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De Coninck V, Mortiers X, Hendrickx L, De Wachter S, Traxer O, Keller EX. Radiation exposure of patients during endourological procedures. World J Urol 2024; 42:266. [PMID: 38676726 DOI: 10.1007/s00345-024-04953-y] [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: 01/20/2024] [Accepted: 03/28/2024] [Indexed: 04/29/2024] Open
Abstract
PURPOSE Considering the existing gaps in the literature regarding patient radiation dose (RD) and its associated risks, a systematic review of the literature on RD was conducted, focusing on percutaneous nephrolithotomy (PCNL), extracorporeal shock wave lithotripsy (SWL), and ureteroscopy (URS). METHODS Two authors conducted a literature search on PubMed, Web of Science, and Google Scholar to identify studies on RD during endourological procedures. Two thousand two hundred sixty-six articles were screened. Sixty-five publications met the inclusion criteria using the PRISMA standards. RESULTS RD was generally highest for PCNL, reaching levels up to 33 mSv, 28,700 mGycm2, and 430.8 mGy. This was followed by SWL, with RD reaching up to 7.32 mSv, 13,082 mGycm2, and 142 mGy. URS demonstrated lower RD, reaching up to 6.07 mSv, 8920 mGycm2, and 46.99 mGy. Surgeon experience and case load were inversely associated with RD. Strategies such as optimizing fluoroscopy settings, implementing ultrasound (US), and following the ALARA (As Low As Reasonably Achievable) principle minimized RD. CONCLUSIONS This is the first systematic review analyzing RD, which was generally highest during PCNL, followed by SWL and URS. There is no specific RD limit for these procedures. Implementation of strategies such as optimizing fluoroscopy settings, utilizing US, and adhering to the ALARA principle proved effective in reducing RD. However, further research is needed to explore the factors influencing RD, assess their impact on patient outcomes, and establish procedure-specific reference levels for RD.
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Affiliation(s)
- Vincent De Coninck
- Department of Urology, AZ Klina, Augustijnslei 100, 2930, Brasschaat, Belgium.
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, The Netherlands.
| | - Xavier Mortiers
- Department of Medicine, University of Antwerp, Campus Drie Eiken, Gebouw S, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Laura Hendrickx
- Department of Medicine, University of Antwerp, Campus Drie Eiken, Gebouw S, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Stefan De Wachter
- Department of Medicine, University of Antwerp, Campus Drie Eiken, Gebouw S, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Olivier Traxer
- GRC N°20, Groupe de Recherche Clinique Sur La Lithiase Urinaire, Hôpital Tenon, Sorbonne Université, Paris, France
- Service d'Urologie, Assistance-Publique Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Etienne X Keller
- Young Academic Urologists (YAU), Urolithiasis & Endourology Working Party, 6846, Arnhem, The Netherlands
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Heesakkers JPFA, Toozs-Hobson P, Sutherland SE, Digesu A, Amundsen CL, McCrery RJ, De Wachter S, Kean ER, Martens F, Benson K, Ferrante KL, Cline KJ, Padron OF, Giusto L, Lane FL, Dmochowski RR. A prospective study to assess the effectiveness and safety of the BlueWind System in the treatment of patients diagnosed with urgency urinary incontinence. Neurourol Urodyn 2024. [PMID: 38634481 DOI: 10.1002/nau.25477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/21/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Overactive bladder (OAB) affects one in six adults in Europe and the United States and impairs the quality of life of millions of individuals worldwide. When conservative management fails, third-line treatments including tibial neuromodulation (TNM) is often pursued. TNM has traditionally been accomplished percutaneously in clinic. OBJECTIVE A minimally invasive implantable device activated by a battery-operated external wearable unit has been developed for the treatment of urgency urinary incontinence (UUI), mitigating the burden of frequent clinic visits and more invasive therapies that are currently commercially available. METHODS A prospective, multicenter, single-arm, open-label, pivotal study evaluated the safety and effectiveness of the device in adult females with UUI (i.e., wet OAB) (BlueWind Implantable Tibial Neuromodulation [iTNM] system; IDE number #G200013; NCT03596671). Results with the device were previously published under the name RENOVA iStim, which has been since renamed as the Revi™ System. Approximately 1-month post-implantation of the device, participants delivered therapy at their convenience and completed a 7-day voiding diary before visits 6- and 12-months post-treatment initiation. The primary efficacy and safety endpoints were the proportion of responders to therapy ( ≥ 50% improvement on average number of urgency-related incontinence episodes) and incidence of adverse events from implantation to 12-month post-activation. RESULTS A total of 151 participants, mean age 58.8 (SD: 12.5), were implanted; 144 and 140 completed the 6- and 12-month visits, respectively. The participants demonstrated mean baseline of 4.8 UUI/day (SD 2.9) and 10 voids/day (SD 3.3). Six and 12-months post-activation, 76.4% and 78.4% of participants, respectively, were responders to therapy in an intent-to-treat analysis. Of the 139 participants with completed 12-month diaries, 82% were responders, 50% were classified as "dry" (on at least 3 consecutive diary days), and 93.5% of participants reported that their symptoms improved. No implanted participant experienced an SAE related to the procedure or device. CONCLUSIONS iTNM, delivered and powered by a patient-controlled external wearable communicating with an implant, demonstrated clinically meaningful and statistically significant improvement in UUI symptoms and a high safety profile. This therapy highlights the value of patient-centric therapy for the treatment of UUI.
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Affiliation(s)
| | | | - Suzette E Sutherland
- Department of Urology, UW Medicine Pelvic Health Center, University of Washington, Seattle, Washington, USA
| | - Alex Digesu
- St Mary's Hospital, Imperial College NHS Trust, London, UK
| | - Cindy L Amundsen
- Department of Obstetrics and Gynecology, Division of Urogynecology and Reconstructive Pelvic Surgery, Duke University, Durham, North Carolina, USA
| | | | - Stefan De Wachter
- Department of Urology, ASTARC Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
| | - Emily R Kean
- Adult Pediatric Urology & Urogynecology, Omaha, Nebraska, USA
| | - Frank Martens
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kevin Benson
- Department of Obstetrics and Gynecology, FPMRS Division, Sanford Health, University of South Dakota School of Medicine, Sioux Falls, South Dakota, USA
| | | | - Kevin J Cline
- Louisiana State University Medical Center, Shreveport, Louisiana, USA
| | | | - Laura Giusto
- Chesapeake Urology Research Associates, Baltimore, Maryland, USA
| | - Felicia L Lane
- Urogynecology and Reconstructive Surgery, University of California, Irvine, Irvine, California, USA
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Fourel M, Hafez S, Ramdane N, Perrouin-Verbe MA, De Wachter S, Vermersch P, Biardeau X. Response to tibial and sacral nerve modulation in overactive bladder: Is there any correlation? Neurourol Urodyn 2024; 43:415-423. [PMID: 38078739 DOI: 10.1002/nau.25352] [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: 07/11/2023] [Revised: 10/26/2023] [Accepted: 11/26/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVES To assess the correlation between the response to transcutaneous tibial nerve stimulation (TTNS) and subsequent response to sacral nerve modulation (SNM) to treat overactive bladder (OAB). MATERIALS AND METHODS All patients who consecutively received TTNS followed by a two-stage SNM between January 2016 and June 2022 to treat OAB in two university hospital centers were included. The response to each therapy was evaluated with success defined by a 50% or greater improvement in one or more bothersome urinary symptoms from baseline. The primary endpoint was the statistical relationship between the response to TTNS and the response to SNM, assessed by logistic regression. Secondary endpoints were the statistical relationship between the response to TTNS and the response to SNM when controlling for gender, age (<57 years vs. >57 years), presence of an underlying neurological disease, and presence of DO, adding the factor and interaction to the previous regression model. RESULTS Among the 92 patients enrolled in the study, 68 of them were women (73.9%), and the median age was 57.0 [41.0-69.0] years. The success was reported in 22 patients (23.9%) under TTNS and 66 patients (71.7%) during the SNM test phase. There was no statistical correlation between response to TTNS and response to SNM in the overall population (confidence interval: 95% [0.48-4.47], p = 0.51). Similarly, there was no statistical correlation when controlling for age <57 years or ≥57 years, with p = 1.0 and p = 0.69, respectively. No statistical study could be conducted for the other subpopulations due to small sample sizes. CONCLUSION The response to TTNS does not predict the response to SNM in the treatment of OAB. TTNS and SNM should be considered as separate therapies, and the decision-making process for OAB treatment should take this into account.
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Affiliation(s)
- Mathieu Fourel
- Department of Urology, Lille Academic Hospital, University of Lille, Lille, France
| | - Samy Hafez
- Centre Hospitalo-Universitaire de Nantes, Urology Department, Nantes Université, Nantes, France
| | | | | | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wlrijk, Belgium
| | - Patrick Vermersch
- Inserm U1172 LilNCog, CHU Lille, FHU Precise, University of Lille, Lille, France
| | - Xavier Biardeau
- Department of Urology, Lille Academic Hospital, University of Lille, Lille, France
- Inserm U1172 LilNCog, CHU Lille, FHU Precise, University of Lille, Lille, France
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Adriaenssens Z, Lamoury RPA, Tilborghs S, Wachter SD, Brits T. Bladder perivascular epithelioid cell neoplasm: Review on clinical features of this rare tumor. Urol Ann 2024; 16:28-35. [PMID: 38415228 PMCID: PMC10896323 DOI: 10.4103/ua.ua_40_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/13/2023] [Indexed: 02/29/2024] Open
Abstract
Perivascular epithelioid cell neoplasm (PEComa) is a rare mesenchymal tumor composed of histologically and immunohistochemically distinctive perivascular epithelioid cells. They can arise in various localizations such as the bladder. A total of 36 case reports regarding bladder PEComa have been described in the literature. Eleven reviews regarding this tumor have been published in literature so far primarily focusing on anatomic pathology. Through these reviews, it is known that in bladder PEComa, the melanocytic marker Human Melanoma Black-45 is expressed in 100% of cases whereas variable expression can be seen in multiple other melanocytic and myoid markers such as smooth muscle actin, Melan-A, CD117, S100, CD31, and CD34. Since current reviews mainly emphasize anatomic pathology, we perform a review focusing on the clinical aspects of PEComa at the level of the clinician. A manual electronic search of the PubMed/Medline and Web of Science Core Collection databases was conducted. Search was done on (perivascular epithelioid cell neoplasms [MeSH terms]) AND (Bladder). All case reports and reviews were encompassed until March 15, 2023, to identify studies that assessed bladder PEComa. The age of presentation is relatively low with a median age of 37 years. There is a female predominance with a female/male ratio of 1.5. The tumor shows no preference in anatomical localization within the bladder. Even involvement of the bladder neck, proximal urethra, and distal ureter has been described. The clinical presentation consists in the majority of patients of symptoms related to the urinary tract such as hematuria, dysuria, passage of urine sediment, frequency, and urgency. Other symptoms include abdominal discomfort and dysmenorrhea. In clinical examination, an abdominal mass can be found based on the size and location of the tumor. Further examination usually encompasses cystoscopy due to the hematuria and radiological investigations such as ultrasound (US), computed tomography, and magnetic resonance imaging. These radiological investigations reveal a heterogeneous solid mass with clear borders. In our center, we performed a transvaginal US additionally in a patient with bladder PEComa, which was the only investigation in our patient that concluded the mass was located in the Retzius space. For treatment, transurethral resection of the bladder tumor and partial cystectomy were both described in equal numbers. The choice of treatment depends on the localization and size of the tumor. Follow-up consists of imaging, but clear guidelines on this matter are lacking. Bladder PEComa is a rare condition and usually presents itself with nonspecific symptoms. Radiological investigations will reveal the tumor, but the final diagnosis is based on cytological and immunohistochemical features. Since bladder PEComa is an entity with uncertain malignant potential, it is important to include this entity in the differential diagnosis when a patient presents with lower abdominal discomfort and lower urinary tract symptoms in combination with a mass in the pelvic region.
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Affiliation(s)
- Zeno Adriaenssens
- Department of Anatomy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
| | - Robby Peter Anna Lamoury
- Department of Anatomy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
| | - Sam Tilborghs
- Department of Anatomy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
| | - Stefan De Wachter
- Department of Anatomy, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | - Tim Brits
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
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Van de Borne S, Tilborghs S, Vaganée D, Vermandel A, De Wachter S. Detailed Investigation of Bladder Diary Parameters During Sacral Neuromodulation in Patients With Overactive Symptoms. Neuromodulation 2023; 26:1831-1835. [PMID: 36266179 DOI: 10.1016/j.neurom.2022.09.006] [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: 05/31/2022] [Revised: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 03/23/2023]
Abstract
AIMS Sacral neuromodulation (SNM) is a well-accepted, minimally invasive modality for patients with overactive bladder (OAB). Successful response to SNM is defined as at least 50% improvement in key symptoms, evaluated in a bladder diary (BD). BDs provide much useful information on bladder behavior during daily life. The aim of this study is to investigate BD parameter changes during SNM therapy in patients with OAB. MATERIALS AND METHODS The International Consultation on Incontinence Questionnaires (ICIQ)-BD was filled out by 34 patients with OAB, for three days at baseline and after three weeks of subthreshold sensory stimulation. The patients were considered responders for SNM when 50% improvement was seen in the BD. They underwent implantation of an internal pulse generator (IPG), and subsequently, an ICIQ-BD and a visual analog scale (VAS) evaluating bladder satisfaction during three days were filled out six weeks, six months, and one year after IPG implantation. RESULTS IPGs were implanted in 29 patients (85%). The BD showed a significant decrease in 24-hour leakage at three weeks from 4.2 to 0.6 (-86%, p < 0.001), similar significant decreases at six weeks and six months, and at one year (-80%). Voided volume (VV) at corresponding bladder sensation codes was not different between baseline and at three weeks of tined-lead procedure (TLP) (p > 0.05), and at six weeks (p > 0.05), six months (p > 0.1), and one year of IPG (p > 0.08). After three weeks of TLP, urgency episodes decreased from 4.8 to 3.4 (-30%, p = 0.025), with 59% reduction at six-weeks IPG (p < 0.001) and 49% at six-months IPG (p = 0.013). At one year, a decrease from 4.7 to 2.3 (52% reduction, p = 0.017) was noted. VAS showed the strongest correlation with urgency (p < 0.001) and frequency (p = 0.006). No significant correlation was found with VV (p = 0.87). CONCLUSIONS Our study describes how bladder sensation parameters change over time in patients on SNM. VV does not significantly increase, nor does frequency significantly decrease over the first year. Leaks and the percentage of urgency episodes significantly decrease, reaching a plateau level between six-weeks and six-months SNM.
