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Cameron AP, Chung DE, Dielubanza EJ, Enemchukwu E, Ginsberg DA, Helfand BT, Holland P, Linder BJ, Rahimi L, Reynolds WS, Rovner ES, Souter L, Suskind AM, Takacs E, Welk B, Smith AL. The AUA/SUFU Guideline on the Diagnosis and Treatment of Idiopathic Overactive Bladder. J Urol 2024:101097JU0000000000003985. [PMID: 38651651 DOI: 10.1097/ju.0000000000003985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE The purpose of this guideline is to provide evidence-based guidance to clinicians of all specialties on the evaluation, management, and treatment of idiopathic overactive bladder (OAB). The guideline informs the reader on valid diagnostic processes and provides an approach to selecting treatment options for patients with OAB through the shared decision-making process that will maximize symptom control and quality of life, while minimizing adverse events and burden of disease. METHODS An electronic search employing OVID was used to systematically search the MEDLINE and EMBASE databases, as well as the Cochrane Library, for systematic reviews and primary studies evaluating diagnosis and treatment of OAB from January 2013 to November 2023. Criteria for inclusion and exclusion of studies were based on the Key Questions and the populations, interventions, comparators, outcomes, timing, types of studies and settings (PICOTS) of interest. Following the study selection process, 159 studies were included and were used to inform evidence-based recommendation statements. RESULTS This guideline produced 33 statements that cover the evaluation and diagnosis of the patient with symptoms suggestive of OAB; the treatment options for patients with OAB, including non-invasive therapies, pharmacotherapy, minimally invasive therapies, invasive therapies, and indwelling catheters; and the management of patients with BPH and OAB. CONCLUSION Once the diagnosis of OAB is made, the clinician and the patient with OAB have a variety of treatment options to choose from and should, through shared decision-making, formulate a personalized treatment approach taking into account evidence-based recommendations as well as patient values and preferences.
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Gomes FH, Fonseca MDF, Favorito LA, Gasparoni MP, da Silva Filho FS, Diniz ALL, de Resende Júnior JAD. Changes in lower urinary tract function after minimally invasive nerve-sparing for complete excision of endometriosis: An observational study. Neurourol Urodyn 2024; 43:862-873. [PMID: 38497524 DOI: 10.1002/nau.25414] [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: 10/27/2023] [Revised: 01/04/2024] [Accepted: 01/24/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES The objective of this paper is to evaluate changes in lower urinary tract symptoms (LUTS), severity of pain and urodynamic parameters after minimally invasive nerve-sparing surgery for patients with endometriosis. METHODS We analyzed 143 patients undergoing minimally invasive nerve-sparing surgery for endometriosis excision (laparoscopy/robot-assisted). The endometriosis was confirmed by preoperative clinical evaluation, magnetic resonance imaging (MRI) showing at least one lesion deeper than 5 mm, and histological confirmation after laparoscopy. We evaluated three points prior and after surgery: LUTS parameters according to the International Urogynecological Association; urodynamic measures of storage and voiding and the severity of the dyspareunia, dyschezia and dysmenorrhea assessed on a self-reported 11-point numeric rating scale. The Wilcoxon signed rank and McNemar tests were used for statistical analyses (p < 0.05). RESULTS We observed significant improvements in LUTS after the surgery with postoperative symptom-free probabilities in urgency (64.5%), daytime frequency (38.5%), and dysuria (87.1%). However, slow stream prevalence increased significantly postsurgery (p = 0.022), with a 20.5% risk of asymptomatic patients developing this symptom. Urodynamic responses varied; for instance, maximum cystometric capacity improved significantly (p = 0.004), while postvoiding residual worsened (p = 0.006). Significant worsening in postvoiding residual occurred in women with normal preoperative values (p = 0.002), with a 17.7% risk of normal values becoming abnormal. Compliance or maximum cystometric capacity not considered normal preoperatively showed significant improvements (p < 0.001), but the risk of normal values becoming abnormal after surgery was 14.5%. CONCLUSION The minimally invasive nerve-sparing surgery for endometriosis excision shows improvement in lower urinary tract symptoms, urodynamics parameters and severity of pain. The majority of patients became asymptomatic in the postoperative period. When compared to the benefits of the patients' surgical treatment, particularly when considering the reduction of pain, the risks of the lower urinary tract treatment seem to be acceptable. The surgical intervention seems to be a safe alternative in patients with endometriosis, although studies with larger samples are needed to confirm these findings.
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Affiliation(s)
- Fernanda Hack Gomes
- Hospital Federal da Lagoa and Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Luciano Alves Favorito
- Hospital Federal da Lagoa and Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - André Luiz Lima Diniz
- Hospital Federal da Lagoa and Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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O'Kelly F, t'Hoen LA, Silay S, Lammers RJM, Sforza S, Bindi E, Baydilli N, Donmez MI, Paraboschi I, Atwa A, Spinoit AF, Marco BB. Neuropsychiatric Developmental Disorders in Children Are Associated With an Impaired Response to Treatment in Bladder Bowel Dysfunction: A Prospective Multi-Institutional European Observational Study. J Urol 2023; 210:899-907. [PMID: 37747130 DOI: 10.1097/ju.0000000000003701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 09/05/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE Bladder and bowel dysfunction is a common but underdiagnosed pediatric entity which may represent up to 47% of pediatric urology consults. The objectives of this observational study were to determine functional 1-year outcomes following standard treatment of bladder and bowel dysfunction in both control and neuropsychiatric developmental disorder groups using validated questionnaires, and to perform an initial cost analysis. MATERIALS AND METHODS This was a prospective observational study conducted across a number of academic European centers (July 2020-November 2022) for new bladder and bowel dysfunction patients. Parents completed a sociodemographic survey, information pertaining to prior neuropsychiatric developmental disorder diagnoses, as well as a number of validated functional scores. RESULTS A total of 240 patients were recruited. In the control bladder and bowel dysfunction group, the baseline Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores were 20% and 17.% lower, respectively, after 1 year compared to the neuropsychiatric developmental disorder group. The change in improvement was diminished for the neuropsychiatric developmental disorder cohort in both Dysfunctional Voiding Scoring System and Childhood Bladder and Bowel Dysfunction Questionnaire scores. The odds ratio of full symptom resolution was 5.7 in the control cohort compared to the neuropsychiatric developmental disorder cohort. A cost analysis on prescribed medications at referral led to a total cost of €32,603.76 (US $35,381.00) in the control group and €37,625.36 (US $40,830.00) in the neuropsychiatric developmental disorder group. CONCLUSIONS This study demonstrates that pediatric patients with a neuropsychiatric developmental disorder exhibit more severe bladder and bowel dysfunction at baseline and throughout treatment with a lower overall quality of life, as well as 15.4% higher medication costs at referral. It is also important that parents' and caregivers' expectations are managed regarding higher levels of treatment resistance for functional bladder and bowel issues.
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Affiliation(s)
- F O'Kelly
- Division of Paediatric Urology, Beacon Hospital, University College Dublin, Dublin, Ireland
| | - L A t'Hoen
- Department of Pediatric Urology, Erasmus MC University Medical Center, Rotterdam-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - S Silay
- Department of Urology, Biruni University, Istanbul, Turkey
| | - R J M Lammers
- Department of Urology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Sforza
- Paediatric Urology, Meyer Children Hospital, University of Florence, Florence, Italy
| | - E Bindi
- Department of Pediatric Surgery, AOU delle Marche, Ospedale Pediatrico G Salesi, Ancona, Italy
| | - N Baydilli
- Department of Pediatric Urology, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - M I Donmez
- Division of Pediatric Urology, Department of Urology, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - I Paraboschi
- Department of Pediatric Urology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - A Atwa
- Urology Department, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
| | - A F Spinoit
- Department of Urology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - B Banuelos Marco
- Department of Urology, University Hospital El Clinico, Madrid, Spain
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Sinha S, Everaert K, Kheir GB, Roberts N, Solomon E, Belal M, Selai C, Perrouin-Verbe MA, Spicchiale CF, Wein A, Abrams P. Could a better understanding of the underlying pathophysiologies lead to more informed treatment choices in patients with lower urinary tract dysfunction due to an acontractile or underactive detrusor? ICI-RS 2023. Neurourol Urodyn 2023. [PMID: 37960931 DOI: 10.1002/nau.25329] [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: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION The underlying pathophysiology behind a diagnosis of acontractile or underactive detrusor at invasive urodynamics is very heterogeneous. Lack of etiological classification currently limits the possibility of stratifying therapy. METHODS This subject was discussed at a think-tank on the subject at the International Consultation on Incontinence-Research Society held in Bristol, June 2023. This manuscript is a result of those deliberations and the subsequent discussions of the think-tank. RESULTS There are challenges in defining abnormalities of detrusor contraction with resultant implications for available evidence. Pathology at any level of the neuromuscular pathway can impair or prevent a detrusor voiding contraction. Attempts have been made to identify clinical markers that might predict an underactive detrusor but strong supporting evidence is lacking. Hence, a holistic approach to phenotyping requires specialized neuro-imaging as well as physiological investigations. Several general measures can help individuals with an abnormal detrusor contraction. The search for a molecule to enhance the detrusor voiding contraction remains elusive but there are promising new candidates. Neuromodulation can help select individuals but data is not well stratified by underlying etiology. Manipulation of central neurotransmitters might offer an alternate therapeutic option. CONCLUSIONS A better understanding of the underlying pathophysiologies behind an abnormality of the detrusor voiding contraction is needed for improving management. Towards this goal, the think-tank proposes a classification of the underactive detrusor that might help in selecting and reporting more well-defined patient cohorts.
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Affiliation(s)
- Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, India
| | | | | | - Neil Roberts
- Division of Cell Matrix Biology and Regenerative Medicine, The University of Manchester, Bristol, UK
| | - Eskinder Solomon
- Department of Functional Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mohammed Belal
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
| | - Caroline Selai
- UCL Department of Clinical and Movement Neurosciences, Queen Square Institute of Neurology, London, UK
| | | | | | - Alan Wein
- Department of Urology, Desai-Seth Institute of Urology, University of Miami, Miami, Florida, USA
| | - Paul Abrams
- Department of Urology, University of Bristol, Bristol, UK
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Kaneko T, Yanagida K, Matsui K, Kawai T, Yamada Y, Ishii K, Kurozumi T, Suzuki T, Watanabe Y, Kawano H, Sakamoto T, Nakagawa T. Predictive Factors of Lower Urinary Tract Injuries and Spontaneous Voiding Failure After Pelvic Fractures. In Vivo 2023; 37:1323-1327. [PMID: 37103070 DOI: 10.21873/invivo.13212] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND/AIM This study aimed to describe the voiding patterns of patients after surgical treatment of pelvic fractures and determine the predictive factors of lower urinary tract injuries (LUTIs) and spontaneous voiding failure among patients with surgically treated pelvic fractures at a tertiary trauma center in Japan. PATIENTS AND METHODS We retrospectively assessed patients with surgically treated pelvic fractures in our tertiary trauma center during May 2009-April 2021. We excluded patients who died during hospitalization and who had indwelling catheter prior to the injury. Patients' LUTIs and spontaneous voiding failure at discharge were recorded. Multivariate analysis was performed to assess the predictive factors of LUTIs and spontaneous voiding failure at discharge. RESULTS In total, 334 eligible patients were identified. Among them, 301 patients (90%) voided spontaneously with or without diapers at discharge. Thirty-three patients required some form of catheterization for bladder drainage. LUTIs were found to be associated with chronological age [odds ratio (OR)=0.96; 95% confidence interval (CI)=0.92-0.99; p=0.024] and pelvic ring fracture (OR=12.0; 95%CI=1.39-255.2; p=0.024). Spontaneous voiding failure was associated with intensive care unit admission (OR=7.17; 95%CI=1.49-34.4; p=0.004). CONCLUSION Overall, 10% of patients with surgically treated pelvic fractures were not able to void spontaneously at discharge. Spontaneous voiding failure after pelvic fractures was related to injury severity.
