daily clinical practice to increase the standardization of OAB treatment.
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Affiliation(s)
- Lynn Ghijselings
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Francois Hervé
- Department of Urology, UCL University Hospital Saint-Luc, Woluwe, Belgium
| | - Frank Van der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Stefan De Wachter
- Department of Urology, University Hospital Antwerp, Urology, Edegem, Belgium.,Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| | - Kim Pauwaert
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Rebecca Haddad
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Piet Pattyn
- Colorectal Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
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Haddad R, Denys P, Arlandis S, Giannantoni A, Del Popolo G, Panicker JN, De Ridder D, Pauwaert K, Van Kerrebroeck PE, Everaert K. Nocturia and Nocturnal Polyuria in Neurological Patients: From Epidemiology to Treatment. A Systematic Review of the Literature. Eur Urol Focus 2020; 6:922-934. [PMID: 32192920 DOI: 10.1016/j.euf.2020.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 10/11/2019] [Revised: 01/12/2020] [Accepted: 02/10/2020] [Indexed: 12/12/2022]
Abstract
CONTEXT Nocturia is among the most common and bothersome lower urinary tract symptoms (LUTS), but there is no clear consensus on how to identify and manage this symptom in the neurological population. OBJECTIVE To systematically review the literature about nocturia in neurological patients. EVIDENCE ACQUISITION Studies were identified by electronic search of Cochrane and Medline databases. The studies were included if their participants had acquired neurological pathology among multiple sclerosis (MS), Parkinson's disease (PD), stroke, spinal cord injury (SCI), and reported data on the epidemiology, aetiology, diagnosis, or treatment of nocturia. An independent extraction of the articles was performed by two authors using predetermined datasets, including quality-of-study indicators. EVIDENCE SYNTHESIS A total of 132 studies were included; 46 evaluated the epidemiology of nocturia, 28 the possible aetiologies, 10 the diagnostic tools, and 60 the treatments. Nocturia prevalence ranged from 15% to 96% depending on the pathology and definition used. It was one of the most frequently reported LUTS in PD and stroke patients. Several validated questionnaires were found to screen for nocturia in this population. Causalities were numerous: LUT, renal, sleep, cardiovascular dysfunctions, etc. Treatments targeted these mechanisms, with an overall risk of bias assessed as high or serious. The highest level of evidence was seen in MS patients: pelvic floor muscle training, cannabinoids, and desmopressin were effective, but not melatonin. In stroke patients, transcutaneous sacral and transcutaneous tibial nerve stimulation (TTNS) improved nocturia; in PD patients, TTNS, solifenacin, and rotigotine did not. CONCLUSIONS Nocturia is highly prevalent in patients with neurological disorders. Causalities and treatments are not different from the general population, but are poorly studied in neurological patients. PATIENT SUMMARY In this report, we looked at the published studies about nocturia-the fact of waking to void during the hours of sleep-in patients with neurological diseases. We found that nocturia is very frequent in this population, that the causes are the same as in the general population but may be combined, and that treatments are also the same but have an overall weak level of evidence. We conclude that more research is needed on this topic.
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Affiliation(s)
- Rebecca Haddad
- Urology Department, Ghent University Hospital, Ghent, Belgium.
