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Hao J, Yao Z, Remis A, Huang B, Li Y, Yu X. Pelvic floor muscle training in telerehabilitation: a systematic review and meta-analysis. Arch Gynecol Obstet 2024; 309:1753-1764. [PMID: 38340157 DOI: 10.1007/s00404-024-07380-x] [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: 11/20/2023] [Accepted: 01/07/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE This systematic review aims to identify, critically appraise, and summarize current evidence regarding the feasibility and efficacy of pelvic floor muscle training in telerehabilitation. METHODS Three bibliographic databases, PubMed, Embase, and Scopus were searched from inception to October 1, 2023. Clinical trials assessing the feasibility and efficacy of pelvic floor muscle training in telerehabilitation were eligible for inclusion. The Physiotherapy Evidence Database scale and National Institutes of Health Study Quality Assessment Tool were used for methodological quality assessment. Study selection, data extraction, and quality assessment were completed by two independent reviewers. Meta-analyses were performed to determine the effects of pelvic floor muscle training in telerehabilitation. RESULTS Five randomized controlled trials and three single cohort clinical trials were included in this review. Four studies were evaluated as good quality, and four as fair. Pelvic floor telerehabilitation was well tolerated and demonstrated good patient compliance and satisfaction. Pooled analysis indicated significant effects of pelvic floor telerehabilitation on the severity of urinary incontinence with a large effect size, pelvic floor muscle strength with a large effect size, and quality of life with a medium effect size. CONCLUSION This systematic review demonstrates that pelvic floor muscle training in telerehabilitation is a feasible and effective approach and highlights its efficacy in patients with urinary incontinence. This review supports the application of pelvic floor muscle training in telerehabilitation and informs further clinical and research endeavors to incorporate digital health technologies in managing pelvic floor dysfunction.
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Affiliation(s)
- Jie Hao
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Zixuan Yao
- Department of Rehabilitation Medicine, Institution of Geriatric Medicine, Beijing Hospital, National Center of Gerontology, Chinese Academy of Medical Science, Beijing, 100051, People's Republic of China.
| | - Andréas Remis
- Health Research Association of Keck Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Biying Huang
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Yanfei Li
- Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198, USA
| | - Xin Yu
- Department of Rehabilitation Medicine, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, People's Republic of China
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Afyouni AS, Wu YX, Balis UGJ, DeLancey J, Sadeghi Z. An Overview of the Effect of Aging on the Female Urethra. Urol Clin North Am 2024; 51:239-251. [PMID: 38609196 DOI: 10.1016/j.ucl.2024.02.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Urethral function declines by roughly 15% per decade and profoundly contributes to the pathogenesis of urinary incontinence. Individuals with poor urethral function are more likely to fail surgical management for stress incontinence that focus on improving urethral support. The reduced number of intramuscular nerves and the morphologic changes in muscle and connective tissue collectively impact urethral function as women age. Imaging technologies like MRI and ultrasound have advanced our understanding of these changes. However, substantial knowledge gaps remain. Addressing these gaps can be crucial for developing better prevention and treatment strategies, ultimately enhancing the quality of life for aging women.
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Affiliation(s)
- Andrew S Afyouni
- Division of Neurourology and Reconstructive Pelvic Surgery, Department of Urology, University of California Irvine, 3800 W. Chapman Avenue, Suite 7200, Orange, CA 92868, USA
| | - Yi Xi Wu
- Division of Neurourology and Reconstructive Pelvic Surgery, Department of Urology, University of California Irvine, 3800 W. Chapman Avenue, Suite 7200, Orange, CA 92868, USA
| | - Ulysses G J Balis
- Division of Pathology Informatics, Department of Pathology, University of Michigan Medical School, 2800 Plymouth Road, NCRC Building 35, Ann Arbor, MI 48109, USA
| | - John DeLancey
- Department of Obstetrics and Gynecology, University of Michigan Medical School, L4208 UH South, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Zhina Sadeghi
- Division of Neurourology and Reconstructive Pelvic Surgery, Department of Urology, University of California Irvine, 3800 W. Chapman Avenue, Suite 7200, Orange, CA 92868, USA.
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Godlewski K, Tekgul S, Gong E, Vanderbrink B, Srinivasan A. Clinical considerations in adults with history of posterior urethral valves. J Pediatr Urol 2024; 20:176-182. [PMID: 37806832 DOI: 10.1016/j.jpurol.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Management of patients with posterior urethral valves (PUV) is commonplace for many pediatric urologists, however adult providers may be far less familiar with this diagnosis, its management and long-term ramifications. As urologic management of these patients has evolved, clinical outcomes have substantially improved with many more patients now surviving into adulthood. These patients remain at increased risk of morbidity due to their condition and therefore are likely to benefit from long term follow-up with adult providers. OBJECTIVE In this review we analyze the psychosocial impacts of PUV on adults, evaluate long term transplant outcomes in PUV patients and discuss effective clinical management strategies of bladder dysfunction in adult PUV patients. STUDY DESIGN A retrospective literature review was performed using the MEDLINE (Pubmed) electronic database using key words such as "posterior urethral valve", "quality of life", "sexual function", "transplant outcomes", "bladder dysfunction", "mitrofanoff" etc. to identify relevant studies. RESULTS Generally, the quality of life of PUV patients is good, those suffering from renal insufficiency or lower urinary tract symptoms, specifically incontinence, appear to be a group that may benefit from more intensive follow-up. Good long-term kidney transplant (KT) function and survival can be achieved in patients with PUV. Rigorous management to optimize bladder function and close follow-up, are key for long term graft survival after KT. DISCUSSION The chronicity of PUV warrants adult providers to be not only well versed in the pathophysiology of the disease, but well prepared to care for these patients as they transition into adulthood. CONCLUSION Additional studies addressing psychosocial, clinical and transplant outcomes of adults with PUV are necessary to develop optimal long-term follow-up regimens for these patients.
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Affiliation(s)
- Karl Godlewski
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd HUB 9th Floor, Philadelphia, PA, 19104, USA.
| | - Serdar Tekgul
- Hacettepe University, Ankara, Cankaya, Gaziosmanpasa, Sihhhiye, 06100 Ankara, Turkey.
| | - Edward Gong
- Lurie Children's Hospital, 225 E. Chicago Ave, Chicago, IL, 60611, USA.
| | - Brian Vanderbrink
- Cincinnati Children's Hospital, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| | - Arun Srinivasan
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd HUB 9th Floor, Philadelphia, PA, 19104, USA.
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4
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Hoelscher SAA, de Angst IB, Buijnsters ZA, Bramer WM, Akkermans FW, Kuindersma ME, Scheepe JR, Hoen LA'. The effect of botulinum toxin A in children with non-neurogenic therapy-refractory dysfunctional voiding - A systematic review. J Pediatr Urol 2024; 20:211-218. [PMID: 38135586 DOI: 10.1016/j.jpurol.2023.10.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/15/2023] [Accepted: 10/27/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Dysfunctional voiding (DV) is a habitual voiding disorder caused by involuntary contraction or non-relaxation of the external urethral sphincter (EUS) during voiding. This contraction causes high post-void residuals (PVR), urinary incontinence and urinary tract infections (UTIs). Various treatments for DV are available, but some children do not respond. Intersphincteric botulinum toxin-A (BTX-A) may be a possible treatment for therapy-refractory children with DV. OBJECTIVE The aim of this systematic review is to summarize the effects and safety of intersphincteric BTX-A as a treatment for therapy-refractory DV in children. METHODS A systematic search in Embase, MEDLINE, Cochrane, and Web of Science databases was performed. Studies reporting on the usage of intersphincteric BTX-A as a treatment for DV in children were included. Data on PVR, maximum flow rate (Qmax), repeat injections and complications were extracted. RESULTS From a total of 277 articles, five cohort studies were identified, reporting on 78 children with DV of whom 53 were female (68 %) and 25 were male (32 %). Sample sizes ranged from ten to twenty patients. Mean or median age at the time of intervention ranged from 8 to 10.5 years. Meta-analysis could not be performed due to lack of data. The narrative synthesis approach was therefore used to summarize the results. All studies showed significant decrease in PVR after BTX-A injection. Three studies showed a 33-69 % improvement on incontinence after BTX-A injection. Less UTIs were reported after treatment. A temporary increase in incontinence, UTIs and transitory numbness to the gluteus muscle were reported as side-effects. CONCLUSIONS BTX-A could be a safe and effective treatment option for therapy-refractory DV in children by reducing PVR, UTIs and incontinence. Hereby, the synergistic effect of BTX-A and urotherapy should be emphasized in future management. Furthermore, this study identified gaps in current knowledge that are of interest for future research.
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Affiliation(s)
- S A A Hoelscher
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - I B de Angst
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - Z A Buijnsters
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - F W Akkermans
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - M E Kuindersma
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - J R Scheepe
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - L A 't Hoen
- Department of Pediatric Urology, Sophia Children's Hospital, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Pinto VBP, de Azevedo MF, Wroclawski ML, Gentile G, Jesus VLM, de Bessa Junior J, Nahas WC, Sacomani CAR, Sandhu JS, Gomes CM. Conformity of ChatGPT recommendations with the AUA/SUFU guideline on postprostatectomy urinary incontinence. Neurourol Urodyn 2024; 43:935-941. [PMID: 38451040 DOI: 10.1002/nau.25442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/24/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Artificial intelligence (AI) shows immense potential in medicine and Chat generative pretrained transformer (ChatGPT) has been used for different purposes in the field. However, it may not match the complexity and nuance of certain medical scenarios. This study evaluates the accuracy of ChatGPT 3.5 and 4 in providing recommendations regarding the management of postprostatectomy urinary incontinence (PPUI), considering The Incontinence After Prostate Treatment: AUA/SUFU Guideline as the best practice benchmark. MATERIALS AND METHODS A set of questions based on the AUA/SUFU Guideline was prepared. Queries included 10 conceptual questions and 10 case-based questions. All questions were open and entered into the ChatGPT with a recommendation to limit the answer to 200 words, for greater objectivity. Responses were graded as correct (1 point); partially correct (0.5 point), or incorrect (0 point). Performances of versions 3.5 and 4 of ChatGPT were analyzed overall and separately for the conceptual and the case-based questions. RESULTS ChatGPT 3.5 scored 11.5 out of 20 points (57.5% accuracy), while ChatGPT 4 scored 18 (90.0%; p = 0.031). In the conceptual questions, ChatGPT 3.5 provided accurate answers to six questions along with one partially correct response and three incorrect answers, with a final score of 6.5. In contrast, ChatGPT 4 provided correct answers to eight questions and partially correct answers to two questions, scoring 9.0. In the case-based questions, ChatGPT 3.5 scored 5.0, while ChatGPT 4 scored 9.0. The domains where ChatGPT performed worst were evaluation, treatment options, surgical complications, and special situations. CONCLUSION ChatGPT 4 demonstrated superior performance compared to ChatGPT 3.5 in providing recommendations for the management of PPUI, using the AUA/SUFU Guideline as a benchmark. Continuous monitoring is essential for evaluating the development and precision of AI-generated medical information.
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Affiliation(s)
- Vicktor B P Pinto
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Matheus F de Azevedo
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Marcelo L Wroclawski
- Division of Urology, ABC Medical School, Sao Paulo, Brazil
- Department of Urology, Albert Einstein Jewish Hospital, Sao Paulo, Brazil
- Department of Urologic Oncology, BP-a Beneficência Portuguesa de São Paulo, Sao Paulo, Brazil
| | - Guilherme Gentile
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Vinicius L M Jesus
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | | | - William C Nahas
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
| | - Carlos A R Sacomani
- Innovation and Information Technology Sector, AC Camargo Cancer Hospital, Sao Paulo, Brazil
| | - Jaspreet S Sandhu
- Department of Surgery/Urology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Cristiano M Gomes
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil
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Erkan R, Özdemir F. Assessment of health literacy and quality of life in women with urinary incontinence. Int Urol Nephrol 2024; 56:1297-1305. [PMID: 37940815 DOI: 10.1007/s11255-023-03864-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE In studies conducted with different groups, the effects of health literacy on quality of life are evident; however, there is no study examining the effect of health literacy on quality of life in women with urinary incontinence. The research was carried out to determine the health literacy level of women with urinary incontinence complaints, evaluate their quality of life, and examine the relationship between the two. METHODS The research was carried out as a descriptive study and conducted with 142 women with urinary incontinence complaints in an education and research hospital in Turkey between October 14 and December 30, 2020. The data were collected using the Introductory Information Form, Turkey Health Literacy Scale-32, Incontinence Quality of Life Scale. RESULTS The THLS-32 total mean score was 28.29 ± 8.68, the IQOL total mean score was 64.35 ± 15.33. It was determined that 41.5% of the women had insufficient, 35.9% had problematic-limited, 12% had adequate and 10.6% had excellent health literacy. A positive, medium-sized statistically significant correlation was found between the TSOY-32 score and the IQOL score (r = 0.436, p < 0.001). CONCLUSIONS Urinary incontinence has significant effects on the quality of life. It is thought that the evaluation of health literacy may be beneficial in nursing approaches to improve the quality of life of women with urinary incontinence.
