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Bondok M, Stothers L, Macnab A, Bondok M, Ackerman AL, Dixon E, Trochez M, Petersen K, Selvakumar R. Health Care Workers Online YouTube Content Compared to AUA Prevention of Recurrent Urinary Tract Infections in Women Guidelines: An Integrative Review of Quality and Comprehensiveness Analysis. Urol Pract 2024; 11:498-505. [PMID: 38447214 DOI: 10.1097/upj.0000000000000537] [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: 09/25/2023] [Accepted: 01/19/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION We document the quality, veracity, and comprehensiveness of recurrent UTI information on YouTube to increase health care workers' (HCWs') awareness of UTI-related content online, and to identify deficits in understanding, clarify misconceptions, and reduce stigmatization risk. METHODS High-traffic topic search terms were curated by Google Trends to extract 200 videos, of which 45 met inclusion criteria. Five independent reviewers used a standardized questionnaire based on the AUA recurrent UTI guidelines to assess the definition of UTI, marketing content, prophylaxis/prevention strategies, and antibiotic use/stewardship. RESULTS Incongruent or incomplete guideline UTI definitions were found in 78% (35/45) of videos (K = 0.40), despite 80% (36/45) being authored by HCWs. Forty-two percent (19/45) promoted nonguideline-based hygiene practices; 25% (11/45) advocated front-to-back wiping (K = 0.71). Descriptors identified within the videos included the mention of women with UTI as unclean. Only 55% (25/45) discussed increasing fluid intake (K = 0.59), while 33% (15/45) discussed the use of cranberry supplementation (K = 0.81). CONCLUSIONS Discussion of hygiene practices which lack a specific guideline statement is particularly evident. Descriptors that characterize women with UTI as "unclean" may create a health equity concern for women experiencing UTIs. These findings should alert HCWs to the scope and emphasis in online education that patients may view to self-educate; both the errors and the issues of equity are problematic. Educational materials on UTI should be based on evidence-based guidelines, such as those by the AUA.
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Affiliation(s)
- Mostafa Bondok
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynn Stothers
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Andrew Macnab
- Department of Urological Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohamed Bondok
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - A Lenore Ackerman
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
| | - Emma Dixon
- College of Medicine, California Northstate University, Elk Grove, California
| | - Marcia Trochez
- School of Medicine, University of California, Riverside, Riverside, California
| | - Kelsey Petersen
- Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rishika Selvakumar
- Faculty of Science, University of British Columbia, Vancouver, British Columbia, Canada
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Burke CA, Nitti VW, Stothers L. Melatonin and melatonin receptor agonists in the treatment of nocturia: A systematic review. Neurourol Urodyn 2024; 43:826-839. [PMID: 38456646 DOI: 10.1002/nau.25443] [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: 12/08/2023] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
AIM Causes of nocturia may extend beyond primary bladder pathology and it has been commonly associated as a side effect of sleep disorders. This has led to the study of melatonin and melatonin receptor agonists as a primary treatment for nocturia hypothesized to be secondary to sleep disorders. We aim to systematically review the efficacy and reported safety of melatonin and melatonin receptor agonists in the treatment of nocturia. METHODS A search strategy of EMBASE and Pubmed/Medline databases was utilized to identify eligible studies. Two thousand and twenty-eight unique references were identified in concordance with the Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines for systematic reviews, of which nine papers met the inclusion criteria. The Cochrane Collaboration risk of bias criteria in the open label and nonplacebo studies was used to assess bias. RESULTS The nine studies identified included 3 randomized double-blinded placebo-controlled trials, 2 randomized non-placebo trial, and 4 prospective open-label trials. Three utilized the melatonin-receptor agonist ramelteon (8 mg) and six utilized melatonin (four 2 mg extended release, two 2 mg normal release). Nocturia improved in 8 studies varying from moderate to low efficacy related to reduction in nocturia episodes. Five studies evaluated sleep parameters finding improvement in both nocturia and sleep quality. Male subjects represented 76.8% of 371 total subjects in prospective and randomized trials. Ramelteon and melatonin were both reported as well tolerated during nocturia treatment. A meta-analysis was not able to be performed due to the heterogeneity of bladder diagnoses. CONCLUSIONS At this time, there is insufficient evidence to routinely recommend melatonin as an effective treatment for nocturia given the limitations of current clinical studies. Randomized placebo-controlled trials and prospective open label studies in non-neurogenic populations report a trend towards nocturia improvement with good tolerability and rare side effects. Therefore, further larger scale randomized trials with focused urologic diagnoses in well-characterized patient populations are warranted.
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Affiliation(s)
- Christine Anh Burke
- Departments of Urology and Gynecology, Female Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine, Los Angeles, California, USA
| | - Victor W Nitti
- Departments of Urology and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Lynn Stothers
- Departments of Urology and Gynecology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
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Ghatas MP, Burkett LS, Grob G, Daniels PT, Stothers L, Query HE, Shields MK, Speich JE, Klausner AP. A stepwise approach for functional near infrared spectroscopy measurement during natural bladder filling. Transl Androl Urol 2023; 12:1477-1486. [PMID: 37969775 PMCID: PMC10643392 DOI: 10.21037/tau-23-275] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/18/2023] [Indexed: 11/17/2023] Open
Abstract
Background Functional near infrared spectroscopy (fNIRS) is a versatile, noninvasive, and inexpensive tool that can be used to measure oxyhemoglobin (O2Hb) changes in the cortical brain caused by increasing bladder sensation during filling in upright posture. This study's purpose is to provide a rigorous methodologic template that can be implemented for comparative studies of fNIRS in the diagnosis and management of lower urinary tract symptoms including overactive bladder (OAB) and other forms of lower urinary tract dysfunction. Methods Participants without any urologic conditions completed a validated oral hydration protocol facilitating and equilibrating natural bladder filling. First desire to void and real time bladder sensation (0-100%) were recorded using a Sensation Meter. A 24-channel fNIRS template simultaneously recorded prefrontal cortical O2Hb. Each channel was analyzed between "first desire" to void and 100% sensation, defined in this study as the period of "high sensation". Channels were sub-divided by cortical regions: right (nine channels), left (nine channels), middle (six channels). Results A total of eight participants (male: n=4, female: n=4) were enrolled with mean age 39±19.9 years and body mass index (BMI) of 25±3.93 kg/m2. There were no differences in age, BMI, race, or OAB survey scores based on biological sex. Signal acquisition improved with power bank use, postural head support for motion reduction, and head cap optimization. Acceleration-based concurrent motion measurement was effectively utilized to remove motion artifacts. O2Hb concentration patterns appeared irregular during low sensation and increased during high sensation after first desire across the frontal cortex. Conclusions Employing a stepwise approach, this study defined a methodological guide for improved prefrontal fNIRS signal acquisition and analysis during bladder filling. The technique demonstrated that prefrontal fNIRS cortical O2Hb increases with elevated bladder sensation in normal subjects and sets the stage for comparative studies in individuals with OAB and other forms of lower urinary tract dysfunction.
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Affiliation(s)
- Mina P. Ghatas
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Linda S. Burkett
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, USA
| | - Gabrielle Grob
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Peter T. Daniels
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Lynn Stothers
- Department of Urology and Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA
| | - Helen E. Query
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael K. Shields
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - John E. Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, VA, USA
| | - Adam P. Klausner
- Department of Surgery, Virginia Commonwealth University, Richmond, VA, USA
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Locke JA, Macnab A, Garg S, McKeown M, Stothers L. Characterizing the cortical pathways underlying visual trigger induced urinary urgency incontinence by functional MRI. Neurourol Urodyn 2021; 41:48-53. [PMID: 34719064 DOI: 10.1002/nau.24824] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/14/2021] [Revised: 09/17/2021] [Accepted: 10/07/2021] [Indexed: 12/14/2022]
Abstract
AIMS Visual triggers have long been recognized clinically to stimulate urgency urinary incontinence (UUI). Current pathophysiology recognizes the importance of cortical control over micturition but there is no standardized methodology for clinicians to study the impact of visual triggers. Our aim was to develop an imaging protocol able to characterize the brain's response to personalized visual triggers, providing a methodology for evaluation on connectivity within the brain in patients with visually triggered urinary urgency. METHODS A magnetic resonance imaging (MRI) methodology specific for urologic use was developed. A 3T-Elition Scanner was first used to acquire static structural images. These images were then used to define approximately 200 brain regions of interest (ROI) using a validated brain atlas. Then, real-time functional MRI (fMRI) scans were conducted during natural bladder filling, where study subjects were shown randomized block sequences of visual stimuli comprised of both subject-specific trigger images and neutral images. The fMRI scan data were merged to identify key ROI underlying UUI. RESULTS Dynamic fMRI scans were conducted in 10 subjects, 4 with trigger-induced UUI, 2 with trigger-induced urgency, and 4 with no urgency or leakage to visual triggers. No subjects with UUI history lost continence during imaging, but all four subjects reported sensations of urgency in response to their own subject-specific trigger images. The ROI identified were the periaqueductal gray, anterior cingulate gyrus, pons, and prefrontal cortex. We found increased activity in the prefrontal cortex and limbic system ROI in response to subject-specific visual triggers of UUI. CONCLUSIONS This information provides proof of principle for further exploration of subject-specific trigger image evaluation using fMRI to explore causation in patients with UUI.