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Affiliation(s)
- Sigrid Van de Borne
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
| | - Sam Tilborghs
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
| | - Donald Vaganée
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
| | - Alexandra Vermandel
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Faculty of Medicine and Health Sciences, Division of Occupational and Physical Therapy, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium.
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Vanderbruggen W, Brits T, Tilborghs S, Derickx K, De Wachter S. The effect of tranexamic acid on perioperative blood loss in transurethral resection of the prostate: A double-blind, randomized controlled trial. Prostate 2023; 83:1584-1590. [PMID: 37602525 DOI: 10.1002/pros.24616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/14/2023] [Accepted: 08/12/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Bleeding and bleeding-related complications remain common after bipolar transurethral resection of the prostate (TURP) for benign prostatic hyperplasia. This may possibly lead to prolonged postoperative irrigation, catheterization, and hospital stay. The objective of this trial was to evaluate the effect of high-dose tranexamic acid (TXA) on perioperative blood loss in patients treated with bipolar TURP for prostate sizes between 30 and 80 g. METHODS We conducted a single-center, prospective, double-blind, randomized controlled trial. Eighty patients were screened for inclusion between March 2020 and January 2023. After exclusion, 65 patients were randomized in two comparable groups. The TXA group (31 patients) received a TXA intravenous loading dose of 10 mg/kg over 30 min before induction, followed by a maintenance dose of 5 mg/kg/h over 12 h. The placebo group (34 patients) received an equal dose of saline infusion. We measured age, weight, preoperative prostate size, anticoagulant use, 5-alpha reductase inhibitor use, preoperative urinary tract infection, American Society of Anesthesiologists score, difference in pre- and 24 h postoperative hemoglobin and hematocrit levels, operative time, resected adenoma weight, duration of postoperative irrigation, total amount of postoperative irrigation fluid, indwelling catheter time, duration of hospital stay, blood transfusion rate, and 4-week complication rate. RESULTS Baseline characteristics in both groups were comparable. Postoperative hemoglobin decrease in TXA versus placebo group was 1 versus 1.6 mg/dL, respectively (p = 0.04). In addition, the amount of postoperative irrigation fluid (10.7 vs. 18.5 L), irrigation time (24.3 vs. 37.9 h), catheterization time (40.8 vs. 53.7 h), and hospital stay (46.9 vs. 59.2 h) were statistically significant in favor of TXA use. No blood transfusions were carried out. Four-week complication rate was comparable between the two groups. CONCLUSIONS Perioperative high-dose TXA seems beneficial in reducing hemoglobin loss, postoperative irrigation, catheterization time, and hospital stay in bipolar TURP for prostate sizes between 30 and 80 g, without increased risk of TXA-related thromboembolic events.
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Affiliation(s)
- Wies Vanderbruggen
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Department of Urology and Urological Rehabilitation, University of Antwerp, Antwerp, Belgium
| | - Tim Brits
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Department of Urology and Urological Rehabilitation, University of Antwerp, Antwerp, Belgium
| | - Sam Tilborghs
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Department of Urology and Urological Rehabilitation, University of Antwerp, Antwerp, Belgium
| | - Katleen Derickx
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Stefan De Wachter
- Department of Urology, University Hospital Antwerp, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Department of Urology and Urological Rehabilitation, University of Antwerp, Antwerp, Belgium
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Nasri J, Al Ashimi I, Tricard T, Fleury R, Matta I, Bey E, Mesnard B, Gaillet S, Martin C, Game X, Thuillier C, Chartier-Kastler E, Karsenty G, Perrouin-Verbe MA, Demeestere A, Wagner L, Ruffion A, Peyronnet B, Saussine C, Phé V, Vermersch P, De Wachter S, Biardeau X. Development of a predictive tool for sacral nerve modulation implantation in the treatment of non-obstructive urinary retention and/or slow urinary stream: a study from the Neuro-Urology Committee of the French Association of Urology. World J Urol 2023; 41:3075-3082. [PMID: 37783844 DOI: 10.1007/s00345-023-04638-y] [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: 07/04/2023] [Accepted: 09/10/2023] [Indexed: 10/04/2023] Open
Abstract
PURPOSE This study aimed to seek predictive factors and develop a predictive tool for sacral nerve modulation (SNM) implantation in patients with non-obstructive urinary retention and/or slow urinary stream (NOUR/SS). METHODS This study was designed as a retrospective study including all patients who have undergone a two-stage SNM for NOUR/SS between 2000 and 2021 in 11 academic hospitals. The primary outcome was defined as the implantation rate. Secondary outcomes included changes in bladder emptying parameters. Univariate and multivariable logistic regression analysis were performed and determined odds ratio for IPG implantation to build a predictive tool. The performance of the multivariable model discrimination was evaluated using the c-statistics and an internal validation was performed using bootstrap resampling. RESULTS Of the 357 patients included, 210 (58.8%) were finally implanted. After multivariable logistic regression, 4 predictive factors were found, including age (≤ 52 yo; OR = 3.31 CI95% [1.79; 6.14]), gender (female; OR = 2.62 CI95% [1.39; 4.92]), maximal urethral closure pressure (≥ 70 cmH2O; OR: 2.36 CI95% [1.17; 4.74]), and the absence of an underlying neurological disease affecting the lower motor neuron (OR = 2.25 CI95% [1.07; 4.76]). Combining these factors, we established 16 response profiles with distinct IPG implantation rates, ranging from 8.7 to 81.5%. Internal validation found a good discrimination value (c-statistic, 0.724; 95% CI 0.660-0.789) with a low optimism bias (0.013). This allowed us to develop a predictive tool ( https://predictivetool.wixsite.com/void ). CONCLUSION The present study identified 4 predictive factors, allowing to develop a predictive tool for SNM implantation in NOUR/SS patients, that may help in guiding therapeutic decision-making. External validation of the tool is warranted.
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Affiliation(s)
- Jordan Nasri
- Department of Urology, Lille Academic Hospital, Univ. Lille, 59000, Lille, France
| | - Intisar Al Ashimi
- Department of Urology, Strasbourg Academic Hospital, University of Strasbourg, Strasbourg, France
| | - Thibault Tricard
- Department of Urology, Strasbourg Academic Hospital, University of Strasbourg, Strasbourg, France
| | - Raphael Fleury
- Department of Urology, Rennes Academic Hospital, University of Rennes, Rennes, France
| | - Imad Matta
- Department of Urology, Nimes Academic Hospital, University of Montpellier, Nimes, France
| | - Elsa Bey
- Department of Urology, Nimes Academic Hospital, University of Montpellier, Nimes, France
| | - Benoit Mesnard
- Department of Urology, Hotel Dieu Hospital, University of Nantes, Nantes, France
| | - Sarah Gaillet
- Department of Urology, Assistance-Publique-Hôpitaux de Marseille (AP-HM), La Conception Academic Hospital, Marseille, France
| | - Claire Martin
- Department of Biostatistics, CHU Lille, 59000, Lille, France
| | - Xavier Game
- Department of Urology, Rangueil Academic Hospital, University of Toulouse, Toulouse, France
| | - Caroline Thuillier
- Department of Urology, Grenoble Academic Hospital, University of Grenoble, Grenoble, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Sorbonne Université, Assistance Publique, Hôpitaux de Paris (AP-HP), La Pitié-Salpêtrière Academic Hospital, Paris, France
| | - Gilles Karsenty
- Department of Urology, Assistance-Publique-Hôpitaux de Marseille (AP-HM), La Conception Academic Hospital, Marseille, France
| | | | - Amelie Demeestere
- Department of Urology, Lille Academic Hospital, Univ. Lille, 59000, Lille, France
- Department of Urology, Valenciennes Hospital, Valenciennes, France
| | - Laurent Wagner
- Department of Urology, Nimes Academic Hospital, University of Montpellier, Nimes, France
| | - Alain Ruffion
- Department of Urology, Hospices Civils de Lyon, Lyon Sud Hospital, 69310, Pierre-Bénite, France
- Equipe 2, Centre d'Innovation en Cancérologie de Lyon (EA 3738 CICLY), Faculté de Médecine Lyon Sud, Université Lyon 1, Villeurbanne, France
| | - Benoit Peyronnet
- Department of Urology, Rennes Academic Hospital, University of Rennes, Rennes, France
| | - Christian Saussine
- Department of Urology, Strasbourg Academic Hospital, University of Strasbourg, Strasbourg, France
| | - Véronique Phé
- Department of Urology, Sorbonne Université, Assistance Publique, Hôpitaux de Paris (AP-HP), Tenon Academic Hospital, Paris, France
| | - Patrick Vermersch
- Univ. Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU Lille, F-59000, Lille, France
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
- Faculty of Medicine and Health Sciences, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Wlrijk, Belgium
| | - Xavier Biardeau
- Department of Urology, Lille Academic Hospital, Univ. Lille, 59000, Lille, France.
- Univ. Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU Lille, F-59000, Lille, France.
- Department of Urology, Claude Huriez Hospital, 1 rue Michel Polonovski, 59037, Lille Cedex, France.
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Bladt L, Kashtiara A, Platteau W, De Wachter S, De Win G. First-Year Experience of Managing Urology Patients With Home Uroflowmetry: Descriptive Retrospective Analysis. JMIR Form Res 2023; 7:e51019. [PMID: 37847531 PMCID: PMC10618888 DOI: 10.2196/51019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Lower urinary tract symptoms affect a large number of people of all ages and sexes. The clinical assessment typically involves a bladder diary and uroflowmetry test. Conventional paper-based diaries are affected by low patient compliance, whereas in-clinic uroflowmetry measurement face challenges such as patient stress and inconvenience factors. Home uroflowmetry and automated bladder diaries are believed to overcome these limitations. OBJECTIVE In this study, we present our first-year experience of managing urological patients using Minze homeflow, which combines home uroflowmetry and automated bladder diaries. Our objective was 2-fold: first, to provide a description of the reasons for using homeflow and second, to compare the data obtained from homeflow with the data obtained from in-clinic uroflowmetry (hospiflow). METHODS A descriptive retrospective analysis was conducted using Minze homeflow between July 2019 and July 2020 at a tertiary university hospital. The device comprises a Bluetooth-connected gravimetric uroflowmeter, a patient smartphone app, and a cloud-based clinician portal. Descriptive statistics, Bland-Altman plots, the McNemar test, and the Wilcoxon signed rank test were used for data analysis. RESULTS The device was offered to 166 patients, including 91 pediatric and 75 adult patients. In total, 3214 homeflows and 129 hospiflows were recorded. Homeflow proved valuable for diagnosis, particularly in cases where hospiflow was unreliable or unsuccessful, especially in young children. It confirmed or excluded abnormal hospiflow results and provided comprehensive data with multiple measurements taken at various bladder volumes, urge levels, and times of the day. As a result, we found that approximately one-fourth of the patients with abnormal flow curves in the clinic had normal bell-shaped flow curves at home. Furthermore, homeflow offers the advantage of providing an individual's plot of maximum flow rate (Q-max) versus voided volume as well as an average or median result. Our findings revealed that a considerable percentage of patients (22/76, 29% for pediatric patients and 24/50, 48% for adult patients) had a Q-max measurement from hospiflow falling outside the range of homeflow measurements. This discrepancy may be attributed to the unnatural nature of the hospiflow test, resulting in nonrepresentative uroflow curves and an underestimation of Q-max, as confirmed by the Bland-Altman plot analysis. The mean difference for Q-max was -3.1 mL/s (with an upper limit of agreement of 13 mL/s and a lower limit of agreement of -19.2 mL/s), which was statistically significant (Wilcoxon signed rank test: V=2019.5; P<.001). Given its enhanced reliability, homeflow serves as a valuable tool not only for diagnosis but also for follow-up, allowing for the evaluation of treatment effectiveness and home monitoring of postoperative and recurrent interventions. CONCLUSIONS Our first-year experience with Minze homeflow demonstrated its feasibility and usefulness in the diagnosis and follow-up of various patient categories. Homeflow provided more reliable and comprehensive voiding data compared with hospiflow.