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Affiliation(s)
- Rabia Erkan
- The Graduate School of Health Sciences of Ankara University, Ankara, Turkey.
- , Ankara, Turkey.
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7
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Koenig JB, Burnett LA. Understanding the Role of Obesity and Metabolism in Pelvic Floor Disorders. Urogynecology (Phila) 2024; 30:389-393. [PMID: 38564623 DOI: 10.1097/spv.0000000000001478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Jenny B Koenig
- From the Department of Obstetrics, Gynecology, and Reproductive Sciences
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Markland AD, Hellemann G, Shan L, Brady SS, Huling JD, Schreiner PJ, Sidney S, Van Den Eeden SK, Lewis CE. Characterizing the spectrum of bladder health and lower urinary tract symptoms among men: Results from the CARDIA study. Neurourol Urodyn 2024; 43:840-848. [PMID: 38407331 PMCID: PMC11031325 DOI: 10.1002/nau.25430] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVES To operationalize a new definition for bladder health, we examined the distribution and impact of lower urinary tract symptoms (LUTS), along with risk factors, among men in the Coronary Artery Risk Development in Young Adults (CARDIA) study. METHODS LUTS were defined by American Urologic Association Symptom Index (AUASI) scores and impact on quality of life (QoL). Separate questions assessed urinary incontinence (UI) and postvoid dribbling. We performed cluster analyses using AUASI scores, with and without urine incontinence and postvoid dribbling, and impact collected in 2010-11. We performed analyses to evaluate sociodemographic and cardiovascular risk factors between clusters. RESULTS Among CARDIA men (mean age: 50.0, SD = 3.6; range: 42-56 years) with complete LUTS data (n = 929), we identified and compared four clusters: men who reported no or very mild symptoms and no impact on well-being (bladder health, n = 696, 75%), men with moderate symptoms and moderate impact on well-being (moderate symptoms/impact, n = 84, 9%), men with high symptoms and high impact on well-being (severe symptoms/impact, n = 117, 13%), and a separate group that reported moderate symptoms and UI with a high impact on well-being (UI + moderate symptoms/severe impact, n = 32, 3%). Exploration of the groupings showed a large percentage of postvoid dribbling across groups (overall 69%). Sociodemographic and cardiovascular risk factors were not associated with symptom/impact groups. CONCLUSIONS Bladder health clustered into four categories. A majority of middle-aged men in the community showed no or mild bladder symptoms without impact on QoL. Postvoid dribbling is pervasive but did not cluster with a specific LUTS or impact category.
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Affiliation(s)
- Alayne D Markland
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research, Education, and Clinical Center (GRECC), Birmingham, Alabama, USA
- Heersink School of Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gerhard Hellemann
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Liang Shan
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sonya S Brady
- School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jared D Huling
- School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Pamela J Schreiner
- School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | | | - Cora E Lewis
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Fontes JM, Oliveira EM, Monteiro de Melo Prazeres TC, Nisya de Oliveira Cruz G, Rizzini M, Passos SD, Lisboa LL, Ferreira de Araújo G, Azevedo de Almeida V, Malacarne J, Emília de Domenico Garcia M, Linhares Barreto LC, Calado AA, Fernandes da Nóbrega L, Moura Nascimento Santos MJ, Gonçalves RP, Farache L, Feliciano da Silva M, Rizzo FV, Dias da Silva L, Maria de Jesus Amorim N, Guedes Pinheiro HC, Suely de Oliveira Melo A, de Oliveira Melo F, Moreira RD, Santos da Costa BJ, de Almeida Melo Maciel Mangueira M, Varela MC, Costa Monteiro LM. Prevalence of urologic sequelae and bladder and bowel dysfunctions in patients with congenital Zika syndrome: A multicenter evaluation of the Zika virus bladder and bowel sequelae assistance network. J Pediatr Urol 2024; 20:220.e1-220.e9. [PMID: 38097421 DOI: 10.1016/j.jpurol.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/17/2023] [Accepted: 11/13/2023] [Indexed: 04/22/2024]
Abstract
INTRODUCTION Neurogenic bladder was first confirmed as a urological sequela of Congenital Zika Syndrome (CZS) in 2018. Further clinical-epidemiological evidence also confirmed neurogenic bowel dysfunction and cryptorchidism. To strengthen the care for these children, the Congenital Zika Virus Bladder and Bowel Sequelae Network (RASZ in Brazilian) was created, including six integrated centers in Brazil. This article represents the initial outcome of the efforts by RASZ. OBJECTIVE To evaluate the prevalence of bladder and bowel dysfunction, cryptorchidism and other urological sequelae related to CZS in cohorts attended in six Brazilian states. STUDY DESIGN Observational, prospective, multicenter study including children with CZS assisted in one of six RASZ collaborative centers between June 2016 and February 2023. Data were collected from patient's first assessment using the same protocols for urological and bowel evaluation. Categorical variables were analyzed by frequency of occurrence and numerical variables by mean, median, and standard deviation. The study was approved by the Research Ethics Committees of each center, all parents/caregivers provided written informed consent. RESULTS The study included 414 children aged 2 months to 7 years (mean 2.77 years, SD 1.73), 227 (54.8 %) were male and 140 (33,8 %) referred urological and bowel symptoms on arrival. Prevalence of both urological and bowel sequelae was 66.7 %, 51 % of children aged 4 years and older had urinary incontinence (UI). UTI was confirmed in 23.4 % (two presented toxemia) and among males, 18.1 % had cryptorchidism. Renal ultrasonography, performed in 186 children, was abnormal in 25 (13.4 %), 7 had hydronephrosis. Among the 287 children who performed urodynamics, 283 (98.6 %) were altered: 232 had a lower bladder capacity, 144 a maximum bladder pressure of ≥40 cm H2O, and 127 did not satisfactorily empty their bladder. DISCUSSION A higher prevalence of NLUTD, neurogenic bowel and cryptorchidism was confirmed in children with CZS. Early diagnosis and appropriate treatment, including a multidisciplinary approach, may reduce the risk of UTIs, UI and kidney damage. A limitation of the study was the inability of children to complete the protocol, specifically urodynamic evaluation, and ultrasonography. In both exams, the percentage of abnormal cases was higher than that expected in the normal population. CONCLUSION A 66,7 % prevalence of combined urological sequelae and bladder-bowel dysfunction related to CZS was confirmed in patients evaluated in six Brazilian cohorts. The most frequent changes were related to NLUTD, neurogenic bowel, and cryptorchidism. Prevalence may be underestimated due to access restrictions to diagnostic tests.
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Affiliation(s)
- Juliana Marin Fontes
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil.
| | | | | | - Glaura Nisya de Oliveira Cruz
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | - Marta Rizzini
- Universidade Federal do Maranhão (UFMA) - Federal University of Maranhão, São Luís, MA, Brazil
| | - Saulo Duarte Passos
- Faculdade de Medicina de Jundiaí (FMJ) - Jundiai Medicine College, Jundiai, SP, Brazil
| | - Lilian Lira Lisboa
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | - Grace Ferreira de Araújo
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | - Valéria Azevedo de Almeida
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | - Jociele Malacarne
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | | | - Lilian Cagliari Linhares Barreto
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
| | | | | | | | - Rafael Pauletti Gonçalves
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | - Luana Farache
- Instituto Santos Dumont, Centro de Ensino e Pesquisa Anita Garibaldi (ISD/CEPs) - Santos Dumont Institute, Anita Garibaldi Teaching and Research Center (ISD/CEPs),Macaíba, RN, Brazil
| | | | - Fábio Valente Rizzo
- Faculdade de Medicina de Jundiaí (FMJ) - Jundiai Medicine College, Jundiai, SP, Brazil
| | - Luiz Dias da Silva
- Faculdade de Medicina de Jundiaí (FMJ) - Jundiai Medicine College, Jundiai, SP, Brazil
| | | | - Hannah Cavalcante Guedes Pinheiro
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), - Professor Joaquim Amorim Neto Research Institute, Campina Grande, PB, Brazil
| | - Adriana Suely de Oliveira Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), - Professor Joaquim Amorim Neto Research Institute, Campina Grande, PB, Brazil
| | - Fabiana de Oliveira Melo
- Instituto de Pesquisa Professor Joaquim Amorim Neto (IPESQ), - Professor Joaquim Amorim Neto Research Institute, Campina Grande, PB, Brazil
| | - Rômulo Dias Moreira
- Universidade Federal do Maranhão (UFMA) - Federal University of Maranhão, São Luís, MA, Brazil
| | | | | | - Margareth Catoia Varela
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional Infectologia (INI), Laboratório de Pesquisa em Imunização e Vigilância em Saúde - Oswaldo Cruz Foundation (Fiocruz), Health Surveillance and Immunization Research Unit - Rio de Janeiro, RJ, Brazil
| | - Lucia Maria Costa Monteiro
- Fundação Oswaldo Cruz (Fiocruz), Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Ambulatório de Urodinâmica Pediátrica - Oswaldo Cruz Foundation, National Institute of Women, Children and Adolescents Health Fernandes Figueira, Pediatric Urodynamics Unit, Rio de Janeiro, RJ, Brazil
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Ximenes RRC, Chaves EMC, Girão ALA, Gonçalves MHRB, Ferreira SL, de Carvalho REFL. Knowledge of nursing staff before and after training on incontinence-associated dermatitis. Rev Esc Enferm USP 2024; 58:e20230272. [PMID: 38558025 PMCID: PMC11021019 DOI: 10.1590/1980-220x-reeusp-2023-0272en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/31/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To verify the knowledge of nursing staff before and after training on incontinence-associated dermatitis. METHOD A study before and after an educational intervention carried out with nursing staff from the medical and surgical clinics and intensive care unit of the university hospital in June 2023. The training took place over three meetings. Data was collected using a questionnaire administered immediately before and after the training. McNemar's test for dependent samples was used to compare before and after training. RESULTS 25 nurses and 14 nursing technicians took part. The items that showed statistical significance were related to the identification and correct differentiation of dermatitis associated with incontinence and pressure injury; and the correct way to sanitize the skin. CONCLUSION The training of the nursing team made it possible to assess their knowledge of how to identify, prevent and treat incontinence-associated dermatitis.