| | - Pierre Denys
- Neuro-Urology Unit, PMR Department, Université de Versailles Saint Quentin, APHP, Raymond Poincaré Hospital, Garches, France
| | - Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Antonella Giannantoni
- Department of Medical and Surgical Sciences and Neurosciences, Functional and Surgical Urology Unit, University of Siena, Siena, Italy
| | - Giulio Del Popolo
- Neuro-Urology & Spinal Unit Department, Careggi University Hospital, Firenze, Italy
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | - Dirk De Ridder
- Urology, University Hospitals KU Leuven, Leuven, Belgium
| | - Kim Pauwaert
- Urology Department, Ghent University Hospital, Ghent, Belgium
| | | | - Karel Everaert
- Urology Department, Ghent University Hospital, Ghent, Belgium
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21
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Monaghan TF, Verbalis JG, Haddad R, Pauwaert K, Agudelo CW, Goessaert AS, Denys MA, Lazar JM, Bliwise DL, Vande Walle J, Wein AJ, Weiss JP, Everaert K. Diagnosing Nocturnal Polyuria from a Single Nocturnal Urine Sample. Eur Urol Focus 2019; 6:738-744. [PMID: 31629681 DOI: 10.1016/j.euf.2019.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 08/08/2019] [Revised: 09/13/2019] [Accepted: 10/01/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Patients with nocturnal polyuria (NP) experience a unique surge in nocturnal diuresis rate during the early hours of sleep. OBJECTIVE To determine the diagnostic utility of the volume and osmolality of a single early nocturnal urine sample in detecting NP. DESIGN, SETTING, AND PARTICIPANTS Analysis of 1 am urine samples obtained from two prospective observational studies at Ghent University Hospital involving participants recruited from a urology ambulatory care unit and those who consulted a continence clinic. Nocturic participants (one or more nocturnal void[s]; n=176) were stratified based on the presence (n=87) or absence (n=89) of NP (>90ml/h). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Receiver operating characteristic curves with Youden's Index were used to determine cutoff values for urine volume and urine osmolality (Uosm). RESULTS AND LIMITATIONS Individuals with NP demonstrated higher 1 am volume (400 [interquartile range 300-515] vs 210 [160-300] ml, area under the curve [AUC]=0.843, p< 0.001, cutoff = 350 ml) and lower Uosm (274 [201-348] vs 430 [320-664] mOsm/kg H2O, AUC=0.774, p<0.001, cutoff=314 mOsm/kg H2O) than those without NP. In combining cutoffs, the criteria of either 1 am volume ≥350ml or Uosm ≤314 mOsm/kg H2O were 85% sensitive and 75% specific for NP, while criteria of both 1 am volume ≥350ml and Uosm ≤314 mOsm/kg H2O were 60% sensitive and 92% specific for NP. Comparable AUC values, sensitivities, and specificities were observed in both men and women. Limitations include post hoc design and a relatively small study sample. CONCLUSIONS Individuals with NP are more likely than those without NP to produce a higher volume of more dilute urine (ie, "aquaresis") in the early hours of sleep. Analysis of easily measurable parameters of the first nocturnal void (for which 1 am values serve as a surrogate) in men and women with nocturia can predict a diagnosis of NP with a reasonably high degree of sensitivity and specificity. PATIENT SUMMARY Urologists often try to understand the specific reason why people wake up to urinate at night by asking them to record the amount of urine they make every time they go to the bathroom (also known as a "voiding diary") during the nighttime as well as the daytime-typically for a total of 1-3 days. In this study, we showed that an analysis of the composition of the urine that people produce when they first wake up to urinate at night might be sufficient to determine whether their symptoms are caused by excessive urine production or something else, and some people might find this urine study easier than keeping a voiding diary.
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Affiliation(s)
- Thomas F Monaghan
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA.
| | - Joseph G Verbalis
- Division of Endocrinology and Metabolism, Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Rebecca Haddad
- Department of Urology, Ghent University Hospital, Ghent, Belgium; Sorbonne Université, UPMC Univ Paris 06, AP-HP, GRC 01, Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Rééducation Neurologique, AP-HP, Hôpitaux Universitaires Est Parisien, Paris, France
| | - Kim Pauwaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Christina W Agudelo
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | | | | | - Jason M Lazar
- Division of Cardiovascular Medicine, Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Donald L Bliwise
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Johan Vande Walle
- Department of Pediatric Nephrology, Ghent University Hospital, Ghent, Belgium
| | - Alan J Wein
- Department of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey P Weiss
- Department of Urology, State University of New York Downstate Health Sciences University, Brooklyn, NY, USA
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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