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Affiliation(s)
- Lola Bladt
- Product Development, Faculty of Design Sciences, University of Antwerp, Antwerp, Belgium
| | - Ardavan Kashtiara
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wouter Platteau
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
| | - Gunter De Win
- Antwerp Surgical Training, Anatomy and Research Centre, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
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9
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Gammie A, Wachter SD. Research priorities for diagnostic instrumentation in urinary incontinence. Proc Inst Mech Eng H 2023:9544119231193884. [PMID: 37667889 DOI: 10.1177/09544119231193884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
The International Consultation on Incontinence (ICI) captures current evidence on incontinence. The conference 'Incontinence: The Engineering Challenge XIII' in November 2021 heard an update on the most recent ICI summary on urodynamic testing. This paper summarises the ICI recommendations for future research in urodynamics, with a view to informing engineers of issues and challenges that could benefit from engineering solutions. Engineers are encouraged to contribute to the following areas of research, which will have a direct and positive effect on patients' quality of life and overall health: (a) Urine flow measurement: home- and app-based devices, machine learning analysis of flow shape, (b) Pressure measurement: normal values for and validation of new technologies, including air-filled, non-invasive and urethral pressure reflectometry, (c) Ultrasound imaging: bladder wall biomechanics, bladder shape analysis, (d) Assess normal and abnormal value ranges, and diagnostic performance and (e) Specific trials in understudied patient groups including those with symptoms resistant to treatment, children and the frail elderly.
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10
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Vereeck S, Pacquée S, De Wachter S, Jacquemyn Y, Neels H, Dietz HP. The effect of prolapse surgery on voiding function. Int Urogynecol J 2023; 34:2141-2146. [PMID: 37010545 DOI: 10.1007/s00192-023-05520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/09/2023] [Indexed: 04/04/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Of women with symptomatic prolapse, 13-39% experience voiding dysfunction (VD). The aim of our observational cohort study was to determine the effect of prolapse surgery on voiding function. METHODS Retrospective analysis of 392 women who underwent surgery between May 2005 and August 2020. All had a standardized interview, POP-Q, uroflowmetry and 3D/4D transperineal ultrasound (TPUS) pre-and postoperatively. Primary outcome was change in VD symptoms. Secondary outcomes were changes in maximum urinary flow rate (MFR) centile and post-void residual urine (PVR). Explanatory measures were change in pelvic organ descent as seen on POP-Q and TPUS. RESULTS Of 392 women, 81 were excluded due to missing data, leaving 311. Mean age and BMI were 58 years and 30 kg/m2, respectively. Procedures performed included anterior repair (n = 187, 60.1%), posterior repair (n = 245, 78.8%), vaginal hysterectomy (n = 85, 27.3%), sacrospinous colpopexy (n = 170, 54.7%) and mid-urethral sling (MUS) (n = 192, 61.7%). Mean follow-up was 7 (1-61) months. Pre-operatively, 135 (43.3%) women reported symptoms of VD. Postoperatively, this decreased to 69 (22.2%) (p < 0.001), and of those, 32 (10.3%) reported de novo VD. The difference remained significant after excluding concomitant MUS surgery (n = 119, p < 0.001). Postoperatively, there was a significant decrease in mean PVR (n = 311, p < 0.001). After excluding concomitant MUS surgery, there was a significant increase in mean MFR centile (p = 0.046). CONCLUSIONS Prolapse repair significantly reduces symptoms of VD and improves PVR and flowmetry.
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Affiliation(s)
- Sascha Vereeck
- Department of Obstetrics and Gynaecology, Antwerp University Hospital UZA, Edegem, Belgium.
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium.
- Global Health Institute (GHI), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium.
| | | | - Stefan De Wachter
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
- Department of Urology, Antwerp University Hospital UZA, Edegem, Belgium
| | - Yves Jacquemyn
- Department of Obstetrics and Gynaecology, Antwerp University Hospital UZA, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
- Global Health Institute (GHI), Faculty of Medicine and Health Sciences, University of Antwerp, 2610, Antwerp, Belgium
| | - Hedwig Neels
- Department of Obstetrics and Gynaecology, Antwerp University Hospital UZA, Edegem, Belgium
- MOVANT, Faculty of Rehabilitation Sciences and Physiotherapy, University of Antwerp, 2610, Antwerp, Belgium
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Jordaens S, Oeyen E, Willems H, Ameye F, De Wachter S, Pauwels P, Mertens I. Protein Biomarker Discovery Studies on Urinary sEV Fractions Separated with UF-SEC for the First Diagnosis and Detection of Recurrence in Bladder Cancer Patients. Biomolecules 2023; 13:932. [PMID: 37371512 DOI: 10.3390/biom13060932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Urinary extracellular vesicles (EVs) are an attractive source of bladder cancer biomarkers. Here, a protein biomarker discovery study was performed on the protein content of small urinary EVs (sEVs) to identify possible biomarkers for the primary diagnosis and recurrence of non-muscle-invasive bladder cancer (NMIBC). The sEVs were isolated by ultrafiltration (UF) in combination with size-exclusion chromatography (SEC). The first part of the study compared healthy individuals with NMIBC patients with a primary diagnosis. The second part compared tumor-free patients with patients with a recurrent NMIBC diagnosis. The separated sEVs were in the size range of 40 to 200 nm. Based on manually curated high quality mass spectrometry (MS) data, the statistical analysis revealed 69 proteins that were differentially expressed in these sEV fractions of patients with a first bladder cancer tumor vs. an age- and gender-matched healthy control group. When the discriminating power between healthy individuals and first diagnosis patients is taken into account, the biomarkers with the most potential are MASP2, C3, A2M, CHMP2A and NHE-RF1. Additionally, two proteins (HBB and HBA1) were differentially expressed between bladder cancer patients with a recurrent diagnosis vs. tumor-free samples of bladder cancer patients, but their biological relevance is very limited.
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Affiliation(s)
- Stephanie Jordaens
- Center for Oncological Research (CORE), Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, 2610 Wilrijk, Belgium
| | - Eline Oeyen
- Health Unit, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
- Centre for Proteomics (CfP), University of Antwerp, 2020 Antwerp, Belgium
| | - Hanny Willems
- Health Unit, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
| | - Filip Ameye
- Department of Urology, AZ Maria Middelares, 9000 Ghent, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital (UZA), 2650 Edegem, Belgium
| | - Patrick Pauwels
- Center for Oncological Research (CORE), Integrated Personalized & Precision Oncology Network (IPPON), University of Antwerp, 2610 Wilrijk, Belgium
- Laboratory of Pathological Anatomy, Antwerp University Hospital (UZA), 2650 Edegem, Belgium
| | - Inge Mertens
- Health Unit, Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium
- Centre for Proteomics (CfP), University of Antwerp, 2020 Antwerp, Belgium
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12
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Lamoury RP, Pauwels J, De Wachter S, Brits T. Review of vasocutaneous fistulas and other rare complications after vasectomy. Cent European J Urol 2023; 76:155-161. [PMID: 37483862 PMCID: PMC10357828 DOI: 10.5173/ceju.2023.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 03/20/2023] [Accepted: 04/03/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Vasectomy is a surgical procedure for male sterilization. It is a very common procedure in daily urological practice with a low complication rate. Haematoma formation, wound infection, chronic scrotal pain, and spontaneous recanalization are well-known complications. Fistula formation and testicular infarction are less common following a vasectomy. In this article we provide a review of literature regarding rare complications after vasectomy. Material and methods A manual electronic search of the PubMed Medline and Web of Science Core Collection databases was performed encompassing all included reports until 30 September 2022 to identify studies that assessed patient complications after a vasectomy. Results Urethrovasocutaneous fistulas are by far the most prevalent, while vasocutaneous, vasovenous, and arteriovenous fistulas are seldom reported. In discharging fistulas, a fluid analysis can be done to discriminate different types. In all cases scrotal exploration and ligation of the fistula was performed. If present, an underlying bladder outlet obstruction should be treated. Scrotal infarction is another infrequently reported complication of vasectomy. Diagnosis is made by scrotal ultrasound and colour Doppler. Treatment is usually conservative, but orchiectomy should be considered in larger infarctions. Simple wound infections are common in patients post vasectomy. More complex infections are rare but can result in serious and even fatal complications. Conclusions Common complications after vasectomy are well known and usually well discussed with patients. However, rare complications can occur, and it is important that they are recognized by clinicians.
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Affiliation(s)
- Robby P.A. Lamoury
- Department of Urology, University of Antwerp, Antwerp, Belgium
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
| | - Jasper Pauwels
- Department of Urology, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Department of Urology, University of Antwerp, Antwerp, Belgium
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
| | - Tim Brits
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
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13
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Vereeck S, Pacquée S, Jacquemyn Y, Neels H, De Wachter S, Weeg N, Dietz HP. Does Cystocele Type Vary Between Vaginally Parous and Nulliparous Women? J Ultrasound Med 2023; 42:809-813. [PMID: 35766234 DOI: 10.1002/jum.16046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To evaluate whether cystocele type varies with vaginal parity. METHODS Retrospective analysis of 464 vaginally nulliparous women seen at 2 urogynecology units between November 2006 and November 2019. A control group consisted of 871 vaginally parous women seen between July 2017 and November 2019. Patients underwent a standardized interview, POPQ, urodynamic testing, and translabial ultrasound. On imaging, significant cystocele was defined as bladder descent to ≥10 mm below symphysis pubis. Volume datasets were analyzed offline and blinded against clinical data. RESULTS Of 5266 women seen during the inclusion period, 464 were vaginally nulliparous. Three were excluded due to missing data, leaving 461. A control group of 871 parous women was generated from patients seen during the last 2.5 years of the inclusion period. Vaginally nulliparous women were presented at a younger age compared to vaginally parous women (P < .001). Symptoms of prolapse were reported in 104 (22%) nulliparae and 489 (56%) parous women (P < .0001). Vaginally parous women demonstrated more bladder descent (P < .0001) and more cystocele (418/871 versus 43/461, P < .0001), with a higher proportion of type III cystocele (cystocele with intact retrovesical angle) (20/43 versus 273/ 418, P < .0001). Cystourethrocele (Green type II) was more common in nulliparae and cystocele type III in parous women (P = .015). On multivariate analysis, these differences in proportions remained significant (P = .049). CONCLUSIONS Nulliparity was associated with a higher proportion of Green type II cystoceles. Green type III cystocele was more common in vaginally parous women, suggesting that the latter may be more likely to be due to childbirth-related pelvic floor trauma.
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Affiliation(s)
- Sascha Vereeck
- Department of Gynaecology, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, ASTARC, Antwerp, Belgium
| | - Stefaan Pacquée
- Department of Obstetrics, Gynaecology & Neonatology, University of Sydney, Sydney, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, 2747, Australia
| | - Yves Jacquemyn
- Department of Gynaecology, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, ASTARC, Antwerp, Belgium
| | - Hedwig Neels
- Department of Gynaecology, Antwerp University Hospital, Edegem, Belgium
- University of Antwerp, ASTARC, Antwerp, Belgium
| | - Stefan De Wachter
- University of Antwerp, ASTARC, Antwerp, Belgium
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | - Natalie Weeg
- Department of Obstetrics, Gynaecology & Neonatology, University of Sydney, Sydney, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, 2747, Australia
| | - Hans Peter Dietz
- Department of Obstetrics, Gynaecology & Neonatology, University of Sydney, Sydney, NSW, Australia
- Sydney Medical School Nepean, University of Sydney, Sydney, NSW, 2747, Australia
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14
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Lourdaux PJ, Vaganée D, Leysen C, De Wachter S, De Win G. Evolution of testicular asymmetry during puberty in adolescents without and with a left varicocele. BJU Int 2023; 131:348-356. [PMID: 36196674 DOI: 10.1111/bju.15914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the evolution of the Testicular Atrophy Index (TAI) in adolescent boys with and without a left varicocele with special attention for the currently postulated cut-off value of 20%. SUBJECTS AND METHODS During 2015-2019, 364 adolescent boys aged 11-16 years were recruited. Genital examination and scrotal ultrasonography were repeatedly performed (≥4 month intervals). Testicular volume (TV) was calculated using the Lambert formula (length × width × height × 0.71). TAI was calculated using the formula: [(TVright - TVleft)/TVlargest (right, left)] × 100. RESULTS The final study population comprised 239 participants, 161 (67.36%) controls and 78 (32.64%) adolescent boys with left varicocele. The mean (sd) number of measurements per participant was 3.82 (1.08). A TAI of ≥20% at first measurement occurred in 9.94% and 35.90%, respectively. Of these, only 31.25% and 46.43% had a TAI of ≥20% at the last measurement, respectively. Nevertheless, the risk of ending up with a TAI of ≥20% was significantly higher if a TAI of ≥20% was recorded at first measurement (P = 0.041 and P = 0.002, respectively). The normalisation rate did not differ significantly between the groups (P = 0.182). Normalisation occurred most frequently in Tanner Stages III and IV. Normalisation was mostly (≥74%) due to catch-up growth of the left testis, in contrast to growth retardation of the right testis, in both groups. The TAI seems to be a fluctuating parameter. CONCLUSION A TAI of ≥20% is a phenomenon seen in boys with and without varicocele but is more common in boys with varicocele. Although normalisation of a high TAI is frequently seen, both adolescent boys with and without a left varicocele who have an initial TAI of ≥20% have a higher risk of a TAI of ≥20% in the future. As the TAI is a fluctuating parameter during pubertal development, it's use as indicator for varicocelectomy based on a single measurement during pubertal development is questioned.