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Affiliation(s)
- Raelly Ramos Campos Ximenes
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | - Edna Maria Camelo Chaves
- Universidade Estadual do Ceará, Programa de Pós-Graduação em Cuidados Clínicos em Enfermagem e Saúde, Fortaleza, CE, Brazil
| | | | | | - Saionara Leal Ferreira
- Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, CE, Brazil
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Yeung E, Baessler K, Christmann-Schmid C, Haya N, Chen Z, Wallace SA, Mowat A, Maher C. Transvaginal mesh or grafts or native tissue repair for vaginal prolapse. Cochrane Database Syst Rev 2024; 3:CD012079. [PMID: 38477494 PMCID: PMC10936147 DOI: 10.1002/14651858.cd012079.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND Pelvic organ prolapse is the descent of one or more of the pelvic organs (uterus, vaginal apex, bladder, or bowel) into the vagina. In recent years, surgeons have increasingly used grafts in transvaginal repairs. Graft material can be synthetic or biological. The aim is to reduce prolapse recurrence and surpass the effectiveness of traditional native tissue repair (colporrhaphy) for vaginal prolapse. This is a review update; the previous version was published in 2016. OBJECTIVES To determine the safety and effectiveness of transvaginal mesh or biological grafts compared to native tissue repair or other grafts in the surgical treatment of vaginal prolapse. SEARCH METHODS We searched the Cochrane Incontinence Group Specialised Register, which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and two clinical trials registers (March 2022). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing different types of vaginal repair (mesh, biological graft, or native tissue). DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, assessed risk of bias, and extracted data. The primary outcomes were awareness of prolapse, repeat surgery, and recurrent prolapse on examination. MAIN RESULTS We included 51 RCTs (7846 women). The certainty of the evidence was largely moderate (ranging from very low to moderate). Transvaginal permanent mesh versus native tissue repair Awareness of prolapse at six months to seven years was less likely after mesh repair (risk ratio (RR) 0.83, 95% confidence interval (CI) 0.73 to 0.95; I2 = 34%; 17 studies, 2932 women; moderate-certainty evidence). This suggests that if 23% of women are aware of prolapse after native tissue repair, between 17% and 22% will be aware of prolapse after permanent mesh repair. Rates of repeat surgery for prolapse were lower in the mesh group (RR 0.71, 95% CI 0.53 to 0.95; I2 = 35%; 17 studies, 2485 women; moderate-certainty evidence). There was no evidence of a difference between the groups in rates of repeat surgery for incontinence (RR 1.03, 95% CI 0.67 to 1.59; I2 = 0%; 13 studies, 2206 women; moderate-certainty evidence). However, more women in the mesh group required repeat surgery for the combined outcome of prolapse, stress incontinence, or mesh exposure (RR 1.56, 95% CI 1.07 to 2.26; I2 = 54%; 27 studies, 3916 women; low-certainty evidence). This suggests that if 7.1% of women require repeat surgery after native tissue repair, between 7.6% and 16% will require repeat surgery after permanent mesh repair. The rate of mesh exposure was 11.8% and surgery for mesh exposure was 6.1% in women who had mesh repairs. Recurrent prolapse on examination was less likely after mesh repair (RR 0.42, 95% CI 0.32 to 0.55; I2 = 84%; 25 studies, 3680 women; very low-certainty evidence). Permanent transvaginal mesh was associated with higher rates of de novo stress incontinence (RR 1.50, 95% CI 1.19 to 1.88; I2 = 0%; 17 studies, 2001 women; moderate-certainty evidence) and bladder injury (RR 3.67, 95% CI 1.63 to 8.28; I2 = 0%; 14 studies, 1997 women; moderate-certainty evidence). There was no evidence of a difference between the groups in rates of de novo dyspareunia (RR 1.22, 95% CI 0.83 to 1.79; I2 = 27%; 16 studies, 1308 women; moderate-certainty evidence). There was no evidence of a difference in quality of life outcomes; however, there was substantial heterogeneity in the data. Transvaginal absorbable mesh versus native tissue repair There was no evidence of a difference between the two methods of repair at two years for the rate of awareness of prolapse (RR 1.05, 95% CI 0.77 to 1.44; 1 study, 54 women), rate of repeat surgery for prolapse (RR 0.47, 95% CI 0.09 to 2.40; 1 study, 66 women), or recurrent prolapse on examination (RR 0.53, 95% CI 0.10 to 2.70; 1 study, 66 women). The effect of either form of repair was uncertain for bladder-related outcomes, dyspareunia, and quality of life. Transvaginal biological graft versus native tissue repair There was no evidence of a difference between the groups at one to three years for the outcome awareness of prolapse (RR 1.06, 95% CI 0.73 to 1.56; I2 = 0%; 8 studies, 1374 women; moderate-certainty evidence), repeat surgery for prolapse (RR 1.15, 95% CI 0.75 to 1.77; I2 = 0%; 6 studies, 899 women; moderate-certainty evidence), and recurrent prolapse on examination (RR 0.96, 95% CI 0.71 to 1.29; I2 = 53%; 9 studies, 1278 women; low-certainty evidence). There was no evidence of a difference between the groups for dyspareunia or quality of life. Transvaginal permanent mesh versus any other permanent mesh or biological graft vaginal repair Sparse reporting of primary outcomes in both comparisons significantly limited any meaningful analysis. AUTHORS' CONCLUSIONS While transvaginal permanent mesh is associated with lower rates of awareness of prolapse, repeat surgery for prolapse, and prolapse on examination than native tissue repair, it is also associated with higher rates of total repeat surgery (for prolapse, stress urinary incontinence, or mesh exposure), bladder injury, and de novo stress urinary incontinence. While the direction of effects and effect sizes are relatively unchanged from the 2016 version of this review, the certainty and precision of the findings have all improved with a larger sample size. In addition, the clinical relevance of these data has improved, with 10 trials reporting 3- to 10-year outcomes. The risk-benefit profile means that transvaginal mesh has limited utility in primary surgery. Data on the management of recurrent prolapse are of limited quality. Given the risk-benefit profile, we recommend that any use of permanent transvaginal mesh should be conducted under the oversight of the local ethics committee in compliance with local regulatory recommendations. Data are not supportive of absorbable meshes or biological grafts for the management of transvaginal prolapse.
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Affiliation(s)
- Ellen Yeung
- Royal Brisbane and Women's Hospital, Brisbane, Australia
- Gold Coast Health, Gold Coast, Australia
| | | | | | - Nir Haya
- Rambam Medical Centre, and Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | - Sheila A Wallace
- Evidence Synthesis Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Alex Mowat
- Greenslopes Hospital, Brisbane, Australia
| | - Christopher Maher
- Wesley and Royal Brisbane and Women's Hospitals, Brisbane, Australia
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Wada N, Mizunaga M, Abe N, Miyauchi K, Kobayashi S, Ohtani M, Tsunekawa R, Nagabuchi M, Morishita S, Ohyama T, Yamaguchi S, Iuchi H, Noda T, Saga Y, Motoya T, Kawakami N, Nishihara M, Numata A, Kakizaki H. Comparison of mirabegron and vibegron for clinical efficacy and safety in female patients with overactive bladder: a multicenter prospective randomized crossover trial. World J Urol 2024; 42:113. [PMID: 38431689 DOI: 10.1007/s00345-024-04799-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/16/2024] [Indexed: 03/05/2024] Open
Abstract
PURPOSE To compare the efficacy and safety of mirabegron and vibegron in female OAB patients. METHODS We conducted a multicenter, prospective, randomized crossover study of female patients with OAB. The patients were assigned to Group MV (mirabegron for 8 weeks, followed by vibegron for 8 weeks) or group VM (vibegron for 8 weeks, followed by mirabegron for 8 weeks). The primary endpoint was the change in OABSS from baseline, and the secondary endpoint was the change in FVC parameters. After completion of the study, each patient was asked which drug was preferable. RESULTS A total of 83 patients were enrolled (40 and 43 in groups MV and VM, respectively). At 8th and 16th week, 33 and 29 in Group MV and 34 and 27 in Group VM continued to receive the treatment. The change in PVR was not significantly different between treatment with mirabegron and vibegron. The changes in OABSS, nighttime frequency, mean, and maximum voided volume were similar between mirabegron and vibegron. The mean change in the daytime frequency was greater in the vibegron than in the mirabegron. Of the 56 patients, 15 (27%) and 30 (53%) preferred mirabegron and vibegron, respectively. The remaining 11 patients (20%) showed no preference. The change in the urgency incontinence score during vibegron was better in patients who preferred vibegron to mirabegron. CONCLUSION The efficacies of mirabegron and vibegron in female patients was similar. The patients' preference for vibegron could depend on the efficacy of vibegron for urgency incontinence.
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Affiliation(s)
- Naoki Wada
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan.
| | | | - Noriyuki Abe
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Kotona Miyauchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Shin Kobayashi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Miyu Ohtani
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Ryoken Tsunekawa
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Masaya Nagabuchi
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Shun Morishita
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
| | - Teppei Ohyama
- Department of Urology, Kitasaito Hospital, Asahikawa, Japan
| | | | - Hiromichi Iuchi
- Department of Urology, Hokushinkai Megumino Hospital, Eniwa, Japan
| | - Tsuyoshi Noda
- Department of Urology, Fukagawa City Hospital, Fukagawa, Japan
| | - Yuji Saga
- Department of Urology, Fukagawa City Hospital, Fukagawa, Japan
| | - Tadasu Motoya
- Department of Urology, Asahikawa Rehabilitation Hospital, Asahikawa, Japan
| | - Norihiro Kawakami
- Department of Urology, Asahikawa Rehabilitation Hospital, Asahikawa, Japan
| | | | - Atsushi Numata
- Department of Urology, Furano Kyokai Hospital, Furano, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan
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Zhang X, Ma L, Li J, Zhang W, Xie Y, Wang Y. Mental health and lower urinary tract symptoms: Results from the NHANES and Mendelian randomization study. J Psychosom Res 2024; 178:111599. [PMID: 38309129 DOI: 10.1016/j.jpsychores.2024.111599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/28/2024] [Accepted: 01/28/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND The clinical observations suggest a correlation between lower urinary tract symptoms (LUTSs) and mental health problems. Nonetheless, establishing a direct causal relationship between them remains challenging. METHODS We initially conducted a cross-sectional study using 2005-2018 the National Health and Nutrition Examination Survey (NHANES) data. Multivariable-adjusted logistic regression was the primary statistical approach. Additionally, we employed Mendelian randomization (MR) to reducing confounding and reverse causation. Genetic instruments were obtained from publicly available genome-wide association study (GWAS) databases. Inverse Variance Weighted was the primary statistical method. RESULTS The cross-sectional study involved 29,439 participants. Individuals with mental health problems had a higher risk of urinary incontinence (OR:4.38; 95%CI:3.32-5.76; P < 0.01) and overactive bladder (OR:2.31; 95%CI:2.02-2.63; P < 0.01). MR analysis then indicated a potential causal relationship between mental health problems and LUTSs. Depression symptoms was linked with urinary tract infection (UTI) (OR:1.005; 95%CI:1.003-1.008; PFDR < 0.01). Anxiety symptoms was related to the occurrence of UTI (OR:1.024; 95%CI:1.011-1.037; PFDR < 0.01) and bladder calcified/ contracted/ overactive (OR:1.017; 95%CI:1.007-1.027; PFDR < 0.01). The personality trait of neuroticism was related to the occurrence of cystitis (OR:1.072; 95%CI:1.022-1.125; PFDR = 0.02), extravasation of urine and difficulties with micturition (OR:1.001; 95%CI:1.001-1.002; PFDR < 0.01), and urinary frequency and incontinence (OR: 1.001; 95%CI:1.000-1.001; PFDR < 0.01). CONCLUSIONS Our study provides various evidence for the correlation between mental health and LUTSs, emphasizing the significance of adopting a holistic approach to LUTSs management that incorporates both physical and psychological factors.
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Affiliation(s)
- Xiaotian Zhang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Leilei Ma
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jing Li
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Wei Zhang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yiran Xie
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yaoguang Wang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China.
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Dai J, Jin Z, Zhang X, Lian F, Tu J. Efficacy of Warm Acupuncture Therapy Combined with Kegel Exercise on Postpartum Pelvic Floor Dysfunction in Women. Int Urogynecol J 2024; 35:599-608. [PMID: 38236284 PMCID: PMC11023953 DOI: 10.1007/s00192-023-05698-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/12/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to observe the clinical efficacy of warm acupuncture combined with Kegel exercise in treating postpartum pelvic floor dysfunction in women. METHODS A total of 70 primiparous women with postpartum pelvic floor muscle (PFM) injury were randomly divided into a combination group (n = 35, receiving warm acupuncture at Zhibian (BL54) acupoint and Kegel exercise) and a sham control group (n = 35, receiving sham warm acupuncture and Kegel exercise). Both groups were treated three times a week for 4 consecutive weeks. The recovery of PFM strength and changes in Urethral Rotation Angle (URA), Bladder Neck Descent (BND), and Retrovesical Angle (RVA) in pelvic floor ultrasound reports, the scores of pelvic floor dysfunction-related questionnaires, and the efficacy of urinary incontinence treatment of the two groups were compared before and after treatment. RESULTS After treatment, the recovery rates of type I and II PFM strength, pelvic floor ultrasound parameters, pelvic floor dysfunction-related scale scores, and urinary incontinence treatment efficacy in the combination group were significantly better than those in the sham control group (p < 0.05). CONCLUSION Warm acupuncture combined with Kegel exercise can significantly improve PFM strength and promote the recovery of postpartum pelvic floor function in women.
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Affiliation(s)
- Jinling Dai
- Shanghai University of Traditional Chinese Medicine, City Seven Clinical Medical College, Shanghai, 201203, China
| | - Zhu Jin
- Department of Acupuncture, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China.
| | - Xiaojin Zhang
- Department of Acupuncture, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Feng Lian
- Department of Ultrasound, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, 200137, China
| | - Jie Tu
- Shanghai University of Traditional Chinese Medicine, City Seven Clinical Medical College, Shanghai, 201203, China
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Chen Y, Song X, Lv T, Huang J, Cai Z, Yan J. A modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique for male stress urinary incontinence: a pilot study. Int Urol Nephrol 2024; 56:901-912. [PMID: 37837505 DOI: 10.1007/s11255-023-03822-8] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/29/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES The aim of this study was to demonstrate the feasibility of a modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique for the treatment of male urinary incontinence and to preliminarily evaluate the short-term clinical efficacy of this technique. PATIENTS AND METHODS The clinical data of patients treated with the modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique using a Pelvimesh pelvic floor repair patch as a sling were collected. The primary evaluation criteria were surgery-related indicators and daily urinal pad usage before and after treatment, and the secondary evaluation criteria were the corresponding incontinence scores and the results of surgery-related questionnaires. RESULTS After 1-12 months of follow-up, seven patients were clinically cured. Follow-up 1 month after surgery showed that one patient (14.3%) used one pad daily, and six patients (85.7%) did not need pads. The incontinence quality of life questionnaire (I-QOL) scores at 3 days and 1 month postoperatively were 89.4 ± 2.5 and 88.1 ± 6.7, respectively, which were significantly higher than the preoperative scores (31.5 ± 18.9) (P < 0.05). The scores of the International Continence Control Association Incontinence Questionnaire Short Form (ICI-Q-SF) at 3 days and 1 month postoperatively were 3.2 ± 0.9 and 4.2 ± 1.7, respectively, which were significantly lower than the preoperative scores of 19.4 ± 5.0 (P < 0.05). In addition, the results of the surgery-related questionnaires were positive. No serious complications occurred in any of the patients. CONCLUSION The modified sling mid-urethral suspension + subcutaneous tunnel-double point fixation technique for the treatment of male urinary incontinence patients is safe, effective, minimally invasive, and has few complications. However, further validation in large sample, randomized, comparative, and longer-term follow-up studies is still needed.