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Affiliation(s)
- Tomoyuki Kaneko
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan;
| | - Kazuki Yanagida
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Kentaro Matsui
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yukio Yamada
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Keisuke Ishii
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Taketo Kurozumi
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takashi Suzuki
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshinobu Watanabe
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- Department of Orthopedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
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Funada S, Luo Y, Yoshioka T, Setoh K, Tabara Y, Negoro H, Yoshimura K, Matsuda F, Efthimiou O, Ogawa O, Furukawa TA, Kobayashi T, Akamatsu S. Development and validation of prediction model for incident overactive bladder: The Nagahama study. Int J Urol 2022; 29:748-756. [PMID: 35393696 PMCID: PMC9546153 DOI: 10.1111/iju.14887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/21/2022] [Indexed: 11/10/2022]
Abstract
Objectives We aimed to develop models to predict new‐onset overactive bladder in 5 years using a large prospective cohort of the general population. Methods This is a secondary analysis of a longitudinal cohort study in Japan. The baseline characteristics were measured between 2008 and 2010, with follow‐ups every 5 years. We included subjects without overactive bladder at baseline and with follow‐up data 5 years later. Overactive bladder was assessed using the overactive bladder symptom score. Baseline characteristics (demographics, health behaviors, comorbidities, and overactive bladder symptom scores) and blood test data were included as predictors. We developed two competing prediction models for each sex based on logistic regression with penalized likelihood (LASSO). We chose the best model separately for men and women after evaluating models' performance in terms of discrimination and calibration using an internal validation via 200 bootstrap resamples and a temporal validation. Results We analyzed 7218 participants (male: 2238, female: 4980). The median age was 60 and 55 years, and the number of new‐onset overactive bladder was 223 (10.0%) and 288 (5.8%) per 5 years in males and females, respectively. The in‐sample estimates for C‐statistic, calibration intercept, and slope for the best performing models were 0.77 (95% confidence interval 0.74–0.80), 0.28 and 1.15 for males, and 0.77 (95% confidence interval 0.74–0.80), 0.20 and 1.08 for females. Internal and temporal validation gave broadly similar estimates of performance, indicating low optimism. Conclusion We developed risk prediction models for new‐onset overactive bladder among men and women with good predictive ability.
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Affiliation(s)
- Satoshi Funada
- Department of Urology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan.,Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima City, Fukushima, Japan
| | - Kazuya Setoh
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan.,Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan.,Graduate School of Public Health, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | | | - Koji Yoshimura
- Department of Urology, Shizuoka General Hospital, Shizuoka, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Orestis Efthimiou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Osamu Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
| | - Shusuke Akamatsu
- Department of Urology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
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Martinez A, Rodriguez MA, Al Snih S. Factors Associated With Urgency Urinary Incontinence Among Older Mexican American Women Aged 65 years and Older. Gerontol Geriatr Med 2022; 8:23337214221119061. [PMID: 36046579 PMCID: PMC9421023 DOI: 10.1177/23337214221119061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/08/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to determine which socio-demographic, clinical, or functional factors are associated with urgency urinary incontinence (UUI) over 20-years of follow-up in a community-dwelling sample of Mexican American women aged 65 years and older without UUI at baseline. We included 1,358 women participants from the Hispanic Established Population for the Epidemiologic Study of the Elderly study conducted in the southwestern of US (Arizona, California, Colorado, New Mexico, and Texas). Measures included self-reported UUI, socio-demographics, smoking status, body mass index, medical conditions, depressive symptoms, physical and cognitive function, and handgrip strength. We used generalized estimating equation models to estimate the odds ratio (OR) and 95% Confidence Interval (CI) of UUI as a function of socioeconomic, clinical, and functional factors. Self-reported UUI increased from 3.1% to 21.9% from baseline (1993/1994) to follow-up (2012/2013). Current smokers, obesity, arthritis, previous heart attacks, and depressive symptoms were factors associated with greater odds of UUI over time. Identification of these factors can help clinicians determine those at high risk of developing UUI. Preventing and/or treating the risk factors early may delay UUI and increase quality of life in this underserved population.
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Affiliation(s)
- Ariza Martinez
- The University of Texas Medical Branch, Galveston, TX, USA
| | | | - Soham Al Snih
- The University of Texas Medical Branch, Galveston, TX, USA
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Alstott J, Jhagroo R. Acute Onset of Dark Urine in a Patient with LVAD Pump Dysfunction. Kidney360 2021; 2:1867-1868. [PMID: 35372999 PMCID: PMC8785837 DOI: 10.34067/kid.0003482021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/23/2021] [Indexed: 02/04/2023]
Affiliation(s)
- James Alstott
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Roy Jhagroo
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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9
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Yamamoto A, Kamoi S, Ikeda M, Yamada T, Yoneyama K, Takeshita T. Effectiveness and Long-term Outcomes of Nerve-Sparing Radical Hysterectomy for Cervical Cancer. J NIPPON MED SCH 2021; 88:386-397. [PMID: 32741908 DOI: 10.1272/jnms.jnms.2021_88-503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Radical hysterectomy (RH) is a type of radical surgery for cervical cancer. Urinary dysfunction due to RH worsens postoperative quality of life of patients with cervical cancer. Nerve-sparing RH (NSRH) technique has been used as an effective means to conserve urinary function. However, few reports have examine long-term outcomes after NSRH. This study describes the details and long-term outcomes of our nerve-sparing technique. METHODS Sixty-one patients underwent radical hysterectomy in a 5-year period during which nerve-sparing technique was introduced; of these, 31 patients underwent NSRH and 30 underwent conventional RH. We retrospectively examined their medical records and compared postoperative urinary function and treatment outcomes between these two groups. RESULTS The median time required for urinary residual volume to fall to ≤50 mL after removal of the urinary catheter was 6 days (range, 2-20 days) in the NSRH group and 13.5 days (range, 3-46 days) in the RH group. The results were significantly better in the NSRH group (p < 0.05). The mean follow-up period was 2456.3 days (range, 48-4,213 days). Analysis of curability revealed no significant difference between the two groups in local recurrence or long-term survival rates. The 5-year survival rate was 0.861 in the NSRH group and 0.782 in the RH group; the 10-year survival rate was 0.861 in the NSRH group and 0.679 in the RH group. CONCLUSIONS NSRH significantly improved postoperative urinary function without worsening local recurrence rates or long-term outcomes.
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Affiliation(s)
| | - Seiryu Kamoi
- Department of Obstetrics and Gynecology, Nippon Medical School
| | - Mariko Ikeda
- Department of Obstetrics and Gynecology, Nippon Medical School
| | - Takashi Yamada
- Department of Obstetrics and Gynecology, Nippon Medical School
| | - Koichi Yoneyama
- Department of Obstetrics and Gynecology, Nippon Medical School
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Elliott CS, Kopp MA, Stampas A, Schwab JM, Chen Y, Shem K, Crew J. The Effect of Early Infection on the Rate of Volitional Voiding after Spinal Cord Injury: A Potential Modifiable Risk Factor for Bladder Outcomes. J Urol 2021;:101097JU0000000000002122. [PMID: 34428092 DOI: 10.1097/JU.0000000000002122] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE Recently, it has been observed that early infections after spinal cord injury (SCI) are associated with decreased long-term motor and sensory recovery. We investigate the effects of early infection after SCI on long-term bladder function. MATERIALS AND METHODS We assessed data for the years 1995 to 2006 using the National Spinal Cord Injury Database. Postoperative wound infections and pneumonia were used to classify infections during the acute inpatient and rehabilitation periods. The effect of early infections on volitional voiding status at 1-year followup was assessed. Age, gender and neurological status at rehabilitation discharge (level of injury, American Spinal Injury Association Impairment Scale [AIS] and bilateral lower extremity motor scores) were included in multivariate logistic regression modeling to control for confounding. RESULTS Of the 3,561 persons studied, 1,233 (34.6%) had an early infection. Those with an infection during early recovery were less likely to void than their noninfected counterparts if in the AIS A (0.3% vs 1.9%, p=0.010), AIS B (3.8% vs 10.5%, p=0.018) and AIS C (29.1% vs 37.3%, p=0.071) classification, while those with less complete injuries (AIS D) did not appear to be affected (62.6% vs 65.4%, p=0.456). Similar findings were found when stratifying by lower extremity motor scores and persisted on multivariate analysis, where early infection decreased the odds of volitional voiding at 1-year followup (OR=0.79, p=0.042). CONCLUSIONS Infections during the early recovery period may modify volitional voiding at 1-year followup by 20% or more. Future investigations to confirm our findings and potentially evaluate mitigation strategies are warranted.
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Lee D, Koo KC, Yoo JW, Lee KS. Effect of systemic atherosclerosis on overactive bladder symptoms in men with benign prostatic hyperplasia. Low Urin Tract Symptoms 2021; 14:35-40. [PMID: 34323012 DOI: 10.1111/luts.12406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/28/2021] [Accepted: 07/18/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Symptoms of male overactive bladder (OAB) may be caused by several systemic pathophysiological factors rather than a single-source etiology. We investigated the clinical factors associated with the severity of OAB symptoms in treatment-naïve men with coexisting benign prostatic hyperplasia. METHODS We obtained records from a health promotion center database of male patients who visited between March 2019 and February 2020. Men without a history of treatment for lower urinary tract symptoms were evaluated using the International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, transrectal ultrasonography, medical history, and carotid duplex ultrasound for the evaluation of atherosclerosis. Benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS) was defined as an IPSS of eight points or higher. Patients with comorbidities that may affect their voiding function were excluded. RESULTS A total of 764 patients were divided into two groups based on their diagnosis: an OAB group and a non-OAB group. The non-OAB group consisted of 627 patients (82.1%) and the OAB group consisted of 137 patients (17.9%). Using multivariable analysis BPH/LUTS was identified as an independent risk factor for OAB. In the OAB group without BPH/LUTS, carotid atherosclerosis was significantly associated with the severity of OAB symptoms. A history of diabetes mellitus was the only variable that was associated with the severity of urinary urgency. Systolic blood pressure was associated with severity of urinary urgency in the OAB group with BPH/LUTS. CONCLUSIONS Factors associated with male OAB exhibit different pathophysiology in the severity of symptoms depending on the presence of BPH/LUTS. Treatment for atherosclerosis and associated systemic pathophysiological factors could lower OAB symptom severity in male patients without BPH/LUTS.
