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Leao Ribeiro I, Lorca LA, Peviani Messa S, Berríos Contreras L, Valdivia Valdés FJ, Roteli Oyarzún VD, Rojas Soto CA. [Effectiveness of early pelvic muscle training on pelvic floor strength, urinary incontinence symptoms, sexual function, and quality of life in post-radical prostatectomy patients: Systematic review of randomized clinical trials]. Rehabilitacion (Madr) 2024; 58:100828. [PMID: 38141425 DOI: 10.1016/j.rh.2023.100828] [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: 12/13/2022] [Revised: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 12/25/2023]
Abstract
This study aimed to evaluate the effectiveness of early pelvic muscle training in reducing urinary incontinence symptoms, improving quality of life, sexual function, and increasing pelvic floor strength in post-radical prostatectomy patients. A search was carried out in 8 databases until October 26, 2022, the methodological quality and the risk of bias of 14 included studies (n=1236) were evaluated, moreover, the evidence and the meta-analysis were calculated. The intervention significantly reduced urinary incontinence symptoms compared to a control group (SMD=-2.80, 95% CI=-5.21 to -0.39, P=.02), with significant heterogeneity (I2=83%; P=<.0001) and moderate evidence. In addition, it presented moderate evidence to improve quality of life, and very low evidence to improve sexual function and pelvic floor strength. These results should be viewed with caution due to the significant heterogeneity of the studies analysed.
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Affiliation(s)
- I Leao Ribeiro
- Departmento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile.
| | - L A Lorca
- Hospital del Salvador, Servicio de Salud Metropolitano Oriente, Santiago de Chile, Chile
| | | | | | - F J Valdivia Valdés
- Departmento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
| | - V D Roteli Oyarzún
- Departmento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
| | - C A Rojas Soto
- Departmento de Kinesiología, Facultad de Ciencias de la Salud, Universidad Católica del Maule, Talca, Chile
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Bilgiç FŞ, Gençtürk N, Arikan B. The effect of electroacupuncture applied to women with stress urinary incontinence on urinary incontinence severity and symptoms: Systematic review and meta-analysis of randomized controlled trials. Actas Urol Esp 2024:S2173-5786(24)00027-1. [PMID: 38556127 DOI: 10.1016/j.acuroe.2024.03.002] [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: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Stress Urinary Incontinence is a condition that impairs the quality of life in women and randomized controlled trials of electroacupuncture for stress urinary incontinence have been conducted. OBJECTIVE The aim of this systematic review and meta-analysis was to examine the effect of electroacupuncture on the severity and symptoms of urinary incontinence in women with stress urinary incontinence. METHODS Literature searches were conducted in PubMed, CINAHL, Scopus and Science Citation Index until November 2023. This study was based on the recommendations of the Cochrane guidelines. Data were analyzed using the Review Manager computer program (Version 5.4). The methodological quality of the studies was assessed using the RoB-2 tool. RESULTS The analysis included 888 women with stress urinary incontinence and three studies. In women with stress urinary incontinence, electroacupuncture intervention improved urinary incontinence severity and quality of life (MD: -2.37, 95% CI: -3.29 to 1.45, Z = 5.07, p < 0.001), urinary leakage (SMD: -0.79, 95% CI: -1.02 to -0.55, Z = 6.60, p = 0.001) and incontinence episode frequency (SMD: -2.24, 95% CI: -4.17 to -0.32, Z = 2.29, p < 0.02). CONCLUSION In women with stress urinary incontinence, electroacupuncture intervention decreased the severity of urinary incontinence and improved the quality of life. Symptoms related to urinary incontinence were found to decrease urinary leakage and incontinence episode frequency. The studies included in the analysis were determined to be low-risk studies in quality assessment.
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Affiliation(s)
- F Ş Bilgiç
- Universidad de Haliç, Facultad de Ciencias de la Salud, Departamento de Partería, Estambul, Turkey
| | - N Gençtürk
- Universidad de Estambul-Cerrahpaşa, Facultad de Ciencias de la Salud, Departamento de Partería, Estambul, Turkey.
| | - B Arikan
- Universidad de Estambul-Cerrahpaşa, Instituto de Estudios de Posgrado, Departamento de Partería, Estambul, Programa de Doctorado, Estambul, Turquía. Universidad Ankara Medipol, Facultad de Ciencias de la Salud, Departamento de Partería, Ankara, Turkey
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Polanco Pujol L, Caño Velasco J, Rodríguez Fernández E, Cancho Gil MJ, Lledó García E, López-Fando Lavalle L, Hernández Fernández C. Prevalence and management of urinary incontinece after pelvic organ prolapse surgery (sacrocolpopexy). A literature review. Actas Urol Esp 2024:S2173-5786(24)00015-5. [PMID: 38369286 DOI: 10.1016/j.acuroe.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 02/20/2024]
Abstract
INTRODUCTION Stress urinary incontinence (SUI) is frequently associated with pelvic organ prolapse (POP) and may occur after its surgical treatment. AIM To determine the incidence, risk factors and management of SUI during and after POP surgery through a review of the available literature. MATERIALS AND METHOD Narrative literature review on the incidence and management of SUI after POP surgery after search of relevant manuscripts indexed in PubMed, EMBASE and Scielo published in Spanish and English between 2013 and 2023. RESULTS Occult SUI is defined as visible urine leakage when prolapse is reduced in patients without SUI symptoms. De novo SUI develops after prolapse surgery without having previously existed. In continent patients, the number needed to treat (NNT) to prevent one case of de novo SUI is estimated to be 9 patients and about 17 to avoid repeat incontinence surgery. In patients with occult UI, the NNT to avoid repeat incontinence surgery is around 7. Patients with POP and concomitant SUI are the group most likely to benefit from combined surgery with a more favorable NNT (NNT 2). CONCLUSION Quality studies on combined surgery for treatment SUI and POP repair are lacking. Continent patients with prolapse should be warned of the risk of de novo SUI, although concomitant incontinence treatment is not currently recommended. Incontinence surgery should be considered on an individual basis in patients with prolapse and SUI.
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Affiliation(s)
- L Polanco Pujol
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - J Caño Velasco
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - M J Cancho Gil
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - E Lledó García
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Karaahmet AY, Bilgiç FŞ, Kızılkaya Beji N. The effect of telehealth on incontinence severity given to women with urinary incontinence: A systematic review and meta-analysis of randomized controlled trials. Actas Urol Esp 2024:S2173-5786(24)00009-X. [PMID: 38360107 DOI: 10.1016/j.acuroe.2024.02.002] [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: 11/28/2023] [Accepted: 01/09/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Although urinary incontinence does not cause mortality, it is a global health problem that adversely affects the quality of life and health of women. OBJECTIVE The aim of this study was to conduct a systematic review and meta-analysis of the studies investigating the effect of telehealth given to women with urinary incontinence (UI) on the severity of incontinence. METHODS The literature review for this systematic review was conducted between August-Semptember 2023 using four electronic databases. Y-based articles were scanned using MeSH-based keywords. Randomized Controlled Trials conducted over the last decade were included in the screening. RESULTS The analysis included six studies involving 826 women with UI. After telehealth intervention, there was a significant difference in UI symptom severity (MD: -2.14 95% CI: -2.67 to -1.62, Z=8.03, p<0.00001) and quality of life (SMD: -2.14 95% CI: -2.67 to -1.62, Z=8.03, p<0.00001) compared to the control groups. It had no effect on sexuality (MD: -4.65 95% CI: -9.60 to 0.30, Z=1.84, p=0.07), and anxiety (SMD: -0.15, 95% CI: -0.38 to 0.08, Z=1.27, p=0.21). CONCLUSION In this analysis, it was found that telehealth interventions performed on women with UI increased the quality of life while reducing the severity of incontinence in women, but had no effect on sexuality, and anxiety.
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Affiliation(s)
- A Y Karaahmet
- Departamento de Partería, Facultad de Ciencias de la Salud, Universidad de Haliç, Estambul, Turkey
| | - F Ş Bilgiç
- Departamento de Partería, Facultad de Ciencias de la Salud, Universidad de Haliç, Estambul, Turkey.
| | - N Kızılkaya Beji
- Facultad de Ciencias de la Salud, Universidad de Biruni, Estambul, Turkey
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Raffo G, Sappia D, Dominici D, Rozenbaum M, García J, Lavigne M, Correa M. Endoscopic implantation of autologous myoblasts for stress urinary incontinence and evaluation of its efficacy in sphincterotomized rabbits. Actas Urol Esp 2023; 47:588-597. [PMID: 37355207 DOI: 10.1016/j.acuroe.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Stress urinary incontinence (SUI) is one of the health problems with more impact on patients' lives. The aim of the present work was to develop a therapy for SUI using tissue engineering by isolation and culture of autologous myoblasts (CAM) followed by endoscopic implantation. We also evaluated the efficacy of this therapy in a rabbit model of incontinence after sphincterotomy. MATERIALS AND METHODS We used healthy male New Zealand rabbits. The animals were first bled to obtain platelet-poor plasma (PPP) and biopsied for myoblast isolation. Post-sphincterotomy, they were divided into two groups: the treatment group (including animals that received CAM resuspended in PPP) and the control group (including animals receiving only PPP). The leak-point pressure (LPP) was used to measure continence in both groups at different time points. The results were evaluated with hierarchical linear regression models. Histological evaluation of the rabbits' sphincters was also performed at the end of follow-up. RESULTS No statistically significant differences were observed between the baseline LPP values of each group. The post-sphincterotomy values of both groups were below 50% of the baseline value, which was a mandatory condition for incontinence. The post-implantation values of the treatment group were higher than 50% of the baseline value, which led us to assume continence recovery. A statistically significant difference was observed in the LPP values between the two treatment groups (p=0.003). Histological study revealed interconnected islands formed by muscle fibers in the treatment group, and connective tissue surrounding the urethral lumen and inflammatory infiltrate in the control group. DISCUSSION AND CONCLUSIONS The implantation of CAM significantly improved LPP values in the treatment group, and the improvement remained throughout the evaluation period. It may be associated with the consistency of the implant and its stability at the injection site. Longer follow-up studies and human clinical investigations are required to consider CAM implantation as an alternative treatment for stress urinary incontinence.