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Affiliation(s)
- Yingxiu Chen
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medicine University, 54 Youdian Road, Hangzhou, 310000, Zhejiang, China
- Department of Urology, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China
- Department of Urology, Hainan Western Central Hospital, Danzhou, Hainan, China
| | - Xin Song
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Tingting Lv
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Jin Huang
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Zhikang Cai
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China
| | - Jiasheng Yan
- Department of Urology, The First Affiliated Hospital of Zhejiang Chinese Medicine University, 54 Youdian Road, Hangzhou, 310000, Zhejiang, China.
- Department of Urology, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China.
- Department of Urology, Shanghai Pudong New Area Gongli Hospital, Shanghai, China.
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Bai S, Lu C, Kong Q, Shen Z, Li R, Xiao Z. Establishing a Rat Model of Pelvic Organ Prolapse with All Compartment Defects by Persistent Cervical Tension. Int Urogynecol J 2024; 35:615-625. [PMID: 38265454 PMCID: PMC11024045 DOI: 10.1007/s00192-024-05734-2] [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: 11/27/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024]
Abstract
INTRODUCTION AND HYPOTHESIS We hypothesized that applying cervical suction and persistent tension can develop a novel and efficient rat model of pelvic organ prolapse. METHODS Fifteen rats underwent pilot testing to optimize the protocol. Sixteen rats were subjected to pelvic organ prolapse induction by cervical suction and constant traction, while five rats served as controls. The pelvic organ prolapse rats were assessed by a Rat Pelvic Organ Prolapse Quantification system at different time points, and their diet, urine, and stool were monitored for 21 days. The pelvic organ prolapse rats were also evaluated for urinary incontinence, urinary retention, leak point pressure, and vaginal histopathology at 21 days after operation. RESULTS This rat model demonstrated pelvic floor prolapse in anatomic level, as well as physiological variations (urine incontinence, urinary retention) and pathological changes (collagen fracture, decreased collagen density). CONCLUSIONS This is the first establishment of the pelvic organ prolapse rat model with all compartment defects, which provides a valuable tool for elucidating pelvic organ prolapse mechanisms and evaluating potential interventions.
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Affiliation(s)
- Siqi Bai
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China
| | - Chenxi Lu
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China
| | - Qingyu Kong
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China
| | - Zhuowei Shen
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China
| | - Rui Li
- Department of Physics, Dalian University of Technology, Dalian, China.
| | - Zhen Xiao
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian, China.
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Pfeuti CK, Madsen A, Habermann E, Glasgow A, Occhino JA. Postoperative Complications After Sling Operations for Incontinence: Is Race a Factor? Urogynecology (Phila) 2024; 30:197-204. [PMID: 38484232 DOI: 10.1097/spv.0000000000001451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Racial and ethnic disparities exist in urogynecologic surgery; however, literature identifying specific disparities after sling operations for stress incontinence are limited. OBJECTIVE The objective of this study was to evaluate racial and ethnic disparities in surgical complications within 30 days of midurethral sling operations. STUDY DESIGN This retrospective cohort study identified women who underwent an isolated midurethral sling operation between 2014 and 2021 using the American College of Surgeons National Surgical Quality Improvement Program database. Women were stratified by racial and ethnic category to assess the primary outcome, 30-day surgical complications, and the secondary outcome, comparison of urinary tract infections (UTIs). RESULTS There were 20,066 patients included. Mean age and body mass index were 53.9 years and 30.8, respectively. More Black or African American women had diabetes and hypertension, and more American Indian or Alaska Native women used tobacco. The only difference in 30-day complications was stroke/cerebrovascular accident, which occurred in only 1 Asian, Native Hawaiian or other Pacific Islander patient (0.1%, P < 0.0001). The most frequent complication was UTI (3.3%). Black or African American women were significantly less likely to have a diagnosis of UTI than non-Hispanic White (P = 0.04), Hispanic White (P = 0.03), and American Indian or Alaska Native women (P = 0.04). CONCLUSIONS Surgical complications within 30 days of sling operations are rare. No clinically significant racial and ethnic differences in serious complications were observed. Urinary tract infection diagnoses were lower among Black or African American women than in non-Hispanic White, Hispanic White, and American Indian or Alaska Native women despite a greater comorbidity burden. No known biologic reason exists to explain lower UTI rates in this population; therefore, this finding may represent a disparity in diagnosis and treatment.
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Affiliation(s)
| | - Annetta Madsen
- Mayo Clinic, Division of Female Pelvic Medicine & Reconstructive Surgery, Rochester, MN
| | | | - Amy Glasgow
- Mayo Clinic, Division of Female Pelvic Medicine & Reconstructive Surgery, Rochester, MN
| | - John A Occhino
- Mayo Clinic, Division of Female Pelvic Medicine & Reconstructive Surgery, Rochester, MN
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Koch VH, Lopes M, Furusawa E, Vaz K, Barroso U. Multidisciplinary management of people with spina bifida across the lifespan. Pediatr Nephrol 2024; 39:681-697. [PMID: 37501019 DOI: 10.1007/s00467-023-06067-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 07/29/2023]
Abstract
The average worldwide prevalence of neural tube defects (NTDs) is 1.0 per 1000 births. Its development is multifactorial due to genetic and non-genetic factors. Spina bifida (SB) is one of main representatives of NTD. The spinal cord lesion level is the main determinant of the level of paralysis, numbness, and difficulties with bladder/bowel functions. Myelomeningocele prenatal repair reduces hydrocephalus and hindbrain herniation and improves motor function. The severity of hydrocephalus is associated with poorer neurodevelopmental outcomes whether operated on prenatally or after birth. People with SB tend to have a lower IQ and cognitive difficulties. Early diagnosis, proactivity, and lifelong multidisciplinary follow-up are key protective issues. Invasive urological interventions should be considered in selected patients after failure of conservative treatment. Transition to adult care should be well planned as it is challenging. Health literacy is directly associated with success at transition. Sexuality and fertility should be addressed before/during puberty. Overall, the rates of fecal and urinary continence and skin breakdown increase with age, whereas the ability to ambulate declines with age. Bowel and urinary incontinence are independent predictors of lower health-related quality of life (HRQoL) in adults with SB. Bowel incontinence has negative impact on HRQoL regardless of frequency or amount. Long-term caregiver support should be offered at diagnosis. Survival at a mean of 50 years is poor, at 32%, due to central nervous system deaths, cancer, urological disease, and sepsis. Challenges to implementation of recommended practices exist, especially in low and middle-income countries.
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Affiliation(s)
- Vera H Koch
- Pediatric Nephrology Unit, Department of Pediatrics, University of São Paulo Medical School, Children's Hospital, Hospital das Clinicas, Sau Paulo, Brazil.
| | - MarcosTomasin Lopes
- Pediatric Nephrology Unit, Department of Pediatrics, University of São Paulo Medical School, Children's Hospital, Hospital das Clinicas, Sau Paulo, Brazil
| | - Erika Furusawa
- Pediatric Nephrology Unit, Department of Pediatrics, University of São Paulo Medical School, Children's Hospital, Hospital das Clinicas, Sau Paulo, Brazil
| | - Katharinne Vaz
- Division of Urology, Federal University of Bahia - UFBA, Salvador, BA, Brazil
| | - Ubirajara Barroso
- Division of Urology - Federal University of Bahia, Bahiana School of Medicine, Salvador, BA, Brazil
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Brown A, Ferguson L, Castillo J, Nguyen HXT, Ervin C, Whishaw DM, Bower W. Determinants of Bladder Care at Night in a Subacute Ward for Aged Patients: An Observational Study. J Wound Ostomy Continence Nurs 2024; 51:146-151. [PMID: 38215216 DOI: 10.1097/won.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
PURPOSE The purpose of this study was to evaluate how bladder care at night correlates to patients' mobility status. DESIGN This was an observational study. SUBJECTS AND SETTING The sample comprises 63 aged care subacute patients who were observed over 3 consecutive nights in an inpatient subacute aged care ward located in Melbourne, Australia. Half of the participants were female; their mean age was 82.0 (standard deviation 8.2) years. Data were collected from December 2020 to March 2021. METHODS Outcome variables included demographic and pertinent clinical characteristics, type and timing of toileting and/or bladder care provided, and mobility classification. Descriptive statistics were used to summarize the frequency of nocturnal bladder care provided each night and as a mean over the 3 nights. The relationship between the type of care units provided and other variables was explored using a 1-way analysis of variance; values ≤.05 were deemed statistically significant. RESULTS Findings indicate that 27% (n = 17), 41% (n = 26), and 48% (n = 30) of participants required assistance to move in bed, sit up in bed, and stand from sitting, respectively. Care episodes for both incontinence and assistance with voiding were significantly associated with functional mobility in bed ( F = 5.52, P < .001; F = 2.14, P = .02) and with ambulation independence ( F = 3.52, P = .001; F = 2.04, P = .03) but not with age or ambulation distance. CONCLUSIONS Care provided for urinary incontinence during the night was related to the need for physical support of ambulation and poor mobility in bed. Targeted input from a multidisciplinary team is warranted to facilitate change of practice at night.
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Affiliation(s)
- Adelle Brown
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Laura Ferguson
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Jasper Castillo
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Huong Xuan Thi Nguyen
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Claire Ervin
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - David Michael Whishaw
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
| | - Wendy Bower
- Adelle Brown, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Laura Ferguson, BPT(Hons), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, Parkville, Australia
- Jasper Castillo, BSN, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Huong Xuan Thi Nguyen, FRACP, MBBS, BiomedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Memory Loss and Dementia Support Service, Merri Health, and Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Australia
- Claire Ervin, RN, MNurs (Urology), GradDipNurse (Comm Health), Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
- David Michael Whishaw, FRACP, MBBS, BMedSci, Department of Medicine and Aged Care, Royal Melbourne Hospital, Parkville, Australia
- Wendy Bower, FACP, PhD, Grad Dip Epid & Biostat, BAppSc (Physio), Physiotherapy Department, Department of Allied Health, Royal Melbourne Hospital, and Department of Medicine and Aged Care, Royal Melbourne Hospital, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, and Sub-Acute Community Services, Royal Melbourne Hospital, Parkville, Australia
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Pontieri-Lewis VV. WOC Nursing History-Reflections: Dr Rupert Turnbull. J Wound Ostomy Continence Nurs 2024; 51:95. [PMID: 38527314 DOI: 10.1097/won.0000000000001064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
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Tourinho-Barbosa R, Sanchez-Salas R, Sivaraman A, Borges RC, Candela L, Batista LT, Cathala N, Mombet A, Marra G, Sanchez LR, Boumezrag CB, Lanz C, Macek P, Cathelineau X, Korkes F. Urinary Symptoms Change and Quality of Life After Robotic Radical Prostatectomy: A Secondary Analysis of a Randomized Controlled Trial. Urology 2024; 185:73-79. [PMID: 38281669 DOI: 10.1016/j.urology.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/26/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To present the patient-reported quality of life (QoL) outcomes from a prospective, randomized controlled trial comparing the use of pelvic floor muscle training (PFMT) and duloxetine after robot-assisted radical prostatectomy (RARP). METHODS We identified 213 men with organ-confined disease having post-RARP urinary incontinence who were randomly assigned to received PFMT, duloxetine, combined PFMT-duloxetine and pelvic floor muscle home exercises. Urinary symptoms burden was measured by marked clinical important difference improvement (MCID) defined by using the International Prostate Symptom Score (IPSS) difference of - 8 points (ΔIPSS ≤-8). QoL was assessed according to Visual Analog Scale (VAS), King's Health Questionnaire (KQH), and International Index of Erectile Function (IIEF-5). Multivariable regression analyses aimed to predict MCID, burden of urinary symptoms (IPSS ≥8), and patients reporting to be satisfied (IPSS QoL ≤2) or comfortable (VAS ≤1) post-RARP. RESULTS Moderate to severe urinary symptoms decreased from 48% preoperatively to 40%, 34%, and 23% at 3, 6, and 12months post-RARP. After surgery, MCID improvement was observed in 19% of patients, and deterioration in 3.3%. Large prostate was the only factor associated to MCID (OR 1.03 [95%CI 1.01-1.05], P = .005). At 6months, patients reached the same degree of preoperative satisfaction. Neurovascular bundle preservation was the only predictor of being comfortable regarding urinary symptoms postoperatively (OR 12.8 [CI95% 1.47-111.7], P = .02 at 3months) and was also associated to higher median postoperative IIEF-5. CONCLUSION Despite urinary incontinence following RARP, patients with larger prostates experience a reduction of lower urinary tract symptoms within a year, which subsequently elevates QoL. Furthermore, nerve-sparing surgery augments erectile function and urinary outcomes, shaping postoperative QoL.