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Affiliation(s)
- Jennifer A Locke
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Macnab
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Saurabh Garg
- Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin McKeown
- Department of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.,Peter Wall Institute of Advanced Studies, University of British Columbia, Vancouver, British Columbia, Canada
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Williams AMM, Deegan E, Walter M, Stothers L, Lam T. Exoskeleton gait training to improve lower urinary tract function in people with motor-complete spinal cord injury: A randomized pilot trial. J Rehabil Med 2021; 53:jrm00222. [PMID: 34383958 PMCID: PMC8638733 DOI: 10.2340/16501977-2864] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The primary aim of this study was to determine the feasibility of delivering an exoskeleton-assisted walking intervention targeting lower urinary tract function in people with motor-complete spinal cord injury. Secondary aims were to determine if exoskeleton walking activates the pelvic floor muscles, and compare 2 exoskeleton programmes regarding lower urinary tract function. DESIGN Randomized pilot trial. SUBJECTS Adults with motor-complete spinal cord injury at or above T10. METHODS Participants were randomized to receive Ekso or Lokomat training. Feasibility outcomes included recruitment rate, adherence, and adverse events. Pelvic floor muscle electromyography was recorded during walking. Urodynamic studies, 3-day bladder diary, and Qualiveen-30 were administered pre- and post-training. RESULTS Twelve people were screened and 6 people enrolled in the study. Two subjects withdrew from unrelated reasons. There was one adverse event. Pelvic floor muscle activity was greater in the Ekso group. Lower urinary tract function did not clearly change in either group. CONCLUSION This pilot study demonstrates the feasibility of delivering an exoskeleton training programme targeting lower urinary tract function. Ekso-walking elicits pelvic floor muscle activity, but it remains unclear how locomotor training impacts lower urinary tract function.
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Stothers L, Locke JA, Abdulaziz M, Lazare D, Kavanagh A, Macnab A. Standing open magnetic resonance imaging improves detection and staging of pelvic organ prolapse. Can Urol Assoc J 2021; 16:E20-E24. [PMID: 34464248 DOI: 10.5489/cuaj.7244] [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: 11/19/2022]
Abstract
INTRODUCTION The role of imaging in pelvic organ prolapse (POP) assessment is unclear. Open magnetic resonance imaging (MRI) systems have a configuration that allows for imaging women with POP in different positions. Herein, we use a 0.5 Tesla open MRI to obtain supine, seated, and standing images. We then compare these images to evaluate the impact of posture on detection and staging of POP. METHODS Women presenting with symptoms of POP at a tertiary care university hospital were asked to participate in this prospective cohort study. Symptom scores, POP-Q staging and three-position MRI imaging of the pelvis data were collected. The pubococcygeal line (PCL) was used to quantify within-patient changes in pelvic organ position as defined by: no displacement, <1 cm inferior to the PCL, mild (1-3 cm), moderate (3.1-6 cm), and severe (>6 cm) in the axial and sagittal T2-weighted images. Statistical analysis was completed (T-test; p<0.05 significant). RESULTS A total of 42 women, age range 40-78 years, participated. There was a significant difference in the mean values associated with anterior prolapse in the supine (0.7±1.8), seated (2.4±3.4), and upright (4.2±1.6) positions (p=0.015). There was a significant difference in the mean values associated with apical prolapse in the supine (0.5±1.5), seated (1.5±1.4), and upright (2.1±1.5) positions (p=0.036). CONCLUSIONS Our findings suggest that POP is more readily detected and upstaged with standing MRI images as compared to supine and seated positions. The developed two-minute standing MRI protocol may enable clinicians to better assess the extent of POP.
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Affiliation(s)
- Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries (ICORD).,Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Jennifer A Locke
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Marwa Abdulaziz
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Darren Lazare
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.,International Collaboration on Repair Discoveries (ICORD)
| | - Andrew Macnab
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.,Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, South Africa
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Keung MS, Streijger F, Herrity A, Ethridge J, Dougherty SM, Aslan S, Webster M, Fisk S, Deegan EG, Tessier-Cloutier B, Chen KYN, Morrison C, Okon EB, Tigchelaar S, Manouchehri N, Kim KT, Shortt K, So K, Damaser MS, Sherwood LC, Howland DR, Boakye M, Hubscher C, Stothers L, Kavanagh A, Kwon BK. Characterization of Lower Urinary Tract Dysfunction after Thoracic Spinal Cord Injury in Yucatan Minipigs. J Neurotrauma 2021; 38:1306-1326. [PMID: 33499736 DOI: 10.1089/neu.2020.7404] [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] [Indexed: 01/23/2023] Open
Abstract
There is an increasing need to develop approaches that will not only improve the clinical management of neurogenic lower urinary tract dysfunction (NLUTD) after spinal cord injury (SCI), but also advance therapeutic interventions aimed at recovering bladder function. Although pre-clinical research frequently employs rodent SCI models, large animals such as the pig may play an important translational role in facilitating the development of devices or treatments. Therefore, the objective of this study was to develop a urodynamics protocol to characterize NLUTD in a porcine model of SCI. An iterative process to develop the protocol to perform urodynamics in female Yucatan minipigs began with a group of spinally intact, anesthetized pigs. Subsequently, urodynamic studies were performed in a group of awake, lightly restrained pigs, before and after a contusion-compression SCI at the T2 or T9-T11 spinal cord level. Bladder tissue was obtained for histological analysis at the end of the study. All anesthetized pigs had bladders that were acontractile, which resulted in overflow incontinence once capacity was reached. Uninjured, conscious pigs demonstrated appropriate relaxation and contraction of the external urethral sphincter during the voiding phase. SCI pigs demonstrated neurogenic detrusor overactivity and a significantly elevated post-void residual volume. Relative to the control, SCI bladders were heavier and thicker. The developed urodynamics protocol allows for repetitive evaluation of lower urinary tract function in pigs at different time points post-SCI. This technique manifests the potential for using the pig as an intermediary, large animal model for translational studies in NLUTD.
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Affiliation(s)
- Martin S Keung
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Neuroscience, Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Femke Streijger
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - April Herrity
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Jay Ethridge
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Susan M Dougherty
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Sevda Aslan
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Megan Webster
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shera Fisk
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily G Deegan
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Basile Tessier-Cloutier
- Pathology and Laboratory Medicine, and Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kuan-Yin N Chen
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlotte Morrison
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elena B Okon
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Seth Tigchelaar
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neda Manouchehri
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kyoung-Tae Kim
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Neurosurgery, School of Medicine, Kyungpook National University, National University Hospital, Daegu, South Korea
| | - Katelyn Shortt
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kitty So
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Margot S Damaser
- Biomedical Engineering Department, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Advanced Platform Technology Center, Louis Stokes Cleveland U.S. Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Leslie C Sherwood
- Comparative Medicine Research Unit, and University of Louisville, Louisville, Kentucky, USA
| | - Dena R Howland
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.,Research Service, Robley Rex U.S. Department of Veterans Affairs Medical Center, Louisville, Kentucky, USA
| | - Max Boakye
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Charles Hubscher
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky, USA.,Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, Kentucky, USA
| | - Lynn Stothers
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Urologic Sciences, and Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Kavanagh
- Urologic Sciences, and Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian K Kwon
- International Collaboration on Repair Discoveries (ICORD), Departments of Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Spine Surgery Institute, Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Ho L, Macnab A, Matsubara Y, Peterson K, Tsang B, Stothers L. Rating of Pelvic Floor Muscle Training Mobile Applications for Treatment of Urinary Incontinence in Women. Urology 2020; 150:92-98. [PMID: 32890617 DOI: 10.1016/j.urology.2020.08.040] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/10/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify pelvic floor muscle therapy mobile health applications (apps) targeting women with urinary incontinence (UI), and evaluate them in a standardized fashion. METHODS A systematic search of English language apps on the Canadian App Store (iOS) and Google Play (Android) Store was performed. Eligible apps were evaluated independently by 5 reviewers using the validated Mobile App Rating Scale (MARS) tool. Descriptive characteristics were summarized and MARS subscale and overall quality scores werereported. RESULTS Of 139 mobile health apps identified, 20 unique apps were included for full review, of which there were 7 iOS only apps, 6 Android only apps, and 7 apps available in both stores. At the time of analysis, most apps had been updated within the last year (60%). Only 1 app had been trialed and verified by evidence in scientific literature. The majority of apps were free to download (80%). The median (interquartile range) MARS overall quality score was 3.7 (0.8) on a 0-5 scale, ranging from 2.7 to 4.1. The highest-rated subscale was "functionality" with a median score of 4.1 (0.6); the lowest-rated was "information" with a median score of 3.4 (0.6). The median MARS subjective quality score was 2.9 (1.0). CONCLUSION There are both free and paid apps available on-line that deliver pelvic floor muscle therapy programs. Evaluation using the MARS tool identified that many apps are not of high quality, and only 1 was evidence-based and has been trialed clinically. This knowledge is relevant to the choice of apps by both patients and caregivers.
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Affiliation(s)
- Louisa Ho
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Andrew Macnab
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.
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Walter M, Kran SL, Ramirez AL, Rapoport D, Nigro MK, Stothers L, Kavanagh A, Krassioukov AV. Intradetrusor OnabotulinumtoxinA Injections Ameliorate Autonomic Dysreflexia while Improving Lower Urinary Tract Function and Urinary Incontinence-Related Quality of Life in Individuals with Cervical and Upper Thoracic Spinal Cord Injury. J Neurotrauma 2020; 37:2023-2027. [PMID: 32631152 PMCID: PMC7470218 DOI: 10.1089/neu.2020.7115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Pilot data of our phase IV clinical trial (pre/post study design) highlighted a beneficial effect of intradetrusor onabotulinumtoxinA (200 IU) injections to reduce autonomic dysreflexia (AD) in individuals with chronic spinal cord injury (SCI) at T6 or above. After trial completion, we assessed whether our primary expectation (i.e., decrease of AD severity in 50% of participants during urodynamics [UDS]) was met. Secondary outcome measures were reduction of spontaneous AD in daily life as well as amelioration of AD-related and urinary incontinence-related quality of life (QoL). In addition, we conducted injury-level–dependent analysis—i.e., cervical and upper thoracic—to explore group-specific treatment efficacy. Post-treatment, AD severity decreased in 82% (28/34) of all participants during UDS and in 74% (25/34) in daily life assessed with 24-h ambulatory blood pressure monitoring. In addition, urinary incontinence-related QoL was improved, cystometric capacity was increased, and maximum detrusor pressure during storage was reduced (all p < 0.001). Further, the treatment was well tolerated, with only minor complications (grade I [n = 7] and II [n = 7]) in accordance with the Clavien-Dindo classification recorded in 11 individuals (cervical n = 9, upper thoracic n = 2). Injury-level–dependent analysis revealed lower incidence (cervical n = 15/23, upper thoracic n = 6/11) and lesser severity (cervical p = 0.009; upper thoracic p = 0.06 [Pearson r = −0.6, i.e., large effect size]) of AD during UDS. Further, reduced AD severity in daily life, improved urinary incontinence-related QoL, greater cystometric capacity, and lower maximum detrusor pressure during storage (all p < 0.05) were found in both groups post-treatment. Intradetrusor onabotulinumtoxinA injections are an effective and safe second-line treatment option that ameliorates AD while improving lower urinary tract function and urinary incontinence-related QoL in individuals with cervical and upper thoracic SCI.