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Affiliation(s)
- Pieter-Jan Lourdaux
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Donald Vaganée
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Faculty of Medicine and Health Sciences, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Wilrijk, Belgium
| | - Cynthia Leysen
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Faculty of Medicine and Health Sciences, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Wilrijk, Belgium
| | - Gunter De Win
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Faculty of Medicine and Health Sciences, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Wilrijk, Belgium
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15
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Vamour N, Dequirez PL, Seguier D, Vermersch P, De Wachter S, Biardeau X. Early interventions to prevent lower urinary tract dysfunction after spinal cord injury: a systematic review. Spinal Cord 2022; 60:382-394. [PMID: 35379959 DOI: 10.1038/s41393-022-00784-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/09/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To synthetise the available scientific literature reporting early interventions to prevent neurogenic lower urinary tract dysfunction (NLUTD) after acute supra-sacral spinal cord injury (SCI). METHODS The present systematic review is reported according to the PRISMA guidelines and identified articles published through April 2021 in the PubMed, Embase, ScienceDirect and Scopus databases with terms for early interventions to prevent NLUTD after SCI. Abstract and full-text screenings were performed by three reviewers independently, while two reviewers performed data extraction independently. An article was considered relevant if it assessed: an in-vivo model of supra-sacral SCI, including a group undergoing an early intervention compared with at least one control group, and reporting clinical, urodynamic, biological and/or histological data. RESULTS Of the 30 studies included in the final synthesis, 9 focused on neurotransmission, 2 on the inflammatory response, 10 on neurotrophicity, 9 on electrical nerve modulation and 1 on multi-system neuroprosthetic training. Overall, 29/30 studies reported significant improvement in urodynamic parameters, for both the storage and the voiding phase. These findings were often associated with substantial modifications at the bladder and spinal cord level, including up/downregulation of neurotransmitters and receptors expression, neural proliferation or axonal sprouting and a reduction of inflammatory response and apoptosis. CONCLUSIONS The present review supports the concept of early interventions to prevent NLUTD after supra-sacral SCI, allowing for the emergence of a potential preventive approach in the coming decades.
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Affiliation(s)
| | | | | | - Patrick Vermersch
- Univ. Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU Lille, FHU Precise, F-59000, Lille, France
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wlrijk, Belgium
| | - Xavier Biardeau
- Univ. Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU Lille, F-59000, Lille, France
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Versi E, Rovner ES, Dmochowski RR, Tu LM, De Wachter S. Does urinary urgency drive urinary frequency in overactive bladder? Low Urin Tract Symptoms 2022; 14:242-247. [PMID: 35233968 DOI: 10.1111/luts.12427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 10/19/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine if reduction in urgency in patients with refractory overactive bladder syndrome (rOAB) is correlated with a reduction in voiding frequency and symptom bother. METHODS Data from a prospective series of women with rOAB undergoing radiofrequency ablation of the subtrigonal tissue, termed selective bladder denervation (SBD), was analyzed. Main outcome measures included urgency voids, nonurgency voids, and urgency urinary incontinence (UUI) epidsodes from a 3-day voiding diary and quality of life (QoL) measures (Overactive Bladder Questionnaire Short Form [OAB-q SF]). RESULTS The dataset comprised 62 completer subjects at 6 months. Compared to baseline, UUI and urgency voids were lower (P < .001), but nonurgency voids were increased (P < .001) and QoL measures were improved (P < .001), but functional bladder capacity did not increase. At baseline and 6 months post treatment, symptom bother was correlated with urgency voids (P < .05) but inversely correlated with nonurgency voids (P < .001). Urgency and nonurgency voids were inversely related at baseline and at 6 months (P < .0001). Following treatment, urgency voids decreased by 41% and nonurgency voids increased by 33%. CONCLUSIONS As with other interventions for OAB, SBD resulted in a reduction in OAB symptoms and an improvement in QoL measures. However, the decrease in urgency voids was offset by an increase in nonurgency voids, suggesting that habit or defensive voiding is a significant driver of urinary frequency. It is not certain if this is a unique finding of the SBD effect, but these data do suggest that analyses of outcomes of other OAB interventions are warranted to gain a better understanding of the genesis of OAB symptoms.
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Affiliation(s)
- Eboo Versi
- Department of Obstetrics, Gynecology, Reproductive Sciences, Rutgers, New Brunswick, New Jersey, USA
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Le Mai Tu
- Division of Urology, Department of Surgery, Sherbrooke University Hospital, Sherbrooke, Quebec, Canada
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital and Faculty of Medicine, University of Antwerp, Antwerp, Belgium
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Tilborghs S, De Wachter S. Sacral neuromodulation for the treatment of overactive bladder: systematic review and future prospects. Expert Rev Med Devices 2022; 19:161-187. [DOI: 10.1080/17434440.2022.2032655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sam Tilborghs
- Department of Urology, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp
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18
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Henderickx MM, Brits T, Zabegalina NS, Baard J, Ballout M, Beerlage HP, De Wachter S, Kamphuis GM. Can operator-controlled imaging reduce fluoroscopy time during flexible ureterorenoscopy? Cent European J Urol 2022; 75:90-95. [PMID: 35591959 PMCID: PMC9074056 DOI: 10.5173/ceju.2022.0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/10/2021] [Accepted: 01/15/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Fluoroscopy is routinely used during ureterorenoscopy. According to the ‘As Low As Reasonably Achievable’ (ALARA) principle, radiation exposure should be kept as low as reasonably achievable to decrease the risk of negative long-term effects of radiation for patients and medical staff. This study aims to assess if operator-controlled imaging during flexible ureterorenoscopy for nephrolithiasis could reduce fluoroscopy time when compared to radiographer-controlled imaging. Material and methods This study was a bicentric, retrospective comparison between patients treated for nephrolithiasis with flexible ureterorenoscopy with either operator-controlled imaging or radiographer-controlled imaging. A total of 100 patients were included, 50 were treated with operator-controlled imaging and 50 with radiographer-controlled imaging. Patients undergoing flexible ureterorenoscopy with a total stone burden <20 mm and data on radiation exposure were included. Patient characteristics, stone characteristics, surgical details and fluoroscopy time were recorded for each patient and both groups were compared. Patient data were expressed as median. A 2-sided p-value <0.005 was considered statistically significant. Results This study found no significant differences between both groups regarding the patient and stone characteristics. However, it found a significant shorter fluoroscopy time in the operator-controlled imaging group of 33.5 seconds (IQR 16.0–70.0) compared to 57.0 seconds (IQR 36.8–95.3) in the radiographer-controlled imaging group (p = 0.001). Conclusions This study shows that operator-controlled imaging in flexible ureterorenoscopy could reduce fluoroscopy time when compared to radiographer-controlled imaging. Operator-controlled imaging might therefore allow urologists to perform ureterorenoscopy with greater independence while additionally reducing fluoroscopy time and its consequent negative effects for medical staff and patients.
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Affiliation(s)
| | - Tim Brits
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | | | - Joyce Baard
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mansour Ballout
- Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | - Harrie P. Beerlage
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Guido M. Kamphuis
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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19
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Tilborghs S, Van de Borne S, Vaganée D, De Win G, De Wachter S. The Influence of Electrode Configuration Changes on the Sensory and Motor Response During (Re)Programming in Sacral Neuromodulation. Neuromodulation 2021; 25:1173-1179. [PMID: 35088741 DOI: 10.1016/j.neurom.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/11/2021] [Accepted: 07/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This study aimed to assess the neurophysiological basis behind troubleshooting in sacral neuromodulation (SNM). Close follow-up of SNM patients with program parameter optimization has proven to be paramount by restoring clinical efficacy and avoiding surgical revision. MATERIALS AND METHODS A total of 34 successful SNM patients (28 overactive bladder wet, six nonobstructive urinary retention) with an implantable pulse generator were included. All possible bipolar and monopolar electrode settings were tested at sensory threshold (ST) to evaluate sensory (mapped on a perineal grid with 1 cm2 coordinates) and motor (peak-to-peak amplitude and latency of muscle action potential) responses of the pelvic floor. Pelvic floor muscle electromyography was recorded using a multiple array probe, placed intravaginally. Parametric tests were used for paired data: repeated-measures ANOVA or t-test. A nonparametric test was used for paired data: Friedman ANOVA or Wilcoxon signed rank (WSR) test; p < 0.05 was considered statistically significant. If significant, ANOVA was followed by Dunn-Bonferroni post hoc analysis. RESULTS Monopolar configurations showed significantly lower STs-1.38 ± 0.73 V vs 1.76 ± 0.89 V (paired t-test: p < 0.0001)-and presented with significantly higher peak-to-peak amplitudes-115.67 ± 79.03 μV vs 90.77 ± 80.55 μV (WSR: p = 0.005)-than bipolar configurations. When polarity was swapped, configurations with the cathode distal to the anode showed significantly lower STs, 1.73 ± 0.91 V vs 1.85 ± 0.87 V (paired t-test: p = 0.003), and mean peak-to-peak amplitudes, 81.32 ± 72.82 μV vs 100.21 ± 90.22 μV (WSR: p = 0.0001). Cathodal changes resulted in more changes in sensory responses than anodal changes (χ2 test: p = 0.044). In cathodal changes only, peak-to-peak amplitudes were significantly higher when the distance between electrodes was maximally spread (WSR: p = 0.046). CONCLUSIONS From a neurophysiological point of view, monopolar configurations stimulated more motor nerve fibers at lower STs, therefore providing more therapeutic efficiency. Swapping polarity or changing the position of the cathode led to different sensory and motor responses, serving as potential reprogramming options.
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Affiliation(s)
- Sam Tilborghs
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
| | - Sigrid Van de Borne
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
| | - Donald Vaganée
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
| | - Gunter De Win
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium; Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Anatomy, University of Antwerp, Antwerp, Belgium.
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20
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Jacobs T, Geysemans B, Van Hal G, Glazemakers I, Fog-Poulsen K, Vermandel A, De Wachter S, De Win G. Associations Between Online Pornography Consumption and Sexual Dysfunction in Young Men: Multivariate Analysis Based on an International Web-Based Survey. JMIR Public Health Surveill 2021; 7:e32542. [PMID: 34534092 PMCID: PMC8569536 DOI: 10.2196/32542] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/24/2021] [Accepted: 09/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Expanding access to the internet has resulted in more and earlier consumption of online pornography. At the same time, a higher prevalence of erectile dysfunction (ED) among young men is seen. Increased pornography consumption has been suggested as a possible explanation for this rise. OBJECTIVE The aim of this study was to better understand associations between problematic pornography consumption (PPC) and ED. METHODS A 118-item survey was published online, and data collection took place between April 2019 and May 2020. Of the 5770 men who responded, the responses from 3419 men between 18 years old and 35 years old were analyzed. The survey used validated questionnaires such as the Cyber Pornography Addiction Test (CYPAT), International Index of Erectile Function (IIEF-5), and Alcohol Use Disorders Identification Test-Concise (AUDIT-C). The estimated amount of porn watching was calculated. Univariable and multivariable analyses were performed. For the multivariable analysis, a logistic regression model using a directed acyclic graph was used. RESULTS According to their IIEF-5 scores, 21.48% (444/2067) of our sexually active participants (ie, those who attempted penetrative sex in the previous 4 weeks) had some degree of ED. Higher CYPAT scores indicating problematic online pornography consumption resulted in a higher probability of ED, while controlling for covariates. Masturbation frequency seemed not to be a significant factor when assessing ED. CONCLUSIONS This prevalence of ED in young men is alarmingly high, and the results of this study suggest a significant association with PPC. TRIAL REGISTRATION Research Registry researchregistry5111; https://tinyurl.com/m45mcaa2.
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Affiliation(s)
- Tim Jacobs
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Björn Geysemans
- Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Guido Van Hal
- Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Inge Glazemakers
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Alexandra Vermandel
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Stefan De Wachter
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Gunter De Win
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
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21
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Voorham J, Vaganée D, Voorham-van der Zalm P, Lycklama À Nijeholt G, Putter H, De Wachter S. Sacral Neuromodulation Changes Pelvic Floor Activity in Overactive Bladder Patients-Possible New Insights in Mechanism of Action: A Pilot Study. Neuromodulation 2021; 25:1180-1186. [PMID: 34547159 DOI: 10.1111/ner.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/27/2021] [Accepted: 08/17/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate if electrodiagnostic tools can advance the understanding in the effect of sacral neuromodulation (SNM) on pelvic floor activity, more specifically if SNM induces changes in pelvic floor muscle (PFM) contraction. MATERIALS AND METHODS Single tertiary center, prospective study (October 2017-May 2018) including patients with overactive bladder syndrome undergoing SNM. Electromyography of the PFM was recorded using the Multiple Array Probe Leiden. The procedure consisted of consecutive stimulations of the lead electrodes with increasing intensity (1-3, 5, 7, 10 V). Recordings were made after electrode placement (T0) and three weeks of SNM (T1). Patients with >50% improvement were defined as responders, others as nonresponders. For the analyses, the highest electrical PFM response (EPFMR), defined as the peak-to-peak amplitude of the muscle response, was identified for each intensity. The sensitivity (intensity where the first EPFMR was registered and the normalized EPFMR as percentage of maximum EPFMR) and the evolution (EMFPR changes over time) were analyzed using linear mixed models. RESULTS Fourteen patients were analyzed (nine responders, five nonresponders). For nonresponders, the PFM was significantly less sensitive to stimulation after three weeks (T0: 1.7 V, T1: 2.6 V). The normalized EPFMR was (significantly) lower after three weeks for the ipsilateral side of the PFM for the clinically relevant voltages (1 V: 36%-23%; p = 0.024, 2 V: 56%-29%; p = 0.00001; 3 V: 63%-37%; p = 0.0002). For the nonresponders, the mean EPFMR was significantly lower at 8/12 locations at T1 (T0: 109 μV, T1: 58 μV; mean p = 0.013, range <0.0001-0.0867). For responders, the sensitivity and evolution did not change significantly. CONCLUSIONS This is the first study to describe in detail the neurophysiological characteristics of the PFM, and the changes over time upon sacral spinal root stimulation, in responders and nonresponders to SNM. More research is needed to investigate the full potential of EPFMR as a response indicator.