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Affiliation(s)
- Rafael Tourinho-Barbosa
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil; Department of Urology, Hospital Cardio Pulmonar, Salvador, Brazil
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada.
| | - Arjun Sivaraman
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Castilho Borges
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
| | - Luigi Candela
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | | | - Nathalie Cathala
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Annick Mombet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Lara Rodriguez Sanchez
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Chahrazad Bey Boumezrag
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Camille Lanz
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Fernando Korkes
- Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
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Aránguiz-Ramírez J, Olivares-Tirado P, Baeza-Correa C, Castells X. Urinary incontinence in health workers as a predisposing factor for presenteeism in Chile: A mixed-methods exploratory study. Medwave 2024; 24:e2779. [PMID: 38412202 DOI: 10.5867/medwave.2024.01.2779] [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] [Indexed: 02/29/2024] Open
Abstract
Introduction Urinary incontinence negatively impacts the quality of life and can harm work activities, causing presenteeism in health professionals and decreasing the quality of care and patient safety. The objective of this study is to explore the self-perception of health workers who suffer from urinary incontinence as a predisposing factor for presenteeism. Methods Mixed study of an exploratory-descriptive nature. The sample was selected in a non-probabilistic and intentional way by criterion and convenience with a size of 14 volunteers, considering the saturation of the information. Reliability criteria defined by Guba for the process and analysis of thematic data were considered. Results The sample had a mean age of 38.9 + 7.1 years and a mean SPS-6 score of 15.8 + 3.5 points, showing alteration in the dimension of avoiding deconcentration. The narratives in the case study provide relevant information on how urinary incontinence affects the work performance of health workers through the interruption in their day, decreases the quality of clinical care, and increases their anxiety regarding their environment. Conclusions Urinary incontinence and presenteeism are subjective, and multidimensional experiences affect work performance. Therefore, further studies are recommended to identify predictor variables and the economic losses associated with this condition to establish improvements in the work environment and the self-care of female employees seeking greater benefits and better levels of efficiency in the organization.
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Affiliation(s)
- Julieta Aránguiz-Ramírez
- Programa de Doctorado en Metodología de la Investigación Biomédica y Salud Pública, Departamento de Pediatría, Obstetricia y Ginecología, Medicina Preventiva y Salud Pública, Universidad Autónoma de Barcelona, Barcelona, España
| | - Pedro Olivares-Tirado
- Centro de Investigación en Innovación Terapéutica del Programa de Postgrado en Gestión y Economía de la Salud, Universidad Federal de Pernambuco, Recife, Brasil
| | - Cecilia Baeza-Correa
- Escuela de Obstetricia y Neonatología, Facultad de Salud y Odontología, Universidad Diego Portales, Santiago, Chile
| | - Xavier Castells
- Departamento de Epidemiología y Evaluación, Instituto Hospital del Mar de Investigaciones Médicas, Barcelona, España
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Qasemi A, Aminian A, Erfanian A. Real-time prediction of bladder urine leakage using fuzzy inference system and dual Kalman filtering in cats. Sci Rep 2024; 14:3879. [PMID: 38365925 PMCID: PMC10873426 DOI: 10.1038/s41598-024-53629-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 02/02/2024] [Indexed: 02/18/2024] Open
Abstract
The use of electrical stimulation devices to manage bladder incontinence relies on the application of continuous inhibitory stimulation. However, continuous stimulation can result in tissue fatigue and increased delivered charge. Here, we employ a real-time algorithm to provide a short-time prediction of urine leakage using the high-resolution power spectrum of the bladder pressure during the presence of non-voiding contractions (NVC) in normal and overactive bladder (OAB) cats. The proposed method is threshold-free and does not require pre-training. The analysis revealed that there is a significant difference between voiding contraction (VC) and NVC pressures as well as band powers (0.5-5 Hz) during both normal and OAB conditions. Also, most of the first leakage points occurred after the maximum VC pressure, while all of them were observed subsequent to the maximum VC spectral power. Kalman-Fuzzy method predicted urine leakage on average 2.2 s and 1.6 s before its occurrence and an average of 2.0 s and 1.1 s after the contraction started with success rates of 94.2% and 100% in normal and OAB cats, respectively. This work presents a promising approach for developing a neuroprosthesis device, with on-demand stimulation to control bladder incontinence.
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Affiliation(s)
- Amirhossein Qasemi
- Department of Biomedical Engineering, School of Electrical Engineering, Iran Neural Technology Research Center, Iran University of Science and Technology (IUST), Tehran, Iran
| | - Alireza Aminian
- Department of Biomedical Engineering, School of Electrical Engineering, Iran Neural Technology Research Center, Iran University of Science and Technology (IUST), Tehran, Iran
| | - Abbas Erfanian
- Department of Biomedical Engineering, School of Electrical Engineering, Iran Neural Technology Research Center, Iran University of Science and Technology (IUST), Tehran, Iran.
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Qian X, Ren D, Gu L, Ye C. Incidence and risk factors of stress urinary incontinence after laparoscopic hysterectomy. BMC Womens Health 2024; 24:105. [PMID: 38331777 PMCID: PMC10851496 DOI: 10.1186/s12905-024-02942-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE To observe the long-term effects of total hysterectomy on urinary function, evaluate the effects of preoperative nutritional status, urinary occult infection, and surgical factors on the induction of postoperative stress urinary incontinence (SUI), and explore the incidence and risk factors of SUI. STUDY DESIGN From January 2017 to December 2017, 164 patients with benign non-prolapsing diseases who underwent a laparoscopic total hysterectomy in the First People's Hospital of Taicang were selected as the analysis objects. The International Incontinence Standard Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS) and Pelvic Floor Impact Questionnaire-short version 20 (PFDI-20) were used for telephone follow-up to subjectively assess the urinary function of patients, collect their medical records, and statistically analyze the number of postoperative SUI cases. Logistic multivariate analysis was used to analyze the influencing factors of postoperative female SUI, presented as adjusted odds ratios with 95% confidence intervals. RESULTS Only 97 out of 164 patients completed the ICIQ-FLUTS and PFDI-20 questionnaires. Among these participants, 28 patients (28.86%) were diagnosed with SUI (study group), while 69 patients (71.13%) were classified as women without SUI (control group). The age, menopause, parity ≥ 2 times, Body mass index (BMI) ≥ 28 kg/m2, neonatal weight ≥ 4000 g, history of chronic cough, preoperative hemoglobin ≤ 100 g/L, preoperative urine bacteria ≥ 100u/L, preoperative uterine volume ≥ 90 cm3, intraoperative blood loss, and operation time of the study group were compared with those of the control group. The differences were statistically significant (P < 0.05). Further Logistic multivariate analysis showed that menopause, preoperative hemoglobin ≤ 100 g/L, preoperative urine bacteria ≥ 100u/L, uterine volume ≥ 90 cm3, history of chronic cough, BMI ≥ 28 kg/m2 were risk factors for postoperative SUI in patients undergoing hysterectomy (P < 0.05). CONCLUSIONS Hysterectomy for benign non-prolapse diseases has a long-term potential impact on the urinary system of patients, and the risk of postoperative SUI increases. The main risk factors of SUI are parity, menopausal status, obesity, preoperative nutritional status, and occult infection of the urinary system.
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Affiliation(s)
- XiaoHong Qian
- Department of Gynecology, Taicang Affiliated Hospital of Soochow University (The First People's Hospital of Taicang), Taicang, Jiangsu Province, 215400, China
| | - DongFang Ren
- Department of Gynecology, Taicang Affiliated Hospital of Soochow University (The First People's Hospital of Taicang), Taicang, Jiangsu Province, 215400, China
| | - liJuan Gu
- Department of Obstetrics, Taicang Affiliated Hospital of Soochow University (The First People's Hospital of Taicang), Taicang, Jiangsu Province, 215400, China
| | - Cong Ye
- Department of Gynecology, Taicang Affiliated Hospital of Soochow University (The First People's Hospital of Taicang), Taicang, Jiangsu Province, 215400, China.
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Liu H, Li Y, Zheng H, Miao Y, Zhao S, Sun W, Zhang Y. Clinical efficacy of traditional Chinese medicine therapy for female stress urinary incontinence: a meta-analysis. Rev Esc Enferm USP 2024; 57:e20230153. [PMID: 38315803 PMCID: PMC10849677 DOI: 10.1590/1980-220x-reeusp-2023-0153en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/08/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVES To investigate the efficacy of traditional Chinese medicine (TCM) in the treatment of female stress urinary incontinence (SUI). METHOD PubMed, Cochrane, Web of Science, Embase, CNKI, Wanfang, and VIP databases were searched for articles published up to September 2022. Variables were analyzed using weighted mean difference (WMD), standardized mean difference (SMD), odds ratios (OR), and 95% confidence interval (CI). RESULTS Eight studies containing 744 patients were included in this study. The results demonstrate that TCM therapy had more advantages in improving the clinical outcome of SUI patients (OR = 2.90, 95%CI:1.92-4.37, P = 0.000), reducing the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF) score (WMD = -2.41, 95%CI:-2.83- -1.98, P = 0.000), reducing 1-h urinary pad leakage urine volume (WMD = -1.86, 95%CI:-2.23- -1.49, P = 0.000) and increasing Maximum urethral closure pressure (MUCP) (SMD = 0.86, 95%CI: 0.61-1.11, P = 0.000). CONCLUSION TCM therapy is effective in improving urinary incontinence symptoms, urodynamics, and quality of life in patients with SUI. This article provides a reference for the application of TCM therapy in women with urinary incontinence.
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Affiliation(s)
- Hui Liu
- Shandong Second Medical University, School of Nursing, Weifang, Shandong Province, China
| | - Yanan Li
- Shandong Second Medical University, School of Nursing, Weifang, Shandong Province, China
| | - Han Zheng
- Shandong Second Medical University, College of Traditional Chinese Medicine, Weifang, Shandong Province, China
| | - Yiqun Miao
- Shandong Second Medical University, School of Nursing, Weifang, Shandong Province, China
| | - Shuliang Zhao
- Shandong Second Medical University, School of Nursing, Weifang, Shandong Province, China
| | - Wenting Sun
- Shandong Second Medical University, School of Nursing, Weifang, Shandong Province, China
| | - Yuanyuan Zhang
- Shandong Second Medical University, School of Nursing, Weifang, Shandong Province, China
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Butori S, Bonanno N, Rico L, Contreras PN, Pagano EM, Blas L. Stent Syndrome: Does the Diameter Matter? Results of a Randomized Trial. J Endourol 2024; 38:193-197. [PMID: 38062759 DOI: 10.1089/end.2023.0378] [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] [Indexed: 02/24/2024] Open
Abstract
Introduction: Double-J (DJ) ureteral stents are used for multiple purposes in urology. Even though they temporize the subsequent treatment of lithiasis, they may cause different symptoms that impact quality of life (QoL). Purpose: In this randomized trial, we assessed whether the diameter of ureteral stents has an impact on catheter-associated symptoms, and their impact on QoL. Methods: A total of 194 consecutive patients undergoing DJ insertion between December 2018 and December 2022 were prospectively enrolled and divided into three categories: 4.7F (Group 1, n = 71), 6F (Group 2, n = 65), and 7F (Group 3, n = 58). Within 1 week after the DJ placement, patients completed the validated Spanish version of the Ureteral Stent Symptoms Questionnaire. Continuous variables were compared using analysis of variance and Student's t-tests. For categorical data, the chi-square test was used. Results: In the domain of "work" and "additional problems," there were significant differences. In the "Work" domain, Group 1 presented the lower symptoms. In the domain "additional problems," patients in Group 1 were prescribed fewer antibiotics owing to low urinary tract symptoms. In question U4 about urinary incontinence, patients in Groups 2 and 3 developed these symptoms more than patients in Group 1. In the "sexual activity" domain, specifically in question S3 (the patient has ever suffered any type of pain during sexual activity?), patients with 4.7F presented lower scores than patients with larger catheters. Conclusion: DJ-related symptoms affect QoL in most cases. Smaller catheters produced significantly less urinary incontinence, faster work reincorporation, fewer symptoms related to sexual activity, and fewer catheter-related symptoms than 7F catheters. In contrast, Group 3 presented fewer outpatient visits because of symptoms related to the DJ.