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Affiliation(s)
- G Raffo
- Servicio de Urología, Policlínica Privada Paz, Tandil, Argentina
| | - D Sappia
- Clínica Veterinaria Sappia, Tandil, Argentina
| | - D Dominici
- División Bioingeniería, Laboratorio Craveri, Buenos Aires, Argentina.
| | - M Rozenbaum
- División Bioingeniería, Laboratorio Craveri, Buenos Aires, Argentina
| | - J García
- Servicio de Diagnóstico Veterinario de la Facultad de Ciencias Veterinarias de Tandil, Tandil, Argentina
| | - M Lavigne
- División Bioingeniería, Laboratorio Craveri, Buenos Aires, Argentina
| | - M Correa
- División Bioingeniería, Laboratorio Craveri, Buenos Aires, Argentina
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Álvarez-García C, Doğanay M. The prevalence of urinary incontinence in female CrossFit practitioners: A systematic review and meta-analysis. ARCH ESP UROL 2022; 75:48-59. [PMID: 35173077] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE CrossFit is a popular sportamong women. It has numerous benefits, but it is unclearwhat effects it has on the pelvic floor, since physicalexercise may be a risk factor for urinary incontinence.The aim of this study was to determine theoverall prevalence of urinary incontinence in femaleCrossFit practitioners. METHODS: A systematic review and meta-analysiswere conducted (PROSPERO, 2020: CRD42020199479).We searched cross-sectional studies in databases (Pub-Med, CINAHL, WOS, Scopus, ProQuest) and search engines,from inception to 17 June, 2020. The AdaptedNewcastle-Ottawa Scale for Cross-Sectional Studies wasused to assess the risk of bias. Pooled prevalence wascalculated using random-effects models. Heterogeneitywas investigated by meta-regression and subgroupanalysis. RESULTS A total of 282 records were identified, ofwhich 13 were included in the qualitative and quantitativesynthesises. The prevalence of urinary incontinenceamong female CrossFit practitioners was 32.1%(95% CI = 22.2-43.8%, n = 2187) and of stress urinaryincontinence was 35.8% (95% CI = 19.4-56.4%, n =1323). The prevalence of urinary incontinence was higher among women over 35 years old, with previouspregnancies and vaginal deliveries (P = 0.004). TheCrossFit exercises associated with higher stress urinaryincontinence were rope jumping, double under,weightlifting, and box jumps. Some preventive strategieswere pelvic floor training, using pads, emptyingthe bladder before workouts, and wearing dark pants. CONCLUSIONS: These results show that the prevalenceof urinary incontinence in female CrossFit practitionerswas similar to that found among women whopractice sport.
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Mateu-Arrom L, Gutiérrez-Ruiz C, Sabiote Rubio L, Martínez Barea V, Palou Redorta J, Errando-Smet C. Efficacy and safety of onabotulinumtoxin A injection in male patients with detrusor overactivity after stress urinary incontinence surgery. Actas Urol Esp 2021; 46:22-27. [PMID: 34838492 DOI: 10.1016/j.acuroe.2020.11.012] [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: 09/12/2020] [Accepted: 11/29/2020] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVE The use of onabotulinumtoxin A (BoNT-A) injection in male patients with detrusor overactivity (DO) after stress urinary incontinence (SUI) surgery has been scarcely described. Our aim was to assess results of this treatment in this specific population. MATERIALS AND METHODS Retrospective analysis of men with previous SUI surgery who had been treated with a first injection of 100 U BoNT-A because of DO since 2010 in our department. Treatment response was assessed with the Treatment Benefit Scale: 1) greatly improved; 2) improved; 3) not changed; 4) worsened after treatment (Treatment Benefit Scale 1 or 2: treatment response). Complications were classified according to the Clavien-Dindo classification. Treatment continuation was considered present if, at the last visit, patients had received a BoNT-A injection within the preceding 12 months. Pre- and post-treatment urodynamic variables were compared. RESULTS Eighteen patients were included, median age 71.1 (59.1-83.5) years. Twelve (66.7%) patients reported response to treatment. Two (11.1%) complications were detected: urinary retention requiring clean intermittent catheterization (Clavien-Dindo 2). No complications related to previous SUI surgery were detected. Fifteen (83.3%) patients had a follow-up >12 months (median follow-up 57 [15-89] months) and all of them had discontinued treatment at the end of follow-up. Urodynamic studies showed significant improvement in terms of DO and bladder compliance. CONCLUSION Although most men with DO after SUI surgery respond to intradetrusor BoNT-A injection, all of them discontinue treatment due to personal reasons. It is a safe procedure, with urinary retention requiring clean intermittent catheterization being the most frequent complication.
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Affiliation(s)
- L Mateu-Arrom
- Unidad de Urología Funcional y Femenina, Fundació Puigvert, Barcelona, Spain.
| | - C Gutiérrez-Ruiz
- Unidad de Urología Funcional y Femenina, Fundació Puigvert, Barcelona, Spain
| | - L Sabiote Rubio
- Unidad de Urología Funcional y Femenina, Fundació Puigvert, Barcelona, Spain
| | - V Martínez Barea
- Unidad de Urología Funcional y Femenina, Fundació Puigvert, Barcelona, Spain
| | | | - C Errando-Smet
- Unidad de Urología Funcional y Femenina, Fundació Puigvert, Barcelona, Spain
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Azuero J, Becerra AM, Barrera Á, Daza F, Fernández N, Rojas AM, García KE, López-Fando L, Plata M. [Videourodynamics: Current indications, technique and considerations.]. ARCH ESP UROL 2021; 74:664-675. [PMID: 34472435] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Describe the technique, indications and the correct interpretation given the findings in different clinical entities, and to serve as a guide for urologists, urology residents and even medical students. MATERIAL AND METHODS A literature search was performed using Pubmed, Cochrane and Scopus database for articles and guidelines published between January 1970 and June 2020. RESULTS Videourodynamics is a diagnostic procedure that combines the urodynamic study with simultaneous images of the lower urinary tract to assess the anatomy and function during the different phases of micturition.This study provides important information that can modify therapeutic behavior and therefore clinical outcomes of patients. CONCLUSION The role of videourodynamics becomes more relevant nowadays in the assessment of the pathophysiology of voiding dysfunction, being the gold standard for the workup of neurogenic bladder and voiding dysfunction in young people and women and, possibly in persistent/recurrent incontinence in both men and women.
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Affiliation(s)
- Julián Azuero
- Departamento de Urología. Hospital Universitario Fundación Santa Fe de Bogotá. Facultad de Medicina de la Universidad de los Andes. Bogotá D.C. Colombia
| | - Ana María Becerra
- Departamento de Urología. Hospital Universitario Fundación Santa Fe de Bogotá. Facultad de Medicina de la Universidad de los Andes. Bogotá D.C. Colombia
| | - Ángela Barrera
- Departamento de Urología. Hospital Universitario Fundación Santa Fe de Bogotá. Facultad de Medicina de la Universidad de los Andes. Bogotá D.C. Colombia
| | - Fabián Daza
- Departamento de Urología. Hospital Universitario Fundación Santa Fe de Bogotá. Facultad de Medicina de la Universidad de los Andes. Bogotá D.C. Colombia
| | - Nicolas Fernández
- Departamento de Urología. Seattle Children´s Hospital. Seattle. Estados Unidos
| | - Adriana Marcela Rojas
- Dirección de Enfermería. Departamento de Urología. Hospital Universitario Fundación Santa Fe de Bogotá. Facultad de Medicina de la Universidad de los Andes. Bogotá D.C. Colombia
| | - Karen Elizabeth García
- Dirección de Enfermería. Departamento de Urología. Hospital Universitario Fundación Santa Fe de Bogotá. Facultad de Medicina de la Universidad de los Andes. Bogotá D.C. Colombia
| | - Luis López-Fando
- Servicio de Urología. Hospital Universitario de La Princesa. Madrid. España
| | - Mauricio Plata
- Departamento de Urología. Hospital Universitario Fundación Santa Fe de Bogotá. Facultad de Medicina de la Universidad de los Andes. Bogotá D.C. Colombia
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Mateu-Arrom L, Gutiérrez-Ruiz C, Sabiote Rubio L, Martínez Barea V, Palou Redorta J, Errando-Smet C. Efficacy and safety of onabotulinumtoxin A injection in male patients with detrusor overactivity after stress urinary incontinence surgery. Actas Urol Esp 2021; 46:S0210-4806(21)00140-6. [PMID: 34462149 DOI: 10.1016/j.acuro.2020.11.013] [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: 09/12/2020] [Revised: 10/29/2020] [Accepted: 11/29/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND OBJECTIVE The use of onabotulinumtoxin A (BoNT-A) injection in male patients with detrusor overactivity (DO) after stress urinary incontinence (SUI) surgery has been scarcely described. Our aim was to assess results of this treatment in this specific population. MATERIALS AND METHODS Retrospective analysis of men with previous SUI surgery who had been treated with a first injection of 100U BoNT-A because of DO since 2010 in our department. Treatment response was assessed with the Treatment Benefit Scale: 1) greatly improved; 2) improved; 3) not changed; 4) worsened after treatment (Treatment Benefit Scale 1 or 2: treatment response). Complications were classified according to the Clavien-Dindo classification. Treatment continuation was considered present if, at the last visit, patients had received a BoNT-A injection within the preceding 12 months. Pre- and post-treatment urodynamic variables were compared. RESULTS Eighteen patients were included, median age 71.1 (59.1-83.5) years. Twelve (66.7%) patients reported response to treatment. Two (11.1%) complications were detected: urinary retention requiring clean intermittent catheterization (Clavien-Dindo 2). No complications related to previous SUI surgery were detected. Fifteen (83.3%) patients had a follow-up>12 months (median follow-up 57 [15-89] months) and all of them had discontinued treatment at the end of follow-up. Urodynamic studies showed significant improvement in terms of DO and bladder compliance. CONCLUSION Although most men with DO after SUI surgery respond to intradetrusor BoNT-A injection, all of them discontinue treatment due to personal reasons. It is a safe procedure, with urinary retention requiring clean intermittent catheterization being the most frequent complication.