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Affiliation(s)
- Jeroen Voorham
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Donald Vaganée
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | | | | | - Hein Putter
- Department of Biomedical Data sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Stefan De Wachter
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
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22
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Quaghebeur J, Petros P, Wyndaele JJ, De Wachter S. Pelvic-floor function, dysfunction, and treatment. Eur J Obstet Gynecol Reprod Biol 2021; 265:143-149. [PMID: 34492609 DOI: 10.1016/j.ejogrb.2021.08.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 04/22/2021] [Revised: 07/15/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
The pelvic floor functions as a holistic entity. The organs, bladder, bowel, smooth and striated muscles, nerves, ligaments and other connective tissues are directed cortically and reflexly from various levels of the nervous system. Such holistic integration is essential for the system's multiple functions, for example, pelvic girdle stability, continence, voiding/defecation, and sexuality. Pelvic floor dysfunction (PFD) is related to a variety of pelvic pain syndromes and organ problems of continence and evacuation. Prior to treatment, it is necessary to understand which part(s) of the system may be causing the dysfunction (s) of Chronic Pelvic Pain Syndrome (CPPS), pelvic girdle pain, sexual problems, Lower Urinary Tract Symptoms (LUTS), dysfunctional voiding, constipation, prolapse and incontinence. The interpretation of pelvic floor biomechanics is complex and involves multiple theories. Non-surgical treatment of PFD requires correct diagnosis and correctly supervised pelvic floor training. The aims of this review are to analyze pelvic function and dysfunction. Because it is a holistic and entirely anatomically based system, we have accorded significant weight to the Integral Theory's explanations of function and dysfunction.
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Affiliation(s)
- Jörgen Quaghebeur
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.
| | - Peter Petros
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia
| | | | - Stefan De Wachter
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
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23
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Quaghebeur J, Petros P, Wyndaele JJ, De Wachter S. The innervation of the bladder, the pelvic floor, and emotion: A review. Auton Neurosci 2021; 235:102868. [PMID: 34391125 DOI: 10.1016/j.autneu.2021.102868] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/26/2021] [Accepted: 08/05/2021] [Indexed: 12/30/2022]
Abstract
The innervation of the pelvic region is complex and includes extensive neurologic pathways. The higher centres' organisation determining the pelvic floor and organs' function remains a challenge understanding the physiological and pain mechanisms. Psychological and emotional factors have a profound influence on the pelvic floor and organ dysfunction such as LUTS. LUTS are associated with stress, depression, and anxiety. Neuroception is a subconscious neuronal system for detecting threats and safety and might explain the permanent disturbance of higher brain centres maintaining functional urological and gastrointestinal disorders and sphincter dysfunction.
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Affiliation(s)
- Jörgen Quaghebeur
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium.
| | - Peter Petros
- Faculty of Medicine, University of New South Wales, Kensington, Sydney, Australia
| | | | - Stefan De Wachter
- Department of Urology, University of Antwerp, Edegem, Belgium; Faculty of Medicine and Health Sciences, University of Antwerp, Edegem, Belgium
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24
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Van Aggelpoel T, De Wachter S, Neels H, Van Hal G, Roelant E, Vermandel A. Implementing a new method of group toilet training in daycare centres: a cluster randomised controlled trial. Eur J Pediatr 2021; 180:1393-1401. [PMID: 33230718 DOI: 10.1007/s00431-020-03879-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 12/27/2022]
Abstract
Despite the existing methods, a trend towards a later initiation and completion of toilet training has been seen in Western society. This study is the first to investigate prospectively the efficacy of intensive group toilet training in daycare centres. The primary outcome of interest is the duration until the child is toilet trained. A cluster randomised controlled trial was established in daycare centres; clusters of participants were randomly allocated to an intervention or control group. Intervention group was subjected to an intensive toilet training session. Innovative aspects of this toilet training method were a 2-h training on two consecutive days, carried out in small groups in daycare centres. Parents of children in the control group were encouraged to start TT in their own manner. Children were monitored until they were considered to be fully toilet trained during the day. Median toilet training duration in the intervention group was 2 weeks compared to 5 weeks in controls (p value log rank test = 0.007). The hazard of being clean during the follow-up of 6 weeks was twice as high in the intervention compared to controls (p = 0.018).Conclusion: The intervention had a significant influence on the duration of toilet training in healthy children, with a median duration of 2 weeks. Our findings are clinically relevant for daycare educators, having a considerable responsibility in the development of children.Trial Registration Number: ClinicalTrials.gov NCT04221776. What is Known: • Despite different existing methods, a later initiation of toilet training has been seen in Western society and coherent to this an increasing age of acquiring full bladder control. • Child daycare centres have a growing role in the toilet training process. What is New: • This is the first prospective report describing the results of a new method of toilet training healthy children in small groups in daycare centres. • The intervention had a significant influence on the duration of toilet training, with a median duration of 2 weeks.
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Affiliation(s)
- Tinne Van Aggelpoel
- Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium. .,Department of Urology, Antwerp University Hospital, Edegem, Belgium.
| | - Stefan De Wachter
- Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | - Hedwig Neels
- Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | - Guido Van Hal
- Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Ella Roelant
- Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital - University of Antwerp, Edegem, Belgium.,StatUa, Center for Statistics, University of Antwerp, Antwerp, Belgium
| | - Alexandra Vermandel
- Faculty of Medicine and Health Sciences, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
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25
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Abstract
The gastrocolic reflex is a response of the colon to the presence of food in the stomach. Our goal was to observe bowel movements in healthy infants and toddlers not yet toilet trained, in response to a meal. Stool behavior of 40 toddlers, aged 18-27 months, was monitored. We observed a bowel movement within the first hour after a meal in 75% of the children. This occurred 15, 30 or 60 minutes after a meal in, respectively, 25%, 48% and 66% of the observations. If we limit to the ones that actually defecated, 37% would defecate within 15 minutes and 72% within half an hour. Fifty-nine percent of all children defecated in the morning, 54% at noon and 28% in the evening. In conclusion, we believe the gastrocolic reflex can be used as a facilitating factor to help a child to defecate on the potty, 15-30 minutes after a meal. In 50% of the cases, a child will have a bowel movement on the potty and learn to defecate on it much easier.
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Affiliation(s)
- Tinne Van Aggelpoel
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerpen, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Stefan De Wachter
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerpen, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Hedwig Neels
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerpen, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
| | - Alexandra Vermandel
- Faculty of Medicine and Health Sciences, Antwerp University, Antwerpen, Belgium.,Department of Urology, University Hospital Antwerp, Edegem, Belgium
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26
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Jottard K, Van den Broeck S, Komen N, Bruyninx L, De Wachter S. Treatment of Fecal Incontinence With a Rechargeable Sacral Neuromodulation System: Efficacy, Clinical Outcome, and Ease of Use-Six-Month Follow-Up. Neuromodulation 2020; 24:1284-1288. [PMID: 33107663 DOI: 10.1111/ner.13298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/01/2020] [Accepted: 10/05/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Sacral neuromodulation is an effective treatment for fecal incontinence (FI) after conservative treatments have failed. A new rechargeable sacral neuromodulation system (r-SNM) includes a rechargeable implantable neurostimulator (INS). No data is available of the use of this technology in patients with fecal incontinence. MATERIALS AND METHODS Fifteen patients with FI were implanted with the Axonics rechargeable SNM system in a single-stage implant procedure and prospectively followed. Primary outcome was fecal incontinence episodes at four weeks and six months measured with stools diary. Success was defined as at least 50% improvement of fecal incontinence episodes. Additionally, quality of life and ease of use were evaluated. RESULTS At four weeks, 13 participants (87%) were test responders based on ≥50% reduction in FI episodes as documented on their bowel diary. Weekly FI episodes decreased from a median (25%-75% range) of 8 (5.8-20.3) at baseline to a median of 1.5 (0.4-4.5) at four weeks (p = 0.001), and 1.5 (0-2.6) at six months (p = 0.001), corresponding to 75% and 79% reduction in weekly FI episodes. Of the 13 subjects having ≥50% reduction in FI episodes at four weeks, 12 (PP = 92%) were therapy responders at six months. There were no unanticipated device or procedure-related adverse events. Mean time to recharge the system was 37 ± 3 min once or twice per week. All patients were moderately or very satisfied with the system and its effect. CONCLUSIONS The r-SNM system provides safe and effective therapy in patients with FI at six months.
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Affiliation(s)
| | - Sylvie Van den Broeck
- Department of Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Surgery, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| | - Niels Komen
- Department of Surgery, Antwerp University Hospital, Edegem, Belgium.,Department of Surgery, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| | - Luc Bruyninx
- Department of Surgery, Brugmann Hospital, Brussels, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
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27
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Jottard K, Bruyninx L, Bonnet P, Mathieu N, De Wachter S. Pilot study: pudendal neuromodulation combined with pudendal nerve release in case of chronic perineal pain syndrome. The ENTRAMI technique: early results. Int Urogynecol J 2020; 32:2765-2770. [PMID: 33048179 DOI: 10.1007/s00192-020-04565-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Chronic perineal pain syndrome due to pudendal nerve impingement is difficult to diagnose and to treat. All the known treatment options leave room for improvement considering the outcome. Early neuromodulation of the pudendal nerve after its surgical release could improve outcomes. OBJECTIVES The aim of the study was to evaluate the potential beneficial effect of pudendal neuromodulation combined with release surgery using the ENTRAMI technique (endoscopic transgluteal minimally invasive technique). STUDY DESIGN This is a single-center prospective descriptive study. Between March 2019 and March 2020, 16 patients (2 males, 14 females) were included. Data were collected at baseline and 1 month after surgery. METHODS Patients eligible for inclusion had chronic perineal pain for at least 3 months in the area served by the pudendal nerve. We combined pudendal nerve release with neuromodulation. RESULTS At 1 month, the numeric pain rating scale (NPRS) dropped from 9.5 at baseline to 3.5 (p = 0.003). Seventy-six percent of patients showed a global impression of change (PGIC) of > 50% at 1 month, and optimal treatment response (PGIC ≥ 90%) was found in 41% of patients. LIMITATIONS The drawback of our study was that it was not randomized or blinded. The peripheral nerve evaluation lead (PNE) used could only be implanted for 1 month because of infection risk and is also prone to dislocations and technical failures. CONCLUSION Pudendal nerve liberation by the ENTRAMI technique combined with short-term pudendal neuromodulation seems feasible and promising in treating patients with chronic perineal pain. Clinical trial number: NCT03880786.
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Affiliation(s)
- Katleen Jottard
- Department of Surgery, CHU Brugmann, Arthur Van Gehuchtenplaats 4, 1020, Brussels, Belgium.
| | - Luc Bruyninx
- Department of Surgery, CHU Brugmann, Arthur Van Gehuchtenplaats 4, 1020, Brussels, Belgium
| | - Pierre Bonnet
- Department of Urology and Department of Anatomy, CHU Sart-Tilman, Liège, Belgium
| | - Nathalie Mathieu
- Department of Anesthesiology, Pain Clinic, Brugmann Hospital, Brussels, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
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28
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Toth R, Zamora M, Ottaway J, Gillbe T, Martin S, Benjaber M, Lamb G, Noone T, Taylor B, Deli A, Kremen V, Worrell G, Constandinou TG, Gillbe I, De Wachter S, Knowles C, Sharott A, Valentin A, Green AL, Denison T. DyNeuMo Mk-2: An Investigational Circadian-Locked Neuromodulator with Responsive Stimulation for Applied Chronobiology. Conf Proc IEEE Int Conf Syst Man Cybern 2020; 2020:3433-3440. [PMID: 33692611 PMCID: PMC7116879 DOI: 10.1109/smc42975.2020.9283187] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Deep brain stimulation (DBS) for Parkinson's disease, essential tremor and epilepsy is an established palliative treatment. DBS uses electrical neuromodulation to suppress symptoms. Most current systems provide a continuous pattern of fixed stimulation, with clinical follow-ups to refine settings constrained to normal office hours. An issue with this management strategy is that the impact of stimulation on circadian, i.e. sleep-wake, rhythms is not fully considered; either in the device design or in the clinical follow-up. Since devices can be implanted in brain targets that couple into the reticular activating network, impact on wakefulness and sleep can be significant. This issue will likely grow as new targets are explored, with the potential to create entraining signals that are uncoupled from environmental influences. To address this issue, we have designed a new brain-machine-interface for DBS that combines a slow-adaptive circadian-based stimulation pattern with a fast-acting pathway for responsive stimulation, demonstrated here for seizure management. In preparation for first-in-human research trials to explore the utility of multi-timescale automated adaptive algorithms, design and prototyping was carried out in line with ISO risk management standards, ensuring patient safety. The ultimate aim is to account for chronobiology within the algorithms embedded in brain-machine-interfaces and in neuromodulation technology more broadly.