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Affiliation(s)
- Sofia Butori
- Department of Urology, Hospital Aleman of Buenos Aires, Buenos Aires, Argentina
| | - Nicolas Bonanno
- Department of Urology, Hospital Aleman of Buenos Aires, Buenos Aires, Argentina
| | - Luis Rico
- Department of Urology, Hospital Aleman of Buenos Aires, Buenos Aires, Argentina
| | | | | | - Leandro Blas
- Department of Urology, Hospital Aleman of Buenos Aires, Buenos Aires, Argentina
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Canmemiş A, Aydöner S, Kerem Özel Ş. Impact of patient position on cystometric parameters in pediatric patients with neurogenic bladder: A prospective study. Neurourol Urodyn 2024; 43:390-395. [PMID: 38169130 DOI: 10.1002/nau.25375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/04/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
AIMS Urodynamic studies (UDSs) play a crucial role in evaluating lower urinary tract function in pediatric patients with neurogenic bladder. However, the influence of patient position on urodynamic parameters in this population remains understudied. This study aims to investigate the effect of patient position on urodynamic results in children with neurogenic bladder. METHODS A prospective study was conducted with 50 pediatric patients diagnosed with neurogenic bladder. Urodynamic recordings were obtained during a single session, with the first two fillings in the supine position and the third filling in the sitting position. Urodynamic parameters assessed included detrusor overactivity (DO), maximum detrusor pressure (MDP), cystometric bladder capacity (CBC), compliance (C), detrusor leak point pressure (DLPP), and bladder volume at the moment of incontinence (DLPV). RESULTS Patient position did not significantly influence CBC, DO, C, and DLPV (p > 0.05). However, there were significant differences in MDP and DLPP between the supine and sitting positions (p < 0.05), with higher values observed in the supine position. CONCLUSIONS These findings highlight the importance of considering the patient's position when interpreting urodynamic results and making treatment decisions for children with neurogenic bladder. The higher MDP and DLPP values in the supine position may have clinical implications for assessing upper urinary tract integrity and treatment planning. However, further research is needed to understand the underlying mechanisms and generalize these findings to broader patient populations.
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Affiliation(s)
- Arzu Canmemiş
- Department of Pediatric Urology, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
| | - Sinem Aydöner
- Department of Pediatric Surgery, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
| | - Şeyhmus Kerem Özel
- Department of Pediatric Urology, Faculty of Medicine, Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Türkiye
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Brownrigg N, Lorenzo AJ, Rickard M, Dos Santos J. The urological evaluation and management of neurogenic bladder in children and adolescents-what every pediatric nephrologist needs to know. Pediatr Nephrol 2024; 39:409-421. [PMID: 37518419 DOI: 10.1007/s00467-023-06064-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 08/01/2023]
Abstract
Neurogenic bladder (NGB) is an encompassing term that includes multiple causes of bladder dysfunction linked to a congenital or acquired neurological condition that adversely impacts the innervation of the lower urinary tract. Multiple static or progressive conditions can be associated with NGB in pediatric and adolescent patients. Currently, spinal dysraphism (i.e., spina bifida) is one of the most common etiologies, which occurs in 3-4 per 10,000 live births in developed nations. Abnormal bladder dynamics can lead to kidney damage secondary to high pressures or recurrent infections, as well as urinary incontinence. The current management paradigm centers on a proactive approach to preserving kidney function and achieving continence through behavioral, pharmacological, and surgical means. This educational review highlights the key components of urological management to maximize collaboration with pediatric nephrologists.
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Affiliation(s)
- Natasha Brownrigg
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Armando J Lorenzo
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Mandy Rickard
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Joana Dos Santos
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Carletti V, Yacoub V, Grilli D, Morgani C, Palazzetti PL, Zullo MA, Luffarelli P, Valensise HC, Maneschi F, Spina V, Schiavi MC. Sequential combined approach in patients with mixed urinary incontinence: surgery followed by posterior tibial nerve stimulation. Minerva Obstet Gynecol 2024; 76:7-13. [PMID: 35785925 DOI: 10.23736/s2724-606x.22.05106-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND The aim of the study was to demonstrate the efficacy of sequential combined treatment with transobturator tape (TOT) followed by posterior tibial nerve stimulation (PTNS) in patients with mixed urinary incontinence (MUI); quality of life and patients' satisfaction was also assessed. METHODS Retrospective analysis on women affected by MUI with prevalent Stress Urinary Incontinence (SUI) component. Women, divided in 2 groups, underwent different treatments, TOT vs. TOT+PTNS. Population was assessed by medical history, previous pelvic surgery, clinical exam, urodynamic exams, pelvic ultrasound examination, and questionnaires (The International Consultation on Incontinence Questionnaire Short Form, Overactive Bladder Questionnaire, Health Related Quality of Life) comparing them before and after 12 weeks after treatment. RESULTS One hundred twelve women were enrolled in the study. The mean age was 57.96±7.34 in the first group (N.=60) and 58.29±6.14 in the second group (N.=52). Peak flow (mL/s) statistically improved after treatment, 22.23±4.29 (TOT) vs. 24.81±5.8 (TOT+PTNS). First voiding desire (mL) improved significantly between the two groups 108.72±19.24 vs. 142.43±19.98. Maximum cystometric capacity (mL) in the TOT group at 12-weeks was 328.76±82.44 vs. TOT+PTNS group of 396.26±91.21. Detrusor pressure at peak flow(cmH2O) showed a greater improvement in TOT+PTNS than TOT alone 14.45±6.10 vs. 11.89±54.49. At 12-week, urinary diary and quality of life improved in terms of urgent urination events, mean number of voids, urge symptoms and nocturia events. The Patient Impression of Global Improvement (PGI-I) after 3 months was better in combined group. CONCLUSIONS Combined and sequential TOT+PTNS is more effective compared to TOT alone in MUI patients with prevalent SUI component.
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Affiliation(s)
- Valerio Carletti
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy -
| | - Veronica Yacoub
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
| | - Debora Grilli
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
- Department of Obstetrics and Gynecology, Sandro Pertini Hospital, Rome, Italy
| | - Claudia Morgani
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
- Department of Obstetrics and Gynecology, Sandro Pertini Hospital, Rome, Italy
| | - Pier L Palazzetti
- Department of Obstetrics and Gynecology, Sandro Pertini Hospital, Rome, Italy
| | - Marzio A Zullo
- Department of Surgery-Week Surgery, Campus Bio-Medico University, Rome, Italy
| | - Paolo Luffarelli
- Department of Surgery-Week Surgery, Campus Bio-Medico University, Rome, Italy
| | - Herbert C Valensise
- Department of Obstetrics and Gynecology, Tor Vergata University, Rome, Italy
- Department of Obstetrics and Gynecology, Casilino Hospital, Rome, Italy
| | - Francesco Maneschi
- Department of Obstetrics and Gynecology, San Giovanni Addolorata Hospital, Rome, Italy
| | - Vincenzo Spina
- Maternal and Child Department, San Camillo de Lellis Hospital, Rieti, Italy
| | - Michele C Schiavi
- Department of Obstetrics and Gynecology, Sandro Pertini Hospital, Rome, Italy
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Smith AL, Berry A, Brubaker L, Cunningham SD, Gahagan S, Low LK, Mueller M, Sutcliffe S, Williams BR, Brady SS. The brain, gut, and bladder health nexus: A conceptual model linking stress and mental health disorders to overactive bladder in women. Neurourol Urodyn 2024; 43:424-436. [PMID: 38078701 PMCID: PMC10872494 DOI: 10.1002/nau.25356] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 07/10/2023] [Revised: 09/28/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVE A small, but growing literature links stressors and mental health disorders (MHDs) across the life course to overactive bladder (OAB) and urinary incontinence symptoms. Mechanisms by which stressors and MHDs may impact bladder health are not fully understood, limiting novel prevention and treatment efforts. Moreover, potential biopsychosocial mechanisms involving the brain and gut have not been considered in an integrated, comprehensive fashion. METHODS Members of the prevention of lower urinary tract symptoms Research Consortium developed conceptual models to inform research on biopsychosocial mechanisms through which stress and MDHs may impact bladder health among girls and women, focusing on brain and gut physiology. RESULTS Two conceptual models were developed-one to explain central (brain-based) and peripheral (gut-based) mechanisms linking stressors and MHDs to OAB and bladder health, and one to highlight bidirectional communication between the brain, gut, and bladder. Traumatic events, chronic stressors, and MHDs may lead to a maladaptive stress response, including dysregulated communication and signaling between the brain, gut, and bladder. Gut bacteria produce molecules and metabolites that alter production of neurotransmitters, amino acids, short-chain fatty acids, and inflammatory immune response molecules that mediate communication between the gut and brain. Microbiota signal neurogenesis, microglia maturation, and synaptic pruning; they also calibrate brain-gut-bladder axis communication through neurotransmission and synaptogenesis, potentially influencing bladder symptom development. Life course trajectories of risk may be prevented or interrupted by central and peripheral resources for neuropsychological resilience. CONCLUSIONS Depicted pathways, including brain-gut-bladder communication, have implications for research and development of novel prevention and treatment approaches.
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Affiliation(s)
- Ariana L. Smith
- Division of Urology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amanda Berry
- Division of Urology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Linda Brubaker
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, University of California San Diego, La Jolla, California
| | - Shayna D. Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT
| | - Sheila Gahagan
- Department of Pediatrics, UC San Diego School of Medicine, University of California, San Diego CA
| | - Lisa Kane Low
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan
| | - Margaret Mueller
- Department of Ob/Gyn, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO
| | - Beverly R. Williams
- Department of Medicine, Division of Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham (UAB) and Birmingham/Atlanta Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs
| | - Sonya S. Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
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Reddy SM, Gray H, Barry T, Bessell B, Shalaby M, Woodward M, Awad K. Efficacy of Biofeedback in Paediatric Urology Patients: A Single Centre Experience. J Pediatr Surg 2024; 59:295-298. [PMID: 37989606 DOI: 10.1016/j.jpedsurg.2023.10.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/11/2023] [Indexed: 11/23/2023]
Abstract
AIM OF THE STUDY Biofeedback assisted pelvic floor muscle training is an underutilised nonpharmacological treatment in paediatric urology. We reviewed all patients who underwent a course of treatment at our centre to evaluate its efficacy. METHODS All patients who underwent a full cycle of biofeedback in the paediatric urology department from 2016 to 2023 were identified. Demographics and outcomes following treatment were accessed. RESULTS 42 patients (28 female) were identified who underwent 8 one-hour sessions on a weekly basis constituted a completed cycle of treatment. Patients were identified for treatment as per local lower urinary tract symptom guidelines and following discussion in a fortnightly urology MDT and including diagnoses of overactive bladder, dysfunctional voiding, and giggle incontinence. Outcomes were measured as successful 29% (continence, normal postvoid residuals, clean intermittent catherization discontinued), partially successful 19% (reduced wetting, abnormal post void residuals, ongoing CIC) and unsuccessful 52% (no change for patient). Age at time of treatment affected likelihood of success: <9 years, 0% success; ≥9 years, 57% [p < 0.05]. There was no significant difference in success for 9-11 years [60%] vs >11 years [56%]. CONCLUSIONS Biofeedback has shown success with improvement in symptoms in 48% of patients (complete or partial), which increases to 57% success in ≥9 years group. We would advocate its use in these difficult to manage patients with LUTS.
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Affiliation(s)
| | - Harriet Gray
- University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Tammy Barry
- University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Bridie Bessell
- University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Mohamed Shalaby
- University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Mark Woodward
- University Hospitals Bristol and Weston NHS Foundation Trust, UK
| | - Karim Awad
- University Hospitals Bristol and Weston NHS Foundation Trust, UK; Ain Sham University Hospital, Cairo, Egypt.