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Affiliation(s)
- Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie L Kran
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,MD Undergraduate Program, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea L Ramirez
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Rapoport
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark K Nigro
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynn Stothers
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Kavanagh
- Department of Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.,G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
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10
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Anger J, Lee U, Ackerman AL, Chou R, Chughtai B, Clemens JQ, Hickling D, Kapoor A, Kenton KS, Kaufman MR, Rondanina MA, Stapleton A, Stothers L, Chai TC. Reply by Authors. J Urol 2019; 202:1274. [DOI: 10.1097/ju.0000000000000503] [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: 11/25/2022]
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11
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Sheen D, Kolli H, Nagle AS, Cullingsworth Z, Vinod NN, Naimi HA, De Wachter SG, Mazzeo SE, Stothers L, Speich JE, Klausner AP. Validation of a real-time bladder sensation meter during oral hydration in healthy adults: Repeatability and effects of fill rate and ultrasound probe pressure. Low Urin Tract Symptoms 2019; 11:224-231. [PMID: 31298501 DOI: 10.1111/luts.12275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 04/22/2019] [Revised: 06/06/2019] [Accepted: 06/17/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES A non-invasive protocol was previously developed using three-dimensional ultrasound and a sensation meter to characterize real-time bladder sensation. This study the protocol by measuring the effects of fill rateand ultrasound probe pressure during oral hydration. METHODS Healthy volunteers with no urinary symptoms (based on International Consultation on Incontinence Questionnaire on Overactive Bladder surveys) were recruited into an oral hydration study. Throughout two complete fill-void cycles, participants drank 2 L Gatorade G2 (The Gatorade Company, Inc., Chicago, Illinois) and used a touch-screen sensation meter to record real-time bladder sensation (0%-100%). The study was repeated three times, once per week (Visits A, B, and C). In Visits A and B, ultrasound was used to measure bladder volume every 5 minutes. Ultrasound was not used in Visit C except at 100% capacity. Volume data from Visit B were used to estimate volumes throughout the fills in Visit C. Sensation-capacity curves were generated for each fill for comparative analysis. RESULTS Ten participants completed three visits (60 total fills). Increased fill rate led to decreased sensation throughout filling, andultrasound probe pressure led to increased sensation. Participants reported higher sensation at low volumes during Fill 1 of Visit A before training with the sensation meter. Sensation curves with intermittent ultrasound showed repeatability for Fill 2 in Visits A and B. Fill rate and ultrasound probe pressure affect real-time bladder sensation during oral hydration. CONCLUSIONS This study demonstrated repeatability of real-time bladder sensation during a two-fill oral hydration protocol with ultrasound.
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Affiliation(s)
- Derek Sheen
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Hiren Kolli
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Anna S Nagle
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, Virginia
| | - Zachary Cullingsworth
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, Virginia
| | - Naomi N Vinod
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Hameeda A Naimi
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Stefan G De Wachter
- Department of Urology, University Hospital Antwerpen, Edegem, Belgium.,Department of Urology, University of Antwerpen, Wilrijk, Belgium
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, College of Humanities and Sciences, Richmond, Virginia
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - John E Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, Virginia
| | - Adam P Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, Virginia
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12
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Macnab A, Stothers L, Deegan E. Development of a near-infrared spectroscopy interface able to assess oxygen recovery kinetics in the right and left sides of the pelvic floor. J Biomed Opt 2019; 24:1-5. [PMID: 31368259 PMCID: PMC6995962 DOI: 10.1117/1.jbo.24.7.075003] [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] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 06/21/2019] [Indexed: 06/10/2023]
Abstract
Near-infrared spectroscopy (NIRS) muscle oxygenation data are relied on in sports medicine. Many women with urinary incontinence (UI) have dysfunctional pelvic floor muscles (PFMs) but their evaluation lacks such measures; a transvaginal NIRS interface would enable the PFM to be interrogated. Paired miniature fiber-optic cables were configured on a rigid foam insert so their emitter detector arrays with an interoptode distance of 20 mm apposed the right and left inner sides of a disposable clear plastic vaginal speculum, and linked to a standard commercial NIRS instrument. Measurement capability was assessed through conduct of three maximum voluntary contractions (MVCs) and one sustained maximum voluntary contraction of the PFM with calculation of HbDiff (½RT), a validated muscle reoxygenation kinetic parameter. In all four asymptomatic controls, mean age 40, mean BMI 21.4, MVCs were associated with changes in PFM oxyhemoglobin (O2Hb), deoxyhemoglobin (HHb) concentration, and their difference (HbDiff) comparable to those in voluntary muscle sports medicine studies. NIRS data during recovery (reoxygenation) allowed calculation of HbDiff (½RT). New techniques are called for to evaluate UI. This NIRS interface warrants further development as the provision of quantitative reoxygenation kinetics offers more comprehensive evaluation of patients with PFM dysfunction.
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Affiliation(s)
- Andrew Macnab
- University of British Columbia, Department of Urologic Sciences, Vancouver, Canada
| | - Lynn Stothers
- University of British Columbia, Department of Urologic Sciences, Vancouver, Canada
| | - Emily Deegan
- University of British Columbia, Department of Experimental Medicine, Vancouver, Canada
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13
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Abstract
PURPOSE OF REVIEW Lower urinary tract symptoms (LUTS) is a common constellation of symptoms that affect the aging male population with an astonishing prevalence. New technology and new uses of established technology are being used to help further evaluate LUTS in the male population and help guide treatment options. This review focuses on the developments and future directions in diagnostic modalities for evaluation of male LUTS, focusing on evaluation of both the filling and voiding phases of micturition. RECENT FINDINGS New techniques in evaluating the voiding phase include penile cuff test, external pressure sensing condom catheter, ultrasound measurement of detrusor wall thickness, ultrasound measurement of intravesical prostatic protrusion, doppler ultrasound and NIRS technology. Evaluation of the filling phase is still undergoing much development and requires additional validation studies. The techniques undergoing evaluation include sensation meters during UDS, assessing bladder micromotion and wall rhythm, assessing detrusor wall biomechanics, ultrasound measurement of detrusor wall thickness, pelvic doppler ultrasound, as well as functional brain imaging including fNIRS and fMRI. SUMMARY The development of novel, non-invasive, diagnostic tools have the potential for better evaluation of LUTS with earlier and enhanced treatments. This will likely improve the quality of life for men with LUTS.
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Affiliation(s)
- Natalie R Swavely
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - John E Speich
- Department of Mechanical & Nuclear Engineering, Virginia Commonwealth University College of Engineering, Richmond, VA
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Adam P Klausner
- Department of Surgery/Division of Urology, Virginia Commonwealth University School of Medicine, Richmond, VA
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14
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Kavanagh A, Baverstock R, Campeau L, Carlson K, Cox A, Hickling D, Nadeau G, Stothers L, Welk B. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Executive summary. Can Urol Assoc J 2019; 13:156-165. [PMID: 31199234 DOI: 10.5489/cuaj.6041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Richard Baverstock
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kevin Carlson
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Genviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec City, QC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Blayne Welk
- University of Western Ontario, London, ON, Canada
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15
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Kavanagh A, Akhavizadegan H, Walter M, Stothers L, Welk B, Boone TB. Surveillance urodynamics for neurogenic lower urinary tract dysfunction: A systematic review. Can Urol Assoc J 2019; 13:133-141. [PMID: 30526805 PMCID: PMC6456346 DOI: 10.5489/cuaj.5563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Baseline urodynamic characterization in patients with neurogenic lower urinary tract dysfunction (NLUTD) allows detection of unsafe storage and voiding pressures and optimization of these parameters through medical or surgical intervention. Surveillance urodynamics (sUDS) studies are performed in the ambulatory setting after baseline characterization, with the goal of monitoring bladder function. How often this study should be performed and the circumstances that should prompt repeated studies are unknown. The primary objective of this review is to evaluate the evidence supporting sUDS in the setting of NLUTD as assessed by whether the study leads to 1) change in patient management; 2) determination of new findings not suggested by imaging or symptoms; and 3) demonstration of superior outcomes compared to observation. The secondary objective is to review sUDS practice patterns among urologists in their assessment of NLUTD. METHODS PubMed, EMBASE, and Cochrane Library databases were reviewed for English-language literature published between January 1975 and March 2018. RESULTS Twenty-eight independent articles (1368 patients, 9486 patient-years of followup) were included. Given heterogeneous data, 49% of 263 subjects were asymptomatic, yet demonstrated sUDS abnormality prompting treatment. Eight cross-sectional studies (four spinal cord injury [SCI], two NLUTD, two spina bifida) surveyed urologists regarding current sUDS patterns; 53% of 498 respondents perform sUDS between one and three years. CONCLUSIONS Evidence supporting optimal surveillance for NLUTD is lacking. Level 2b-4 evidence suggests that sUDS is likely to modify patient treatment and often demonstrates findings that modify treatment in the absence of symptoms or imaging changes.