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Affiliation(s)
- L Mateu-Arrom
- Unidad de Urología Funcional y Femenina, Fundació Puigvert, Barcelona, España.
| | - C Gutiérrez-Ruiz
- Unidad de Urología Funcional y Femenina, Fundació Puigvert, Barcelona, España
| | - L Sabiote Rubio
- Unidad de Urología Funcional y Femenina, Fundació Puigvert, Barcelona, España
| | - V Martínez Barea
- Unidad de Urología Funcional y Femenina, Fundació Puigvert, Barcelona, España
| | | | - C Errando-Smet
- Unidad de Urología Funcional y Femenina, Fundació Puigvert, Barcelona, España
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Espuña Pons M, Cassadó J, Díez Itza I, Valero Fernández EM. Post-void residual and voiding dysfunction symptoms in women with pelvic organ prolapse before and after vaginal surgery. A multicenter cohort study. Actas Urol Esp 2021; 45:57-63. [PMID: 32593638 DOI: 10.1016/j.acuro.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/03/2020] [Accepted: 03/22/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The present study evaluates the impact of vaginal surgery for pelvic organ prolapse (POP) on voiding dysfunction (VD) symptoms and post-void residual (PVR) one year after the intervention. MATERIAL AND METHODS Epidemiological, longitudinal, prospective study. Thirty-nine gynecology units included women with symptomatic POP grade 2 or higher according to the Pelvic Organ Prolapse Quantification (POP-Q) system, who would undergo surgery for vaginal prolapse (CIRPOP-IUE study). Sociodemographic and clinical variables were collected before and after the intervention. At both visits, patients completed the 'Epidemiology of Prolapse and Incontinence Questionnaire' (EPIQ) and 'Pelvic Floor Distress Inventory' (PFDI-20) questionnaire. PVR volume was measured by bladder catheterization immediately after spontaneous urination. RESULTS VD symptoms were present in 50% cases before the intervention. PVR was measured in 277 women of which 116 (41.87%) were >50ml and 42/277 (15.2%) were >100ml. Objective and subjective reduction in VD symptoms was observed one year after the intervention. Mean PVR volume was reduced with statistical significance, from a mean (SD) of 66.4 (68.9)ml to 48.3 (51.3)ml. The number of patients who reported difficulty in emptying and sensation of incomplete emptying on the EPIQ and PFDI-20 questionnaires also decreased. CONCLUSIONS In general, improved voiding functions were observed in the CIRPOP-IUE study through a decrease in specific VD symptoms and a reduction in mean PVR volume.
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Martínez-Holguín E, Herranz-Amo F, Lledó-García E, Ruiz-Bel J, Esteban-Labrador L, Subirá-Ríos D, Hernández-Fernández C. Comparison between laparoscopic and open prostatectomy: Postoperative urinary continence analysis. Actas Urol Esp 2020; 44:535-541. [PMID: 32151470 DOI: 10.1016/j.acuro.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 09/01/2019] [Accepted: 10/08/2019] [Indexed: 10/24/2022]
Abstract
INTRODUCTION There are very few articles comparing open radical prostatectomy (ORP) vs. laparoscopic radical prostatectomy (LRP) and their functional results or urinary continence (UC), which is one of the most important objectives to pursue after oncological results. OBJECTIVES To compare postoperative UC in patients with localized prostatic adenocarcinoma treated with OPR or LRP. MATERIAL AND METHODS Comparison between two patient cohorts (312 for ORP and 206 for LRP) between 2007-2015. The UC was evaluated at 3, 6, 12, 18 and 24months. Continence was defined and classified as follows: a)UC, no need of pads, and b)urinary incontinence (UI), use of pads. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variable UI. Statistical significance when P<.05. RESULTS Nerve-sparing was performed in 51.7% cases. At 24months after surgery, 72.4% patients had UC, of which 87.7% were from the ORP group and 78.1% in the LRP group (P=.004). 22,7% of patients experienced biochemical recurrence (BR), with 83% treated with salvage radiotherapy (SRT), presenting greater UI percentage (P=.036). ORP patients showed a higher percentage of anastomosis stricture (P=.03). CONCLUSIONS LRP, non-nerve sparing, and SRT were directly related to postoperative UI.
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Salazar A, Regis L, Planas J, Celma A, Díaz F, Gallardo I, Trilla E, Morote J. Early continence after radical prostatectomy: A systematic review. Actas Urol Esp 2019; 43:526-35. [PMID: 31606163 DOI: 10.1016/j.acuro.2019.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/11/2019] [Accepted: 06/23/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Urinary incontinence is the adverse effect with more impact on patients' quality of life after undergoing radical prostatectomy. The objective of this study is to review the present evidence that describes the variations on surgical techniques which aim to preserve urinary continence after radical prostatectomy. EVIDENCE ACQUISITION We searched the literature on PubMed, Cochrane, and ScienceDirect according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement, using the PICO review protocol. The search terms were urinary continence, urinary incontinence, urinary leakage, radical prostatectomy, open radical prostatectomy, laparoscopic prostatectomy, robot-assisted laparoscopic prostatectomy, robotic prostatectomy. We identified 1,603 registers, and 27 articles were reviewed for meeting the inclusion criteria. Six of them are randomized clinical trials and 4 of them, meta-analysis. EVIDENCE SYNTHESIS The surgical techniques more frequently used to achieve early urinary continence are bladder neck and neurovascular bundles preservation, as well as the reconstruction of the rhabdosphincter. The latter has been presented in three randomized clinical trials. Even though some approaches have obtained improved functional outcomes, the lack of consensus on the definition of urinary incontinence and its measurement methods have not advocated for the creation of technical recommendations based on scientific evidence. CONCLUSIONS The reconstruction of the rhabdosphincter is the only technique that has shown improved functional results through randomized trials. The current evidence is limited and heterogenous, and more studies with consistent criteria are needed in order to establish a standard surgical technique.
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Vega-López J, Sánchez-Moreno D, Durán-Torres F. [Second-line treatment in recurrent urinary incontinence after the use of mid-urethral tapes. Systematic review and metaanalysis of proportions.]. ARCH ESP UROL 2019; 72:891-903. [PMID: 31697249] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Female urinary incontinence has a prevalence of up to 40%. Stress urinary incontinence is the most frequent type, about 50%. When primary management fails, it is unclear what the behavior should be. This study aims to show the cure rate of the second-line management options described in the literature. MATERIAL AND METHOD Systematic review of the literature with meta-analysis of proportions. Observational and interventional studies were included in which the different types of management of recurrent/persistent urinary incontinence were evaluated in women who had a mid-urethral tape as primary management. RESULTS 161 studies were identified and screened, including 29 in the qualitative synthesis and 27 in the quantitative synthesis. Given the high clinical and methodological heterogeneity, an estimation of the cure rate for each type of management was performed, with the following results regarding the total combined cure rate: in the implantation of adjustable tapes of 86% ( IC95%: 76.4% -92.1%), the implantation of a second mid urethral tape was 75.1% (95% CI: 68% -81.1%), in the shortening of the previous mid urethral tape was 62.3% (95% CI: 49.1% -73.9%) and finally the implantation of bulking agents was 55.4% (95% CI: 43.2% -67%). We did not find enough studies to perform a quantitative synthesis with respect to: pubovaginal sling, colposuspension and pelvic floor therapy, as well as secondary outcomes. CONCLUSION The evidence found shows that there may be superiority of the adjustable tapes versus the mid urethral tapes and other included treatments. However, a comparison to statistically corroborate this difference could not be made. These results should be confirmed with multicenter collaborative randomized clinical trials.
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Affiliation(s)
- Johanna Vega-López
- Médico y cirujano. Universidad del Rosario. Especialista en Urología. Universidad del Rosario. Especialista en Docencia Universitaria. Universidad El Bosque. Magister en Epidemiología Universidad del Rosario. Universidad CES. Instructor asociado Urología. Hospital de La Samaritana-Universidad del Rosario. Bogotá D.C. Colombia
| | - David Sánchez-Moreno
- Médico y cirujano. Universidad Militar Nueva Granada. Especialista en Epidemiología. Universidad CES. Universidad del Rosario. Magister en Epidemiología Universidad del Rosario-Universidad CES. Epidemiólogo Dirección de Sanidad Policía Nacional. Bogotá D.C. Colombia
| | - Felipe Durán-Torres
- Médico y cirujano. Universidad del Rosario. Magister en Epidemiología Universidad del Rosario-Universidad CES. Profesor de carrera escuela de Medicina y Ciencias de la Salud. Universidad del Rosario. Bogotá D.C. Colombia
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Fernández-Cuadros M, Albaladejo-Florín M, Álava-Rabasa S, Pérez-Moro O. [Effectiveness of 6 manometric biofeedback sessions on urinary incontinence and quality of life: A before-after study of 67 patients]. Rehabilitacion (Madr) 2019; 53:146-154. [PMID: 31370941 DOI: 10.1016/j.rh.2019.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether a short 6-session protocol of tonic/ phasic exercises can enhance quality of life and muscular strength in patients with urinary incontinence (UI). MATERIAL AND METHODS A prospective before-after study was performed in 67 patients with UI referred to the Rehabilitation Department of the Santa Cristina University Hospital in Madrid, Spain. In the initial assessment, the patient's personal details, predisposing factors and type of UI were registered. Patients received lifestyle recommendations. The ICIQ-SF/I-QOL questionnaires/scales were completed at the beginning and end of treatment. The manometric evaluation was registered in the first and last assessment by the MYOMED® 932 equipment. The protocol consisted of a 30-minute session of tonic/phasic exercises (15minutes each) twice weekly for a maximum of 6 sessions, supervised by a physiotherapist. RESULTS The mean age was 52.1±12.7 years and 94% of the patients (n=63) were women. The maximum and mean strength of the pelvic floor contraction was 26.4±15.6 and 5.3±3.9mmHg, respectively, which significantly increased after treatment to 35.5±19.6 and 7.6±4.4mmHg (P<.0001). The ICIQ-SF score was 10.1±5 and significantly decreased to 6.6±4.6 (P<0.0001). The I-QOL score significantly increased from 66.1±21.9 to 77.9±18.1 points (P<.0001). The I-QOL ALB subscale (avoidance and limiting behaviour) increased from 63.7±22.6 to 77.3±17.8 (P<.0001); the I-QoL PSI subscale (psychosocial impact) increased from 73.8±23.9 to 82.5±18.7 (P=.0004); and the I-QOL SE subscale (social embarrassment) increased from 56.5±23.7 to 70.5±22.1 (P<.0001). CONCLUSION Manometric feedback reduces UI and improves both quality of life and manometric values. This short 6-session protocol could be applied in other public and private centres and could provide economic benefits to the health system and to patients.