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Affiliation(s)
- Dongu Lee
- Department of Urology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyo Chul Koo
- Department of Urology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeong Woo Yoo
- Department of Urology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwang Suk Lee
- Department of Urology, Yonsei University College of Medicine, Seoul, South Korea.,Health Promotion Center, Gangnam Severance Hospital, Seoul, South Korea
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Gilling P, Meffan P, Kaaki B, MacDiarmid S, Lucente V, Clark M, Sen SK, English S, Sand PK. Twelve-month Durability of a Fully-implanted, Nickel-sized and Shaped Tibial Nerve Stimulator for the Treatment of Overactive Bladder Syndrome with Urgency Urinary Incontinence: A Single-Arm, Prospective Study. Urology 2021:S0090-4295(21)00434-9. [PMID: 34048826 DOI: 10.1016/j.urology.2021.04.039] [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: 02/10/2021] [Revised: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES To evaluate the safety and efficacy of the eCoin - a nickel-sized, primary battery-powered, neuromodulation device for the treatment of urgency urinary incontinence which is implanted in the lower leg in a 20-minute procedure under local anesthesia. A feasibility clinical trial was conducted and the results after 1 year of treatment with the eCoin are presented. METHODS A total of 46 participants with refractory urgency urinary incontinence were included in this prospective, single-arm, open-label study. This study was conducted at 7 sites in the United States and New Zealand. Participants in this study were implanted with the eCoin in the lower leg over the tibial nerve and activated after 4 weeks. Bladder diary data and validated quality-of-life instruments, collected at 3, 6, and 12 months' post-activation, were compared to baseline values. RESULTS Responders were defined as those who had a ≥50% reduction in reported episodes of urgency urinary incontinence. At 12 months', 65% of participants were considered responders with 26% of participants achieving complete continence. The median number of urgency urinary incontinence episodes per day decreased from 4.2 at baseline to 1.7 at 12 months'. Seventy percent of participants reported feeling "better", "much better", or "very much better" on the Likert 7-point maximum scale. One participant experienced a related serious adverse event. CONCLUSION The eCoin is a safe and effective treatment for urgency urinary incontinence associated with overactive bladder syndrome, with significant reduction or complete resolution of symptoms and no significant safety concerns.
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王 涛, 许 克, 张 维, 胡 浩, 张 晓, 王 焕, 刘 献, 陈 京, 张 晓. [Urodynamic classification of male patients with symptoms of overactive bladder and the outcome classification]. Beijing Da Xue Xue Bao Yi Xue Ban 2019; 51:1048-1051. [PMID: 31848502 PMCID: PMC7433595 DOI: 10.19723/j.issn.1671-167x.2019.06.012] [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] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To introduce a urodynamic classification of male patients with symptoms of overactive bladder (OAB) and discuss its clinical significance in practice. METHODS From January 2015 to January 2017, there were 181 male patients from Peking University People's Hospital who were diagnosed clinically with OAB and underwent preoperative urodynamic test. Finally 126 male patients were enrolled in the research. Male OAB patients could be stratified into four groups based on the chief complaints (whether or not presenting urgency) and the results of urodynamic test (whether or not presenting detrusor overactivity and the ability to stop the involuntary contraction). The contents of this follow-up study included the basic information, the preoperative and postoperative scores of the OAB symptom score (OABSS), the preoperative and postoperative scores of the international prostate symptom score (IPSS), and the amount of the concomitant diseases. RESULTS According to the classification, the amounts of the four types of OAB patients were 32 (25.40%) for type I, 27 (21.43%) for type II, 59 (46.83%) for type III, and 8 (6.35%) for type IV, respectively. The data of their heights showed no statistical significance (P>0.05). The ages, weights and the amount of the concomitant diseases of type IV were obviously higher than those of the other three types (P<0.05). And the ages, weights and the amount of the concomitant diseases of the other three types had shown no statistical significance (P>0.05). The improvement of the OABSS and IPSS scores of the type IV were obviously inferior to the other three types (P<0.05). The improvements of the OABSS and IPSS scores of type III were obviously higher than those of the other three (P<0.05). The discrepancy of the OABSS and IPSS scores of type I and type II had shown no statistical significance (P>0.05). CONCLUSION Type IV has the worst outcome and type III has the best among the four types of OAB. And this classification system will certainly have a profound significance in guiding and directing our clinical diagnosis and treatments, and evaluating the prognosis of the patients with OAB.
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Affiliation(s)
- 涛 王
- />北京大学人民医院泌尿外科,北京 100044Department of Urology, Peking University People’s Hospital, Beijing 100044, China
| | - 克新 许
- />北京大学人民医院泌尿外科,北京 100044Department of Urology, Peking University People’s Hospital, Beijing 100044, China
| | - 维宇 张
- />北京大学人民医院泌尿外科,北京 100044Department of Urology, Peking University People’s Hospital, Beijing 100044, China
| | - 浩 胡
- />北京大学人民医院泌尿外科,北京 100044Department of Urology, Peking University People’s Hospital, Beijing 100044, China
| | - 晓威 张
- />北京大学人民医院泌尿外科,北京 100044Department of Urology, Peking University People’s Hospital, Beijing 100044, China
| | - 焕瑞 王
- />北京大学人民医院泌尿外科,北京 100044Department of Urology, Peking University People’s Hospital, Beijing 100044, China
| | - 献辉 刘
- />北京大学人民医院泌尿外科,北京 100044Department of Urology, Peking University People’s Hospital, Beijing 100044, China
| | - 京文 陈
- />北京大学人民医院泌尿外科,北京 100044Department of Urology, Peking University People’s Hospital, Beijing 100044, China
| | - 晓鹏 张
- />北京大学人民医院泌尿外科,北京 100044Department of Urology, Peking University People’s Hospital, Beijing 100044, China
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Murphy A, Teplitsky S, Das AK, Leong JY, Margules A, Lallas CD. Medical evaluation and management of male and female voiding dysfunction: a review. Rom J Intern Med 2019; 57:220-232. [PMID: 30990789 DOI: 10.2478/rjim-2019-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Indexed: 06/09/2023]
Abstract
A significant workforce shortage of urologists available to serve the US population has been projected to occur over the next decade. Accordingly, much of the management of urologic patients will need to be assumed by other specialties and practitioners. Since primary care physicians are often first evaluate common urologic complaints, it makes sense that these physicians are in an excellent position to intervene in the management of these patients when appropriate. One of the most common complaints in urology is voiding dysfunction. The incidence of voiding dysfunction increases with age, with conservative estimates showing that over 50% of elderly patients suffer. Despite this high prevalence and its negative impact on quality of life, however, few seek or receive treatment, as many do not readily disclose these impactful yet personal symptoms. We sought to summarize the typical presentation, evaluation, assessment and therapeutic options for both male and female patients presenting with voiding dysfunction.
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MESH Headings
- Cystitis, Interstitial/diagnosis
- Cystitis, Interstitial/etiology
- Cystitis, Interstitial/therapy
- Female
- Humans
- Male
- Prostatism/diagnosis
- Prostatism/etiology
- Prostatism/therapy
- Urinary Bladder, Overactive/diagnosis
- Urinary Bladder, Overactive/etiology
- Urinary Bladder, Overactive/therapy
- Urinary Bladder, Underactive/diagnosis
- Urinary Bladder, Underactive/etiology
- Urinary Bladder, Underactive/therapy
- Urinary Incontinence, Stress/diagnosis
- Urinary Incontinence, Stress/etiology
- Urinary Incontinence, Stress/therapy
- Urination Disorders/diagnosis
- Urination Disorders/etiology
- Urination Disorders/therapy
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Affiliation(s)
- Alana Murphy
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Seth Teplitsky
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Akhil K Das
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Joon Yau Leong
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Andrew Margules
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Costas D Lallas
- Department of Urology, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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Abstract
PURPOSE Hinman syndrome is a rare disease with urodynamic findings and a clinical course resembling neuropathic bladder, without a neuropathic etiology. Diffusion tensor imaging is a special technique of magnetic resonance imaging that has recently been used to evaluate the peripheral nerves but has been demonstrated to be applicable for evaluation of the lumbosacral plexus. We examined the lumbosacral plexus using diffusion tensor imaging, which has not previously been reported in patients with Hinman syndrome. MATERIALS AND METHODS The study included 12 patients who fulfilled criteria for Hinman syndrome, with severe bladder dysfunction on urodynamics, renal scarring on scintigraphy and no pathological findings on magnetic resonance imaging. The 12 subjects serving as controls required pelvic or spinal magnetic resonance imaging for reasons other than spinal abnormalities. Evaluation was performed with a 3.0 Tesla magnetic resonance imaging system and 16-channel body coil. Tractography was done to examine the lumbosacral plexus. Fractional anisotropy and mean diffusivity were computed and compared between groups for the right and left plexuses. RESULTS Mean fractional anisotropy was 0.24 and 0.35 for the right plexus in patients and controls, respectively, and 0.24 and 0.36 for the left plexus. Mean diffusivity was 1.39 for the right and left plexuses in patients, and 1.28 for the right and left plexuses in controls (p <0.001 for all). CONCLUSIONS Our study focusing on the lumbosacral plexus as a possible origin of neuropathy revealed abnormal findings in patients with Hinman syndrome resembling nerve injury series. This is the first known study to provide data showing that Hinman syndrome may have a neuropathic etiology.
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Affiliation(s)
- Sibel Tiryaki
- Department of Pediatric Surgery, Division of Pediatric Urology, Ege University , Izmir , Turkey
| | - Cenk Eraslan
- Department of Radiology, Ege University , Izmir , Turkey
| | - Tutku Soyer
- Department Pediatric Surgery, Hacettepe University , Ankara , Turkey
| | - Cem Calli
- Department of Radiology, Ege University , Izmir , Turkey
| | - Ibrahim Ulman
- Department of Pediatric Surgery, Division of Pediatric Urology, Ege University , Izmir , Turkey
| | - Ali Avanoglu
- Department of Pediatric Surgery, Division of Pediatric Urology, Ege University , Izmir , Turkey
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16
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Rove KO, Vricella GJ, Hershey T, Thu MH, Lugar HM, Vetter J, Marshall BA, Austin PF. Lower Urinary Tract Dysfunction and Associated Pons Volume in Patients with Wolfram Syndrome. J Urol 2018; 200:1107-1113. [PMID: 29883657 DOI: 10.1016/j.juro.2018.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE Wolfram syndrome is a neurodegenerative disorder characterized by childhood onset diabetes mellitus, optic nerve atrophy, diabetes insipidus, hearing impairment, and commonly bladder and bowel dysfunction. We hypothesized that there is an association between a smaller pons, which contains the pontine micturition center, and abnormal lower urinary tract function. MATERIALS AND METHODS Patients with genetically confirmed Wolfram syndrome attended an annual multidisciplinary research clinic. Subjects underwent noninvasive urodynamic testing and brain magnetic resonance imaging, and completed validated patient reported outcome measures. Bowel and bladder diaries were completed before visits. Age and gender corrected linear and logistic mixed effects models were used to correlate pons volume, corrected for whole brain size, to urodynamic and patient reported outcomes. RESULTS A total of 36 patients attended 142 visits between 2010 and 2016. Mean age was 16.9 years (range 7 to 30) and 64% of patients were female. Functional bladder capacity was decreased in 31% of the patients, normal in 54% and increased in 14%. Of the patients 44% and 54% had abnormal uroflowmetry and post-void residual, respectively, on at least 1 occasion. There was no increase through time in incidence of lower urinary tract dysfunction. Decreased pons volume was associated with increased post-void residual (p = 0.048) and higher PinQ (Pediatric Incontinence Questionnaire) score (p = 0.011), indicating lower quality of life and higher levels of dysfunction. CONCLUSIONS A significant number of children, adolescents and young adults with Wolfram syndrome have objective evidence of lower urinary tract dysfunction. Decreased pons volume is associated with more abnormal urinary function and lower quality of life in patients with Wolfram syndrome.