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Affiliation(s)
- Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Hamed Akhavizadegan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
- Urology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Blayne Welk
- Division of Urology, Western University, London, ON, Canada
| | - Timothy B. Boone
- Department of Urology, Houston Methodist Hospital, Houston, TX, United States
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16
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Macnab AJ, Stothers L, Berkowitz J, Elliott S, Bajunirwe F. Associations between sexual satisfaction and function and the severity of lower urinary tract symptoms among men in a rural sub-Saharan African community. Can Urol Assoc J 2019; 13:E350-E356. [PMID: 30817291 DOI: 10.5489/cuaj.5603] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The recognized association between erectile dysfunction (ED) with lower urinary tract symptoms (LUTS) from high-income countries is unreported from Africa. Authentic figures on prevalence of ED and LUTS from Africa are scarce in the literature. This study was conducted to quantify sexual function and satisfaction among Ugandan men in relation to LUTS severity. METHODS A convenience sample of men participating in a parallel, cross-sectional survey was used. The population, men >55 years living in Sheema district, Uganda, were recruited into two cohorts: those living in the community and those seeking clinic care due to bother from LUTS. This was to ensure inclusion of a full spectrum of LUTS. The instruments were the International Prostate Symptom Score (IPSS) to quantify LUTS and the Epstein Inventory (EI) to assess four measures of sexual functioning. Bivariate analysis compared community and clinic cohort participants, LUTS severity, and each sexual functioning item with two-sample t-tests for means and Chi-square tests of independence for categorical versions. RESULTS Participants included 415 men (238 community and 177 clinic) at mean age of 67.5 years vs. 62.9 (p=<0.001) with mean IPSS of 9.32 vs. 17.07 (p≤0.001). Lower mean satisfaction with sexual activity and frequency of erections occurred in the clinic cohort (p≤0.001). Overall, all four questions assessing dissatisfaction with sexual function were significantly correlated with worsening LUTS; sexual satisfaction and frequency of sexual drive were also influenced by age and low levels of education. CONCLUSIONS These are the first data describing the severity relationship between LUTS and ED in African men. Respondents reported dissatisfaction in the past year with the level of their sexual activity, frequency of sexual drive, ability to have erections, and sexual performance that related statistically to the severity of their LUTS.
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Affiliation(s)
- Andrew John Macnab
- Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, South Africa.,Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health Division of Global Health, University of British Columbia, Vancouver, BC, Canada and Principal Investigator International Collaboration on Repair Discover (ICORD)
| | - Jonathan Berkowitz
- Sauder School of Business, University of British Columbia, Vancouver, BC, Canada.,Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Stacy Elliott
- BC Centre for Sexual Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
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17
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Kavanagh A, Baverstock R, Campeau L, Carlson K, Cox A, Hickling D, Nadeau G, Stothers L, Welk B. Canadian Urological Association guideline: Diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction - Full text. Can Urol Assoc J 2019; 13:E157-E176. [PMID: 30763235 DOI: 10.5489/cuaj.5912] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Richard Baverstock
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Kevin Carlson
- vesia [Alberta Bladder Centre]; Division of Urology, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Genviève Nadeau
- Division of Urology, CIUSSS-Capitale Nationale Université Laval, Quebec City, QC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Blayne Welk
- University of Western Ontario, London, ON, Canada
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18
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Bajunirwe F, Stothers L, Berkowitz J, Macnab AJ. Prevalence estimates for lower urinary tract symptom severity among men in Uganda and sub-Saharan Africa based on regional prevalence data. Can Urol Assoc J 2018; 12:E447-E452. [PMID: 29989889 PMCID: PMC6217950 DOI: 10.5489/cuaj.5105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In the absence of specific regional data, the prevalence of urinary symptoms in the developing world is currently estimated. Regional prevalence data and estimates based on them have relevance for accurate planning/provision of future healthcare. We sought to extrapolate prevalence estimates for lower urinary tract symptom (LUTS) severity and associated sexual dysfunction for Uganda as a whole and sub-Saharan Africa (SSA) using newly available regional data from a community-based cohort of men in Uganda. METHODS Global Burden of Disease Study (GBDS) population statistics were applied to a regional dataset to provide prevalence estimates for Uganda and SSA; 415 men >55 years from five rural Ugandan communities had completed the International Prostate Symptom Scale (IPSS) and Epstein inventory to grade their LUTS severity and satisfaction with sexual function. RESULTS Prevalence rates for moderate and severe LUTS were 40.5% and 20%, respectively, in men >55 in the Ugandan regional data; associated scores for all four Epstein sexual satisfaction measures were low. GBDS population figures (2016) for men >55 years are 942 115 (Uganda) and 33.9 million (SSA); hence, scaling up from regional prevalence data suggests 381 557 and 188 423 men >55 years in Uganda, and 13 729 500 and 6 780 000 in SSA have moderate and severe LUTS, respectively, and the majority will have compromise of elements of their sexual function. CONCLUSIONS Extrapolation from a small regional dataset (for which we have no guarantee of national or SSA representability) provides the first prevalence estimates for LUTS severity based on African data, and suggests a large proportion of men >55 years are troubled with LUTS and associated sexual dysfunction.
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Affiliation(s)
- Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Lynn Stothers
- Department of Urologic Sciences, and Associate Member School of Population and Public Health Division of Global Health, University of British Columbia, Vancouver, BC, Canada, and Principal Investigator, International Collaboration on Repair Discoveries (ICORD)
| | - Jonathan Berkowitz
- Department of Family Practice, Sauder School of Business, University of British Columbia, Vancouver, BC, Canada
| | - Andrew J. Macnab
- Stellenbosch Institute for Advanced Study, Wallenberg Research Centre, Stellenbosch, South Africa, and Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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19
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Abstract
Nocturnal enuresis (NE) is a combined symptom of nocturia and urinary incontinence. In this review, we aim to summarize the current literature on NE in terms of its definition, diagnosis, and management. Recommended diagnostic evaluation of NE includes a focused history and physical examination, urinalysis, and when indicated, ultrasound examination, flow rate, urine volume chart, urodynamics, and cystoscopy. Therapeutic options include lifestyle modification and medications (i.e., desmopressin and anticholinergics).
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Affiliation(s)
- Hamed Akhavizadegan
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada.,Urology Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Jennifer A Locke
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Lynn Stothers
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada.,Principal Investigator, International Collaboration On Repair Discovery (ICORD), Peter Wall Institute for Advanced Studies Scholar, University of British Columbia, Vancouver, BC, Canada
| | - Alex Kavanagh
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
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20
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Wade AJ, Doyle JS, Gane E, Stedman C, Draper B, Iser D, Roberts SK, Kemp W, Petrie D, Scott N, Higgs P, Agius PA, Roney J, Stothers L, Thompson AJ, Hellard ME. Community-based provision of direct-acting antiviral therapy for hepatitis C: study protocol and challenges of a randomized controlled trial. Trials 2018; 19:383. [PMID: 30012192 PMCID: PMC6048874 DOI: 10.1186/s13063-018-2768-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 06/27/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To achieve the World Health Organization hepatitis C virus (HCV) elimination targets, it is essential to increase access to treatment. Direct-acting antiviral (DAA) treatment can be provided in primary healthcare services (PHCS), improving accessibility, and, potentially, retention in care. Here, we describe our protocol for assessing the effectiveness of providing DAAs in PHCS, and the impact on the HCV care cascade. In addition, we reflect on the challenges of conducting a model of care study during a period of unprecedented change in HCV care and treatment. METHODS Consenting patients with HCV infection attending 13 PHCS in Australia or New Zealand are randomized to receive DAA treatment at the local tertiary institution (standard care arm), or their PHCS (intervention arm). The primary endpoint is the proportion commenced on DAAs and cured. Treatment providers at the PHCS include: hepatology nurses, primary care practitioners, or, in two sites, a specialist physician. All PHCS offer opioid substitution therapy. DISCUSSION The Prime Study is the first real-world, randomized, model of care study exploring the impact of community provision of DAA therapy on HCV-treatment uptake and cure. Although the study has faced challenges unique to this period of time characterized by changing treatment and service delivery, the data gained will be of critical importance in shaping health service policy that enables the elimination of HCV. TRIAL REGISTRATION ClinicalTrials.gov , ID: NCT02555475 . Registered on 15 September 2015.
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Affiliation(s)
- A. J. Wade
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004 Australia
- School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - J. S. Doyle
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004 Australia
- Department of Infectious Diseases, The Alfred, Melbourne, VIC Australia
| | - E. Gane
- New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand
| | - C. Stedman
- Department of Gastroenterology, Christchurch Hospital, and University of Otago, Christchurch, New Zealand
| | - B. Draper
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004 Australia
| | - D. Iser
- Department of Infectious Diseases, The Alfred, Melbourne, VIC Australia
| | - S. K. Roberts
- Department of Gastroenterology, The Alfred, Melbourne, VIC Australia
- Department of Medicine, Monash University, Melbourne, VIC Australia
| | - W. Kemp
- Department of Gastroenterology, The Alfred, Melbourne, VIC Australia
- Department of Medicine, Monash University, Melbourne, VIC Australia
| | - D. Petrie
- Centre for Health Economics, Monash University, Melbourne, VIC Australia
| | - N. Scott
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004 Australia
| | - P. Higgs
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004 Australia
- School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
- Department of Public Health, La Trobe University, Bundoora, VIC Australia
| | - P. A. Agius
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004 Australia
- Department of Infectious Diseases, The Alfred, Melbourne, VIC Australia
- Judith Lumley Centre, La Trobe University, Melbourne, VIC Australia
| | - J. Roney
- Department of Infectious Diseases, The Alfred, Melbourne, VIC Australia
| | - L. Stothers
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, VIC Australia
| | - A. J. Thompson
- Department of Medicine, University of Melbourne, Melbourne, VIC Australia
- Department of Gastroenterology, St Vincent’s Hospital, Melbourne, VIC Australia
| | - M. E. Hellard
- Disease Elimination Program, Burnet Institute, 85 Commercial Rd, Melbourne, VIC 3004 Australia
- Department of Infectious Diseases, The Alfred, Melbourne, VIC Australia
- School of Population Health and Preventive Medicine, Monash University, Melbourne, VIC Australia
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21
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Macnab AJ, Mukisa R, Stothers L. The Use of Photo-Essay to Report Advances in Applied Science and Health. Global Health Management Journal 2018. [DOI: 10.35898/ghmj-22199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: In the applied health and science disciples there is an expectation that project work is reported through a publication. The conventional papers written to do this follow a structure that includes sections providing background, methods, results and a discussion or conclusion, supported by figures and tables. Sometimes photographs are included, and with more on-line publications the opportunities have increased for these to be available in full color. Borrowing from the field of photojournalism photo-essays are now a publication option where a series of images are used to tell the story; these are often related to health and well-being.Aims: To summarize the methodology used to effectively combine a series of images with a brief text, and short reference list to create a visually engaging and informative short report.Guidelines: Images are taken throughout the project with consent obtained from those whose images will be recognisable. Creative licence is used to compile representative images into a sequence that conveys the background, method, results and outcome(s) of the project. Images need to be of high resolution; editing for light, colour and contrast, and cropping is allowed to increase their clarity and relevance. The ethics of photojournalism apply making inappropriate manipulation of images or erroneous captions unacceptable.Conclusions: Photo-essays are a novel and informative way to report on an applied health, social or scientific topic. The format is an excellent one to use for a brief report, or to prepare a research presentation for a scientific meeting.Keywords: Photograph, Photojournalism, Photo-manipulation.