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Affiliation(s)
- M Fernández-Cuadros
- Servicio de Rehabilitación y Medicina Física, Fundación Hospital General de la Santísima Trinidad, Salamanca, España; Servicio de Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Madrid, España.
| | - M Albaladejo-Florín
- Servicio de Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Madrid, España
| | - S Álava-Rabasa
- Servicio de Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Madrid, España
| | - O Pérez-Moro
- Servicio de Rehabilitación y Medicina Física, Hospital Universitario Santa Cristina, Madrid, España
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Romero-Cullerés G, Jané-Feixas C, Vilaseca-Grané A, Arnau A, Montesinos J, Abenoza-Guardiola M. Inter-rater reliability of the digital palpation of pelvic floor muscle by the modified Oxford Grading Scale in continent and incontinent women. ARCH ESP UROL 2019; 72:602-607. [PMID: 31274126] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The first choice treatment in stress urinary incontinence (SUI) is rehabilitation of the pelvic floor in order to improve muscle strength. However, no entirely reliable instruments for quantifying pelvic floor muscle (PFM) strength are currently available. Our aim was to test the inter-rater reliability of the Modified Oxford Scale (MOS) used as the gold standard for measuring PFM strength. METHODS Test-retest reliability study. One hundred and twenty-two women with SUI and thirty continent women were recruited. Patients were excluded if they had a history consistent with pelvic organ prolapse, pregnancy, previous urogynaecological surgery, or neurological conditions. Bidigital palpation quantified by the MOS was carried out by three independent examiners. Each subject answered a two-part questionnaire: demographic and clinical characteristics and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The Cohen's Kappa index with quadratic (Kw) weighting was used to assess the inter-rater agreement. RESULTS 122 incontinent and 30 continent women were included. MOS ranged between 0 and 2 in 72.2% incontinent and 19.5% of continent women. The degree of agreement was substantial in the group of incontinent women (Kw between 0.73 and 0.81) and moderate in the group of continent women (Kw between 0.55 and 0.72). CONCLUSIONS Our results suggest that the inter-observer reliability of MOS is improbable, especially in continent women.
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Affiliation(s)
- Georgia Romero-Cullerés
- Physical Medicine and Rehabilitation. Althaia Xarxa Assistencial Universitària de Manresa. Manresa. Barcelona. Spain
| | - Cecilia Jané-Feixas
- Physical Medicine and Rehabilitation. Althaia Xarxa Assistencial Universitària de Manresa. Manresa. Barcelona. Spain
| | | | - Anna Arnau
- Clinical Research Unit. Althaia Xarxa Assistencial Universitària de Manresa. Manresa. Barcelona. Spain
| | - Jesús Montesinos
- Clinical Research Unit. Althaia Xarxa Assistencial Universitària de Manresa. Manresa. Barcelona. Spain
| | - Montserrat Abenoza-Guardiola
- Physical Medicine and Rehabilitation. Althaia Xarxa Assistencial Universitària de Manresa. Manresa. Barcelona. Spain
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Regis L, Salazar A, Cuadras M, Miret E, Roche S, Celma A, Planas J, Lorente D, Placer J, Trilla E, Morote J. Preoperative magnetic resonance imaging in predicting early continence recovery after robotic radical prostatectomy. Actas Urol Esp 2019; 43:137-142. [PMID: 30420112 DOI: 10.1016/j.acuro.2018.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/08/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND AIMS Urinary incontinence is a common complication after radical prostatectomy. The aim of our study was to describe the preoperative anatomical features using magnetic resonance imaging in order to predict early continence recovery after robotic radical prostatectomy. MATERIAL AND METHODS 72 patients who underwent robotic radical prostatectomy were prospectively analysed. EPIC questionnaire (1, 6 and 12 mo) and first self-reported continence were used to assess functional outcomes. Membranous urethral length (MUL) and MUL-prostate axis angle (aMULP) were assessed preoperatively on T2 weighted sagittal images. RESULTS Continence rate was 67.2%, 92.6% and 95.2% at 1, 6 and 12 months, respectively. Early continence was achieved in patients with the lower aMULP. At 1 month, average aMULP in continent patients was 107.21° (IC 95% 90.3-124.6) vs. 118.5° (IC 95% 117.7-134) in incontinent ones (P=.014). At 6 month differences in aMULP among groups were found: 114.24° (IC 95% 104.6-123.9) in continents vs. 142° (IC 95% 126.5-157.6) in incontinents (P=0.015). At 12 month, continent group showed a significantly higher preoperative aMULP. aMULP was revealed as the only independent predictor of urinary continence at 6 mo in multivariate analysis, OR 0.007 (IC 95% 0.002-0.012), P=0.012. CONCLUSIONS Preoperative anatomical parameters assessment prior surgery can help to identified those patients will achieve early continence recovery and it supports therapeutic decisions making.
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Affiliation(s)
- L Regis
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España.
| | - A Salazar
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - M Cuadras
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - E Miret
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - S Roche
- Institut de Imatge i Diagnostic, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - A Celma
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - J Planas
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - D Lorente
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - J Placer
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - E Trilla
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
| | - J Morote
- Departamento de Urología, Hospital Universitari Vall d' Hebron, Universitat Autonoma de Barcelona, Barcelona, España
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Míguez-Fortes L, Somoza-Argibay I, Casal-Beloy I, García-González M, García-González M, Dargallo-Carbonell T. [Analisys of non-neurogenic lower urinary tract dysfunction patterns controlled in a Pediatric urodynamic unit.]. ARCH ESP UROL 2019; 72:45-53. [PMID: 30741652] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Between 7-10% of schoolagechildren are seen by specialists for non-neurogeniclower urinary tract dysfunction (LUTD). The objective ofour study is to classify these functional alterations in difused for the diagnosis and treatment in each pattern. MATERIAL AND METHODS We reviewed patients referredto our Urodynamic Unit for suspected LUTD for3 years; We reviewed epidemiological data, supplementarytest and treatments. We classified these patientsaccording to their diagnosis and we stablished a LUTDpattern. We analyzed the incidence of each pattern andthe differences in the management. RESULTS We studied 96 patients. The mean age was7.91 years; with 53.1% children and 46.9% girls. Themost frequent symptom was diurnal urinary loss (75%),being also the most common reason for consultation(65%). 35.4% had bladder and bowel dysfunction (constipation35.4% and/or fecal incontinence 12.5%). Theprevalence of overactive bladder (56.4%), followed by:hypoactive bladder (21.9%), uncoordinated urination(6.3%), frequent urination syndrome (6.3%), urinary incontinencewith Laughter (5.2%) and post-void dribbling(2.1%). 51% of the patients presented a postponing habit.In 41.7%, the pathology was resolved with conservativemeasures. 52.1% of patients required anticholinergicsand 11.4% other therapies such as biofeedback. CONCLUSIONS LUTD is a common disorder that maybe underestimated. The prognosis is favorable in mostcases but serious long-term complications such as renalfailure may occur. The symptoms of LUTD can negativelyaffect the child's psychosocial development. The advancesin the knowledge of this pathology and the differentpatterns of dysfunction have allowed an advance inthe treatment, making it more and more behavioral andpreventive. Patients who do not improve with standardurotherapy recommendations should be referred to specificunits for proper diagnosis and treatment.
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Soto González M, Da Cuña Carrera I, Lantarón Caeiro EM, Gutiérrez Nieto M. [Circumstances that may decrease the reliability of instruments to assess male urinary incontinence]. Rehabilitacion (Madr) 2019; 53:8-12. [PMID: 30929835 DOI: 10.1016/j.rh.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 08/30/2018] [Accepted: 09/01/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To identify situations that may alter the results of the 1-hour and 24-hour Pad test and the short-form International Consultation in Incontinence Questionnaire (SF-ICIQ). PARTICIPANTS Five physiotherapists, who conducted the interviews and treatment of 81 patients undergoing radical prostatectomy. METHOD A qualitative descriptive phenomenological study was carried out, using a focus group technique with five people (4 women and 1 man) responsible for the treatment and assessment of patients with urinary incontinence after prostatectomy. Recordings were transcribed and the Atlas.ti7 programme was used to carry out the coding of the variables. RESULTS Important factors were identified in the use of measuring instruments for the diagnosis and assessment of urinary incontinence in all the tools used. CONCLUSIONS Some situations can modify the objectivity of the various tests for the assessment of urinary incontinence. Some of the factors identified were lower fluid intake, less activity, use of manual clamp or urinals to avoid leakage, as well as the interference of certain drugs.
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Affiliation(s)
- M Soto González
- Facultad de Fisioterapia, Universidad de Vigo, Pontevedra, España.
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Garcia-Baquero R, Fernandez-Avila CM, Alvarez-Ossorio JL. Functional results in the treatment of localized prostate cancer. An updated literature review. Rev Int Androl 2018; 17:143-154. [PMID: 30473332 DOI: 10.1016/j.androl.2018.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/02/2018] [Accepted: 06/12/2018] [Indexed: 01/22/2023]
Abstract
Prostate cancer is the second most frequently diagnosed cancer in men. The initial diagnosis is made in increasingly younger patients, so it seems to be essential to guarantee optimal functional results. We carried out a systematic search to define the functional results of each of the therapeutic options for localized prostate cancer. Radical prostatectomy generates a greater negative effect on urinary continence and erectile function compared to active surveillance and radiotherapy. Robotic surgery seems to offer better functional results, especially at the level of erectile function. Urinary and bowel symptoms are more pronounced after radiotherapy compared to other options. Patients must be warned of the possible functional results prior to choice of treatment.