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Affiliation(s)
- Kyle O Rove
- Division of Pediatric Urology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri.
| | - Gino J Vricella
- Division of Pediatric Urology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Tamara Hershey
- Department of Neurology and Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Muang H Thu
- Division of Pediatric Urology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Heather M Lugar
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Joel Vetter
- Division of Pediatric Urology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Bess A Marshall
- Departments of Pediatrics and Cell Biology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Paul F Austin
- Scott Department of Urology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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Orom H, Biddle C, Underwood W, Nelson CJ. Worse Urinary, Sexual and Bowel Function Cause Emotional Distress and Vice Versa in Men Treated for Prostate Cancer. J Urol 2018; 199:1464-1469. [PMID: 29288122 PMCID: PMC7197257 DOI: 10.1016/j.juro.2017.12.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE Definitive therapy for prostate cancer (eg surgery or radiotherapy) often has side effects, including urinary, sexual and bowel dysfunction. The purpose of this study was to test whether urinary, sexual and bowel functions contribute to emotional distress during the first 2 years after treatment and whether distress may in turn decrease function. MATERIALS AND METHODS The study participants were 1,148 men diagnosed with clinically localized disease who were treated with surgery (63%) or radiotherapy (37%). Urinary, sexual and bowel functions were assessed with EPIC (Expanded Prostate Cancer Index Composite). Emotional distress was assessed with the NCCN® (National Comprehensive Cancer Network®) Distress Thermometer. Assessment time points were before treatment, and 6 weeks, and 6, 12, 18 and 24 months after treatment. We used time lagged multilevel models to test whether physical function predicted emotional distress and vice versa. RESULTS Men with worse urinary, bowel and sexual functions reported more emotional distress than others at subsequent time points. The relationships were bidirectional. Men who reported worse distress also reported worse urinary, bowel and sexual functions at subsequent time points. CONCLUSIONS Clinicians supported by practice and payer policies should screen for and facilitate the treatment of side effects and heightened emotional distress to improve well-being in survivors of prostate cancer. These interventions may be cost-effective, given that emotional distress can negatively impact functioning across life domains.
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18
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Wiener JS, Suson KD, Castillo J, Routh JC, Tanaka ST, Liu T, Ward EA, Thibadeau JK, Joseph DB. Bladder Management and Continence Outcomes in Adults with Spina Bifida: Results from the National Spina Bifida Patient Registry, 2009 to 2015. J Urol 2018; 200:187-194. [PMID: 29588216 DOI: 10.1016/j.juro.2018.02.3101] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Most children with spina bifida now survive into adulthood, although most have neuropathic bladder with potential complications of incontinence, infection, renal damage and diminished quality of life. In this study we sought to 1) describe contemporary bladder management and continence outcomes of adults with spina bifida, 2) describe differences from younger individuals and 3) assess for association with socioeconomic factors. MATERIALS AND METHODS We analyzed data on bladder management and outcomes in adults with spina bifida from the National Spina Bifida Patient Registry. A strict definition of continence was used. Results were compared to young children (age 5 to 11 years) and adolescents (12 to 19). Statistical analysis compared cohorts by gender, ethnicity, spina bifida type, lesion level, insurance status, educational attainment, employment status and continence. RESULTS A total of 5,250 patients with spina bifida were included, of whom 1,372 (26.1%) were adults. Of the adult patients 45.8% did not take medication, but 76.8% performed clean intermittent catheterization. Continence was decreased in adults with myelomeningocele (45.8%) vs those with nonmyelomeningocele spina bifida (63.1%, p <0.0001). Continence rates were higher in the older cohorts with myelomeningocele (p <0.0001) but not in those with nonmyelomeningocele spina bifida (p = 0.1192). Bladder management and history of urological surgery varied among age groups. On univariate analysis with spina bifida related or socioeconomic variables continence was significantly associated with educational level but on multivariable logistic regression analysis bladder continence was significantly associated with employment status only. CONCLUSIONS Bladder management techniques differ between adults and children with spina bifida. Bladder continence outcomes were better in adults, with nearly half reporting continence. Continence was significantly associated with employment status in patients age 25 years or older.
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Affiliation(s)
- John S Wiener
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina.
| | - Kristina D Suson
- Department of Urology, Children's Hospital of Michigan, Detroit, Michigan
| | - Jonathan Castillo
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Jonathan C Routh
- Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Stacy T Tanaka
- Department of Urology, Vanderbilt University, Nashville, Tennessee
| | - Tiebin Liu
- Centers for Disease Control and Prevention, Atlanta Georgia
| | - Elisabeth A Ward
- Centers for Disease Control and Prevention, Atlanta Georgia; Carter Consulting, Inc., Atlanta Georgia
| | | | - David B Joseph
- Department of Urology, University of Alabama at Birmingham, Birmingham, Alabama
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Abstract
Pelvic organ prolapse is the downward descent of the pelvic floor organs and has a prevalence of 3%–6% and can even reach to 50% if defined by a vaginal examination. The anatomical concepts of pelvic diaphragm, lateral attachment of vagina to arcus tendineus fascia pelvis, and intrinsic and extrinsic sphincter control mechanisms are elaborated. The anatomic and physiological mechanisms of autonomic and voluntary control of continence are discussed. The clinical and urodynamic tests and their implications in guiding the management are explained. Finally, uroflowmetry, cystometry, urethral pressure profile, postvoid urine measurement, leak point pressure (LPP) test, video urodynamic tests, and electromyography studies of pelvic floor are discussed as an integral part of the assessment.
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Affiliation(s)
- Nidhi Sharma
- Departments of Obstetrics and Gynaecology and Anatomy, Saveetha Medical College, Saveetha University, Chennai, Tamil Nadu, India
| | - Sudakshina Chakrabarti
- Departments of Obstetrics and Gynaecology and Anatomy, Saveetha Medical College, Saveetha University, Chennai, Tamil Nadu, India
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Avulova S, Zhao Z, Lee D, Huang LC, Koyama T, Hoffman KE, Conwill RM, Wu XC, Chen V, Cooperberg MR, Goodman M, Greenfield S, Hamilton AS, Hashibe M, Paddock LE, Stroup A, Resnick MJ, Penson DF, Barocas DA. The Effect of Nerve Sparing Status on Sexual and Urinary Function: 3-Year Results from the CEASAR Study. J Urol 2017; 199:1202-1209. [PMID: 29253578 DOI: 10.1016/j.juro.2017.12.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Nerve sparing contributes to the recovery of sexual and urinary function after radical prostatectomy but it may be ineffective in some patients or carry the risk of a positive surgical margin. We evaluated sexual and urinary function outcomes according to the degree of nerve sparing in patients with prostate cancer treated with radical prostatectomy. MATERIALS AND METHODS The CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study is a prospective, population based, observational study of men diagnosed with localized prostate cancer in 2011 to 2012. Patient reported sexual and urinary functions were measured using the 26-item Expanded Prostate Index Composite at baseline within 6 months after diagnosis, and 6, 12 and 36 months after enrollment. Study inclusion criteria included radical prostatectomy as primary treatment, documentation of nerve sparing status and absent androgen deprivation therapy. Nerve sparing status was defined as none, unilateral or bilateral according to the operative report. RESULTS The final analytical cohort included 991 men. The 11 men treated with unilateral nerve sparing and the 75 treated with a nonnerve sparing procedure were grouped together. In the multivariable model there was a significant difference in the sexual function score 3 years after radical prostatectomy in the bilateral nerve sparing group compared with the unilateral and nonnerve sparing group (6.1 points, 95% CI 2.0-10.3, p = 0.004). This was more pronounced in men with high baseline sexual function (8.23 points, 95% CI 1.6-14.8, p = 0.014) but not in those with low baseline function (4.0 points, 95% CI -0.6-8.7, p = 0.090). Similar effects were demonstrated on urinary incontinence scores. CONCLUSIONS Bilateral nerve sparing resulted in better sexual and urinary function outcomes than unilateral or nonnerve sparing but the difference was not significant in men with low baseline sexual function.
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Affiliation(s)
- Svetlana Avulova
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Daniel Lee
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Karen E Hoffman
- Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, Texas
| | - Ralph M Conwill
- Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Xiao-Cheng Wu
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Vivien Chen
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Matthew R Cooperberg
- Department of Urology, University of California-San Francisco Medical Center, San Francisco, California
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sheldon Greenfield
- Center for Health Policy Research and Department of Medicine, University of California-Irvine, Irvine, California
| | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mia Hashibe
- Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Lisa E Paddock
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Antoinette Stroup
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Matthew J Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Roulette P, Castel-Lacanal E, Sanson S, Caremel R, Phé V, Bart S, Duchêne F, De Sèze M, Even A, Manunta A, Scheiber-Nogueira MC, Mouracade P, Loche CM, Chartier-Kastler E, Ruffion A, Karsenty G, Gamé X. Sacral neuromodulation and pregnancy: Results of a national survey carried out for the neuro-urology committee of the French Association of Urology (AFU). Neurourol Urodyn 2017; 37:792-798. [PMID: 29160571 DOI: 10.1002/nau.23349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/06/2017] [Indexed: 11/09/2022]
Abstract
AIMS To assess the impact of sacral neuromodulation (SNM) on pregnancy and vice-versa, by identifying women who had received SNM for lower-urinary tract symptoms (LUTS) and had become pregnant. METHODS A cross-sectional descriptive study was carried out based on responses to an on-line questionnaire sent to practitioners listed on the InterStim enCaptureTM National Registry. Questions were related to pre-pregnancy health and SNM efficacy, deactivation of the device, its impact on LUTS, childbirth, the infant, its reactivation and postpartum effectiveness. RESULTS Twenty-seven pregnancies were recorded among 21 women. Six women had had a pregnancy prior to implantation, two of whom had had a c-section. A total of 18.5% of women had the device disabled prior to conception. The others had their device disabled during the first trimester and did not reactivate it before delivery. Complications were reported in 25.9% of pregnancies: six women had urinary infections, including three of the four treated for chronic retention of urine (CRU), and 1 woman had pain at the stimulation site. There were 24 live births (including one premature birth and four c-sections), one spontaneous miscarriage and two voluntary interruptions of pregnancy. No neonatal disorders have been reported. Effectiveness of sacral neuromodulation decreased in 20% in postpartum. CONCLUSIONS In 27 pregnancies established during SNM for LUTS, 18.5% of patients deactivated their case before pregnancy and the others switched it off during the first trimester. Three-quarters of women with CRU had urinary infection. No adverse effects on fetuses were found. SNM effectiveness deteriorated in 20% cases after childbirth.