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22
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Abdulaziz M, Kavanagh A, Stothers L, Macnab AJ. Relevance of open magnetic resonance imaging position (sitting and standing) to quantify pelvic organ prolapse in women. Can Urol Assoc J 2018; 12:E453-E460. [PMID: 29989885 DOI: 10.5489/cuaj.5186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In pelvic organ prolapse (POP), posture and gravity impact organ position and symptom severity. The advanced magnet configuration in open magnetic resonance imaging (MRO) allows patients to be imaged when sitting and standing, as well in a conventional supine position. This study evaluated if sitting and standing MRO images are relevant as a means of improving quantification of POP because they allow differences in organ position not seen on supine imaging to be identified. METHODS Forty women recruited from a university urogynecology clinic had MRO imaging (0.5 T scanner) with axial and sagittal T2-weighted pelvic scans obtained when sitting, standing, and supine. Pelvic reference lines were used to quantify the degree of POP, and the relevance of imaging position on the detection of POP compared. RESULTS Images from 40 participants were evaluated (20 with POP and 20 asymptomatic controls). Our results indicate that the maximal extent of prolapse is best evaluated in the standing position using H line, M line, mid-pubic line, and perineal line as reference lines to determine POP. CONCLUSIONS MRO imaging of symptomatic patients in a standing position is relevant in the quantification of POP. Compared with supine images, standing imaging identifies that greater levels of downward movement in the anterior and posterior compartments occur, presumably under the influence of posture and gravity. In contrast, no appreciable benefit was afforded by imaging in the sitting position, which precluded use of some reference lines due to upward movement of the anorectal junction.
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Affiliation(s)
- Marwa Abdulaziz
- PhD Candidate, Department of Experimental Medicine, Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Alex Kavanagh
- Department of Urologic Sciences, University of British Columbia, and Principal Investigator, International Collaboration on Repair Discovery (ICORD), Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Lynn Stothers
- Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
| | - Andrew J Macnab
- Department of Urologic Sciences, University of British Columbia, and Principal Investigator, International Collaboration on Repair Discovery (ICORD), Blusson Spinal Cord Centre, Vancouver, BC, Canada.,Stellenbosch Institute for Advanced Study, Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
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Abdulaziz M, Stothers L, Macnab A. MP63-09 A CLINICAL PROTOCOL FOR 3D IMAGE RECONSTRUCTION OF THE FEMALE PELVIS AND LEVATOR ANI DEFECTS SEEN WITH UPRIGHT POSTURE USING UPRIGHT OPEN MRI (MRO) IMAGING. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.2032] [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: 11/16/2022]
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Stothers L, Mutabazi S, Mukisa R, Macnab AJ. The burden of bladder outlet obstruction in men in rural Uganda. Int J Epidemiol 2018; 45:1763-1766. [PMID: 28064199 DOI: 10.1093/ije/dyw285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- L Stothers
- Department of Urologic Sciences, International Collaboration on Repair Discoveries (ICORD) and Department of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada
| | - S Mutabazi
- Health and Development Agency (HEADA) Uganda, Mbarara, Uganda
| | - R Mukisa
- Health and Development Agency (HEADA) Uganda, Mbarara, Uganda
| | - A J Macnab
- Stellenbosch Institute for Advanced Study, Stellenbosch, South Africa and Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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Stothers L, Macnab A, Bajunirwe F, Mutabazi S, Lobatt C. Comprehension and construct validity of the Visual Prostate Symptom Score (VPSS) by men with obstructive lower urinary tract symptoms in rural Africa. Can Urol Assoc J 2017; 11:E405-E408. [PMID: 29072569 DOI: 10.5489/cuaj.4589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Visual Prostate Symptom Score (VPSS) is an image-based interpretation of the International Prostate Symptom Score (IPSS) intended to quantify frequency, nocturia, weak stream, and quality of life (QoL) in a literacy-independent manner. METHODS Ugandan men presenting with lower urinary tract symptons (LUTS) to a rural clinic completed VPSS and IPSS independently and then with assistance. They verbally interpreted VPSS images, rated question usefulness, and suggested improvements. Responses between word-based and image-based measures were compared (Student's T, Fisher's exact, and Spearman's correlation tests). RESULTS One hundred thirty-two scores from 33 men (mean age: 61 years, range 28-93; education: no schooling 20%, grades 1-4 62%, 5-7 9%, 8-12 9%). Correlation between IPSS and VPSS scores was positive (r=0.70), as was that between the individual irritative, obstructive, and QoL questions. Independent of education, the weak stream image was best-recognized. Likert scale measures indicated this was the most useful image, followed by daytime frequency. Nocturia and QoL images were rated as less clear, with explanation required before most understood that QoL facial expression images reflected overall LUTS impact. Improvements suggested included: increased image size for frequency and nocturia pictograms, increased black/white contrast for nocturia, and addition of an image to allow reporting of urgency. CONCLUSIONS In a population with little formal education, there was positive correlation between IPSS and VPSS, with inherent recognition best for weak stream and worst for QoL images. Increased image clarity and an additional image for urgency will enhance the global utility of the VPSS for men to report symptoms of LUTS.
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Affiliation(s)
- Lynn Stothers
- Department of Urologic Sciences and Associate Member School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada, and Principal Investigator International Collaboration on Repair Discoveries (ICORD)
| | - Andrew Macnab
- Stellenbosch Institute for Advanced Study, Wallenberg Search Centre at Stellenbosch University, Stellenbosch, South Africa and Associate Member Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Francis Bajunirwe
- Department of Community Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Catherine Lobatt
- Resident, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
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Abdulaziz M, Deegan EG, Kavanagh A, Stothers L, Pugash D, Macnab A. Advances in basic science methodologies for clinical diagnosis in female stress urinary incontinence. Can Urol Assoc J 2017; 11:S117-S120. [PMID: 28616108 DOI: 10.5489/cuaj.4583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We provide an overview of advanced imaging techniques currently being explored to gain greater understanding of the complexity of stress urinary incontinence (SUI) through better definition of structural anatomic data. Two methods of imaging and analysis are detailed for SUI with or without prolapse: 1) open magnetic resonance imaging (MRI) with or without the use of reference lines; and 2) 3D reconstruction of the pelvis using MRI. An additional innovative method of assessment includes the use of near infrared spectroscopy (NIRS), which uses non-invasive photonics in a vaginal speculum to objectively evaluate pelvic floor muscle (PFM) function as it relates to SUI pathology. Advantages and disadvantages of these techniques are described. The recent innovation of open-configuration magnetic resonance imaging (MRO) allows images to be captured in sitting and standing positions, which better simulates states that correlate with urinary leakage and can be further enhanced with 3D reconstruction. By detecting direct changes in oxygenated muscle tissue, the NIRS vaginal speculum is able to provide insight into how the oxidative capacity of the PFM influences SUI. The small number of units able to provide patient evaluation using these techniques and their cost and relative complexity are major considerations, but if such imaging can optimize diagnosis, treatment allocation, and selection for surgery enhanced imaging techniques may prove to be a worthwhile and cost-effective strategy for assessing and treating SUI.
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Affiliation(s)
- Marwa Abdulaziz
- PhD Candidate, Department of Experimental Medicine; University of British Columbia, Vancouver, BC, Canada
| | - Emily G Deegan
- Masters Candidate, Department of Experimental Medicine; University of British Columbia, Vancouver, BC, Canada
| | - Alex Kavanagh
- Department of Urologic Sciences; University of British Columbia, Vancouver, BC, Canada
| | - Lynn Stothers
- Department of Urologic Sciences; University of British Columbia, Vancouver, BC, Canada
| | - Denise Pugash
- Department of Radiology, BC Women's Hospital; University of British Columbia, Vancouver, BC, Canada
| | - Andrew Macnab
- Department of Urologic Sciences; University of British Columbia, Vancouver, BC, Canada
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Abdulaziz M, Deegan EG, Stothers L, Pugash D, Macnab A. Advances in basic science methodologies for clinical diagnosis in female stress urinary incontinence. Can Urol Assoc J 2017. [DOI: 10.5489/cuaj.4582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We provide an overview of advanced imaging techniques currently being explored to gain greater understanding of the complexity of stress urinary incontinence (SUI) through better definition of structural anatomic data. Two methods of imaging and analysis are detailed for SUI with or without prolapse: (1) open magnetic resonance imaging with or without the use of reference lines, and (2) 3D reconstruction of the pelvis using MRI. An additional innovative method of assessment includes the use of near infrared spectroscopy (NIRS), which uses noninvasive photonics in a vaginal speculum to objectively evaluate pelvic floor muscle (PFM) function as it relates to SUI pathology. Advantages and disadvantages of these techniques are described. The recent innovation of open-configuration magnetic resonance imaging allows images to be captured in sitting and standing positions, which better simulates states that correlate with urinary leakage and can be further enhanced with 3D reconstruction. By detecting direct changes in oxygenated muscle tissue, the NIRS vaginal speculum is able to provide insight into how the oxidative capacity of the PFM influences SUI. The small number of units able to provide patient evaluation using these techniques and their cost and relative complexity are major considerations, but if such imaging can optimize diagnosis, treatment allocation, and selection for surgery enhanced imaging techniques may prove to be a worthwhile and cost-effective strategy for assessing and treating SUI.