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Affiliation(s)
- Rodrigo Garcia-Baquero
- Andrology and Reconstructive Surgery Unit, Urology Department, Hospital Universitario Puerta del Mar [Puerta del Mar University Hospital], Cadiz, Spain.
| | - Cristina Margarita Fernandez-Avila
- Andrology and Reconstructive Surgery Unit, Urology Department, Hospital Universitario Puerta del Mar [Puerta del Mar University Hospital], Cadiz, Spain
| | - José Luis Alvarez-Ossorio
- Andrology and Reconstructive Surgery Unit, Urology Department, Hospital Universitario Puerta del Mar [Puerta del Mar University Hospital], Cadiz, Spain
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Esquinas C, Arance I, Pamplona J, Moraga A, Dorado JF, Angulo JC. Treatment of stress urinary incontinence after prostatectomy with the adjustable transobturator male system (ATOMS®) with preattached scrotal port. Actas Urol Esp 2018; 42:473-482. [PMID: 29642999 DOI: 10.1016/j.acuro.2018.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Stress urinary incontinence (SUI) is a significant sequela of prostate cancer surgery. In this article, we present the surgical technique and safety and efficacy of the adjustable transobturator male system (ATOMS®) with preattached scrotal port. MATERIAL AND METHOD An open prospective study was conducted at a university hospital with the main objective of changing the baseline condition after adjustment in the daily pad count and their wet weight (pad test). The secondary objectives were the quality-of-life assessment (International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF] and Incontinence Impact Questionnaire-7 [IIQ-7], baseline and after the adjustment), patient-perceived results (Patient Global Index [PGI] and Global Response Assessment [GRA] at 1 year) and assessment of complications according to Clavien-Dindo. The numerical values are expressed in median ± IQR. RESULTS We analysed 60 consecutive patients with a follow-up of 21±22 months. The baseline pad-test was 465±450mL, and the pad-count was 5+3 pads/day. The baseline SUI was mild (11.6% of patients), moderate (25%) and severe (63.3%). The operative time was 60±25min, the hospital stay was 1±0 days, and the visual analogue scale of pain on day 1 after surgery was 0±1. The total filling was 16.5±7mL, and the number of refillings was 1±2. The pad-test and pad-count after the adjustment were 0±20mL and 0±1, respectively (both p<.0001 compared with baseline). SUI disappeared (81.7%) or remained mild (11.7%), moderate (5%) or severe (1.6%). We observed a reduction in the ICIQ-SF (p<.0001) and IIQ-7 scores (p=.0003). Both continence (p=.002) and satisfaction (p=.03) were lower in the irradiated patients. Complications occurred in 11 cases (18.6%), 8 (13.5%) of which were grade I and 3 (5.1%) of which were grade 3. The treatment satisfaction rate was 91.7%, and the patient-perceived overall improvement at 1 year was highly pronounced (PGI-I score, 1±1; GRA, 6±1). CONCLUSIONS SUI treatment of men using third-generation ATOMS® is safe and effective in the short-term, even in patients with severe SUI. The rate of dry patients after the adjustment exceeded 80%, and the satisfaction rates exceeded 90%. The patients assessed this treatment highly positively.
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Affiliation(s)
- C Esquinas
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España
| | - I Arance
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España
| | - J Pamplona
- Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España
| | - A Moraga
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España
| | | | - J C Angulo
- Servicio de Urología, Hospital Universitario de Getafe, Madrid, España; Departamento Clínico, Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Laureate Universities, Getafe, Madrid, España.
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Rapariz M, Mora AM, Roset M. Impact of overactive bladder symptoms on work activity: The ACTIVHA study. Actas Urol Esp 2018; 42:176-84. [PMID: 29103735 DOI: 10.1016/j.acuro.2017.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/14/2017] [Accepted: 09/14/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To analyse the impact of overactive bladder (OAB) symptoms on the work activity of patients in Spain. METHOD An observational, multicentre cross-sectional study was conducted with 149 urologists and 131 gynaecologists of Spain and included patients diagnosed with OAB, according to clinical judgment, who were of working age (18-65 years). We collected sociodemographic, clinical and work activity data. The patients filled out the Bladder Control Self-Assessment Questionnaire (B-SAQ) and the Work Productivity and Activity Impairment Questionnaire-General Health (WPAI-GH). The effect of each symptom on the daily and occupational activity was assessed. The results were stratified according to sex and the presence of emergency and urinary incontinence (UI) according to the B-SAQ. RESULTS We assessed 768 patients (89% women), with a mean (SD) age of 52.5 (9.3) years and 2.6 (2.6) years of OAB progression. The most common symptoms according to the patients were urgent urination (89.8%), nocturia (75.7%), urge incontinence (68.5%) and frequent urination (68.2%). Ninety-six percent of the patients adopted adaptive measures for their OAB. According to the B-SAQ, 543 patients (71%) presented urgent urination; of these, 294 (54%) showed UI. The symptom that most affected work activity was frequent urination (59.8%). According to the WPAI-GH, the patients reported an impact of 32% during the workday (41% in patients with urgent urination and UI) and a loss of work time of 6.5% (9.9% in patients with urgent urination and UI). CONCLUSIONS The symptoms of OAB negatively affect work activity, especially in patients who have urgent urination and UI.
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Romero Hoyuela A, Reina Alcaina L, Izquierdo Morejon E, Rosino Sanchez A, Carrillo George C, Rivero Guerra A, Barcelo Bayonas I, Pardo Martinez A, Muñoz Guillermo V, Pietricica B, Fernandez Aparicio T, Hita Villaplana G, Miñana Lopez B. Long-term follow-up of the AdVance ®/AdVanceXP ® sling. What are the surgeons' impressions? What are the patients'? Actas Urol Esp 2018; 42:185-190. [PMID: 29132933 DOI: 10.1016/j.acuro.2017.09.004] [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: 06/22/2017] [Revised: 09/08/2017] [Accepted: 09/11/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To analyse the safety, efficacy and quality of life of patients with male stress urinary incontinence after radical prostatectomy treated with the AdVance® and AdvanceXP® slings. PATIENTS AND METHOD The study included 92 patients with stress urinary incontinence after radical prostatectomy treated with the AdVance® and AdVanceXP® sling between May 2008 and December 2015. A perineal repositioning test was performed in all cases with sphincter coaptation of≥1.5cm. Mild stress urinary incontinence was defined as the use of 1-2 absorbers/24h; moderate was defined as 3-5 absorbers/24h; and severe was defined as more than 5 absorbers/24h. Healing was defined as the total absence of using pads; improvement was defined as a reduction>50% in the number of pads; and failure was defined as a reduction<50, no improvement or worsened incontinence. Check-ups were conducted at 3, 12 and 36 months after the surgery. We employed the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) for the quality of life index. The complications are listed according to the Clavien-Dindo classification. RESULTS The degree of preoperative incontinence was mild in 23.9%, moderate in 67.4% and severe in 8.7% of the patients. The mean use of preoperative pads was 3.1 (range 1-6, 95% CI). The mean preoperative ICIQ-SF score was 16.5 (15-20). Sphincter coaptation≥1.5cm using the perineal repositioning test was present in 87 patients (94.6%). The mean follow-up from insertion of the sling was 42.1 months. Some 89.1% of the patients were healed at 3 months, 70.7% were healed at 12 months, and 70.4% were healed at 36 months. The ICIQ-SF score at 3, 12 and 36 months showed significant improvement (P<.001) compared with the preoperative score. CONCLUSIONS The Advance® and AdvanceXP® system are effective over time in terms of urinary continence and patient satisfaction.
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Affiliation(s)
- A Romero Hoyuela
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España.
| | - L Reina Alcaina
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - E Izquierdo Morejon
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - A Rosino Sanchez
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - C Carrillo George
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - A Rivero Guerra
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - I Barcelo Bayonas
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - A Pardo Martinez
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - V Muñoz Guillermo
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - B Pietricica
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | | | - G Hita Villaplana
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
| | - B Miñana Lopez
- Servicio de Urología, Hospital Universitario Morales Meseguer, Murcia, España
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Weibl P, Rutkowski M, Huebner W. Management of iatrogenic cystoscopic urethral lesion associated with sequela of cuff erosion in a patient after previous AMS 800 implantation. One-step technique with revision, without cuff explantation. Actas Urol Esp 2018; 42:202-206. [PMID: 29100651 DOI: 10.1016/j.acuro.2017.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 02/10/2017] [Accepted: 02/13/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Iatrogenic urethral lesion with subsequent cuff erosion during cystoscopy is a rare complication. The alternative surgical strategy with in situ urethroplasty while maintaining the open cuff left in situ will be presented. MATERIALS AND METHODS The authors report 3cases of iatrogenic urethral lesion with cuff erosion during cystoscopic evaluation to exclude stricture or cuff erosion due to new onset of obstructive lower urinary tract symptoms. All patients had a history of a AMS 800 implantation due to posprostatectomy incontinence. Rigid cystoscopy was performed, which revelaed no pathologies; however, iatrogenic small urethral lesion was identified during the removal of the cystoscope at the projection of the cuff. RESULTS In situ urethroplasty was performed, and the cuff was left open in situ. Additionally a protection fat flap was placed around the urethra from the dorsolateral aspect, separating the cuff and urethra from the direct contact with each other. After 6 weeks the urethral defect was completely healed and via a primary perineal incision the cuff was readapted and closed. The device was fully functioning without any additional adjustments. CONCLUSION Our modification should be considered in select cases with absence of infection as part of management strategy for cases of iatrogenic urethral lesions with subsequent cuff erosion. Thereby the original cuff can be spared and the possibly difficult preparation of the urethra during reoperation can be avoided. However, additional more cases should be presented in the world-wide literature, to confirm the utility of this surgical principle.