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Affiliation(s)
- Robert Toth
- MRC Brain Network Dynamics Unit, and the Department of Engineering Science, University of Oxford, Oxford OX2 7DQ, UK
| | - Mayela Zamora
- MRC Brain Network Dynamics Unit, and the Department of Engineering Science, University of Oxford, Oxford OX2 7DQ, UK
| | | | | | - Sean Martin
- Department of Neurosurgery, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Moaad Benjaber
- MRC Brain Network Dynamics Unit, and the Department of Engineering Science, University of Oxford, Oxford OX2 7DQ, UK
| | - Guy Lamb
- Bioinduction Ltd, Bristol BS8 4RP, UK
| | | | | | - Alceste Deli
- Department of Neurosurgery, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Vaclav Kremen
- Bioelectronics Neurophysiology and Engineering Lab, Mayo Clinic, Rochester, MN, US
| | - Gregory Worrell
- Bioelectronics Neurophysiology and Engineering Lab, Mayo Clinic, Rochester, MN, US
| | - Timothy G Constandinou
- Department of Electrical and Electronic Engineering and the UK Dementia Research Institute (Care Research and Technology Centre), Imperial College London, London SW7 2AZ, UK
| | | | - Stefan De Wachter
- Department of Urology, University of Antwerp Hospital, 2650 Edegem, Belgium
| | - Charles Knowles
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London E1 2AT, UK
| | - Andrew Sharott
- MRC Brain Network Dynamics Unit, and the Department of Engineering Science, University of Oxford, Oxford OX2 7DQ, UK
| | - Antonio Valentin
- Department of Basic and Clinical Neuroscience, King's College London, London SE5 9RT, UK
| | - Alexander L Green
- Department of Neurosurgery, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Timothy Denison
- MRC Brain Network Dynamics Unit, and the Department of Engineering Science, University of Oxford, Oxford OX2 7DQ, UK
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Jottard K, Bruyninx L, Bonnet P, De Wachter S. Endoscopic trans gluteal minimal-invasive approach for nerve liberation (ENTRAMI technique) in case of pudendal and/or cluneal neuralgia by entrapment: One-year follow-up. Neurourol Urodyn 2020; 39:2003-2007. [PMID: 32678485 DOI: 10.1002/nau.24462] [Citation(s) in RCA: 4] [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: 04/07/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chronic neuropathic perineal pain syndrome is a collective term that encompasses several diagnoses. In patients where the neuropathic pain syndrome is caused by pudendal or cluneal nerve entrapment, surgical release can be proposed if other measures have failed. The aim of this study is to evaluate the clinical outcome of patients suffering from pudendal and/or cluneal nerve entrapment at 1 year after this minimal invasive surgery, which is based on the open trans gluteal approach who has proven its efficacy compared to medical treatment in a randomized control trial. METHODS Patients eligible for inclusion had chronic perineal neuropathic pain for at least 3 months in the area served by the pudendal and/or cluneal nerve, refractory to conservative measurements. Patients met all five of the Nantes criteria. RESULTS Fifteen patients underwent the ENTRAMI technique. At 1 year after surgery, overall reduction of the average maximal Numeric Pain rating Scale (NPRS-score) was from 9 (range, 7-10) at baseline to 5 (range, 0-10; P-value <.05). At 1 year 73% of patients declared to have a "good treatment response" (patient global impression of change [PGIC] >30%) and optimal treatment response (PGIC ≥90%) was found in 40% (P-value <.05). No complications were recorded. CONCLUSION This study clearly shows that the technique is feasible with promising long-term results in a difficult to manage patient group.
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Affiliation(s)
| | - Luc Bruyninx
- Department of Surgery, Brugmann Hospital, Brussels, Belgium
| | - Pierre Bonnet
- Department of Urology and Department of Anatomy, CHU Sart-Tilman, Liège, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
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30
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Vaganée D, Voorham J, Van de Borne S, Voorham-van der Zalm P, Fransen E, De Wachter S. Pelvic floor activation upon stimulation of the sacral spinal nerves in sacral neuromodulation patients. Neurourol Urodyn 2020; 39:1815-1823. [PMID: 32585049 DOI: 10.1002/nau.24425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/11/2020] [Accepted: 06/01/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess the activation of the different parts of the pelvic floor muscles (PFM) upon electrical stimulation of the sacral spinal nerves while comparing the different lead electrode configurations. MATERIAL AND METHODS PFM electromyography (EMG) was recorded using an intravaginal multiple array probe with 12 electrodes pairs, which allows to make a distinction between the different sides and depths of the pelvic floor. In addition concentric needle EMG of the external anal sphincter was performed to exclude far-field recording. A medtronic InterStim tined lead (model 3889) was used as stimulation source. Standard SNM parameters (monophasic pulsed square wave, 210 microseconds, 14 Hz) were used to stimulate five different bipolar electrode configurations (3+0-/3+2-/3+1-/0+3-/1+3-) up to and around the sensory threshold. Of each EMG signal the stimulation intensity needed to evoke the EMG signals as well as its amplitude and latency were determined. Linear mixed models was used to analyse the data. RESULTS Twenty female patients and 100 lead electrode configurations were stimulated around the sensory response threshold resulting in 722 stimulations and 12 times as many (8664) EMG recordings. A significant increase in EMG amplitude was seen upon increasing stimulation intensity (P < .0001). Large differences were noted between the EMG amplitude recorded at the different sides (ipsilateral>posterior>anterior>contralateral) and depths (deep>center>superficial) of the pelvic floor. These differences were noted for all lead electrodes configurations stimulated (P < .0001). Larger EMG amplitudes were measured when the active electrode was located near the entry point of the sacral spinal nerves through the sacral foramen (electrode #3). No differences in EMG latency could be withheld, most likely due to the sacral neuroanatomy (P > .05). CONCLUSIONS A distinct activation pattern of the PFM could be identified for all stimulated lead electrode configurations. Electrical stimulation with the most proximal electrode (electrode #3) as the active one elicited the largest PFM contractions.
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Affiliation(s)
- Donald Vaganée
- Department of Urology, Antwerp University Hospital (UZA), Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Jeroen Voorham
- Department of Urology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Sigrid Van de Borne
- Department of Urology, Antwerp University Hospital (UZA), Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | | | - Erik Fransen
- StatUa Center for Statistics UAntwerpen, Antwerp, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital (UZA), Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
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Vaganée D, Van de Borne S, Voorham-van der Zalm P, Voorham J, Fransen E, De Wachter S. Pelvic Floor Muscle Electromyography as a Guiding Tool During Lead Placement and (Re)Programming in Sacral Neuromodulation Patients: Validity, Reliability, and Feasibility of the Technique. Neuromodulation 2020; 23:1172-1179. [PMID: 32558094 DOI: 10.1111/ner.13177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/10/2020] [Accepted: 04/27/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE To assess the validity, reliability, and feasibility of electromyography (EMG) as a tool to measure pelvic floor muscle (PFM) contractions during placement and (re)programming of the tined lead electrodes in sacral neuromodulation (SNM) patients. MATERIALS AND METHODS Single tertiary center, prospective study conducted between 2017 and 2019 consisting of three protocols including a total of 75 patients with overactive bladder (wet/dry) or nonobstructive urinary retention. PFM EMG was recorded using the multiple array probe (MAPLe), placed intravaginally. All stimulations (monophasic pulsed square wave, 210 μsec, 14 Hz) were performed using Medtronic's standard SNM stimulation equipment. During lead implantation, all four lead electrodes were stimulated with fixed increasing stimulation intensities (1-2-3-5-7-10 V). During lead electrode (re)programming, five bipolar lead electrode configurations were stimulated twice up to when an electrical PFM motor response (EPFMR), sensory response, and pain response were noted (i.e., the threshold), respectively. Additionally, amplitude and latency of the EPFMRs were determined. Validity, reliability, and feasibility were statistically analyzed using the intraclass correlation coefficient, weighted Cohen's kappa and linear regression, respectively. RESULTS Validity: EPFMRs were strongly associated with visually detected PFM motor responses (κ = 0.90). Reliability: EPFMR amplitude (ICC = 0.99) and latency (ICC = 0.93) showed excellent repeatability. Feasibility: linear regression (EPFMR threshold = 0.18 mA + 0.76 * sensory response threshold) showed an increase in the sensory response threshold is associated with a smaller increase in EPFMR threshold, with the EPFMR occurring before or on the sensory response threshold in 83.8% of all stimulations. CONCLUSIONS Measuring PFM contractions with EMG during placement and (re)programming of lead electrodes in SNM patients is valid, reliable, and feasible. Therefore, the use of PFM EMG motor responses could be considered as a tool to assist in these procedures.
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Affiliation(s)
- Donald Vaganée
- Department of Urology, Antwerp University Hospital (UZA), Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Sigrid Van de Borne
- Department of Urology, Antwerp University Hospital (UZA), Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | | | - Jeroen Voorham
- Department of Urology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Erik Fransen
- StatUa Center for Statistics UAntwerpen, Antwerp, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital (UZA), Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
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Ghijselings L, Hervé F, Van der Aa F, De Wachter S, Pauwaert K, Haddad R, Beeckman D, Pattyn P, Everaert K. Development of a flowchart reflecting the current attitude and approach towards idiopathic overactive bladder treatment in Belgium: A Delphi study. Neurourol Urodyn 2020; 39:1781-1795. [PMID: 32531082 DOI: 10.1002/nau.24421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/25/2020] [Indexed: 11/07/2022]
Abstract
AIMS Idiopathic overactive bladder syndrome (iOAB) is a prevalent condition in urological practice. The variability in management between specialists and between centers remains high. Even existing guidelines contain inconsistencies. We aimed to develop a treatment algorithm for iOAB for use in daily clinical practice. METHODS From October 2018 till November 2019, a Delphi study was conducted to obtain expert consensus on the management of iOAB. Members from the Belgian Working Group of Functional Urology were asked to rate online statements, based on gaps and variabilities between the American Urology Association (AUA), European Association of Urology (EAU) and International Consultation on Incontinence (ICI) guidelines on iOAB. The consensus was reached if ≥75% of the panel agreed on the level of appropriateness. Two Delphi rounds and an open discussion session were held. RESULTS Twenty out of 49 members completed the first round and 18 completed the second round. The consensus was reached on 44/143 statements and 15/56 statements in the first and second round, respectively. The consensus was reached on criteria by which to phenotype OAB patients, the terminology relating to the first-, second- and third-line treatment, the duration of therapies, the chronological order, and the choice between therapies. No consensus was reached on the role of percutaneous tibial nerve stimulation (PTNS) in the treatment algorithm. CONCLUSIONS A flowchart reflecting the current attitude and approach of a Delphi expert panel towards the treatment of iOAB was developed. We propose its use in daily clinical practice to increase the standardization of OAB treatment.
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Affiliation(s)
- Lynn Ghijselings
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Francois Hervé
- Department of Urology, UCL University Hospital Saint-Luc, Woluwe, Belgium
| | - Frank Van der Aa
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Stefan De Wachter
- Department of Urology, University Hospital Antwerp, Urology, Edegem, Belgium.,Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wilrijk, Belgium
| | - Kim Pauwaert
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Rebecca Haddad
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Piet Pattyn
- Colorectal Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
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Vaganée D, Voorham J, Panicker JN, Fransen E, Voorham-van der Zalm P, Van de Borne S, De Wachter S. Neural pathway of bellows response during SNM treatment revisited: Conclusive evidence for direct efferent motor response. Neurourol Urodyn 2020; 39:1576-1583. [PMID: 32484961 DOI: 10.1002/nau.24408] [Citation(s) in RCA: 4] [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: 03/21/2020] [Revised: 05/01/2020] [Accepted: 05/15/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND In sacral neuromodulation (SNM) patients, it is thought the bellows response elicited upon sacral spinal nerve stimulation is reflex-mediated. Therefore the mechanism of action of SNM is considered to be at the spinal or supraspinal level. These ideas need to be challenged. OBJECTIVE To identify the neural pathway of the bellows response upon sacral spinal nerve stimulation. DESIGN, SETTING, AND PARTICIPANTS Single tertiary center, prospective study (December 2017-June 2019) including 29 patients with overactive bladder refractory to first-line treatment. INTERVENTION Recording of the pelvic floor muscle response (PFMR) using a camcorder and electromyography (EMG) (intravaginal probe and concentric needles) upon increasing stimulation during lead or implantable pulse generator placement. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The lowest stimulation intensity needed to elicit a visual PFMR and electrical PFMR was determined. Electrical PFMRs were subdivided according to their latency. OUTCOME the association between visual and electrical PFMRs. Statistical analyses were performed using the weighted kappa coefficient. RESULTS Three different electrical PFMRs could be identified by surface and needle EMG, corresponding with a direct efferent motor response (R1), oligosynaptic (R2), and polysynaptic (R3) afferent reflex response. Only the R1 electrical PFMR was perfectly associated with the visual PFMR (κ = 0.900). CONCLUSIONS The visual PFMRs upon sacral spinal nerve stimulation are direct efferent motor responses. A reopening of the discussion on the mechanism of action of SNM is possibly justified.
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Affiliation(s)
- Donald Vaganée
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jeroen Voorham
- Department of Urology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Erik Fransen
- StatUa Center for Statistics, UAntwerpen, Antwerp, Belgium
| | | | - Sigrid Van de Borne
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Vermandel A, Van Hall G, Van der Cruyssen K, Van Aggelpoel T, Neels H, De Win G, De Wachter S. 'Elimination signals' in healthy, NON toilet trained children aged 0-4 years: A systematic review. J Pediatr Urol 2020; 16:342-349. [PMID: 32253149 DOI: 10.1016/j.jpurol.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 03/05/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE An early start of toilet training, which is related to a younger age of acquiring full bladder control, can generate important health advantages. Children display different 'elimination signals' related to voiding or defaecation. The aim of this systematic review is to map these 'elimination signals' in young, healthy children aged 0-4 years. METHOD The systematic literature search was performed in two databases and was conducted using the preferred reporting items for systematic reviews and meta-analyses (PRISMA statement). RESULTS Two main distinctions in elimination signals were made. The first could be classified as visual, auditory and tactile, most frequently involving a change in facial expression, often combined with body movements and verbal expressions such as a short cry or grunting. Secondly significant changes in heart rate, respiratory frequency or EEG frequency could be defined as 'clinically assessed elimination signals'. CONCLUSION Different 'elimination signals' could be detected in healthy children while voiding or defaecating and should be observed when initiating toilet training. Detection of noticeable visual, auditory and tactile signals will facilitate and shorten this process.