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Affiliation(s)
- Pauline Roulette
- Department of Urology, Andrology and Transplantation, CHU Rangueil, Toulouse, France
| | | | - Sylvain Sanson
- Department of Urology, Clinique du Pont de Chaume, Montauban, France
| | - Romain Caremel
- Clinique du Cèdre, Cèdre's Urology Center, Bois Guillaume, France
| | - Véronique Phé
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Pitié-Salpêtrière Academic Hospital, Paris, France
| | - Stéphane Bart
- Department of Urology, CH René-Dubos, Pontoise, France
| | - Franck Duchêne
- Clinique de l'Alliance, Department of Urology, Saint Cyr sur Loire, France
| | - Marianne De Sèze
- Clinique Saint Augustin, Neuro-Urology, Pelviperineology and Urodynamic Clinical Center, Bordeaux, France
| | - Alexia Even
- Department of Physical Medicine and Rehabilitation, Hôpital Raymond-Poincaré AP-HP, Garches, France
| | - Andréa Manunta
- Department of Urology, University Hospital of Rennes, Rennes, France
| | | | - Pascal Mouracade
- Department of Urology, Strasbourg University Hospital, Strasbourg, France
| | - Catherine-Marie Loche
- Department of Physical Medicine and Rehabilitation, Assistance Publique des Hôpitaux de Paris, Henri Mondor Teaching Hospital, Créteil, France
| | - Emmanuel Chartier-Kastler
- Department of Urology, Assistance Publique-Hôpitaux de Paris, Pierre and Marie Curie Medical School, Pitié-Salpêtrière Academic Hospital, Paris, France
| | - Alain Ruffion
- Department of Urology, Centre hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France
| | - Gilles Karsenty
- Department of Urology and Kidney Transplantation, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Xavier Gamé
- Department of Urology, Andrology and Transplantation, CHU Rangueil, Toulouse, France
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Breyer BN, Creasman JM, Richter HE, Myers D, Burgio KL, Wing RR, West DS, Kusek JW, Subak LL. A Behavioral Weight Loss Program and Nonurinary Incontinence Lower Urinary Tract Symptoms in Overweight and Obese Women with Urinary Incontinence: A Secondary Data Analysis of PRIDE. J Urol 2017; 199:215-222. [PMID: 28807645 DOI: 10.1016/j.juro.2017.07.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE We sought to determine whether a behavioral weight reduction intervention would improve nonurinary incontinence lower urinary tract storage symptoms at 6 months, including urinary frequency, nocturia and urgency, compared to a structured education program serving as the control group among overweight and obese women with urinary incontinence. MATERIALS AND METHODS PRIDE (Program to Reduce Incontinence by Diet and Exercise) was a randomized clinical trial performed in 338 overweight or obese women with urinary incontinence. Participants were randomized, including 226 to 6-month behavioral weight loss intervention and 112 to the control group. All participants received a self-help behavioral treatment booklet to improve bladder control. On this secondary data analysis we examined changes in nonurinary incontinence lower urinary tract storage symptoms from baseline to 6 months and the impact of treatment allocation (intervention vs control), weight loss and physical activity. RESULTS Nonurinary incontinence lower urinary tract storage symptoms were common at baseline, varying from 48% to 62%. In the 2 groups combined women experienced significant improvement in nocturia, urgency and International Prostate Symptom Score at 6 months (all p <0.001). However, lower urinary tract storage symptom outcomes at 6 months did not differ between the intervention and control groups. Similarly no difference was observed in the amount of weight lost (5% or greater vs less than 5%) or physical activity (1,500 kcal or greater expenditure per week compared to less than 1,500 kcal). CONCLUSIONS Lower urinary tract storage symptoms were common among overweight and obese women with urinary incontinence. The prevalence decreased significantly after 6 months independent of treatment group assignment, amount of weight lost or physical activity. These improvements may have been due to self-help behavioral educational materials, trial participation or repeat assessment of symptoms.
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Affiliation(s)
- Benjamin N Breyer
- Departments of Urology and Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California; Department of Urology, University of California-San Francisco, San Francisco, California; Departments of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, California.
| | - Jennifer M Creasman
- Departments of Obstetrics, Gynecology and Reproductive Sciences, Women's Health Clinical Research Center, University of California-San Francisco, San Francisco, California; Departments of Obstetrics, Gynecology and Reproductive Sciences, University of California-San Francisco, San Francisco, California
| | - Holly E Richter
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Deborah Myers
- Departments of Obstetrics and Gynecology, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Kathryn L Burgio
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama; Department of Veterans Affairs, Birmingham, Alabama
| | - Rena R Wing
- Miriam Hospital, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Delia Smith West
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - John W Kusek
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Leslee L Subak
- Department of Veterans Affairs, San Francisco, California
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Bradley CS, Erickson BA, Messersmith EE, Pelletier-Cameron A, Lai HH, Kreder KJ, Yang CC, Merion RM, Bavendam TG, Kirkali Z. Evidence of the Impact of Diet, Fluid Intake, Caffeine, Alcohol and Tobacco on Lower Urinary Tract Symptoms: A Systematic Review. J Urol 2017; 198:1010-1020. [PMID: 28479236 DOI: 10.1016/j.juro.2017.04.097] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2017] [Indexed: 11/18/2022]
Abstract
PURPOSE Diet, fluid intake and caffeine, alcohol and tobacco use may have effects on lower urinary tract symptoms. Constructive changes in these modifiable nonurological factors are suggested to improve lower urinary tract symptoms. To better understand the relationship between nonurological factors and lower urinary tract symptoms, we performed a systematic literature review to examine, grade and summarize reported associations between lower urinary tract symptoms and diet, fluid intake and caffeine, tobacco and alcohol use. MATERIALS AND METHODS We performed PubMed® searches for eligible articles providing evidence on associations between 1 or more nonurological factors and lower urinary tract symptoms. A modified Oxford scale was used to grade the evidence. RESULTS We reviewed 111 articles addressing diet (28 studies), fluid intake (21) and caffeine (21), alcohol (26) and tobacco use (44). The evidence grade was generally low (6% level 1, 24% level 2, 11% level 3 and 59% level 4). Fluid intake and caffeine use were associated with urinary frequency and urgency in men and women. Modest alcohol use was associated with decreased likelihood of benign prostatic hyperplasia diagnosis and reduced lower urinary tract symptoms in men. Associations between lower urinary tract symptoms and ingestion of certain foods and tobacco were inconsistent. CONCLUSIONS Evidence of associations between lower urinary tract symptoms and diet, fluid intake and caffeine, alcohol and tobacco use is sparse and mostly observational. However, there is evidence of associations between increased fluid and caffeine intake and urinary frequency/urgency, and between modest alcohol intake and decreased benign prostatic hyperplasia diagnosis and lower urinary tract symptoms. Given the importance of these nonurological factors in daily life, and their perceived impact on lower urinary tract symptoms, higher quality evidence is needed.
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Affiliation(s)
| | | | | | | | - H Henry Lai
- Washington University School of Medicine, St. Louis, Missouri
| | - Karl J Kreder
- University of Iowa Carver College of Medicine, Iowa City, Iowa
| | | | - Robert M Merion
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Tamara G Bavendam
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Ziya Kirkali
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
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Dray E, Mueller ER. Use of Urodynamic Studies among Certifying and Recertifying Urologists from 2003 to 2014. Urol Pract 2017; 4:251-256. [PMID: 37592629 DOI: 10.1016/j.urpr.2016.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Guidelines for the use of urodynamics have undergone a significant narrowing of scope in recent years, particularly as they pertain to the use of urodynamics for stress incontinence in women. Whether these changes have affected the use of urodynamics in practice is unknown. The goal of this study is to quantify the percentage of urologists who are performing urodynamics, to determine how trends have changed during the time studied and to better understand why these studies are being performed by identifying the associated diagnosis codes. METHODS We queried the 6-month procedure logs submitted by applicants for part II ABU (American Board of Urology) certification or recertification between 2003 and 2014. The number of procedures with urodynamics CPT codes were abstracted (51725, 51726, 51772, 51784, 51785, 51792, 51795, 5179, 51797) along with the certification year, patient gender and ICD-9 diagnosis used for each procedure. RESULTS During the 11-year period of data 7,849 practice logs were submitted to the ABU. Overall 91% of certifying applicants and 89.5% of recertifying applicants performed urodynamics. This number increased from 82.6% of certifying urologists and 70.3% of recertifying urologists in 2003 to 94.7% of recertifying urologists and 93.7% of certifying urologists in 2014. In 2003, on average, each certifying applicant performed 99 urodynamics procedures. This number increased to 149 procedures per applicant in 2014, for a 49.8% increase overall from the start of the study period. For recertification candidates an average of 125 procedures was performed per candidate in 2003. The average increased to 187 procedures per candidate in 2014 for a 49.5% increase in procedures performed. Videourodynamics were performed by 8.1% of certification or recertification applicants overall. This increased from 1% of recertification applicants and 1.8% of certification applicants in 2003 to 6% and 12.5% of recertification and certification applicants, respectively, in 2013. The ICD-9 codes most frequently associated with pressure flow studies were 625.6 (stress urinary incontinence-female) and 788.41 (urinary frequency). The ICD-9 code most commonly associated with videourodynamics across our study was 625.6 (stress urinary incontinence-female). CONCLUSIONS Since 2003 the percentage of applicants for ABU certification or recertification using urodynamics in their practice has increased from 76.5% to 94.2%. There has also been a 49.7% increase in the number of urodynamics procedures performed per candidate during that period, indicating an overall increase in the use of urodynamic studies.
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Affiliation(s)
- E Dray
- Department of Urology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - E R Mueller
- Department of Urology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
- Department of Obstetrics & Gynecology, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
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Simon RM, Howard LE, Moreira DM, Roehrborn C, Vidal A, Castro-Santamaria R, Freedland SJ. Does Peak Urine Flow Rate Predict the Development of Incident Lower Urinary Tract Symptoms in Men with Mild to No Current Symptoms? Results from REDUCE. J Urol 2017; 198:650-6. [PMID: 28428110 DOI: 10.1016/j.juro.2017.04.075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE We determined whether decreased peak urine flow is associated with future incident lower urinary tract symptoms in men with mild to no lower urinary tract symptoms. MATERIALS AND METHODS Our population consisted of 3,140 men from the REDUCE (Reduction by Dutasteride of Prostate Cancer Events) trial with mild to no lower urinary tract symptoms, defined as I-PSS (International Prostate Symptom Score) less than 8. REDUCE was a randomized trial of dutasteride vs placebo for prostate cancer prevention in men with elevated prostate specific antigen and negative biopsy. I-PSS measures were obtained every 6 months throughout the 4-year study. The association between peak urine flow rate and progression to incident lower urinary tract symptoms, defined as the first of medical treatment, surgery or sustained and clinically significant lower urinary tract symptoms, was tested by multivariable Cox models, adjusting for various baseline characteristics and treatment arm. RESULTS On multivariable analysis as a continuous variable, decreased peak urine flow rate was significantly associated with an increased risk of incident lower urinary tract symptoms (p = 0.002). Results were similar in the dutasteride and placebo arms. On univariable analysis when peak flow was categorized as 15 or greater, 10 to 14.9 and less than 10 ml per second, flow rates of 10 to 14.9 and less than 10 ml per second were associated with a significantly increased risk of incident lower urinary tract symptoms (HR 1.39, p = 0.011 and 1.67, p <0.001, respectively). Results were similar on multivariable analysis, although in the 10 to 14.9 ml per second group findings were no longer statistically significant (HR 1.26, p = 0.071). CONCLUSIONS In men with mild to no lower urinary tract symptoms a decreased peak urine flow rate is independently associated with incident lower urinary tract symptoms. If confirmed, these men should be followed closer for incident lower urinary tract symptoms.