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Abstract
INTRODUCTION In high-resource countries, modern treatments for urological diseases have led to significant reductions in mortality and morbidity; however, the benefits of modern treatment have yet to reach the majority of people worldwide. As attention is focused on improving urological care in the global community, policy and implementation research (PIR) offers a platform for effective organization and engagement. METHODS We have compiled a photo essay to illustrate the fundamental components of PIR. RESULTS There are four central components to the conduct of PIR. These are: 1) understanding the unique characteristics of the environment; 2) studying the implementation processes that fit within the environment; 3) testing innovative and novel ways to implement; and 4) programmatic implementation and scale-up. CONCLUSIONS PIR is a process that will help to identify, quantify, prioritize, and implement translation of modern methods of care to meet specific global needs.
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Affiliation(s)
- Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Associate Member School of Population and Public Health Division of Global Health, University of British Columbia, Vancouver, BC, Canada, and Principal Investigator, International Collaboration on Repair Discover (ICORD)
| | - Andrew Macnab
- Fellow, Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research at Stellenbosch University, Stellenbosch 7600, South Africa and Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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Corcos J, Przydacz M, Campeau L, Gray G, Hickling D, Honeine C, Radomski SB, Stothers L, Wagg A. Appendix: Executive summary of CUA guideline on adult overactive bladder. Can Urol Assoc J 2017; 11:E248-E249. [PMID: 28503243 DOI: 10.5489/cuaj.4694] [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: 11/19/2022]
Affiliation(s)
- Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Mikolaj Przydacz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Gary Gray
- Northern Alberta Urology Centre, Edmonton, AB, Canada
| | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Christiane Honeine
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Sidney B Radomski
- Division of Urology, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Lynn Stothers
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Deegan EG, Stothers L, Kavanagh A, Macnab AJ. Quantification of pelvic floor muscle strength in female urinary incontinence: A systematic review and comparison of contemporary methodologies. Neurourol Urodyn 2017; 37:33-45. [DOI: 10.1002/nau.23285] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/20/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Emily G. Deegan
- Department of Experimental Medicine, International Collaboration on Repair DiscoveriesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Lynn Stothers
- Department of Urological Sciences, Principal Investigator, International Collaboration on Repair Discoveries (ICORD)University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Alex Kavanagh
- Stellenbosch Institute for Advanced StudyWallenberg Research CentreStellenboschSouth Africa
| | - Andrew J. Macnab
- Stellenbosch Institute for Advanced StudyWallenberg Research CentreStellenboschSouth Africa
- Department of Urologic SciencesUniversity of British ColumbiaVancouverBritish ColumbiaCanada
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Corcos J, Przydacz M, Campeau L, Witten J, Hickling D, Honeine C, Radomski SB, Stothers L, Wagg A. CUA guideline on adult overactive bladder. Can Urol Assoc J 2017; 11:E142-E173. [PMID: 28503229 PMCID: PMC5426936 DOI: 10.5489/cuaj.4586] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Mikolaj Przydacz
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Lysanne Campeau
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | | | - Duane Hickling
- Division of Urology, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Christiane Honeine
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Sidney B. Radomski
- Division of Urology, Toronto Western Hospital, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Lynn Stothers
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Stothers L, Macnab AJ, Mukisa R, Mutabazi S, Bajunirwe F. Traumatic spinal cord injury in Uganda: a prevention strategy and mechanism to improve home care. Int J Epidemiol 2017; 46:1086-1090. [DOI: 10.1093/ije/dyx058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 11/13/2022] Open
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Lovatt C, Stothers L, Macnab A, Lazare D. PD39-10 DEVELOPMENT AND VALIDATION OF A NOVEL PICTOGRAM-BASED URINARY SYMPTOM SCORE: THE VISUAL URINARY SYMPTOM SCORE (VUSS) FOR WOMEN. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1737] [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: 11/26/2022]
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Stothers L, Tsang B, Nigro M, Lazare D, Macnab A. An integrative review of standardized clinical evaluation tool utilization in anticholinergic drug trials for neurogenic lower urinary tract dysfunction. Spinal Cord 2016; 54:1114-1120. [PMID: 27241452 PMCID: PMC5308214 DOI: 10.1038/sc.2016.63] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/01/2016] [Accepted: 03/21/2016] [Indexed: 02/08/2023]
Abstract
STUDY DESIGN To review prospective and randomized trials studying anticholinergic therapy for neurogenic bladder in SCI to identify whether trials included standardized clinical evaluation tools and reporting measures now recognized to enhance clinical trial data. METHODS A systematic search via EMBASE, MEDLINE, CENTRAL, CINAHL (Cumulative Index to Nursing and Allied Health Literature), HTA (Health Technology Assessment), CMR (Comprehensive Microbial Resource), HAPI (Health and Psychosocial Instruments) and PsycINFO using the key term spinal cord injury crossed with oxybutynin, tolterodine, darifenacin, solifenacin, fesoterodine, trospium chloride, propiverine, propantheline and anticholinergic(s) for 1946-2015 inclusive. We then collated whether standardized clinical tools, measures and descriptors were used within each study identified: American Spine Injury Association (ASIA) impairment scale; symptom scores validated in SCI; technical methodology for urodynamics/video urodynamics; urinary diaries; and standardized urologic terminology. RESULTS A total of 1225 entries with 610 unique articles were identified, 14 randomized and 16 prospective studies. In 6/30 the population comprised SCI patients with neurogenic bladder alone; the remainder included mixed neurogenic etiologies. Classification using the ASIA impairment scale was used in <10% of studies; none used symptom scores validated in SCI; <50% reported urodynamic test methodology fully, incorporated urinary diaries or used International Continence Society Standardization Subcommittee urinary tract terminology. CONCLUSION Integrative review of trials from 1946 to 2015 identified infrequent use of standardized clinical evaluation tools and reporting measures. Data from future trials evaluating therapies for neurogenic bladder would likely be more applicable to specific SCI patients if current standardized classification and descriptors now available were used consistently: for example, the ASIA scale, symptom scores validated in SCI, standardized urodynamic methodology, urinary diaries and urinary tract terminology. Studies recruiting SCI patients exclusively would also provide additional benefit.
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Affiliation(s)
- L Stothers
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Associate Member Department of Obstetrics and Gynaecology and School of Population and Public Health University of British Columbia, Vancouver, BC, Canada
| | - B Tsang
- St Andrews University, Fife, Scotland, UK
| | - M Nigro
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - D Lazare
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - A Macnab
- Department of Urologic Sciences and Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Stothers L, Locke JA, Macnab A, Nigro M. Long-Term Urologic Evaluation Following Spinal Cord Injury. Curr Bladder Dysfunct Rep 2016. [DOI: 10.1007/s11884-016-0367-2] [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: 11/24/2022]
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Fougere RJ, Currie KD, Nigro MK, Stothers L, Rapoport D, Krassioukov AV. Reduction in Bladder-Related Autonomic Dysreflexia after OnabotulinumtoxinA Treatment in Spinal Cord Injury. J Neurotrauma 2016; 33:1651-7. [PMID: 26980078 PMCID: PMC5035837 DOI: 10.1089/neu.2015.4278] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Bladder-related events, including neurogenic detrusor overactivity, are the leading cause of autonomic dysreflexia in spinal cord injured individuals. Self-reported autonomic dysreflexia is reduced following onabotulinumtoxinA treatment for neurogenic detrusor overactivity; however, none of these trials have assessed autonomic dysreflexia events using the clinical cutoff of an increase in systolic blood pressure ≥20 mm Hg. This study used a prospective, open-labelled design from 2013 to 2014 to quantitatively assess the efficacy of one cycle 200 U intradetrusor-injected onabotulinumtoxinA (20 sites) on reducing the severity and frequency of bladder-related autonomic dysreflexia events and improving quality of life. Twelve men and five women with chronic, traumatic spinal cord injuries at or above the sixth thoracic level, and concomitant autonomic dysreflexia and neurogenic detrusor overactivity, underwent blood pressure monitoring during urodynamics and over a 24 h period using ambulatory blood pressure monitoring pre- and 1 month post-treatment. Post-onabotulinumtoxinA, autonomic dysreflexia severity was reduced during urodynamics (systolic blood pressure increase: 42 ± 23 mm Hg vs. 20 ± 10 mm Hg, p < 0.001) and during bladder-related events across the 24 h period (systolic blood pressure increase: 49 ± 2 mm Hg vs. 26 ± 22 mm Hg, p = 0.004). Frequency of 24 h bladder-related autonomic dysreflexia events was also decreased post-onabotulinumtoxinA (4 ± 2 events vs. 1 ± 1 events, p < 0.001). Autonomic dysreflexia and incontinence quality of life indices were also improved post-onabotulinumtoxinA (p < 0.05). Intradetrusor injections of onabotulinumtoxinA for the management of neurogenic detrusor overactivity in individuals with high level spinal cord injuries decreased the severity and frequency of bladder-related episodes of autonomic dysreflexia, and improved bladder function and quality of life.