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Muranaka I, Kyoda Y, Nofuji S, Shinkai N, Hashimoto K, Kobayashi K, Tanaka T, Masumori N. [A Case of Neuropathic Lower Urinary Tract Dysfunction Due to Spina Bifida Occulta Discovered at the Age of 19 Years and Successfully Treated with Multidisciplinary Therapy]. Hinyokika Kiyo 2024; 70:55-59. [PMID: 38447946 DOI: 10.14989/actauroljap_70_2_55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
A 19-year-old man had been aware of dysuria and urinary incontinence since childhood but did not seek medical attention. He was diagnosed with acute pyelonephritis due to lower urinary tract dysfunction associated with spina bifida occulta and tethered cord syndrome (TCS) due to spinal cord lipoma. After placement of a urethral catheter and antibacterial chemotherapy, the patient was cured of acute pyelonephritis. He was treated with solifenacin and started clean self-intermittent catheterization (CIC). Shortly after the start of CIC, the acute pyelonephritis flared up again, and he was managed with a reinserted urethral catheter until an untethering operation. Preoperative video urodynamics showed that the bladder morphology was Ogawa classification grade III with vesicoureteral reflux (VUR) at 92 ml infusion. With the combination of an untethering operation and additional mirabegron, the functional bladder capacity was increased to 353 ml and VUR improved, allowing for safe urinary management of the CIC. TCS can be diagnosed at any age and requires appropriate urinary management and therapeutic intervention as early as possible after diagnosis.
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Affiliation(s)
- Ippei Muranaka
- The Department of Urology, Sapporo Medical University School of Medicine
| | - Yuki Kyoda
- The Department of Urology, Sapporo Medical University School of Medicine
| | - Seisuke Nofuji
- The Department of Urology, Sapporo Medical University School of Medicine
| | - Nobuo Shinkai
- The Department of Urology, Sapporo Medical University School of Medicine
| | - Kohei Hashimoto
- The Department of Urology, Sapporo Medical University School of Medicine
| | - Ko Kobayashi
- The Department of Urology, Sapporo Medical University School of Medicine
| | - Toshiaki Tanaka
- The Department of Urology, Sapporo Medical University School of Medicine
| | - Naoya Masumori
- The Department of Urology, Sapporo Medical University School of Medicine
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Abbott J, Billow M, Gallant T, Hackett L, Kho RM, Knapman B, Russo MAL, Maheux-Lacroix S, Gonzalez AM, Ng C, Orlando MS, Sit A, Xu X. Patient-Reported Outcome Measures Used in Randomized Controlled Trials Following Surgical Intervention for Endometriosis: A Structured Review from the AAGL Practice Guidelines Group. J Minim Invasive Gynecol 2024; 31:71-83.e17. [PMID: 37931893 DOI: 10.1016/j.jmig.2023.10.017] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/09/2023] [Accepted: 10/18/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE No consensus currently exists regarding patient-reported outcome measure (PROM) instruments. This structured review was conducted to identify the PROMs used by randomized controlled trials (RCTs) that evaluated surgical treatment in patients with endometriosis. DATA SOURCES Two parallel searches were conducted by a medical librarian using Ovid MEDLINE, Ovid Embase, and Cochrane Library for RCTs published from 2000 to July 2022. One search focused on studies reporting quality of life (QoL), and the second search focused on studies reporting pain and sexual, bowel, and bladder function. METHOD OF STUDY SELECTION During the title and abstract screening and reference check, 600 results were identified on PROMs relating to QoL and 465 studies on PROMs relating to pain and sexual, bowel, and/or bladder function and an evaluation of 17 and 12 studies conducted, respectively. The inclusion criteria involved selecting RCTs that focused on surgical intervention and assessing QoL, pain, and sexual, bowel, and/or bladder function using PROMs. TABULATION, INTEGRATION, AND RESULTS Covidence software was used to organize and identify duplicate articles through screening. We developed a data extraction form to collect key information about each included study, as well as the pertinent PROMs used in the study. Assessment of the risk of bias of each study was also performed. A total of 19 studies were identified involving 2089 participants and a total of 16 PROMs used across the studies; 9 of 19 studies (47%) were rated as having a low risk of bias. There were no high-risk studies identified in this review. CONCLUSION This study identified a large number of RCTs in surgical treatment of endometriosis that used various PROMs to assess QoL, pain, and bladder, bowel, and sexual function. The PROMs used by high-quality RCTs for QoL include Endometriosis Health Profile-30, Endometriosis Health Profile-5, Short-Form 36, Short-Form 12, and EQ-5D; for bowel-related symptoms Knowles-Eccersley-Scott-Symptom Questionnaire, Gastrointestinal Quality of Life Index, and Cleveland Clinic Fecal Incontinence Severity Scoring System/Wexner; for bladder-related function Bristol Female Lower Urinary Tract Symptoms, International Prostate Symptom Score, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, and Urinary Symptom Profile; and finally for sexual function Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire and Sexual Activity Questionnaire. Unlike other domains, only one tool (visual analog scale) was the dominant PROM used for the assessment of pain. In addition, the use of more than one PROM in each study to assess different aspects of patient's health and pain symptoms did not become prevalent until after 2015.
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Affiliation(s)
- Jason Abbott
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Medicine and Health, UNSW Sydney, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng); Gynaecological Research and Clinical Evaluation Unit, Royal Hospital for Women, Randwick, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng and Ms. Sit)
| | - Megan Billow
- Women's Health Institute (Drs. Billow, Gallant, and Luna Russo)
| | - Thomas Gallant
- Women's Health Institute (Drs. Billow, Gallant, and Luna Russo)
| | - Loren Hackett
- Cleveland Clinic Foundation, Cleveland, OH (Dr. Hackett); AAGL Practice Guidelines Committee, in-house team (Drs. Hackett, Kho, and Xu)
| | - Rosanne M Kho
- Department of Obstetrics and Gynecology, University of Arizona Phoenix/Banner University Medical Center Phoenix, Phoenix, AZ (Dr. Kho); AAGL Practice Guidelines Committee, in-house team (Drs. Hackett, Kho, and Xu)..
| | - Blake Knapman
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Medicine and Health, UNSW Sydney, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng); Gynaecological Research and Clinical Evaluation Unit, Royal Hospital for Women, Randwick, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng and Ms. Sit)
| | | | | | - Adriana Meneses Gonzalez
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Medicine and Health, UNSW Sydney, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng); Gynaecological Research and Clinical Evaluation Unit, Royal Hospital for Women, Randwick, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng and Ms. Sit)
| | - Cecilia Ng
- Division of Obstetrics and Gynaecology, School of Clinical Medicine, Medicine and Health, UNSW Sydney, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng); Gynaecological Research and Clinical Evaluation Unit, Royal Hospital for Women, Randwick, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng and Ms. Sit)
| | - Megan S Orlando
- Department of Obstetrics and Gynecology, University of Colorado, Aurora, CO (Dr. Orlando)
| | - Andrea Sit
- Gynaecological Research and Clinical Evaluation Unit, Royal Hospital for Women, Randwick, NSW, Australia (Drs. Abbott, Knapman, Gonzalez, and Ng and Ms. Sit)
| | - Xiao Xu
- Department of Obstetrics and Gynecology, Yale University, New Haven, CT (Dr. Xu); AAGL Practice Guidelines Committee, in-house team (Drs. Hackett, Kho, and Xu)
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Lou Z, Li M, Kong N, Campbell NL, Tu W. An Improved Statistical Modeling Approach to Individual Anticholinergic Drug Use Trend Analysis. IEEE J Biomed Health Inform 2024; 28:1122-1133. [PMID: 37963002 DOI: 10.1109/jbhi.2023.3332598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Anticholinergic (AC) drugs are commonly prescribed to older adults for treating diseases and chronic conditions, such as chronic obstructive pulmonary disease, urinary incontinence, gastrointestinal disorder, or simply pain and allergy. The high prevalence of AC drug use can have a detrimental effect on the mental health of older adults. We aim to improve the prediction of future trends of AC drug use at the individual level, with pharmacy refill data. The individual drug use data presents challenges in the modeling, such as data being discrete-valued with excess zeros and having significant unobserved heterogeneity in the trend pattern. To address these challenges, we propose a statistical model of hierarchical structure and an EM scheme for the model parameter estimation. We evaluate the proposed modeling approach through a numerical study with synthetic data and a case study with real-world pharmacy refill data. The simulation study show that our analysis method outperforms the existing ones (e.g., reducing MSE significantly), particularly in terms of accurately predicting the trend pattern. The real-world case study further verifies the out-performance and demonstrate the advantageous features of our method. We expect the prediction tool developed based on our study can assist pharmacists' decision on initiating or strengthening behavioral interventions with the hope of discontinuing AC drug misuse.
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Franić D, Franić Ivanišević M, Verdenik I. Radiofrequency as the New Opportunity in Treating Overactive Bladder and Urge Urinary Incontinence-A Single-Arm Pilot Study. Medicina (Kaunas) 2024; 60:197. [PMID: 38399486 PMCID: PMC10890003 DOI: 10.3390/medicina60020197] [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: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/15/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Until now, overactive bladder (OAB) with or without urge urinary incontinence (UUI) has been treated mainly in two ways: with behavioral methods and patient education, or using antimuscarinic drugs and/or beta-3 adrenergic receptor agonists. Unfortunately, these drugs may cause side effects in some women or are insufficiently effective, so patients abandon them. Therefore, in this pilot study, radiofrequency was evaluated as a new option in the treatment of OAB and UUI. Materials and Methods: Nineteen patients were enrolled in this pilot study using radiofrequency (RF), where the level of OAB and UUI was assessed using the validated ICIQ-OAB questionnaire. RF was applied four times for 20 min, once a week. Two weeks after treatment, the level of OAB and UUI was reassessed and processed statistically and the treatment effect evaluated. Results: Using the ICIQ-OAB, the severity of OAB and UUI was assessed: 0-3 mild symptoms; 4-7 moderate symptoms; 8-11 severe symptoms; 12-16 very severe symptoms. Before treatment, 10.5% of patients had mild symptoms, 21.1% moderate symptoms, 63.2% severe symptoms and 5.3% very severe symptoms. After treatment, 42.9% had mild symptoms, 50% moderate symptoms and 7% severe OAB and UUI symptoms. All four main symptoms-frequency, nocturia, urgency and incontinence-decreased statistically significantly, with the best results being found in urgency (p = 0.002). Conclusions: Based on this pilot study, RF seems a very promising method in the treatment of OAB and UUI. To extend our initial findings, it is necessary to perform a prospective, randomized and placebo-controlled study in order to obtain reliable results and to determine for how long one set of treatment maintains the results obtained immediately after the end of that treatment. In this way, we may determine how often the treatment needs to be repeated, if necessary, and when.
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Affiliation(s)
- Damir Franić
- Ginekologija Dr. Franić d.o.o., 3250 Rogaška Slatina, Slovenia
- Medical Faculty, University of Maribor, 2000 Maribor, Slovenia
| | - Maja Franić Ivanišević
- Obstetric and Gynecology Unit, Health Centre Slovenske Konjice, 3210 Slovenske Konjice, Slovenia;
| | - Ivan Verdenik
- Research Unit, University Gynecological Clinic Ljubljana, 1000 Ljubljana, Slovenia;
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Li Z, Lu X, Zhang K, Wu S, Yu W, Chen X, Zheng W. U-shaped association between serum 25-hydroxyvitamin D concentrations and urinary leakage among adult females aged 45 years and over in the United States: a cross-sectional study. BMC Womens Health 2024; 24:58. [PMID: 38263023 PMCID: PMC10804705 DOI: 10.1186/s12905-024-02906-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 01/13/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The relationship between serum vitamin D status and urinary leakage (UL) among middle-aged females needs to be further studied. The aim of this study was to evaluate the association of serum 25-hydroxyvitamin D [25(OH)D] concentrations with UL among American females ages 45 years and over. METHODS Seven cycles of the National Health and Nutrition Examination Survey (NHANES) with self-report UL data, were used. A total of 9525 women aged 45 years and older were enrolled in this study. Univariate and multivariate logistic regression models and the smooth curve fitting were utilized to analyze the association between clinical UL and serum 25-hydroxyvitamin D [25(OH)D] concentrations. RESULTS A non-linear relationship between serum 25(OH)D concentrations and clinical ULwas observed. When serum 25(OH)D concentration was higher than the inflection point 63.5 nmol/L, a positive correlation was observed between serum 25(OH)D concentrations and clinical UL ([OR]: 1.007, 95%CI: 1.005-1.009, P < 0.01). However, when serum 25(OH)D concentration was below the inflection point 63.5 nmol/L, a negative correlation was observed between serum 25(OH)D concentrations and clinical UL ([OR]: 0.993, 95%CI: 0.989-0.996, P < 0.01). CONCLUSIONS The association between serum vitamin D and the risk of UL exhibited a U-shaped pattern among US middle-aged females, with an inflection point occurring at a serum 25(OH)D concentration of 63.5 nmol/L.
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Affiliation(s)
- Zeyu Li
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Xinzhuo Lu
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Keshuai Zhang
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Shuangyan Wu
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Wei Yu
- School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Xiaoling Chen
- Department of Intensive Care Unit, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Wenzhong Zheng
- Department of Urology, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou, 200001, Fujian Province, P.R. China.