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Ku JY, Lee CH, Lee JZ, Ha HK. Comparison of functional outcomes between laparoscopic radical prostatectomy and robot-assisted laparoscopic radical prostatectomy: a propensity score-matched comparison study. Asia Pac J Clin Oncol 2016; 13:212-218. [PMID: 27667779 DOI: 10.1111/ajco.12595] [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: 06/29/2016] [Revised: 07/26/2016] [Accepted: 07/28/2016] [Indexed: 11/26/2022]
Abstract
AIM To compare the functional outcomes after laparoscopic radical prostatectomy (LRP) and robot-assisted laparoscopic radical prostatectomy (RARP). METHODS Between September 2008 and January 2016, 712 patients underwent radical prostatectomy (RP; 614 LRP and 98 RARP). Recovery of incontinence was evaluated through a 24-h pad test. Urinary and erectile function was evaluated using the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function-5. Follow-up interval was 1, 3, 6 and 12 months after the surgery. The propensity score matching was used to balance the preoperative characteristics. RESULTS The recovery of incontinence was similar to the two groups at 6 and 12 months after the surgery. However, patients underwent RARP restored the continence sooner than those in the LRP group in 1 and 3 months after the surgery (P < 0.001 and 0.001). For the multivariable analysis, the type of RP procedure was a uniquely meaningful contributing factor (P = 0.001, HR = 1.925; 95% CI, 1.299-2.851). In the case of urinary function, the RARP groups showed a better IPSS score than LRP groups at the 1-, 3- and 6-month visits, respectively (P = 0.008, 0.026, 0.001), and the RARP groups early improved compared with LRP groups at the 3-month visit in the case of erectile function (P = 0.018). CONCLUSION The RARP tended toward getting back the urinary continence earlier than the LRP. In addition, urinary and erectile function recovered more quickly in the RARP group than in the LRP group.
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Affiliation(s)
- Ja Yoon Ku
- Department of Urology, Pusan National University School of Medicine and, Busan, South Korea
| | - Chan Ho Lee
- Department of Urology, Pusan National University School of Medicine and, Busan, South Korea
| | - Jeong Zoo Lee
- Department of Urology, Pusan National University School of Medicine and, Busan, South Korea
| | - Hong Koo Ha
- Department of Urology, Pusan National University School of Medicine and, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
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Gadzhieva ZK, Kazilov YB, Alyaev YG, Aboyan IA. [Features of diagnosis and treatment of various disorders of urination by physicians of the Republic of Dagestan and other regions of the North Caucasus and Southern Federal districts]. Urologiia 2016:48-56. [PMID: 28247726] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE This study was aimed to the evaluation of the features of diagnosis and treatment of various urination disorders by physicians of the Republic of Dagestan. MATERIALS AND METHODS A anonymous questionnaire survey of 32 urologists of the Republic of Dagestan was performed. In addition to urologists, survey was performed among 104 doctors of other specialties, who also treat patients with various urination disorders in their practice: neurologists (9), obstetricians (22), therapists (38), and surgeons (35). Together with the doctors of the Republic of Dagestan, 323 specialists working in different areas of the Southern Federal District, and 144 specialists of the North Caucasus region participated in the survey. RESULTS The findings suggest the confusion in determining the manifestations of overactive bladder, as well as various forms of urinary incontinence, incomplete knowledge on the issues of differential diagnosis of various forms of urinary incontinence and treatment policy in respect of each of these forms. Unfortunately, there is still unjustified use of M-anticholinergics in the treatment of stress urinary incontinence in terms of the its pathogenesis. In addition, there is misunderstanding of the importance of the correct and rational use of antimicrobial drugs according to Russian clinical guidelines in the light of the worldwide problem of antibiotic resistance, as well as lack of knowledge of both Russian and European recommendations for the treatment of LUTS in men with BPH, and the indications and the need for combination therapy. Interestingly, a small number of urologists use M-anticholinergics in the treatment of men with symptomatic BPH. CONCLUSIONS The findings of the present study revealed inadequate degree of training of medical specialists of the Republic of Dagestan and the North Caucasus and Southern federal districts in this interdisciplinary field of medicine, which dictates the need for educational programs for urologists, as well as for specialists in related specialties.
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Affiliation(s)
- Z K Gadzhieva
- Urology Clinic FSBEI HPE First Moscow State Medical University n.a. I.M. Sechenov of RMH
| | - Yu B Kazilov
- SRI of Uronephrology and Human Reproductive Health
- SBI RD Republican Urological Centre
| | - Yu G Alyaev
- Urology Clinic FSBEI HPE First Moscow State Medical University n.a. I.M. Sechenov of RMH
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Clement KD, Burden H, Warren K, Lapitan MCM, Omar MI, Drake MJ. Invasive urodynamic studies for the management of lower urinary tract symptoms (LUTS) in men with voiding dysfunction. Cochrane Database Syst Rev 2015; 2015:CD011179. [PMID: 25918922 PMCID: PMC10823470 DOI: 10.1002/14651858.cd011179.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Invasive urodynamic tests are used to investigate men with lower urinary tract symptoms (LUTS) and voiding dysfunction to determine a definitive objective diagnosis. The aim is to help clinicians select the treatment that is most likely to be successful. These investigations are invasive and time-consuming. OBJECTIVES To determine whether performing invasive urodynamic investigation, as opposed to other methods of diagnosis such as non-invasive urodynamics or clinical history and examination alone, reduces the number of men with continuing symptoms of voiding dysfunction. This goal will be achieved by critically appraising and summarising current evidence from randomised controlled trials related to clinical outcomes and cost-effectiveness. This review is not intended to consider whether urodynamic tests are reliable for making clinical diagnoses, nor whether one type of urodynamic test is better than another for this purpose.The following comparisons were made.• Urodynamics versus clinical management.• One type of urodynamics versus another. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2014, issue 10), MEDLINE (1 January 1946 to Week 4 October 2014), MEDLINE In-Process and other non-indexed citations (covering 27 November 2014; all searched on 28 November 2014), EMBASE Classic and EMBASE (1 January 2010 to Week 47 2014, searched on 28 November 2014), ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) (searched on 1 December 2014 and 3 December 2014, respectively), as well as the reference lists of relevant articles. SELECTION CRITERIA Randomised and quasi-randomised trials comparing clinical outcomes in men who were and were not investigated with the use of invasive urodynamics, or comparing one type of urodynamics against another, were included. Trials were excluded if they did not report clinical outcomes. DATA COLLECTION AND ANALYSIS Three review authors independently assessed trial quality and extracted data. MAIN RESULTS We included two trials, but data were available for only 339 men in one trial, of whom 188 underwent invasive urodynamic studies. We found evidence of risk of bias, such as lack of outcome information for 24 men in one arm of the trial.Statistically significant evidence suggests that the tests did change clinical decision making. Men in the invasive urodynamics arm were more likely to have their management changed than men in the control arm (proportion with change in management 24/188 (13%) vs 0/151 (0%), risk ratio (RR) 39.41, 95% confidence interval (CI) 2.42 to 642.74). However, the quality of the evidence was low.Low-quality evidence indicates that men in the invasive urodynamics group were less likely to undergo surgery as treatment for voiding LUTS (164/188 (87%) vs 151/151 (100%), RR 0.87, 95% CI 0.83 to 0.92).Investigators observed no difference in urine flow rates before and after surgery for LUTS (mean percentage increase in urine flow rate, 140% in invasive urodynamic group vs 149% in immediate surgery group, P value = 0.13). Similarly, they found no differences between groups with regards to International Prostate Symptom Score (IPSS) (mean percentage decrease in IPSS score, 58% in invasive urodynamics group vs 59% in immediate surgery group, P value = 0.22).No evidence was available to demonstrate whether differences in management equated to improved health outcomes, such as relief of symptoms of voiding dysfunction or improved quality of life.No evidence from randomised trials revealed the adverse effects associated with invasive urodynamic studies. AUTHORS' CONCLUSIONS Although invasive urodynamic testing did change clinical decision making, we found no evidence to demonstrate whether this led to reduced symptoms of voiding dysfunction after treatment. Larger definitive trials of better quality are needed, in which men are randomly allocated to management based on invasive urodynamic findings or to management based on findings obtained by other diagnostic means. This research will show whether performance of invasive urodynamics results in reduced symptoms of voiding dysfunction after treatment.
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Affiliation(s)
| | - Helena Burden
- North Bristol NHS Trust, Southmead HospitalBristolUK
| | | | - Marie Carmela M Lapitan
- National Institutes of Health Manila, University of the Philippines ManilaDivision of UrologyTaft AveManilaPhilippines1000
| | - Muhammad Imran Omar
- University of AberdeenAcademic Urology UnitHealth Sciences Building (second floor)ForesterhillAberdeenScotlandUKAB25 2ZD
- London School of Hygiene and Tropical MedicineLondonUK
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Linder BJ, Piotrowski JT, Ziegelmann MJ, Rivera ME, Rangel LJ, Elliott DS. Perioperative Complications following Artificial Urinary Sphincter Placement. J Urol 2015; 194:716-20. [PMID: 25776908 DOI: 10.1016/j.juro.2015.02.2945] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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] [Accepted: 02/27/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE We evaluated perioperative complications in patients undergoing primary artificial urinary sphincter placement and the potential impact of these complications on device outcomes. MATERIALS AND METHODS During the 2-year period from 2012 to 2014 we retrospectively evaluated the outcomes of 197 consecutive artificial urinary sphincter implantation procedures performed at our institution for post-prostatectomy incontinence. Of these cases 100 that were primary implantations comprise the study cohort. Perioperative complications, defined as those occurring within 6 weeks postoperatively, were classified by the Clavien-Dindo classification. After office evaluation at 6 weeks patients were followed for symptoms. Patient followup was obtained through office examination and telephone correspondence. RESULTS Patients undergoing primary artificial urinary sphincter implantation had a median age of 71.5 years (IQR 66, 76). The overall rate of any complication (Clavien I-V) within 6 weeks of surgery was 35%, including urinary retention in 31% of cases, cellulitis in 1%, device infection in 2% and urethral erosion in 2%. No significant differences in pertinent clinical comorbidities such as age (p = 0.69), hypertension (p = 0.95), coronary artery disease (p = 0.57), diabetes mellitus (p = 0.17), body mass index (p = 0.47), prior pelvic radiation therapy (p = 0.45), prior urethral sling placement (p = 0.91) or transcorporeal urethral cuff placement (p = 0.22) were found between patients with and without complications. Median followup was similar between those with and without postoperative urinary retention (p = 0.14). Postoperative urinary retention was associated with adverse 6-month device survival (76% vs 89%, p = 0.04). CONCLUSIONS The most common complication of artificial urinary sphincter placement is urinary retention. Serious adverse events following artificial urinary sphincter placement are rare. Postoperative urinary retention is associated with adverse short-term device survival rates.
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Dybowski B, Bres-Niewada E, Radziszewski P. Pressure-flow nomogram for women with lower urinary tract symptoms. Arch Med Sci 2014; 10:752-6. [PMID: 25276161 PMCID: PMC4175777 DOI: 10.5114/aoms.2014.44867] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 09/20/2013] [Accepted: 10/19/2013] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Results of urodynamic studies performed in female patients are often difficult to interpret. The objective of the study was to develop a nomogram that would help in diagnosing functional bladder outlet obstruction (BOO) in neurologically intact women with any kind of lower urinary tract symptoms. MATERIAL AND METHODS From the urodynamic database adult women were chosen with maximal flow rate (Q max ) ≤ 12 ml/s in a pressure-flow study. Four criteria were used to identify a group of patients suspected of BOO: thickened bladder wall, presence of bladder diverticula, subjective improvement on α-blockers and improvement of voiding symptoms on any form of treatment. The line separating high and low pressure zones on the pressure-flow chart was established according to the position of patients who met at least one of them. RESULTS Sixty-seven patientswere investigated. Twenty-one women met at least one of the specified criteria. They had significantly higher voiding pressures (p det(Qmax) 35 cm H2O vs. 16.5 cm H2O; p = 0.002). A new nomogram with one separating line (p det(Qmax) = 1.5 × Q max + 10) was proposed. The difference in the distribution of women fulfilling the criteria between high pressure zone and low pressure zone was highly significant (19/35 vs. 2/32; p < 0.0001). Sensitivity, specificity, positive and negative predictive values of our nomogram in identifying patients suspected of BOO was 90.5%, 65.2%, 54.3% and 94% respectively. CONCLUSIONS The new nomogram can be considered a screening test which efficiently excludes obstruction among women with low Q max in a pressure-flow study.