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Villamil V, Girón Vallejo O, Fernández-Ibieta M, Sánchez Sánchez Á, Reyes Ríos PY, Martínez Castaño I, Rojas-Ticona J, Ruiz Pruneda R, Ruiz Jiménez JI. [Functional and aesthetic evaluation of sacrococcygeal teratomas. Not everything ends with surgery]. An Pediatr (Barc) 2018; 88:39-46. [PMID: 28669487 DOI: 10.1016/j.anpedi.2017.03.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/03/2017] [Accepted: 03/16/2017] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Sacrococcygeal teratoma is the most common solid neonatal tumour. The improvement in survival has meant that postoperative sequelae can be diagnosed and treated. The aim of this article is to evaluate the long-term outcomes of patients treated in our centre. MATERIAL AND METHODS Records of patients treated for a sacrococcygeal teratoma in our hospital from 1977 to 2014 were retrospectively reviewed. Personal data was collected and a telephone questionnaire was used to assess long-term bowel and urinary habits, as well as an aesthetic and functional self-assessment. RESULTS A total of 14 patients were treated during the study period, of whom 11 were females and 3 males, with a mean age at the time of the survey of 17 years (8 months-37 years). Eight patients completed the questionnaire (57.1%). The mean age of the 8 patients was 23 years (4-37 years), of whom 37.5% were operated on due to a sacrococcygeal teratoma type i, 25% type ii, 25% type iii, and 12.5% type iv. Two of them (25%) had constipation, and one (12.5%) had faecal incontinence. Two (25%) patients suffered from recurrent urinary tract infections, and 3 (37.5%) patients had urinary incontinence. Five patients (62.5%) had a perception of being physically impaired, with limitation of their social life. CONCLUSIONS The incidence of constipation does not differ from that found in the literature. Faecal incontinence is slightly improved compared to what has been published. However, urinary tract infections and incontinence are more prevalent in our series. Five patients out of the eight that responded suffered from psychosocial problems, according to DAS-59 questionnaire. Patients with SCT require urological, bowel, and psychological counselling, until they have a complete functional and emotional development.
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Affiliation(s)
- Vanesa Villamil
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
| | - Oscar Girón Vallejo
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - María Fernández-Ibieta
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Ángela Sánchez Sánchez
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Paulo Y Reyes Ríos
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Irene Martínez Castaño
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Javier Rojas-Ticona
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - Ramón Ruiz Pruneda
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
| | - José I Ruiz Jiménez
- Servicio de Cirugía Pediátrica, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, España
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Leirós-Rodríguez R, Romo-Pérez V, García-Soidán J. Prevalence of urinary incontinence and its relation with sedentarism in Spain. Actas Urol Esp 2017; 41:624-630. [PMID: 28587843 DOI: 10.1016/j.acuro.2017.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine the prevalence of urinary incontinence in the elderly Spanish population of both sexes and identify a possible relationship between physical activity habits and the presence of urinary incontinence in the elderly. MATERIAL AND METHODS We used data from 8146 individuals older than 60 years (age range, 60-94 years), from which data from a 15-year cohort were obtained. Of these, 4745 (58.2%) were women and 3401 (41.8%) were men. We analysed the presence of urinary incontinence, physical activity habits and the influence of other variables such as sex, age, weight and body mass index. RESULTS We detected a prevalence of urinary incontinence of 15% for the women and 11.6% for the men. Those with urinary incontinence had a greater average age, weight and body mass index than the healthy participants. At the same time, the patient group with incontinence showed more sedentary habits compared with the healthy participants. CONCLUSIONS A strong relationship was observed between the body mass index and prevalence of urinary incontinence. Urinary incontinence was also related to attitudinal aspects such as physical inactivity, a behaviour that predisposes the elderly to developing incontinence. For the first time, we observed a reduction in the prevalence of incontinence compared with previous studies.
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González-Ruiz de León C, Pérez-Haro ML, Jalón-Monzón A, García-Rodríguez J. [Female urinary incontinence: An update]. Semergen 2017; 43:578-584. [PMID: 28318909 DOI: 10.1016/j.semerg.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/01/2017] [Accepted: 01/10/2017] [Indexed: 10/19/2022]
Abstract
The urinary incontinence is a highly prevalent symptom in the adult female population. It has important psychosocial and economic connotations, and affects the quality of life of these patients. As it is an under-diagnosed problem due to patients not always consulting for it, it is very important to keep this in mind and to provide an opportunistic screening from Primary Health Care. It is difficult to determine the costs of this, but it is estimated to be the 2% of the health budget. Because of all of this, it is very important to know how to make a correct diagnose of this condition, to determine the different types of incontinence, possible causes, and treatments available. The purpose of this review is to show the different diagnostic and therapeutic tools available, to show the Primary Health Care role in this condition, and when to refer to specialist care.
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Affiliation(s)
| | - M L Pérez-Haro
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, España
| | - A Jalón-Monzón
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, España
| | - J García-Rodríguez
- Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, España
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Martín-Martínez A, Fernández-Mederos A, García-Hernández JÁ. OnabotulinumtoxinA in urinary incontinence: Prospective Study of a Case Series. Actas Urol Esp 2017; 41:458-64. [PMID: 28196743 DOI: 10.1016/j.acuro.2017.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/03/2017] [Accepted: 01/09/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the safety and efficacy of a single intravesical injection of onabotulinumtoxinA (OnaBTA) for treating urge urinary incontinence (UUI) in women. METHOD We performed a prospective case-series study of consecutive patients with refractory UUI treated with an intravesical injection of OnaBTA. The patients were administered 100 units of OnaBTA injected into the bladder wall following 4 weeks of flushing with anticholinergic agents or beta 3 agonists. The urodynamic and clinical endpoints were evaluated before and 6 months after the injection of OnaBTA. The primary study endpoint was the number of episodes of urinary leakage. RESULTS A total of 204 of the 210 selected patients conducted a valid visit 6 months after the therapeutic application. At 6 months of treatment with OnaBTA, 110 (53.9%) patients remained continent and were considered a success. However, 57 (27.9%) patients experienced one episode of urinary leakage per day, and 37 (18.2%) had 2 or more. In terms of the urodynamic parameters, we observed the following changes: increase in maximum bladder capacity (P<.0001) and reduced maximum pressure of the detrusor (P<.0001). In terms of the safety profile, 8 (3.9%) patients had self-limiting haematuria during the procedure, which resolved spontaneously, and 9 (4.4%) patients had acute urinary retention that required intermittent catheterisation. CONCLUSIONS This study supports the use of OnabotulinumtoxinA in patients with urge urinary incontinence that does not respond to medical treatment.
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Sánchez-Ferrer M, Moya-Jiménez L, Mendiola J. Comparison of the anogenital distance and anthropometry of the perineum in patients with and without pelvic organ prolapse. Actas Urol Esp 2016; 40:628-634. [PMID: 27372734 DOI: 10.1016/j.acuro.2016.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 04/06/2016] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine whether there are differences in the anthropometric measures of the perineum for women with symptomatic pelvic organ prolapse who are candidates for surgery, with or without urinary incontinence, and for patients without pelvic floor dysfunction. The main objective was to measure the anogenital distance in its 2 variants: anoclitoral and anofourchette. The anogenital distance appears to be determined prenatally and is influenced by the intrauterine hormonal environment. The secondary objective was to measure the length of the genital hiatus, the perineal body and the distance between the 2 ischial tuberosities. MATERIAL AND METHODS An observational case-control study was conducted with 58 patients. The cases (n=22) were patients with stages >II 2 in the Baden-Walker classification system. The controls were patients with normal pelvic floors. Measurements were performed with a digital calliper. The patients' tocogynecological history, lifestyle habits and risk factors were recorded. RESULTS The case patients had a significantly shorter anogenital anofourchette distance than that of the control patients (P=.001), a significantly longer anogenital anoclitoral distance than the control patients (P=.0001) and a significantly longer genital hiatus length than the control patients (P=.02). CONCLUSIONS This was an observational study with a small sample. We cannot determine whether the difference in these distances are caused by or are the result of this disease. Given that the anogenital distance appears to be determined prenatally, we question whether this changed distance could be a risk factor for developing pelvic floor dysfunction.
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Garcia-Gordillo MA, Collado-Mateo D, Olivares PR, Adsuar JC. Application of EQ-5D-5L questionnaire in patients suffering from urinary incontinence. Actas Urol Esp 2016; 40:457-62. [PMID: 26975979 DOI: 10.1016/j.acuro.2016.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/01/2015] [Revised: 01/22/2016] [Accepted: 01/22/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Urinary incontinence is associated with reduced quality of life and given the high prevalence of people with this condition, it could be useful to know the impact of having urinary incontinence on physical, psychological and social aspects. The Spanish value set of EQ-5D was used to assign single scores to the EQ-5D-5L health states. EQ-5D-5L is a health-related quality of life questionnaire, which allows assessing health status. The aim of this study was to provide normative values of EQ-5D-5L in a population sample with urinary incontinence. STUDY DESIGN Cross-sectional study. METHODS A total of 965 people with urinary incontinence (297 men and 668 women) were included in this study. EQ-5D-5L index, VAS and health status are showed in the current study considering gender, age group, region, marital status, smoking status, net monthly incomes of household and educational level. RESULTS Higher prevalence was observed in women (69.22%) compared with men (30.78%). Mean (SD) EQ-5D-5L utility index and VAS score were 0.58 (0.40) and 53.91 (22.16), respectively, for overall population. The 16.1% (155 people) reported perfect health status (11111). The utility equivalent to set values 55555 was not reported by anyone. CONCLUSION This study provides normative values of EQ-5D-5L in a Spanish population sample with urinary incontinence.