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Affiliation(s)
- Renée J Fougere
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Katharine D Currie
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Mark K Nigro
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,2 Department of Urologic Sciences, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Lynn Stothers
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,2 Department of Urologic Sciences, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Daniel Rapoport
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,2 Department of Urologic Sciences, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Andrei V Krassioukov
- 1 International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,2 Department of Urologic Sciences, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,3 Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,4 G.F. Strong Rehabilitation Centre , Vancouver, British Columbia, Canada
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Stothers L, Brown P, Fenster H, Levine M, Berkowitz J. MP26-05 DOSE RESPONSE OF CRANBERRY IN THE TREATMENT OF LOWER URINARY TRACT INFECTIONS IN WOMEN. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Ho M, Stothers L, Lazare D, Tsang B, Macnab A. Evaluation of educational content of YouTube videos relating to neurogenic bladder and intermittent catheterization. Can Urol Assoc J 2015; 9:320-54. [PMID: 26644803 DOI: 10.5489/cuaj.2955] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Many patients conduct internet searches to manage their own health problems, to decide if they need professional help, and to corroborate information given in a clinical encounter. Good information can improve patients' understanding of their condition and their self-efficacy. Patients with spinal cord injury (SCI) featuring neurogenic bladder (NB) require knowledge and skills related to their condition and need for intermittent catheterization (IC). METHODS Information quality was evaluated in videos accessed via YouTube relating to NB and IC using search terms "neurogenic bladder intermittent catheter" and "spinal cord injury intermittent catheter." Video content was independently rated by 3 investigators using criteria based on European Urological Association (EAU) guidelines and established clinical practice. RESULTS In total, 71 videos met the inclusion criteria. Of these, 12 (17%) addressed IC and 50 (70%) contained information on NB. The remaining videos met inclusion criteria, but did not contain information relevant to either IC or NB. Analysis indicated poor overall quality of information, with some videos with information contradictory to EAU guidelines for IC. High-quality videos were randomly distributed by YouTube. IC videos featuring a healthcare narrator scored significantly higher than patient-narrated videos, but not higher than videos with a merchant narrator. About half of the videos contained commercial content. CONCLUSIONS Some good-quality educational videos about NB and IC are available on YouTube, but most are poor. The videos deemed good quality were not prominently ranked by the YouTube search algorithm, consequently user access is less likely. Study limitations include the limit of 50 videos per category and the use of a de novo rating tool. Information quality in videos with healthcare narrators was not higher than in those featuring merchant narrators. Better material is required to improve patients' understanding of their condition.
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Affiliation(s)
- Matthew Ho
- Medical student, University of British Columbia, Vancouver, BC
| | - Lynn Stothers
- Department of Urological Sciences, University of British Columbia, Vancouver, BC
| | - Darren Lazare
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC
| | - Brian Tsang
- Medical Student, St. Andrew's University, St Andrews, Fife, UK
| | - Andrew Macnab
- Department of Urological Sciences, University of British Columbia, Vancouver, BC
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Friedman B, Stothers L, Lazare D, Macnab A. Positional pelvic organ prolapse (POP) evaluation using open, weight-bearing magnetic resonance imaging (MRI). Can Urol Assoc J 2015. [PMID: 26225170 DOI: 10.5489/cuaj.2767] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Magnetic resonance imaging (MRI) of patients with pelvic organ prolapse (POP) is completed in the supine position. Open magnetic resonance imaging (MRO) uses vertical magnets, allowing imaging in a variety of upright postures. This pilot study used MRO to evaluate the change of prolapse in different positions compared to non-prolapsed images. METHODS In total, 11 women (6 POP, 5 controls) aged 24 to 65 years had 12 MRO images (midline sagittal pelvic line) consecutively when supine, sitting and standing with a full and empty bladder. Lengths between the lowest point of the bladder to the pubococcygeal (PC) and pubopromontoreal (PP) lines in each image were compared, and the ratio of bladder area under the PC and PP lines to the total bladder area. RESULTS Significant elongation between the PC line and lowest point of the bladder was evident in subjects with POP comparing supine and standing images (p = 0.03), but not controls (p = 0.07). Similarly, this axis was significantly longer in cystocele subjects versus controls only in the standing position. Bladder area under the PC line was significantly increased between supine and standing positions only among subjects with cystocele (p < 0.01), and significantly larger among the study group in the standing position (p < 0.005), less significant in the supine position (p = 0.015), and not significant in the sitting position (p = 0.3). CONCLUSIONS MRO imaging allows us to investigate the effects of upright position and weight bearing on the staging of POP. Imaging patients when sitting and standing identified that significant changes occur in the maximal descent of the bladder.
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Affiliation(s)
- Boris Friedman
- Associate Member, Department of Urology, Lady Davis Carmel medical center, Technion Institute of Technology, Haifa, Israel
| | - Lynn Stothers
- Department of Urologic Sciences University of British Columbia, Canada
| | - Darren Lazare
- Clinical Assistant Professor, Division of Specialty Gynaecology, Dept. of Obstetrics and Gynaecology, University of British Columbia, Canada
| | - Andrew Macnab
- Department of Urologic Sciences University of British Columbia, Canada
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Abdulaziz M, Stothers L, Lazare D, Macnab A. An integrative review and severity classification of complications related to pessary use in the treatment of female pelvic organ prolapse. Can Urol Assoc J 2015. [PMID: 26225188 DOI: 10.5489/cuaj.2783] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Pessary use is the preferred non-surgical treatment option for female pelvic organ prolapse. As pessaries can be used chronically to alter pelvic floor anatomy, consideration of short-and long-term complications is important in patient management. We systematically reviewed articles describing the complications of pessary use to determine frequency and severity. METHODS A systematic search via MEDLINE and PubMed using the key terms "complications," "pessary," "pelvic organ prolapse," "side effects" was conducted for the years 1952 to 2014 inclusively. Selected articles cited in the publications identified were also considered. Only full-text material published in English was reviewed. All pessary-related complications described were collated; overall frequency within case reports and case series were calculated and severity was graded using the Clavien-Dindo classification. RESULTS In total, 61 articles met the inclusion criteria. The most common complications reported were vaginal discharge/vaginitis, erosion, and bleeding. Complications were related to pessary shape and material, and duration in situ. Clavien-Dindo classification of complication severity found that all 5 grade levels were attributed to pessary use; serious grade 4 and 5 complications included cancer, adjacent organ fistula and death. CONCLUSION There are few detailed reports of complications of pessary use relative to the estimated frequency of pessary use worldwide. Prospective studies documenting complications by shape, material, and size, and objectively classifying complication severity are required. As serious grade 4 and 5 complications of pessary use occur, further development of clinical follow-up guidelines for long-term pessary users is justified.
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Affiliation(s)
- Marwa Abdulaziz
- PhD Candidate, Department of Experimental Medicine, University of British Columbia, Vancouver, BC
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Darren Lazare
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - Andrew Macnab
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
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Shadgan B, Nigro M, Macnab A, Fareghi M, Stothers L, Sharifi-Rad L, Kajbafzadeh AM. Optical diagnosis of lower urinary tract infection: a pilot study in children. J Pediatr Urol 2015; 11:74.e1-7. [PMID: 25791425 DOI: 10.1016/j.jpurol.2014.08.017] [Citation(s) in RCA: 2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 08/27/2014] [Indexed: 11/25/2022]
Abstract
UNLABELLED Conventionally, diagnosis of lower urinary tract infection (LUTI) is made on the basis of history, urine microscopy and culture. But there are limitations to this methodology especially in children and special populations where there is difficulty in obtaining a full history and details of clinical symptoms. The aim of this study was to determine if monitoring bladder wall oxygenation as a measure of bladder mucosal inflammation using transcutaneous near-infrared spectroscopy (NIRS) allows detection of the presence or absence of LUTI in children. MATERIALS AND METHODS A convenience sample of children referred to a pediatric urology clinic with an acute LUTI and a control group were studied. Diagnosis was confirmed by history, physical examination, laboratory investigations, and urine culture. Participants had transcutaneous measurement of an absolute measure of tissue oxygen saturation (TSI%) in their bladder wall, and a quadriceps muscle control site, using a spatially resolved (SR) wireless NIRS device. Average measures of bladder wall TSI% (B.TSI%) and quadriceps TSI% (Q.TSI%) and their differences (TSI.diff) were calculated and compared between those with LUTI and controls by performing a two-way repeated analysis of variance. RESULTS Thirty-four patients met the inclusion criteria (LUTI n = 12 and controls n = 22). Comparing LUTI to controls B.TSI% and TSI.diff values were significantly higher in the LUTI group (p < 0.0001), while Q.TSI% values were not significantly different. CONCLUSIONS Optical monitoring of bladder wall oxygenation is feasible in children. In this study a significant difference was evident in a SR NIRS-derived measure of absolute oxygen saturation in the bladder wall between children with UTI diagnosed by conventional testing methods, and those in a control group without infection. SR-NIRS monitoring of bladder wall oxygenation may offer a rapid and non-invasive means of bedside screening for LUTI where history and/or clinical signs are not available or adequate.
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Affiliation(s)
- Babak Shadgan
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada; Center for International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada.
| | - Mark Nigro
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada; Center for International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada.
| | - Andrew Macnab
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada.
| | - Mehdi Fareghi
- Pediatric Urology Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Iran.
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, Canada; Center for International Collaboration on Repair Discoveries (ICORD), Vancouver, Canada.
| | - Lida Sharifi-Rad
- Pediatric Urology Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Iran.
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Iran.
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Larouche M, Stothers L, Geoffrion R, Lazare D, Clancy A, Koenig N, Cundiff G. Mid-YouTube Slings: A Systematic Appraisal pf Social Media on Information Quality, Surgical Content and Bias about Mid-urethral Slings. J Minim Invasive Gynecol 2015. [DOI: 10.1016/j.jmig.2014.12.161] [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]
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Tsang B, Stothers L, Macnab A, Lazare D, Nigro M. A systematic review and comparison of questionnaires in the management of spinal cord injury, multiple sclerosis and the neurogenic bladder. Neurourol Urodyn 2015; 35:354-64. [PMID: 25620137 DOI: 10.1002/nau.22720] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 07/26/2014] [Accepted: 11/03/2014] [Indexed: 11/11/2022]
Abstract
AIMS Validated questionnaires are increasingly the preferred method used to obtain historical information. Specialized questionnaires exist validated for patients with neurogenic disease including neurogenic bladder. Those currently available are systematically reviewed and their potential for clinical and research use are described. METHODS A systematic search via Medline and PubMed using the key terms questionnaire(s) crossed with Multiple Sclerosis (MS) and Spinal Cord Injury (SCI) for the years 1946 to January 22, 2014 inclusive. Additional articles were selected from review of references in the publications identified. Only peer reviewed articles published in English were included. RESULTS 18 questionnaires exist validated for patients with neurogenic bladder; 14 related to MS, 3 for SCI, and 1 for neurogenic bladder in general; with 4 cross-validated in both MS and SCI. All 18 are validated for both male and female patients; 59% are available only in English. The domains of psychological impact and physical function are represented in 71% and 76% of questionnaires, respectively. None for the female population included elements to measure symptoms of prolapse. CONCLUSION The last decade has seen an expansion of validated questionnaires to document bladder symptoms in neurogenic disease. Disease specific instruments are available for incorporation into the clinical setting for MS and SCI patients with neurogenic bladder. The availability of caregiver and interview options enhances suitability in clinical practice as they can be adapted to various extents of disability. Future developments should include expanded language validation to the top 10 global languages reported by the World Health Organization.