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Schroeck FR, Kaufman SR, Jacobs BL, Hollenbeck BK. Receipt of best care according to current quality of care measures and outcomes in men with prostate cancer. J Urol 2015; 193:500-4. [PMID: 25108275 DOI: 10.1016/j.juro.2014.08.001] [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] [Accepted: 08/01/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE We evaluated whether patients with prostate cancer who received best care according to a set of 5 nationally endorsed quality measures had decreased treatment related morbidity and improved cancer control. MATERIALS AND METHODS In this retrospective cohort study we included 38,055 men from the SEER (Surveillance, Epidemiology and End Results)-Medicare database treated for localized prostate cancer between 2004 and 2010. We determined whether each patient received best care, defined as care adherent to all applicable measures. We measured associations of best care with the need for interventions, addressing treatment related morbidity, and with the need for secondary cancer therapy using Cox proportional hazards models. RESULTS Only 3,412 men (9.0%) received best care. Five years after treatment these men and men who did not receive best care had a similar likelihood of undergoing procedures for urinary morbidity (prostatectomy subset 10.7% vs 12.9%, p = 0.338) and secondary cancer therapy (prostatectomy for high risk prostate cancer subset 40.9% vs 37.3%, p = 0.522). However, they were more likely to be treated with a procedure for sexual morbidity (prostatectomy 17.3% vs 10.8%, p <0.001). Similar trends were observed in men treated with radiotherapy. CONCLUSIONS Overall men who received best care did not fare better in regard to treatment related morbidity or cancer control. Collectively our findings suggest that the current process of care measures are not tightly linked to outcomes and further research is needed to identify better measures that are meaningful and important to patients.
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Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P, Rittig S, Vande Walle J, von Gontard A, Wright A, Yang SS, Nevéus T. The standardization of terminology of lower urinary tract function in children and adolescents: update report from the Standardization Committee of the International Children's Continence Society. J Urol 2014; 191:1863-1865.e13. [PMID: 24508614 DOI: 10.1016/j.juro.2014.01.110] [Citation(s) in RCA: 329] [Impact Index Per Article: 32.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2014] [Indexed: 12/18/2022]
Abstract
PURPOSE The impact of the original International Children's Continence Society terminology document on lower urinary tract function resulted in the global establishment of uniformity and clarity in the characterization of lower urinary tract function and dysfunction in children across multiple health care disciplines. The present document serves as a stand-alone terminology update reflecting refinement and current advancement of knowledge on pediatric lower urinary tract function. MATERIALS AND METHODS A variety of worldwide experts from multiple disciplines in the ICCS leadership who care for children with lower urinary tract dysfunction were assembled as part of the standardization committee. A critical review of the previous ICCS terminology document and the current literature was performed. In addition, contributions and feedback from the multidisciplinary ICCS membership were solicited. RESULTS Following a review of the literature during the last 7 years the ICCS experts assembled a new terminology document reflecting the current understanding of bladder function and lower urinary tract dysfunction in children using resources from the literature review, expert opinion and ICCS member feedback. CONCLUSIONS The present ICCS terminology document provides a current and consensus update to the evolving terminology and understanding of lower urinary tract function in children. For the complete document visit http://jurology.com/.
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Affiliation(s)
- Paul F Austin
- Division of Urology, Washington University in St. Louis, St. Louis Children's Hospital, St. Louis, Missouri.
| | - Stuart B Bauer
- Department of Urology, Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Wendy Bower
- Pediatrics (Nephrology Section), Skejby University Hospital, Aarhus, Denmark
| | - Janet Chase
- The Children's Centre, Cabrini Hospital, Melbourne, Australia
| | | | - Piet Hoebeke
- Pediatric Urology and Nephrology, Gent University Hospital, Ghent, Belgium
| | - Søren Rittig
- Pediatrics (Nephrology Section), Skejby University Hospital, Aarhus, Denmark
| | - Johan Vande Walle
- Pediatric Urology and Nephrology, Gent University Hospital, Ghent, Belgium
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Anne Wright
- Pediatrics, Evelina Children's Hospital, St Thomas' Hospital, London, England
| | - Stephen S Yang
- Division of Urology, Taipei Tzu Chi Hospital, The Buddhist Medical Foundation, New Taipei, and School of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
| | - Tryggve Nevéus
- Section of Paediatric Nephrology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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O'Neil BB, Presson A, Gannon J, Stephenson RA, Lowrance W, Dechet CB, Tward JD, Myers JB, Brant WO. Climacturia after definitive treatment of prostate cancer. J Urol 2013; 191:159-63. [PMID: 24050893 DOI: 10.1016/j.juro.2013.06.122] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Prostate cancer treatment results in several sexually related side effects beyond the well studied erectile dysfunction. Climacturia (leakage of urine during orgasm) has been reported after prostatectomy but studies have been limited by multiple factors. In this study we examine the prevalence, causes and impact on orgasm function of climacturia after definitive treatment of prostate cancer with surgery or radiation. MATERIALS AND METHODS A total of 906 anonymous surveys were sent to patients with prostate cancer treated with surgery and/or radiation. Respondents were asked about the presence of urinary leakage, climacturia and various elements related to sexual and orgasmic function. We estimated the prevalence of climacturia, evaluated the differences between those with and without climacturia, and assessed the impact of climacturia on orgasmic function. RESULTS Overall 412 surveys were returned and available for analysis, and of these respondents 75.2% were sexually active or experiencing orgasms. Climacturia was reported by 22.6% of these respondents, and by 28.3%, 5.2% and 28.6% of those treated with surgery, radiation, or both, respectively (p <0.001). The use of aides to obtain an erection (OR 2.24, 95% CI 1.08-4.93, p = 0.035) and the presence of urinary incontinence (OR 3.09, 95% CI 1.66-5.88, p <0.001) were also associated with climacturia in a multivariate logistic regression model. Climacturia had no significant impact on orgasmic function and satisfaction. CONCLUSIONS Climacturia is experienced by a substantial proportion of men after undergoing definitive treatment of prostate cancer. We found a complex relationship between stress urinary incontinence and climacturia, and noted that the presence of climacturia does not necessarily negatively impact sexual satisfaction.
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Affiliation(s)
- Brock B O'Neil
- Division of Urology, Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, Utah
| | - Angela Presson
- Division of Epidemiology, University of Utah, Salt Lake City, Utah
| | - John Gannon
- Division of Urology, Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, Utah
| | - Robert A Stephenson
- Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - William Lowrance
- Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Christopher B Dechet
- Division of Urology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jonathan D Tward
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Jeremy B Myers
- Division of Urology, Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, Utah
| | - William O Brant
- Division of Urology, Center for Reconstructive Urology and Men's Health, University of Utah, Salt Lake City, Utah
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Maserejian NN, Chen S, Chiu GR, Araujo AB, Kupelian V, Hall SA, McKinlay JB. Treatment status and progression or regression of lower urinary tract symptoms in a general adult population sample. J Urol 2013; 191:107-13. [PMID: 23851181 DOI: 10.1016/j.juro.2013.07.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE We report progression and regression of lower urinary tract symptoms in a population based cohort by race/ethnicity, gender, age and lower urinary tract symptom medication use. MATERIALS AND METHODS The BACH (Boston Area Community Health) Survey enrolled 5,502 participants 30 to 79 years old of black, Hispanic or white race/ethnicity. The 5-year followup interviews were completed by 1,610 men and 2,534 women for a conditional response rate of 80%. Population weighted estimates of lower urinary tract symptoms severity were assessed using the AUASI (American Urological Association symptom index) and analyzed using multivariate models. RESULTS Symptom progression (increase in AUASI score of 3 or more points) was reported by 21% to 33% of participants and regression (decrease 3 or greater) by 30% to 44% of participants, most commonly women and Hispanic participants. Age and higher body mass index were associated with progression (p <0.01), but not with regression. Lower urinary tract symptom medication use at baseline only was associated with improved symptoms scores 5 years later (multivariate adjusted OR 3.10, 95% CI 1.28-7.51, compared to nonusers), whereas using medication at baseline and followup was associated with similar rates of progression and regression as observed among participants not using lower urinary tract symptom medication at either point. CONCLUSIONS Lower urinary tract symptoms persisted at followup for approximately half of the population experiencing symptoms at baseline, including many men and women using lower urinary tract symptom medications. However, overall lower urinary tract symptom medication use and surgical treatment appeared beneficial for symptom control at 5-year followup. Age and body mass index were associated with symptom worsening, and Hispanic ethnicity was associated with greater symptom fluctuation. Clinicians should consider the higher likelihood of lower urinary tract symptom progression for older or heavier patients, and monitor responsiveness to lower urinary tract symptom medication.
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Affiliation(s)
| | - Shan Chen
- New England Research Institutes, Watertown, Massachusetts
| | | | - Andre B Araujo
- New England Research Institutes, Watertown, Massachusetts
| | | | - Susan A Hall
- New England Research Institutes, Watertown, Massachusetts
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Amarenco G, Chartier-Kastler E, Denys P, Jean JL, de Sèze M, Lubetzski C. First-line urological evaluation in multiple sclerosis: validation of a specific decision-making algorithm. Mult Scler 2013; 19:1931-7. [PMID: 23698129 DOI: 10.1177/1352458513489758] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Urinary disorders that lead to urological complications are frequent in multiple sclerosis, resulting in diminished quality of life. Urinary management guidelines are scarce and targeted to neuro-urology specialists. OBJECTIVE This study aimed to construct and validate an algorithm dedicated to neurologists and general practitioners to facilitate first-line evaluation and treatment of urinary disorders associated with multiple sclerosis. METHODS 49 items concerning urological symptom evaluation and therapeutic strategies were derived from literature analysis and evaluated by an expert panel. The Delphi method established consensus between the experts and allowed development of the First-Line Urological Evaluation in Multiple Sclerosis (FLUE-MS) algorithm. Two questions from the Urinary Bothersome Questionnaire in Multiple Sclerosis were included and their validation to verify comprehensiveness and acceptability was also conducted. RESULTS Three rounds of expert review obtained consensus of all 49 items and allowed finalisation of the algorithm. Comprehension and acceptability of two Urinary Bothersome Questionnaire in Multiple Sclerosis questions were verified (mean comprehensiveness score: 1.99/2 [99.7% total comprehensiveness], mean acceptability score: 1.99/2 [99.1% complete acceptability]). CONCLUSION The FLUE-MS algorithm was designed for neurologists and general practitioners, enabling identification of 'red flags', timely patient referral to specialist neuro-urology units, and appropriate first-line therapy.