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Affiliation(s)
- M A Garcia-Gordillo
- Departamento de Economía, Universidad de Extremadura, Badajoz, España; Departamento de Economía Aplicada, Universidad de Murcia, Murcia, España.
| | - D Collado-Mateo
- Facultad de Ciencias del Deporte, Universidad de Extremadura, Cáceres, España
| | - P R Olivares
- Instituto de Actividad Física y Salud, Universidad Autonoma de Chile, Talca, Chile
| | - J C Adsuar
- Departamento de Economía Aplicada, Universidad de Murcia, Murcia, España; Facultad de Ciencias del Deporte, Universidad de Extremadura, Cáceres, España
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Ros C, Espuña-Pons M, Ortega J, Aliaga F. Urinary incontinence in gynaecological consultations. Do all women with symptoms wish to be treated? Actas Urol Esp 2015; 39:628-34. [PMID: 26233478 DOI: 10.1016/j.acuro.2015.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 06/16/2015] [Accepted: 06/17/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To determine the prevalence and symptom severity of urinary incontinence (UI) in women who attend primary care gynaecological consultations, as well as the proportion of women with UI symptoms who wish to be studied and treated. MATERIALS AND METHODS A multicentre, observational, descriptive cross-sectional study was conducted of women who visit the 8 specialised consultations for sexual and reproductive health (SRH) in the 4 Catalan provinces for any reason (except UI, pregnancy and postpartum). We employed the ICQ-UI-SF questionnaire to detect UI symptoms. Women with UI symptoms (ICI-Q-SF>0) were asked whether they wanted specific care for their UI problem. Those who answered "no" were asked why. RESULTS The study included 2840 women, 41.8% of whom reported urine losses, especially mild to moderate symptoms. Some 53.62% of the women with UI responded that they did not wish to be treated. Of these, 75% had mild symptoms, 45% had moderate symptoms, and only 16% and 5% had severe or very severe symptoms, respectively. Fifty-three percent of the women did not want treatment because the UI was not a significant problem for them. CONCLUSIONS Almost half of the women who attended a specialised consultation for SRH for any reason reported UI symptoms, especially mild and moderate. More than half of the patients with UI symptoms did not want to start a diagnostic and treatment process for their problem. Symptom severity is associated with the willingness to be treated.
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Salinas-Casado J, Esteban-Fuertes M, Serrano O, Galván J. The value of oxybutynin in transdermal patches for treating overactive bladder. Actas Urol Esp 2015; 39:599-604. [PMID: 26321038 DOI: 10.1016/j.acuro.2015.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 07/13/2015] [Indexed: 11/15/2022]
Abstract
CONTEXT There is currently a broad therapeutic arsenal of drugs for treating overactive bladder syndrome (OAB). However, there is still a need for new compounds and for improving known drugs in terms of efficacy, compliance and tolerability. OBJECTIVE To report the scientific evidence on the safety and efficacy of transdermal oxybutynin (OXY-TDS) for treating OAB. MATERIAL AND METHODS A systematic review without time restrictions was conducted until May 2015 in the MEDLINE/PubMed database. We also performed a manual review of abstracts published in international urogynaecology congresses. RESULTS The evaluated studies show that patients treated with OXY-TDS experience a significant reduction in urinary incontinence episodes compared with placebo, which is comparable to that observed in patients treated with oral oxybutynin or with tolterodine. In all of the studies, we observed improvements in symptoms from the second or third week of treatment and in a sustained manner until the end of treatment (6, 12 or 24 weeks). The clinical practice study also showed improved quality of life, achieving benefits in numerous patient profiles, with an efficacy independent of previous treatments. The safety of the drug was demonstrated in the various patient profiles. CONCLUSIONS OXY-TDS represents an effective alternative for the symptomatic treatment of adult patients with OAB, which, thanks to its pharmacokinetic profile, better tolerability, different administration method and dosage, could represent an added value in treating special populations.
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Affiliation(s)
- J Salinas-Casado
- Servicio de Urología, Hospital Clínico San Carlos, Madrid, España.
| | - M Esteban-Fuertes
- Servicio de Urología, Hospital Nacional de Parapléjicos, Toledo, España
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Lorenzo-Gómez MF, Padilla-Fernández B, Virseda-Rodríguez AJ, Collazos-Robles RE, García-Cenador MB, Mirón-Canelo JA. Severe complications and failures of incontinence surgery using the Remeex(®) adjustable tension sling (external mechanical regulator). Actas Urol Esp 2015; 39:558-63. [PMID: 26072998 DOI: 10.1016/j.acuro.2015.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 05/02/2015] [Accepted: 05/04/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Since 1999, we have performed implantations of Remeex® adjustable prosthetics as rescue treatment for complex or persistent stress urinary incontinence (SUI) after failure of other surgical treatments (Burch colposuspension, Marshall-Marchetti-Krantz (MMK) or tension-free transvaginal tape [TVT] until 2003 and transobturator tape [TOT] since 2003). We present the results of our series, which include cases with severe complications. MATERIAL AND METHOD Retrospective study of women diagnosed with complex or refractory SUI who underwent Remeex(®) implantation between October 1999 and December 2013. In 5 cases, we conducted cystocele correction in the same operation as the placement of the Remeex(®). RESULTS Sixty women, with a mean age of 66.87 years (range 39-85), underwent operations. The procedure was successful in 68.33% of the cases. The failures consisted of the following: 10% of the women had mixed urinary incontinence (UI) with multiple bladder diverticula; 8.33% had mild SUI; and 13.33% had urgency urination without UI. Thirty-five percent required adjustments. We recorded 3 cases with severe complications: disabling severe UI in a patient who underwent multiple operations, massive pelvic hemorrhage in a patient undergoing standard antiplatelet therapy and infected vaginal calculi measuring 7cm on an extruding Remeex thread in a paraplegic patient 4 years after the implantation. CONCLUSIONS Remeex(®) is an effective and safe procedure for achieving continence in cases of complex or refractory SUI, although it is not exempt from severe complications. Following rigorous protocols can help detect complications and treat them in a timely manner.
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Mestre M, Lleberia J, Pubill J, Espuña-Pons M. Questionnaires in the assessment of sexual function in women with urinary incontinence and pelvic organ prolapse. Actas Urol Esp 2015; 39:175-82. [PMID: 25174768 DOI: 10.1016/j.acuro.2014.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 05/26/2014] [Indexed: 11/20/2022]
Abstract
CONTEXT Integrating sexual health in clinical practice is important. In women with pelvic floor disorders, the evaluation of the anatomical defects, lower urinary tract function and the anorectal function often receives more attention than the sexual function. METHODS Review of Medline using defined search terms to identify articles related to sexual health assessment in urogynecology and manual analyses was performed. Only articles published in English or Spanish were included. RESULTS Only 50% of women attending urogynecological clinics are sexually active. Of those, 60% present with some sort of sexual sexual dysfunction (FSD). Questionnaires and sexuality scales would facilitate discussion of sexual matters between the Health Care professionals and the women, and may increase the likelihood of FSD being diagnosed. The Pelvic Organ Prolapse Incontinence Sexual Questionnaire (PISQ) and the PISQ-IR (IUGA-Revised) are the only female sexual function specific questionnaires currently validated and developed specifically to assess sexual function in women with urinary incontinence and/or pelvic organ prolapse. Furthermore, the PISQ-IR also allows evaluation of the outcomes of women who are not sexually active when requiring urogynecologic care. PISQ-IR is also designed for international validation. In order to use the PISQ-IR in Spain, a proper interpretation and validation of the questionnaire is needed. CONCLUSIONS The evaluation of sexual function through specific questionnaires facilitates the identification of the sexual dysfunctions associated to the pelvic floor disorders. The inclusion of sexuality questionnaires as an outcome measure allows to analyze the impact in the sexual life of women treated for an urogynecological problem.
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Carrión Pérez F, Rodríguez Moreno MS, Carnerero Córdoba L, Romero Garrido MC, Quintana Tirado L, García Montes I. [Telerehabilitation to treat stress urinary incontinence. Pilot study]. Med Clin (Barc) 2014; 144:445-8. [PMID: 25087210 DOI: 10.1016/j.medcli.2014.05.036] [Citation(s) in RCA: 8] [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: 01/22/2014] [Revised: 05/26/2014] [Accepted: 05/29/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE We aimed to test a new telerehabilitation device for stress urinary incontinence (SUI) in order to make an initial assessment of its effectiveness. PATIENTS AND METHOD Randomized, controlled pilot study. INTERVENTION experimental group (10 patients): pelvic floor muscle training, device training and home treatment with it; control group (9 patients): conventional rehabilitation treatment. Outcome measures (baseline and 3 months) overall and specific quality of life: International Consultation Incontinence Questionnaire and King's Health Questionnaire, bladder diary, perineometry, satisfaction with the program and degree of compliance. RESULTS Baseline characteristics were similar in both groups. There was no statistically significant difference for any outcome measures between groups at the end of the follow-up. The change in perineometry values at baseline and after the intervention was significant in the experimental group (23.06 to 32.00, P=.011). No group in this study had any serious adverse effects. CONCLUSIONS The tested device is safe and well accepted. Although there is some evidence of its efficacy in the rehabilitation treatment of SUI, larger trials are needed to appropriately evaluate the potential advantages.
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Affiliation(s)
| | | | | | | | - Laura Quintana Tirado
- Servicio de Rehabilitación, Hospital Universitario Virgen de las Nieves, Granada, España
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Ocampo-Trujillo A, Carbonell-González J, Martínez-Blanco A, Díaz-Hung A, Muñoz CA, Ramírez-Vélez R. Pre-operative training induces changes in the histomorphometry and muscle function of the pelvic floor in patients with indication of radical prostatectomy. Actas Urol Esp 2014; 38:378-84. [PMID: 24440083 DOI: 10.1016/j.acuro.2013.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Revised: 09/09/2013] [Accepted: 10/11/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy of preoperative pelvic floor muscle training (PFMT) on histomorphometry, muscle function, urinary continence and quality of life of patients undergoing radical prostatectomy (RP). MATERIAL AND METHODS A prospective intervention clinical study was designed in 16 patients with indication of RP who were randomized into two groups. The Control Group received routine pre-surgical education (hygienic-dietary measures). The intervention group received a training session with supervised PFMT, three times a day, for four weeks, 30 days before the PR. Muscle function of the external urethral sphincter, contraction pressure of the levator ani, urinary continence and quality of life related to health (HRQoL) were evaluated before and after the intervention. At the end of the intervention and day of the surgery, samples of residual muscle tissue were obtained from the external sphincter muscle of the urethra for histomorphometric analysis. RESULTS After the intervention, those participants who carried out PFMT showed an increase in the cross-sectional area of the muscle fibers of the external urethral sphincter (1,313 ± 1,075 μm(2)vs. 1,056 ± 844 μm(2), P=.03) and higher pressure contraction of the levator ani (F=9.188; P=.010). After catheter removal, 62% of patients in the experimental group and 37% in the control group showed no incontinence. After removal of the catheter, 75% of the experimental group did not require any pad compared to 25% in the control group (p=NS). There were no significant differences between the two groups in any of the HRQoL domains studied. CONCLUSIONS Pre-surgical PFMT in patients with RP indication induces changes in the histology and function of the pelvic floor muscles, without changes in urogenital function and HRQoL. These results provide new evidence regarding the benefit of PFMT in preventing RP associated complications.