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Affiliation(s)
- B Tsang
- St. Andrews University, United Kingdom
| | - L Stothers
- Department of Urological Sciences, University of British Columbia
| | - A Macnab
- Department of Urological Sciences, University of British Columbia
| | - D Lazare
- Department of Obstetrics and Gynecology, University of British Columbia
| | - M Nigro
- Department of Urological Sciences, University of British Columbia
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Shadgan B, Fareghi M, Stothers L, Macnab A, Kajbafzadeh AM. Diagnosis of testicular torsion using near infrared spectroscopy: A novel diagnostic approach. Can Urol Assoc J 2014; 8:E249-52. [PMID: 24839492 DOI: 10.5489/cuaj.1672] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report a case of testicular torsion in a 14-month old boy. Testicular ischemia was suspected based on history and clinical presentations. The patient was referred following 24 hours of left acute scrotum. Erythema, swelling and tenderness associated with nausea and emesis were present, but the patient was not febrile. We used a spatially resolved near-infrared spectroscopy (SR-NIRS) device to study and compare the tissue saturation index (TSI) on both right and left spermatic cords. The TSI was significantly reduced in the left side. Both testicles were surgically explored and the left testis was found non-viable with a 1080-degree intra-vaginal torsion. NIRS monitoring of spermatic cord oxygen saturation appears feasible as a non-invasive bedside optical method to identify testicular torsion.
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Affiliation(s)
- Babak Shadgan
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Mehdi Fareghi
- Pediatric Urology Research Center, Tehran University of Medical Sciences, Islamic Republic of Iran
| | - Lynn Stothers
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - Andrew Macnab
- Department of Pediatrics, Department of Urologic Sciences, University of British Columbia, Vancouver, BC
| | - A M Kajbafzadeh
- Pediatric Urology Research Center, Tehran University of Medical Sciences, Islamic Republic of Iran
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Shadgan B, Kajbafzadeh A, Stothers L, Andrew M, Nigro M. MP8-03 OPTICAL DIAGNOSIS OF LOWER URINARY TRACT INFECTION: A PILOT STUDY IN CHILDREN. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.346] [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: 11/24/2022]
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Abstract
There is no consensus on the amount of exercise necessary to improve pelvic floor muscle (PFM) function. We reviewed the pathophysiology of PFM dysfunction and the evolution of PFM training regimens since Kegel introduced the concept of pelvic floor awareness and the benefits of strength. This paper also describes the similarities and differences between PFM and other muscular groups, reviews the physiology of muscle contraction and principles of muscle fitness and exercise benefits and presents the range of protocols designed to strengthen the PFM and improve function. We also discuss the potential application of new technology and methodologies. The design of PFM training logically requires multiple factors to be considered in each patient. Research that defines measures to objectively quantify the degree of dysfunction and the efficacy of training would be beneficial. The application of new technologies may help this process.
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Affiliation(s)
- Andrea Marques
- Postdoctoral student, Bladder Care Centre University of British Columbia (Canada), Department of Physiotherapy of the Center for Assistance to Women's Health, CAISM-UNICAMP, Campinas (SP), Brazil
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Marques A, Stothers L, Macnab A. The status of pelvic floor muscle training for women. Can Urol Assoc J 2013. [DOI: 10.5489/cuaj.963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There is no consensus on the amount of exercise necessary toimprove pelvic floor muscle (PFM) function. We reviewed thepathophysiology of PFM dysfunction and the evolution of PFMtraining regimens since Kegel introduced the concept of pelvic floorawareness and the benefits of strength. This paper also describesthe similarities and differences between PFM and other musculargroups, reviews the physiology of muscle contraction and principlesof muscle fitness and exercise benefits and presents the rangeof protocols designed to strengthen the PFM and improve function.We also discuss the potential application of new technologyand methodologies. The design of PFM training logically requiresmultiple factors to be considered in each patient. Research thatdefines measures to objectively quantify the degree of dysfunctionand the efficacy of training would be beneficial. The applicationof new technologies may help this process.Il n’existe aucun consensus concernant la quantité d’exercicerequis pour améliorer la fonction du muscle du plancher pelvien(MPP). Nous avons examiné la physiopathologie d’un mauvaisfonctionnement du MPP et l’évolution des plans d’entraînement dece muscle depuis que Kegel a introduit le concept de la prise deconscience du MPP et les avantages de son renforcement. L’articledécrit également les similitudes et les différences entre le MPP etd’autres groupes musculaires, passe en revue la physiologie descontractions musculaires et les principes de bon fonctionnementmusculaire et les avantages liés à l’exercice. Nous présentons aussidivers protocoles visant à renforcer le MPP et à en améliorer lefonctionnement, ainsi que l’application potentielle de nouvellestechnologies et méthodologies. Le plan d’entraînement du MPPnécessite en toute logique la prise en compte de multiples facteursselon les patients. Des études cherchant à définir les mesures àutiliser pour quantifier de manière objective le niveau de dysfonctionet l’efficacité de l’entraînement seraient utiles. L’application denouvelles technologies pourrait contribuer à cet objectif.
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Weins K, Green S, Grecov D, Stothers L. 2276 FLUID BIOMECHANICS OF MALE UROFLOW USING IMAGE PROCESSING OF HIGH-SPEED VIDEO PHOTOGRAPHY. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.2205] [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: 10/27/2022]
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Macnab AJ, Shadgan B, Stothers L, Afshar K. Ambulant monitoring of bladder oxygenation and hemodynamics using wireless near-infrared spectroscopy. Can Urol Assoc J 2013; 7:E98-E104. [PMID: 23671516 PMCID: PMC3650823 DOI: 10.5489/cuaj.271] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Near-infrared spectroscopy (NIRS) non-invasively detects changes in the concentration of the chromophores oxygenated (ΔO2Hb) and deoxygenated hemoglobin (ΔHHb) as the bladder detrusor muscle contracts during voiding. Such data provide novel information on bladder oxygenation and hemodynamics. We evaluated the feasibility of monitoring ambulant subjects using a wireless NIRS device. METHODS The wireless device uses paired light-emitting diodes (wavelengths 760 and 850 nm) and a silicon photodiode detector. We monitored 14 asymptomatic subjects (10 adults, 4 children) and 6 symptomatic children with non-neurogenic lower urinary tract dysfunction (NLUTD) during spontaneous voiding after natural filling. The device was taped to the abdominal skin 2 cm above the symphysis pubis across the midline. The wireless NIRS data (patterns of change in chromophore concentration) were compared between subjects and to the data obtained using a laser-powered instrument. RESULTS Graphs of ΔO2Hb, ΔHHb and total hemoglobin (ΔtHb) were obtained from all 20 patients. Data during uroflow showed reproducible patterns of bladder chromophore change between asymptomatic subjects (rise in ΔtHb/ΔO2Hb), consistent with laser instrument data. In contrast, all 6 symptomatic children had a negative trend in ΔtHb, with falls in ΔO2Hb. One adult experienced "shy" bladder and changes in hemodynamics/oxygenation occurred while bladder volume was unchanged. CONCLUSIONS Wireless NIRS bladder monitoring is feasible in ambulant adults and children; wireless and laser-derived data in asymptomatic subjects are comparable. Pilot data suggest that subjects with symptomatic NLUTD have impaired bladder oxygenation/hemodynamics. The fact that chromophore changes occur when bladder volume remains constant supports the concept that NIRS data are a physiologic measure.
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Affiliation(s)
- Andrew John Macnab
- Department of Urology, Faculty of Medicine, University of British Columbia, UBC Hospital Bladder Care Centre, Vancouver BC
| | - Babak Shadgan
- UBC Bladder Care Centre, University of British Columbia, Vancouver BC
| | - Lynn Stothers
- Department of Urology, Faculty of Medicine, University of British Columbia, UBC Hospital Bladder Care Centre, Vancouver BC
| | - Kourosh Afshar
- Department of Urology, British Columbia’s Children’s Hospital, Vancouver, BC
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Afshar K, Stothers L, Scott H, MacNeily AE. Cranberry juice for the prevention of pediatric urinary tract infection: a randomized controlled trial. J Urol 2012; 188:1584-7. [PMID: 22910239 DOI: 10.1016/j.juro.2012.02.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [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: 11/29/2011] [Indexed: 11/17/2022]
Abstract
PURPOSE Proanthocyanidins found in cranberry have been reported to have in vitro and in vivo antibacterial activity. We determined the effectiveness of cranberry juice for the prevention of urinary tract infections in children. MATERIALS AND METHODS A total of 40 children were randomized to receive daily cranberry juice with high concentrations of proanthocyanidin vs cranberry juice with no proanthocyanidin for a 1-year period. The study was powered to detect a 30% decrease in the rate of symptomatic urinary tract infection with type I and II errors of 0.05 and 0.2, respectively. Toilet trained children up to age 18 years were eligible if they had at least 2 culture documented nonfebrile urinary tract infections in the calendar year before enrollment. Patients with anatomical abnormalities (except for primary vesicoureteral reflux) were excluded from study. Subjects were followed for 12 months. The participants, clinicians, outcome assessor and statistician were all blinded to treatment allocation. RESULTS Of the children 39 girls and 1 boy were recruited. Mean and median patient age was 9.5 and 7 years, respectively (range 5 to 18). There were 20 patients with comparable baseline characteristics randomized to each group. After 12 months of followup the average incidence of urinary tract infection in the treatment group was 0.4 per patient per year and 1.15 in the placebo group (p = 0.045), representing a 65% reduction in the risk of urinary tract infection. CONCLUSIONS Cranberry juice with high concentrations of proanthocyanidin appears to be effective in the prevention of pediatric nonfebrile urinary tract infections. Further studies are required to determine the cost-effectiveness of this approach.
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Affiliation(s)
- K Afshar
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
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