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Affiliation(s)
- Gérard Amarenco
- Service de Neuro-Urologie et d'Explorations Périnéales, Hôpital TENON, APHP, France, GREEN UPMC, GRC 01 UPMC
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Abstract
PURPOSE We determined flow rates and generated flow rate-voided volume nomograms based on healthy children 5 to 15 years old voiding spontaneously in their natural environment. MATERIALS AND METHODS A total of 824 healthy school children of both genders were enrolled. A single uroflow record from each child was evaluated. A total of 103 children with a voided volume of less than 50 ml and/or a staccato/interrupted uroflow pattern were excluded, and 721 records were analyzed. Data were evaluated using several mathematical formulas and goodness of fit was determined. Linear regression analysis was used to generate nomograms. RESULTS Flow rates and voided volumes increased with increasing age, with the effect being more pronounced in girls. No significant difference was noted in uroflow rates from 5 to 10 years, but significant differences (p <0.001) started appearing at 11 to 15 years. Also no significant difference was noted in uroflow rates among children 11 to 15 years. Therefore, 2 age groups were designated, with group 1 consisting of patients 5 to 10 years old and group 2 consisting of patients 11 to 15 years old. There were 222 boys and 122 girls in group 1 and 240 boys and 137 girls in group 2. In group 1 the maximum and average ± SD flow rates were 15.26 ± 4.54 ml per second and 7.68 ± 3.26 ml per second, respectively, for boys and 17.98 ± 6.06 ml per second and 9.19 ± 4.23 ml per second, respectively, for girls. In group 2 these rates were 22.50 ± 7.24 ml per second and 10.78 ± 4.03 ml per second, respectively, for boys and 27.16 ± 9.37 ml per second and 13.48 ± 5.21 ml per second, respectively, for girls. CONCLUSIONS This large study, which expands the scant existing literature on uroflow parameters in healthy children, will hopefully promote wider application of uroflowmetry testing in the pediatric population.
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Affiliation(s)
- Dheeraj Kumar Gupta
- Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Jackson RE, Casanova NF, Wallner LP, Dunn RL, Hedgepeth RC, Faerber GJ, Wei JT. Risk factors for delayed hematuria following photoselective vaporization of the prostate. J Urol 2013; 190:903-8. [PMID: 23538242 DOI: 10.1016/j.juro.2013.03.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2013] [Indexed: 01/04/2023]
Abstract
PURPOSE Photoselective vaporization of the prostate has become an increasingly popular option for the treatment of benign prostatic hyperplasia. However, delayed bleeding has been raised as a potential issue as more cases are performed. We characterize delayed bleeding after photoselective vaporization of the prostate and identify associated risk factors. MATERIALS AND METHODS We defined delayed gross hematuria as any complaint of hematuria following hospital discharge, and further stratified it as delayed gross hematuria requiring emergency department evaluation, hospital admission, continuous bladder irrigation, transfusions or reoperation. We performed an explicit chart review of 290 patients who underwent photoselective vaporization of the prostate at a single center from 2002 through 2009. Exposures of interest included age, prostate volume, followup duration, operative factors (watts/joules), and use of oral anticoagulation therapy or 5α-reductase inhibitors. RESULTS Delayed gross hematuria occurred in 33.8% of patients during an average followup of 33 months. For 8.5% of patients the bleeding was severe enough to prompt presentation to the emergency department. For 4.8% of patients hospitalization was required and for 4.5% reoperation was required. Multivariate analysis revealed that the odds of bleeding increased with prostate size (OR 1.08, 1.03-1.14), longer followup (OR 1.35, 1.12-1.62) and anticoagulant use (OR 3.35, 1.43-7.83), and decreased with increasing age (OR 0.71, 0.51-0.98) and use of a 5α-reductase inhibitor (OR 0.41, 0.24-0.73). CONCLUSIONS Delayed hematuria occurs commonly after photoselective vaporization of the prostate but severe hematuria is rare. Larger prostate size, longer followup and use of anticoagulation were associated with a higher risk of delayed gross hematuria while preoperative 5α-reductase inhibitor use and older age were protective.
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Affiliation(s)
- Robert E Jackson
- Dow Division for Urologic Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan 48109, USA
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Fast AM, Nees SN, Van Batavia JP, Combs AJ, Glassberg KI. Outcomes of targeted treatment for vesicoureteral reflux in children with nonneurogenic lower urinary tract dysfunction. J Urol 2013; 190:1028-32. [PMID: 23473909 DOI: 10.1016/j.juro.2013.03.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 03/01/2013] [Accepted: 03/01/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE There is a known association between nonneurogenic lower urinary tract conditions and vesicoureteral reflux. Whether reflux is secondary to the lower urinary tract condition or coincidental is controversial. We determined the rate of reflux resolution in patients with lower urinary tract dysfunction using targeted treatment for the underlying condition. MATERIALS AND METHODS Patients diagnosed and treated for a lower urinary tract condition who had concomitant vesicoureteral reflux at or near the time of diagnosis were included. Patients underwent targeted treatment and antibiotic prophylaxis, and reflux was monitored with voiding cystourethrography or videourodynamics. RESULTS Vesicoureteral reflux was identified in 58 ureters in 36 females and 5 males with a mean age of 6.2 years. After a mean of 3.1 years of treatment reflux resolved with targeted treatment in 26 of 58 ureters (45%). All of these patients had a history of urinary tract infections before starting targeted treatment. Resolution rates of vesicoureteral reflux were similar for all reflux grades. Resolution or significant improvement of reflux was greater in the ureters of patients with dysfunctional voiding (70%) compared to those with idiopathic detrusor overactivity disorder (38%) or detrusor underutilization (40%). CONCLUSIONS Vesicoureteral reflux associated with lower urinary tract conditions resolved with targeted treatment and antibiotic prophylaxis in 45% of ureters. Unlike the resolution rates reported in patients with reflux without a coexisting lower urinary tract condition, we found that there were no differences in resolution rates among grades I to V reflux in patients with lower urinary tract conditions. Patients with dysfunctional voiding had the most improvement and greatest resolution of reflux. Additionally grade V reflux resolved in some patients.
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Affiliation(s)
- Angela M Fast
- Division of Pediatric Urology, Morgan Stanley Children's Hospital of New York-Presbyterian, Department of Urology, Columbia University, College of Physicians and Surgeons, New York, New York 10032, USA
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Abstract
Objectives Health professionals commonly advise patients with incontinence and other lower urinary tract symptoms about modifiable contributing factors such as drinking and voiding habits. Poor drinking and voiding habits may begin early in life, before symptoms emerge. However, little is known about the habits and knowledge young people have regarding healthy drinking and voiding behaviors. This research aimed to assess the habits and health knowledge of young people regarding fluid intake and voiding. Methods A questionnaire was used to assess the drinking and voiding behaviors of first year university students and their knowledge about healthy fluid intake and voiding. Results The average daily fluid intake was >2 L/day for both genders. Poor drinking and voiding habits (such as high consumption of caffeinated drinks and alcohol, or nocturia) were common. Widely reported myths about the benefits of a high fluid intake were commonly believed. Conclusion More informed public education regarding healthy fluid intake, and drinking and voiding habits, is required as part of the effort to reduce the development of lower urinary tract symptoms, including incontinence.
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Affiliation(s)
- Rebekah N Das
- School of Health Sciences, University of South Australia, City East Campus, North Terrace, Adelaide, SA 5000, Australia
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Maserejian NN, Kupelian V, McVary KT, Doshi M, Link CL, McKinlay JB. Prevalence of post-micturition symptoms in association with lower urinary tract symptoms and health-related quality of life in men and women. BJU Int 2011; 108:1452-8. [PMID: 21223471 PMCID: PMC3135743 DOI: 10.1111/j.1464-410x.2010.10014.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE • To estimate the prevalence of post-micturition symptoms (a feeling of incomplete emptying following urination and post-micturition dribble) in a population-based sample of men and women, and to examine overlap with storage and voiding LUTS and associations with health-related quality of life (HRQL). PATIENTS AND METHODS • Data were obtained by in-person interview in the Boston Area Community Health survey, a population-based random sample of 2301 men and 3202 women aged 30-79 years in the USA. • Lower urinary tract symptoms (LUTS) were defined using the International Prostate Symptom Score and standardized terminology. • Multivariate linear regression was used to evaluate associations between urological symptoms and validated HRQL measures (SF-12 and activities interference) cross-sectionally. RESULTS • The overall prevalence of post-micturition symptoms was 11.8% in men and 8.5% in women. • The prevalence increased with age in men but not women. • In men, post-void dribbling contributed to much of the post-micturition symptoms, whereas, in women, incomplete emptying was more common. • For both genders, over 50% with voiding symptoms also had post-micturition symptoms, compared to less than 50% of respondents who reported storage symptoms. • The presence of post-micturition symptoms, particularly incomplete emptying, was indicative of mildly impaired physical HRQL and activities interference in men and women, and mental HRQL in men (P < 0.01). CONCLUSIONS • Post-micturition symptoms were more prevalent than any individual voiding symptom and commonly overlapped with other LUTS. • Over half of men and women with a voiding symptom also had a post-micturition symptom. • The presence of post-micturition symptoms was indicative of impaired HRQL.
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Affiliation(s)
- Nancy N Maserejian
- Department of Epidemiology, New England Research Institutes, Watertown, MA, USA.
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Hall SA, Chiu GR, Link CL, Steers WD, Kupelian V, McKinlay JB. Are statin medications associated with lower urinary tract symptoms in men and women? Results from the Boston Area Community Health (BACH) Survey. Ann Epidemiol 2011; 21:149-55. [PMID: 21311603 DOI: 10.1016/j.annepidem.2010.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Statins may ameliorate lower urinary tract symptoms (LUTS) through anti-inflammatory or other pathways. We investigated the association between statin use and storage, voiding, and overall LUTS symptoms. METHODS The Boston Area Community Health Survey is an epidemiologic study of Boston, MA residents (2301 men; 3202 women) 30-79 years of age. LUTS, voiding, and storage symptoms were ascertained through an interviewer-administered questionnaire and defined as scores of greater than or equal to 8, greater than or equal to 5, and greater than or equal to 4, respectively, on relevant components of the American Urologic Association Symptom Index. Participants were included if they had a history of provider-diagnosed high cholesterol or recently used statin medications (n = 1346). Associations were estimated using odds ratios (ORs) and 95% confidence intervals (CI) from multivariate logistic regression. RESULTS In multivariate models, statin use had no association with LUTS (OR= 1.03, 95% CI: 0.70, 1.51) among women. No associations were observed for any LUTS among younger (<60) men, but among older (60+) men, we observed significant inverse associations for voiding (OR= 0.23, 95% CI: 0.08, 0.66), storage (OR = 0.24, 95% CI: 0.11, 0.56), and overall LUTS (OR = 0.15, 95% CI: 0.05, 0.44). CONCLUSIONS Our results suggest that use of statins is associated with a lower prevalence of urologic symptoms among older men but not among women or younger men.
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Abstract
This study was undertaken to identify risk factors for postoperative voiding dysfunction and factors having impact on patient global satisfaction after a tension-free vaginal tape (TVT) procedure. Two hundred and eighty-five women who underwent the TVT procedure for stress urinary incontinence were analyzed to identify risk factors predictive of voiding dysfunction. Postoperative voiding dysfunction was defined as a peak urinary flow rate (PFR) <10 mL/sec (straining voiding, n = 17) or residual urine volume >30% of bladder capacity (incomplete emptying, n = 13). The global satisfaction rate was 91.6%. Voiding dysfunction developed in 29 (10.2%) patients. Among the factors, PFR was only factor of significance for voiding dysfunction. There was no significant difference between patients with and without voiding dysfunction in terms of their satisfaction. But postoperative PFR <10 mL/sec significantly compromised global satisfaction after the surgery. In those patients with a preoperative PFR <20 mL/sec, there were more patients with postoperative PFR <10 mL/sec. Peak urinary flow rate is an important factor for the postoperative voiding dysfunction. The inevitable decline in PFR can compromise patients' satisfaction with the procedure, when their postoperative PFR was <10 mL/sec.
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Affiliation(s)
- Sungchan Park
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Bumsik Hong
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kyu-Sung Lee
- Department of Urology, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
| | - Myung-Soo Choo
- Department of Urology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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