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Barnoiu O, Vozmediano-Chicharro R, García-Galisteo E, Soler-Martinez J, del Rosa-Samaniego J, Machuca-Santacruz J, Baena-Gonzalez V. Urodynamic assessment of bladder and urethral sphincter function before and after robot-assisted radical prostatectomy. Actas Urol Esp 2014; 38:78-83. [PMID: 24119381 DOI: 10.1016/j.acuro.2013.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 06/03/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Affectation of the bladder after open prostatectomy is demonstrated. Decrease in bladder capacity and bladder compliance, detrusor hyper-or hypo-activity and voiding dysfunction are observed. We propose to investigate the effects of robotic surgery on bladder and sphincter function through the comparative study of preoperative and postoperative urodynamic values 3 months after prostatectomy. MATERIAL AND METHODS Prospective study of 32 consecutive patients undergoing robotic prostatectomy. They all underwent urodynamic study one month before the intervention and 3 months after the radical prostatectomy. RESULTS Twenty five percent of patients undergoing robotic prostatectomy showed detrusor hyperactivity accompanied by a decrease in bladder compliance of 30.2 to 21.8 ml/cmH2O. Urethral profile showed diminished functional length of 67 to 44 mm and decreased maximum urethral pressure of 48.5 to 29.3 cmH2O. After robotic prostatectomy 21.8% of patients had detrusor hypoactivity, obstruction decreased between 28.1% to 12.5%. CONCLUSIONS Decreased bladder compliance, detrusor hypo- or hyperactivity and obstruction improvement observed in the study of the flow pressure have been associated with sphincter involvement. It is part of the complex of lower urinary tract dysfunction that occurs after robotic prostatectomy.
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Gavira Pavón A, Walker Chao C, Rodríguez Rodríguez N, Gavira Iglesias FJ. [Prevalence and risk factors of urinary incontinence in women who visit the doctor with low back pain: multicentre study]. Aten Primaria 2013; 46:100-8. [PMID: 24129279 PMCID: PMC6983577 DOI: 10.1016/j.aprim.2013.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 11/19/2022] Open
Abstract
Objetivos Estimar la prevalencia y los factores de riesgo de incontinencia urinaria (IU) en mujeres con dolor lumbopélvico (DLP) y describir sus características sociodemográficas y clínicas. Diseño Estudio observacional transversal. Emplazamiento Dos centros de Atención Primaria del Sur de Córdoba y un centro privado en Madrid. Participantes Trescientas sesenta y cuatro mujeres de 20-65 años (de 466 contactadas, 33 fueron excluidas y 69 rechazaron participar) que consultaron por dolor de espalda localizado entre la doceava costilla y el pliegue glúteo. Intervenciones Entrevista mediante cuestionario. Mediciones principales Cuestionarios (Índice de discapacidad de Oswestry y cuestionarios de IU [International Consultation on Incontinence Questionnaire SF e Cuestionario de Impacto de la Incontinencia-7]), prueba funcional (test ASLR) y comorbilidad de interés para la IU. Análisis estadístico descriptivo y multivariante. Resultados Se encontró IU en 155 mujeres (43%; IC del 95%, 37%-48%), en su mayoría de esfuerzo (83%) y mínimo impacto (60%). Frente a las continentes, las mujeres incontinentes presentaron diferencias significativas en la edad, el índice de masa corporal (IMC), el estado civil, el nivel de instrucción y la convivencia, el consumo de fármacos/día, el número de partos vaginales y totales, las intervenciones quirúrgicas abdominopélvicas, el asma, el estreñimiento, la hipertensión, la diabetes, el porcentaje de incapacidad y el test funcional ASLR. En el análisis multivariante, las variables que más influyen en la probabilidad de ser incontinente fueron el asma, la hipertensión, el estreñimiento, el número de partos totales, el IMC y el porcentaje de incapacidad. Conclusiones La prevalencia de IU en mujeres con DLP es mayor que la encontrada en mujeres de similar edad sin DLP. El asma, el estreñimiento y la paridad son los factores más influyentes en la aparición de IU.
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Affiliation(s)
| | - Carolina Walker Chao
- Facultad de Ciencias de la Salud, Fundación Universitaria del Bages, Universidad Autónoma de Barcelona, Manresa, Barcelona, España
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Lucas MG, Bosch RJ, Burkhard FC, Cruz F, Madden TB, Nambiar AK, Neisius A, de Ridder DJ, Tubaro A, Turner WH, Pickard RS; European Association of Urology. EAU guidelines on surgical treatment of urinary incontinence. Actas Urol Esp 2013; 37:459-72. [PMID: 23835037 DOI: 10.1016/j.acuro.2013.02.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/12/2013] [Indexed: 11/22/2022]
Abstract
CONTEXT The European Association of Urology (EAU) guidelines on urinary incontinence published in March 2012 have been rewritten based on an independent systematic review carried out by the EAU guidelines panel using a sustainable methodology. OBJECTIVE We present a short version here of the full guidelines on the surgical treatment of patients with urinary incontinence, with the aim of dissemination to a wider audience. EVIDENCE ACQUISITION Evidence appraisal included a pragmatic review of existing systematic reviews and independent new literature searches based on Population, Intervention, Comparator, Outcome (PICO) questions. The appraisal of papers was carried out by an international panel of experts, who also collaborated in a series of consensus discussions, to develop concise structured evidence summaries and action-based recommendations using a modified Oxford system. EVIDENCE SUMMARY The full version of the guidance is available online (www.uroweb.org/guidelines/online-guidelines/). The guidance includes algorithms that refer the reader back to the supporting evidence and have greater accessibility in daily clinical practice. Two original meta-analyses were carried out specifically for these guidelines and are included in this report. CONCLUSIONS These new guidelines present an up-to-date summary of the available evidence, together with clear clinical algorithms and action-based recommendations based on the best available evidence. Where high-level evidence is lacking, they present a consensus of expert panel opinion.
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Jerez-Roig J, Souza D, Espelt A, Costa-Marín M, Belda-Molina A. Pelvic floor electrostimulation in women with urinary incontinence and/or overactive bladder syndrome: a systematic review. Actas Urol Esp 2013; 37:429-44. [PMID: 23246103 DOI: 10.1016/j.acuro.2012.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/04/2012] [Accepted: 08/29/2012] [Indexed: 10/27/2022]
Abstract
CONTEXT Electrostimulation (ES) is one of the techniques employed in conservative treatment of urinary incontinence (UI) and/or overactive bladder syndrome (OAB). Nevertheless, there is controversy in the scientific literature regarding its effectiveness as monotherapy. OBJECTIVE To evaluate the scientific evidence on ES of the pelvic floor in women with UI and with/without OAB. EVIDENCE ACQUISITION A systematic review of clinical trials was carried out in the following databases: PubMed, Cochrane, PEDro, Elsevier (Doyma) and EnFisPo (1980-2011). Quality of study registries was evaluated and information was obtained from those that presented the inclusion criteria established in the review. EVIDENCE SYNTHESIS The 27 clinical trials were included in the review: 13 randomized controlled trials, 11 randomized non-controlled trials and 3 non-randomized trials. CONCLUSION Most of the clinical trials conclude that ES is effective in the treatment of UI and OAB in women. However, better methodological quality studies are needed to obtain a higher level of scientific evidence and to know the optimal current modality, type and parameters for each type of UI and OAB.
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Ruiz de Viñaspre Hernández R, Rubio Aranda E, Tomás Aznar C. [Urinary incontinence 6 months after childbirth]. Med Clin (Barc) 2013; 141:145-51. [PMID: 22818183 DOI: 10.1016/j.medcli.2012.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 05/03/2012] [Accepted: 05/10/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Urinary incontinence initiated before and right after delivery and persisting 3 months after delivery tends to become chronic. We intended to estimate the persistence of urinary incontinence 6 months postpartum and to analyse the different factors associated with it. PATIENTS AND METHODS Follow-up study 6 months after delivery of women presenting urinary incontinence symptoms in gestation or in the first 2 months of postpartum. The dependent variable was the persistence and the independent variables were grouped in obstetric and non-obstetric. Odds ratio (OR) were calculated with their confidence interval at 95% (IC 95%) in the bivariate analysis. The variables that showed an important risk of persistence of incontinence were used to perform a multivariate model of logistic regression. RESULTS The persistence of incontinence 6 months after delivery was 21.4% (CI 95% 16-26.7). The risk of persistence increased with the Kristeller maneuver (OR 7.89, CI 95% 3.04-20.49), not weight recovery (OR 3.64, CI 95% 1.10-12.02), not practising pelvic floor muscle exercises in postpartum (OR 9.36, CI 95% 2.71-32.33), appearance of incontinence after delivery (OR 6.66, CI 95% 2.37-18.68) and the weight of the newborn>3.5 kg (OR 6.76, CI 95% 2.54-18.03), all of them explaining 58% of the variability of persistence. CONCLUSION 21.4% of women with urinary incontinence caused by pregnancy/delivery will continue to have it 6 months postpartum. An important part of this persistence is associated with some factors easy to modify.
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