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Affiliation(s)
- Alexandra Vermandel
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Guido Van Hall
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium.
| | | | - Tinne Van Aggelpoel
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Hedwig Neels
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Gunter De Win
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
| | - Stefan De Wachter
- Antwerp University, Faculty of Medicine and Health Sciences, Belgium; University Hospital Antwerp, Department of Urology, Belgium.
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De Wachter S, Vaganee D, Kessler TM. Sacral Neuromodulation: Mechanism of Action. Eur Urol Focus 2020; 6:823-825. [PMID: 32019718 DOI: 10.1016/j.euf.2019.11.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 11/17/2019] [Accepted: 11/29/2019] [Indexed: 11/30/2022]
Abstract
Although the mechanism of action of sacral neuromodulation (SNM) is still not fully elucidated, it seems to involve modulation of spinal cord reflexes and brain networks by peripheral afferents according to findings from neurophysiology, electroencephalography, positron emission tomography, and magnetic resonance imaging studies. Moreover, motor effects mediated via efferents on direct stimulation cannot be fully excluded. In this mini-review, we summarize current knowledge on the mechanism of action of SNM. PATIENT SUMMARY: We reviewed the literature on the mechanism of action of sacral neuromodulation, in which electrical stimulation is applied to the nerves that regulate bladder activity. The mechanism seems to involve modulation of spinal cord reflexes and brain networks by peripheral sensory and possibly motor neurons.
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Affiliation(s)
- Stefan De Wachter
- Department of Urology, Antwerp Academic Hospital, Edegem, Belgium; Department of Urology, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium.
| | - Donald Vaganee
- Department of Urology, Antwerp Academic Hospital, Edegem, Belgium; Department of Urology, Faculty of Medicine and Health Sciences, Antwerp University, Wilrijk, Belgium
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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De Wachter S, Knowles CH, Elterman DS, Kennelly MJ, Lehur PA, Matzel KE, Engelberg S, Van Kerrebroeck PEV. New Technologies and Applications in Sacral Neuromodulation: An Update. Adv Ther 2020; 37:637-643. [PMID: 31875299 PMCID: PMC7004424 DOI: 10.1007/s12325-019-01205-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Indexed: 11/26/2022]
Abstract
Recently rechargeable devices have been introduced for sacral neuromodulation (SNM) with conditional safety for full-body magnetic resonance imaging (MRI). Currently a recharge-free SNM device represents the standard implant; however, it is only approved for MRI head scans. As further new technologies with broader MRI capabilities are emerging, the advantages as well as disadvantages of both rechargeable versus recharge-free devices will be briefly discussed in this commentary from the perspective of patients, healthcare professionals, and providers.
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Affiliation(s)
- Stefan De Wachter
- Department of Urology, University Hospital Antwerpen, Antwerp, Belgium.
- Department of Urology, Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wlrijk, Belgium.
| | - Charles H Knowles
- Blizard Institute, Barts and the London SMD, Queen Mary University of London, London, UK
| | - Dean S Elterman
- Division of Urology, University Health Network, Department of Surgery, University of Toronto, Toronto, Canada
| | - Michael J Kennelly
- Department of Urology, Carolinas Medical Center, Atrium Health, Charlotte, NC, USA
| | - Paul A Lehur
- Coloproctology Unit, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Klaus E Matzel
- Chirurgische Klinik, Universität Erlangen, Erlangen, Germany
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De Wachter S, Hervé F, Averbeck M. Can we predict the success of prostatic surgery for male lower urinary tract symptoms: ICI-RS 2018? Neurourol Urodyn 2019; 38 Suppl 5:S111-S118. [PMID: 31821634 DOI: 10.1002/nau.24036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 04/11/2019] [Indexed: 11/05/2022]
Abstract
AIMS Male lower urinary tract symptoms (LUTS) are common and bothersome symptoms in the aging population, of which the etiology is multifactorial. Prostatic surgery may be considered to alleviate some of these LUTS, especially in patients in which benign prostatic obstruction is believed to be the underlying cause. The aim of this paper is to discuss underlying pathophysiology, signs, and conditions that may lead to success or failure after prostatic surgery in male patients with LUTS. METHODS The paper is a report of presentations and subsequent discussions at the annual International Consultation on Incontinence Research Society, in June 2018 in Bristol. RESULTS AND CONCLUSIONS Unfavorable outcomes after prostatic surgery are reported in 25% to 30% of the patients. This may be due to persistent or de novo symptoms, related to the multifactorial origin of symptoms. Specific underlying conditions such as with detrusor overactivity, detrusor underactivity, and nocturnal polyuria are discussed in their relationship with prostatic surgery. Knowledge gaps are addressed and specific research questions proposed.
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Affiliation(s)
- Stefan De Wachter
- Department of Urology, Antwerp University Hospital (UZA), Edegem, Belgium.,Department of Urology, Faculty of Medicine and Health Sciences, University of Antwerp (UA), Antwerp, Belgium
| | - Francois Hervé
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Marcio Averbeck
- Department of Urology, Moinhos de Vento Hospital, Porto Alegre, Brazil
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Gajewski JB, Gammie A, Speich J, Kirschner-Hermanns R, De Wachter S, Schurch B, Korstanje C, Valentini F, Rahnama'i MS. Are there different patterns of detrusor overactivity which are clinically relevant? ICI-RS 2018. Neurourol Urodyn 2019; 38 Suppl 5:S40-S45. [PMID: 31821631 DOI: 10.1002/nau.23964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/09/2018] [Accepted: 01/29/2019] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Different patterns of detrusor overactivity (DO) have been described and included in several standardization terminology documents. However, it is unclear if these different patterns have any clinical significance. METHODS This is a report of the proceedings of Proposal 3: "Are there different patterns of detrusor overactivity which are clinically relevant?" from the annual International Consultation on Incontinence-Research Society (ICIRS) meeting, which took place from 14 to 16 June 2018, in Bristol, UK. RESULTS We have collected and discussed, as a committee, the evidence about different urodynamic (UD) patterns of detrusor overactivity and their potential clinical significance. We reviewed the important previous basic research and clinical studies and compiled summaries. The discussion focused on clinical relevance of different UD patterns of DO and what further research is required. CONCLUSIONS There are several UD definitions of patterns of detrusor overactivity, however the clinical relevance of these definitions remains unclear. Future research should concentrate on defining the pattern of DO in relation to clinical diagnosis, gender, age, and treatment outcomes.
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Affiliation(s)
- Jerzy B Gajewski
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - John Speich
- Department of Mechanical and Nuclear Engineering, College of Engineering, Virginia Commonwealth University, Richmond, Virginia
| | - Ruth Kirschner-Hermanns
- Department of Neuro-Urology, University Hospital of the Rheinische Friedrich-Wilhelms University Bonn, Bonn, Germany.,Department of Urology and Paediatric Urology, Neuro-Urology, Neurological Rehabilitation Center "Godeshoehe e.V.", Bonn, Germany
| | | | - Brigitte Schurch
- Neurourology Unit Department of Neurosciences, University Hospital Lausanne, Lausanne, Switzerland
| | - Cees Korstanje
- Department of Drug Discovery Science & Management, Astellas Pharma Europe BV, Leiden, The Netherlands
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Oeyen E, Willems H, 't Kindt R, Sandra K, Boonen K, Hoekx L, De Wachter S, Ameye F, Mertens I. Determination of variability due to biological and technical variation in urinary extracellular vesicles as a crucial step in biomarker discovery studies. J Extracell Vesicles 2019; 8:1676035. [PMID: 31681468 PMCID: PMC6807909 DOI: 10.1080/20013078.2019.1676035] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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] [Received: 01/25/2019] [Revised: 09/09/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022] Open
Abstract
Urinary extracellular vesicles (EVs) are an attractive source of biomarkers for urological diseases. A crucial step in biomarker discovery studies is the determination of the variation parameters to perform a sample size calculation. In this way, a biomarker discovery study with sufficient statistical power can be performed to obtain biologically significant biomarkers. Here, a variation study was performed on both the protein and lipid content of urinary EVs of healthy individuals, aged between 52 and 69 years. Ultrafiltration (UF) in combination with size exclusion chromatography (SEC) was used to isolate the EVs from urine. Different experimental variation set-ups were used in this variation study. The calculated standard deviations (SDs) of the 90% least variable peptides and lipids did not exceed 2 and 1.2, respectively. These parameters can be used in a sample size calculation for a well-designed biomarker discovery study at the cargo of EVs.
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Affiliation(s)
- Eline Oeyen
- Health Department, Flemish Institute for Technological Research (VITO), Mol, Belgium.,Centre for Proteomics (CFP), University of Antwerp, Antwerp, Belgium
| | - Hanny Willems
- Health Department, Flemish Institute for Technological Research (VITO), Mol, Belgium.,Centre for Proteomics (CFP), University of Antwerp, Antwerp, Belgium
| | - Ruben 't Kindt
- Research Institute for Chromatography, Kortrijk, Belgium
| | - Koen Sandra
- Research Institute for Chromatography, Kortrijk, Belgium
| | - Kurt Boonen
- Health Department, Flemish Institute for Technological Research (VITO), Mol, Belgium.,Centre for Proteomics (CFP), University of Antwerp, Antwerp, Belgium
| | - Lucien Hoekx
- Urology Department, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Stefan De Wachter
- Urology Department, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Filip Ameye
- Urology Department, AZ Maria Middelares Ghent, Ghent, Belgium
| | - Inge Mertens
- Health Department, Flemish Institute for Technological Research (VITO), Mol, Belgium.,Centre for Proteomics (CFP), University of Antwerp, Antwerp, Belgium
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40
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Rovner ES, Versi E, Le Mai T, Dmochowski RR, De Wachter S. One-year results with selective bladder denervation in women with refractory overactive bladder. Neurourol Urodyn 2019; 38:2178-2184. [PMID: 31359508 DOI: 10.1002/nau.24110] [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: 04/15/2019] [Accepted: 06/30/2019] [Indexed: 01/23/2023]
Abstract
AIMS To report 1-year results with selective bladder denervation (SBD) of the trigone in women with refractory overactive bladder (OAB). METHODS In this prospective, international, multicenter case series, women with refractory OAB underwent a single SBD treatment of the bladder subtrigone region using temperature-controlled radiofrequency. Patients were followed for 1 year and evaluated for changes in OAB symptoms and adverse events. RESULTS Among 35 women, 29 (83%) returned for 1-year follow up. Median symptom reductions based on 3-day bladder diaries were 68% for urgency urinary incontinence ( P < .001), 67% for urinary incontinence ( P < .001), 43% for urgency episodes ( P < .001), 5% for urinary frequency ( P = .19), and 33% for the total urgency and frequency score ( P < .001), with the majority of treatment benefit realized in the first month. Treatment benefit was reported in 72% of patients, the clinical success rate (≥50% reduction in urgency urinary incontinence) was 69%, and the dry rate was 10%. Statistically significant improvements occurred on Symptom Bother and Health-related Quality of Life scales on the Overactive Bladder questionnaire, and on 6 of 9 King's Health Questionnaire domains. Patients with less severe baseline symptoms had similar quality of life improvements as those with more severe baseline symptoms. Device- or procedure-related adverse events were reported in 6 (17%) patients. CONCLUSIONS A single treatment with selective bladder denervation is durable for 1-year in a significant proportion of women with refractory overactive bladder.
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Affiliation(s)
- Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Eboo Versi
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers University, New Brunswick, New Jersey
| | - Tu Le Mai
- Division of Urology, Department of Surgery, Sherbrooke University Hospital, Sherbrooke, Quebec, Canada
| | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital and Faculty of Medicine, University of Antwerp, Antwerp, Belgium
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41
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Vaganée D, Voorham J, Voorham‐van der Zalm P, De Wachter S. Needle Placement and Position of Electrical Stimulation Inside Sacral Foramen Determines Pelvic Floor Electromyographic Response—Implications for Sacral Neuromodulation. Neuromodulation 2019; 22:709-715. [DOI: 10.1111/ner.12953] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 02/01/2019] [Accepted: 03/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Donald Vaganée
- Department of UrologyAntwerp University Hospital Edegem Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
| | - Jeroen Voorham
- Department of UrologyLeiden University Medical Center Leiden The Netherland
| | | | - Stefan De Wachter
- Department of UrologyAntwerp University Hospital Edegem Belgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
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42
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De Wachter S, Benson KD, Dmochowski RR, Rovner ES, Versi E, Miller LE, Tu LM. Six-Month Results of Selective Bladder Denervation in Women with Refractory Overactive Bladder. J Urol 2019; 201:573-580. [PMID: 30240691 DOI: 10.1016/j.juro.2018.09.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We report 6-month efficacy and safety outcomes of selective bladder denervation in women with refractory overactive bladder. MATERIALS AND METHODS Women with refractory overactive bladder and urgency urinary incontinence were enrolled in 2 prospective feasibility studies with the same entry criteria. They underwent selective bladder denervation of the subtrigonal region containing afferent sensory nerves. Patients were followed for 6 months and assessed for adverse events, overactive bladder symptoms and health related quality of life measures. RESULTS In the 35 women with a mean age of 66 years who were enrolled in the study all selective bladder denervation procedures were completed successfully. During 6 months of followup the symptom improvement based on 3-day bladder diaries was 59% for urgency urinary incontinence (p <0.001), 59% for urinary incontinence (p <0.001), 39% for urgency (p <0.001), 9% for urinary frequency (p = 0.01) and 27% for the total urgency and frequency score (p <0.001). Most of this treatment benefit was realized in the first month. The rate of clinical success, defined as a 50% or greater reduction in urgency urinary incontinence, was 70%, treatment benefit was reported in 75% of patients and the dry/cure rate was 27%. Statistically significant improvements during 6 months were identified on the symptom bother and health related quality of life scales on the OAB-q (Overactive Bladder Questionnaire) and on all KHQ (King's Health Questionnaire) domains except general health perception. Device or procedure related adverse events were reported in 6 patients (17%). CONCLUSIONS Pooled results of 2 prospective feasibility studies suggest that selective bladder denervation is a promising minimally invasive treatment option in women with refractory overactive bladder.
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Affiliation(s)
- Stefan De Wachter
- Department of Urology, Antwerp University Hospital and Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | | | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, South Carolina
| | - Eboo Versi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers University, New Brunswick, New Jersey
| | | | - Le Mai Tu
- Division of Urology, Department of Surgery, Sherbrooke University Hospital, Sherbrooke, Quebec, Canada
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De Wachter S, Benson KD, Dmochowski RR, Rovner ES, Versi E, Miller LE, Tu LM. Re: Six-Month Results of Selective Bladder Denervation in Women with Refractory Overactive Bladder. J Urol 2019:101097JU0000000000000274. [PMID: 30958745 DOI: 10.1097/ju.0000000000000274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Stefan De Wachter
- Department of Urology, Antwerp University Hospital and Faculty of Medicine, University of Antwerp , Antwerp , Belgium
| | | | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center , Nashville , TN , United States
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina , Charleston , SC , United States
| | - Eboo Versi
- Department of Obstetrics, Gynecology, Reproductive Sciences, Rutgers , New Brunswick , NJ , United States
| | - Larry E Miller
- Miller Scientific Consulting , Asheville , NC , United States
| | - Le Mai Tu
- Division of Urology, Department of Surgery, Sherbrooke University Hospital , Sherbrooke , QC , Canada
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44
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Rees J, Foley S, Huang M, Rosa Arias J, Skoumal R, Walters C, Yavuz Y, De Wachter S. Vesomni improves the quality of life in men with lower urinary tract symptoms in routine clinical practice in Europe. Neurourol Urodyn 2019; 38:981-989. [PMID: 30801782 PMCID: PMC6916269 DOI: 10.1002/nau.23944] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/15/2019] [Accepted: 01/28/2019] [Indexed: 01/08/2023]
Abstract
Aim To evaluate the impact of Vesomni/Urizia/Volutsa, a fixed‐dose combination tablet containing 6 mg solifenacin (antimuscarinic) and 0.4 mg tamsulosin (α‐blocker), on health‐related quality of life (HRQoL) and treatment satisfaction in men with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in routine clinical practice. Methods EUROPA was a noninterventional study of men with LUTS/BPH not responding to monotherapy who were prescribed Vesomni in routine clinical practice. Data were collected retrospectively (1 year) and prospectively (1 year). Assessments were performed at baseline, weeks 4 to 8, weeks 9 to 18 (optional), weeks 19 to 39 (optional), and Weeks 40 to 52. The primary endpoint was change from baseline in HRQoL, as assessed by the Overactive Bladder Questionnaire (OAB‐q) symptom bother subscale score. Change from baseline in OAB‐q total and coping, sleep, and social interaction subscale scores, treatment satisfaction‐visual analog scale (TS‐VAS), International Prostate Symptom Score (IPSS), and European Quality of Life 5‐Dimension‐5‐Level (EQ‐5D‐5L) questionnaire were also evaluated. Results Five hundred and eighty‐nine patients were enrolled. The mean changes in adjusted mean (95% confidence interval [CI]) OAB‐q symptom bother subscale scores were −16.40 (−24.31, −8.49) at weeks 4 to 8 and −19.59 (−28.26, −10.92) at weeks 40 to 52; at weeks 40 to 52, changes were clinically meaningful in 84.6% of patients. Adjusted mean (95% CI) change from baseline to weeks 40 to 52 were 15.02 (7.35, 22.69), 19.37 (10.86, 27.89), 18.65 (7.44, 29.86), 9.85 (3.90, 15.81), and 16.09 (9.07, 23.11) for concern, coping, sleep, social interaction, and total, respectively. TS‐VAS, IPSS, and EQ‐5D‐5L all improved, and treatment persistence at weeks 40 to 52 was 77.1%. Urinary retention was reported in four (0.7%) patients. Conclusions Vesomni was well‐tolerated and improved HRQoL and treatment satisfaction in patients with LUTS/BPH.
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Affiliation(s)
- Jonathan Rees
- Department of Brockway Medical Centre, Tyntesfield Medical Group, Bristol, UK
| | - Steve Foley
- Department of Urology, Royal Berkshire Hospital, Reading, RG 1 5AN, Berkshire, UK
| | - Moses Huang
- Department of European Medical Affairs, Astellas Pharma Europe Ltd., Chertsey, UK
| | - José Rosa Arias
- Department of Urology, Hospital Santiago Apóstol, Miranda de Ebro-Burgos, Spain
| | - René Skoumal
- Department of Urology, Urocentrum Brno, Brno, Czechia
| | - Carien Walters
- Department of Medical and Clinical Operations EMEA, Astellas Pharma Europe Ltd., Chertsey, UK
| | - Yalcin Yavuz
- Department of Data Science, Formerly with Astellas Pharma Global Development, Leiden, The Netherlands
| | - Stefan De Wachter
- Department of Urology, University Hospital Antwerpen, Edegem, Belgium
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Oeyen E, Hoekx L, De Wachter S, Baldewijns M, Ameye F, Mertens I. Bladder Cancer Diagnosis and Follow-Up: The Current Status and Possible Role of Extracellular Vesicles. Int J Mol Sci 2019; 20:ijms20040821. [PMID: 30769831 PMCID: PMC6412916 DOI: 10.3390/ijms20040821] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 12/24/2022] Open
Abstract
Diagnostic methods currently used for bladder cancer are cystoscopy and urine cytology. Cystoscopy is an invasive tool and has low sensitivity for carcinoma in situ. Urine cytology is non-invasive, is a low-cost method, and has a high specificity but low sensitivity for low-grade urothelial tumors. Despite the search for urinary biomarkers for the early and non-invasive detection of bladder cancer, no biomarkers are used at the present in daily clinical practice. Extracellular vesicles (EVs) have been recently studied as a promising source of biomarkers because of their role in intercellular communication and tumor progression. In this review, we give an overview of Food and Drug Administration (FDA)-approved urine tests to detect bladder cancer and why their use is not widespread in clinical practice. We also include non-FDA approved urinary biomarkers in this review. We describe the role of EVs in bladder cancer and their possible role as biomarkers for the diagnosis and follow-up of bladder cancer patients. We review recently discovered EV-derived biomarkers for the diagnosis of bladder cancer.
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Affiliation(s)
- Eline Oeyen
- Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium.
- Centre for Proteomics (CFP), University of Antwerp, 2020 Antwerp, Belgium.
| | - Lucien Hoekx
- Urology Department, Antwerp University Hospital (UZA), 2650 Edegem, Belgium.
| | - Stefan De Wachter
- Urology Department, Antwerp University Hospital (UZA), 2650 Edegem, Belgium.
| | - Marcella Baldewijns
- Pathological Anatomy Department, Antwerp University Hospital (UZA), 2650 Edegem, Belgium.
| | - Filip Ameye
- Urology Department, General Hospital Maria Middelares Ghent, 9000 Ghent, Belgium.
| | - Inge Mertens
- Flemish Institute for Technological Research (VITO), 2400 Mol, Belgium.
- Centre for Proteomics (CFP), University of Antwerp, 2020 Antwerp, Belgium.
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46
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Vaganée D, Van de Borne S, Fransen E, Voorham J, Voorham‐van der Zalm P, De Wachter S. Repeatability of tools to assist in the follow up and troubleshooting of sacral neuromodulation patients using the sensory response. Neurourol Urodyn 2019; 38:801-808. [DOI: 10.1002/nau.23925] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 12/20/2018] [Indexed: 11/12/2022]
Affiliation(s)
- Donald Vaganée
- Department of UrologyAntwerp University Hospital (UZA)EdegemBelgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp (UA)AntwerpBelgium
| | - Sigrid Van de Borne
- Department of UrologyAntwerp University Hospital (UZA)EdegemBelgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp (UA)AntwerpBelgium
| | - Erik Fransen
- StatUa Center for Statistics UAntwerpenAntwerpBelgium
| | - Jeroen Voorham
- Department of UrologyLeiden University Medical Center (LUMC)LeidenThe Netherlands
| | | | - Stefan De Wachter
- Department of UrologyAntwerp University Hospital (UZA)EdegemBelgium
- Faculty of Medicine and Health SciencesUniversity of Antwerp (UA)AntwerpBelgium
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47
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Vaganée D, Kessler TM, Van de Borne S, De Win G, De Wachter S. Sacral neuromodulation using the standardized tined lead implantation technique with a curved vs a straight stylet: 2-year clinical outcomes and sensory responses to lead stimulation. BJU Int 2019; 123:E7-E13. [DOI: 10.1111/bju.14650] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Donald Vaganée
- Department of Urology; Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp; Edegem Belgium
| | - Thomas M. Kessler
- Neuro-Urology, Spinal Cord Injury and 6 Research; University of Zürich; Balgrist University Hospital; Zürich Switzerland
| | - Sigrid Van de Borne
- Department of Urology; Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp; Edegem Belgium
| | - Gunter De Win
- Department of Urology; Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp; Edegem Belgium
| | - Stefan De Wachter
- Department of Urology; Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp; Edegem Belgium
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48
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Abstract
A double J stent (DJS) is the main therapy for ureteral obstruction when conservative treatment fails. Antegrade migration in the bladder - or retrograde migration in the ureter - are well-known complications. We present a case with intravascular migration of a DJS into the inferior vena cava. Inferior venocavagraphy confirmed the position of the stent, and thrombus formation was excluded at its tip. The stent was retracted endoscopically. After the procedure, limited contrast leakage was seen at the perforation site on venography. The current available literature is reviewed. Based on this, a management algorithm is drawn up.
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Affiliation(s)
- Sam Tilborghs
- Department of Urology, University of Antwerp, Antwerp, Belgium
| | - Donald Vaganée
- Department of Urology, University of Antwerp, Antwerp, Belgium
| | - Stefan De Wachter
- Department of Urology, University of Antwerp, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
| | - Lucien Hoekx
- Department of Urology, University of Antwerp, Antwerp, Belgium.,Department of Urology, Antwerp University Hospital, Edegem, Belgium
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49
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Tu LM, De Wachter S, Robert M, Dmochowski RR, Miller LE, Everaert K. Initial clinical experience with selective bladder denervation for refractory overactive bladder. Neurourol Urodyn 2018; 38:644-652. [PMID: 30499155 PMCID: PMC7379657 DOI: 10.1002/nau.23881] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/01/2018] [Indexed: 11/12/2022]
Abstract
Aims To report the initial clinical experience with selective bladder denervation (SBD) of the trigone in women with refractory overactive bladder (OAB). Methods Females with refractory OAB underwent SBD of the bladder sub‐trigone region. Patients were treated using a 10‐s voltage‐controlled radiofrequency (RF) algorithm (RF10) at study onset. The protocol was modified during the study after which point remaining patients received 60‐s temperature‐controlled RF (RF60). Patients were followed for 12 weeks and evaluated for adverse events and changes in OAB symptoms. Exploratory analyses on the influence of RF duration were performed. Results Among 63 patients, SBD resulted in statistically significant and clinically important improvements for most outcomes. Comparing RF10 (n = 34) to RF60 (n = 29), treatment benefit was greater with RF60 including mean reduction in urgency urinary incontinence (−2.5 vs −0.9; P < 0.01), urinary incontinence (−2.6 vs −0.8; P < 0.001), and total urgency and frequency score (−13 vs −7; P = 0.02); and improvements in symptom bother (−33 vs −18; P < 0.01) and quality of life (28 vs 16; P = 0.02) on the OAB questionnaire. The proportion of urgency urinary incontinence treatment responders (≥50% reduction in episodes) was 79% with RF60 and 31% with RF10. The frequency of device‐ or procedure‐related adverse events was comparable in RF10 versus RF60 groups (14.7% vs 17.2%). Conclusions This study demonstrated the feasibility of SBD in alleviating symptoms of refractory OAB. A 60‐s RF algorithm using deeper ablations of the sub‐trigonal tissues was more effective and comparably safe to a 10‐s RF algorithm using more superficial ablations.
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Affiliation(s)
- Le Mai Tu
- Division of Urology, Department of Surgery, Sherbrooke University Hospital, Sherbrooke, Quebec, Canada
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital and Faculty of Medicine, University of Antwerp, Antwerp, Belgium
| | - Magali Robert
- Department of Obstetrics and Gynecology, Division of Urogynecology, University of Calgary, Alberta, Canada
| | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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50
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Eggermont M, De Wachter S, Eastham J, Gillespie J. Innervation of the Epithelium and Lamina Propria of the Urethra of the Female Rat. Anat Rec (Hoboken) 2018; 302:201-214. [DOI: 10.1002/ar.23937] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/19/2018] [Accepted: 01/26/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Monica Eggermont
- Department of Urology, Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
| | - Stefan De Wachter
- Department of Urology, Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
| | - Jane Eastham
- Uro‐physiology Research Group, The Dental and Medical SchoolNewcastle University Newcastle upon Tyne UK
| | - James Gillespie
- Department of Urology, Faculty of Medicine and Health SciencesUniversity of Antwerp Antwerp Belgium
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