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Wu Y, Li G, Zhou H, Wu A, Tan G, Huang S, Chen G, Chen X, Li Z. Mirabegron Add-On Tamsulosin for Men with Overactive Bladder Symptoms: A Pooled Analysis of Four Randomized Controlled Trials. Urol Int 2024; 108:118-127. [PMID: 38185112 DOI: 10.1159/000536110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Overactive bladder symptoms (OABSs) affect patients' quality of life (QOL) worldwide. This pooled analysis compared the efficacy and safety of mirabegron add-on tamsulosin with those of tamsulosin add-on placebo in OABS treatment. METHODS PubMed, Embase, MEDLINE, and the Cochrane Controlled Trial Register databases were searched for randomized controlled trials (RCTs) examining the efficacy of mirabegron add-on therapy to tamsulosin in the treatment of OABS. Moreover, references from the selected studies were screened. Review Manager 5.4 was used to analyze data. RESULTS Four RCTs involving 1,397 patients with OABS were selected. Of the total, 697 patients receiving mirabegron add-on tamsulosin constituted the experimental group, and 700 patients receiving tamsulosin add-on placebo constituted the control group. The efficacy endpoints were as follows: mean number of micturition per day (mean difference [MD] = -0.26, 95% confidence interval [CI] = -0.41 to -0.10, p = 0.0001), urgency episodes per day (MD = -0.67, 95% CI = -1.02 to -0.32, p = 0.0002), urgency urinary incontinence (UUI) episodes per day (MD = -0.42, 95% CI = -0.66 to -0.19, p = 0.0005), mean volume voided/micturition (MD = 10.84, 95% CI = 4.97-16.71, p = 0.0003), total International Prostate Symptom Score (IPSS) (MD = -2.01, 95% CI = -4.02 to -0.01, p = 0.05), and IPSS QOL index (MD = -0.65, 95% CI = -0.94 to -0.35, p < 0.0001). Mirabegron therapy, an add-on therapy to tamsulosin, was effective in treating patients with OABS. Moreover, mirabegron might reduce the total IPSS (MD = -2.01, 95% CI = -4.02 to -0.01, p = 0.05). The safety endpoint, treatment-emergent adverse events (odds ratio = 0.94, 95% CI = 0.78-1.13, p = 0.49), suggested that although mirabegron was well-tolerated, it possibly increased the post-void residual urine volume (MD = 10.28, 95% CI = 1.82-18.75, p = 0.02). CONCLUSION Combination therapy using mirabegron and tamsulosin may be effective in treating patients with non-neurogenic OABS in terms of UUI episodes, total IPSS, and IPSS QOL index. However, its effectiveness must be verified by analyzing additional factors for OABS through further RCTs.
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Affiliation(s)
- Yonglu Wu
- Department of Urology, Maoming People's Hospital, Maoming, China
| | - Guanjun Li
- Department of Urology, Maoming People's Hospital, Maoming, China
| | - Haimin Zhou
- Department of Operating Room, Maoming People's Hospital, Maoming, China
| | - Aiming Wu
- Department of Urology, Maoming People's Hospital, Maoming, China
| | - Guobin Tan
- Department of Urology, Maoming People's Hospital, Maoming, China
| | - Shuitong Huang
- Department of Urology, Maoming People's Hospital, Maoming, China
| | - Guangming Chen
- Department of Urology, Maoming People's Hospital, Maoming, China
| | - Xianxi Chen
- Department of Urology, Maoming People's Hospital, Maoming, China
| | - Zhiqin Li
- Department of Urology, Maoming People's Hospital, Maoming, China
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Zhao K, Harandi AA, Ramgopal J, Kim J, Weissbart S. Fluid intake behavior in women with refractory overactive bladder undergoing third line therapy. Neurourol Urodyn 2024; 43:44-51. [PMID: 37961997 DOI: 10.1002/nau.25328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/29/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Fluid intake has been shown to be related to urinary symptoms, but no studies to date have investigated the effect of fluid intake on urinary symptoms in women with refractory overactive bladder (OAB). As this group of women are considered to have a possible unique pathophysiologic mechanism of OAB, we investigated the relationship between fluid intake, fluid intake behavior, and urinary symptoms in women with refractory OAB. METHODS A prospective cross-sectional study of women with refractory OAB was conducted by assessing the relationship between fluid intake and lower urinary tract symptoms (LUTS) in women undergoing third line OAB therapies. Fluid intake and behavior were measured by the questionnaire based voiding diary and urinary symptoms were measured by the International Consultation on Incontinence Questionnaire for Female Lower Urinary Tract Symptoms (ICIQ-FLUTS). The relationship between fluid intake and symptom severity was assessed using Spearman's rank correlation and χ2 tests. RESULTS Of the 126 individuals undergoing third line therapy for OAB, 60 (48%) underwent intradetrusor onabotulinumtoxinA injection (BTX) injection, 42 (33%) peripheral tibial nerve stimulation, and 24 (19%) sacral neuromodulation. The mean total daily fluid intake was 2567.0 ± SD 1292.4 mL and did not differ significantly across treatment groups. Total fluid intake was weakly correlated with worse filling-type LUTS (r = 0.241, p = 0.007), and there was no relationship between LUTS and caffeinated fluid intake. Half (52%) of the subjects reported current fluid restricting behavior to control urinary symptoms, but this behavior was not correlated with LUTS severity (all p > 0.05). Patients that currently use tobacco have greater LUTS (current = 25.8 ± SD 9.5, former = 14.8 ± SD 6.1, never = 15.0 ± SD 6.1; p < 0.001). BMI was also positively correlated with worse incontinence symptoms (r = 0.351, p < 0.001). CONCLUSIONS Fluid intake along with other lifestyle factors, including tobacco use and weight, are minimally related to the symptomatology seen in women with refractory OAB. Further studies are needed to assess if behaviors change during treatment with third line therapies, and if these behavioral changes may affect treatment response.
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Affiliation(s)
- Kelley Zhao
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York, USA
| | | | | | - Jason Kim
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York, USA
| | - Steven Weissbart
- Department of Urology, Stony Brook University Hospital, Stony Brook, New York, USA
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Shaw NM, Breyer BN, Walter LC, Sudore RL, Suskind AM, Baussan C, Quanstrom K, Allen IE, Cooperberg MR, Dohan D, Hampson LA. How older men live with stress urinary incontinence: Patient experience and navigation to treatment. Neurourol Urodyn 2024; 43:11-21. [PMID: 38014566 PMCID: PMC10866353 DOI: 10.1002/nau.25325] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/29/2023] [Accepted: 10/22/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES To explore the context in which older men navigate treatment for stress urinary incontinence (SUI) following prostate surgery by characterizing lived experience of men with symptomatic SUI. SUBJECTS/PATIENTS AND METHODS Mixed method study using surveys and semistructured interviews to examine a cohort of men who underwent evaluation for treatment of postprostatectomy SUI. RESULTS Thirty-six men were interviewed after consultation for SUI and 31 had complete quantitative clinical data. Twenty-six underwent surgery and 10 chose no surgical intervention. In qualitative interviews, respondents experienced substantial decline in quality of life due to incontinence citing concerns associated with use of pads and worrying about incontinence. Most patients reported "workarounds"-efforts to mitigate or manage incontinence including Kegels, physical therapy, and garments. Participants also reported lifestyle changes including less strenuous physical activity, less sexual activity, and/or fewer social gatherings. Patients then described a "breaking point" where incontinence workarounds were no longer sufficient. After seeking evaluation, men described challenges in exploring treatment for SUI, including access to care and provider knowledge of treatment options. CONCLUSION In a novel study of patients living with SUI a predictable lived experience was observed that culminated in a desire for change or "breaking point." In all men, this led to treatment-seeking behaviors and for many it led to SUI intervention. Despite effective treatments, patients continue to meet barriers gaining access to SUI evaluation and treatment.
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Affiliation(s)
- Nathan M Shaw
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Urology, MedStar Georgetown, Washington, District of Columbia, USA
| | - Benjamin N Breyer
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Louise C Walter
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Rebecca L Sudore
- Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Anne M Suskind
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Caitlin Baussan
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Kathryn Quanstrom
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Isabel E Allen
- Department of Epidemiology & Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Matthew R Cooperberg
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Dan Dohan
- Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, USA
| | - Lindsay A Hampson
- Department of Urology, School of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Horgan C, Charatcharungkiat N. Fluoxetine-Associated Enuresis in a Pediatric Patient. J Clin Psychopharmacol 2024; 44:63-64. [PMID: 38100781 DOI: 10.1097/jcp.0000000000001794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
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Fujisaki Y, Otsuka I, Kobayashi T, Miyake N, Ito K, Terada N, Kamoto T, Iwamoto H. Use of the anterior prostatic urethral mucosa preservation technique during holmium laser enucleation of the prostate can reduce postoperative stress urinary incontinence. Asian J Endosc Surg 2024; 17:e13256. [PMID: 37885361 DOI: 10.1111/ases.13256] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/21/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Holmium laser enucleation of the prostate (HoLEP) is an effective and safe surgery for patients with benign prostatic hyperplasia. However, some patients exhibit postoperative urinary incontinence. Here, we compared surgical outcomes and incidence of stress urinary incontinence between HoLEP with and without anterior prostatic urethral mucosa preservation (APUMP). METHODS All patients in this study underwent HoLEP with APUMP technique (APUMP group) and without APUMP technique (no-APUMP group). Enucleation weight, enucleation time, max flow rate increase at 3 months, and urinary incontinence rates immediately after catheter removal and at 1 month after surgery were compared between the groups. RESULTS In the APUMP (n = 340) and no-APUMP (n = 75) groups, the median enucleation weights were 34.5 and 35.0 g, respectively (p = .982). The corresponding median enucleation times were 33.0 and 46.5 min (p < .01), and median max flow rate increases at 1 month were 10.5 and 9.9 mL/s (p = .89). The urinary incontinence rates immediately after catheter removal were 4.1% and 14.7% (p < .01), and were 3.8% and 12.0% (p < .01) at 1 month after surgery. CONCLUSION HoLEP using the APUMP technique could be performed with a shorter operative time while maintaining efficacy. The incidence of postoperative urinary incontinence could be decreased by APUMP, indicating that such preservation facilitates the maintenance of urinary continence after surgery.
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Affiliation(s)
| | - Isamu Otsuka
- Department of Urology, Miyazaki University, Miyazaki, Japan
| | | | - Nao Miyake
- Department of Urology, Miyazaki University, Miyazaki, Japan
| | - Kaoru Ito
- Department of Urology, Miyazaki University, Miyazaki, Japan
| | - Naoki Terada
- Department of Urology, Miyazaki University, Miyazaki, Japan
- Department of Urology, University of Fukui, Fukui, Japan
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Rutten JJS, Smalbrugge M, van Buul LW, van Eijk J, Geerlings SE, Natsch S, Sloane PD, van der Wouden JC, Hertogh CMPM, Gerritsen DL. A Process Evaluation of an Antibiotic Stewardship Intervention for Urinary Tract Infections in Nursing Homes. J Am Med Dir Assoc 2024; 25:146-154.e9. [PMID: 38173264 DOI: 10.1016/j.jamda.2023.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To assess the internal and external validity of a cluster randomized controlled trial (cRCT) evaluating a decision tool with supportive interventions for the empirical treatment of urinary tract infections (UTIs) in nursing homes (NHs), and to identify facilitators and barriers in implementing this antibiotic stewardship intervention. DESIGN Mixed-methods process evaluation study. SETTING AND PARTICIPANTS Physicians, nursing staff, client council members, and residents of Dutch NHs. METHODS We used cRCT data of the ANNA study (Antibiotic Prescribing and Non-prescribing in Nursing Home Residents With Signs and Symptoms Ascribed to Urinary Tract Infection). In addition, we sent out an online evaluation questionnaire, conducted semistructured interviews with physicians and nursing staff, and consulted client council members. RESULTS Internal validity was lowered: control group physicians participated in several non-study-related activities regarding UTI. External validity was good: almost all intervention components had a high fidelity (52%-74%) and were perceived as relevant (physicians: 7.2-8.6 of 10, nursing staff: 6.5-8.5 of 10) and feasible (physicians: 7.5 of 10, nursing staff 6.4 of 10), with feasibility for residents with dementia and urine incontinence needing attention. The most common reason for deviating from the advice generated by the decision tool was an unclear illness presentation. Identified facilitators to implementation were confidence in the intervention, repeated intervention encounter, and having "champions" in the NH. Barriers were limited involvement of nursing staff, unstable nursing teams, residents' and representatives' belief that antibiotics should be prescribed, and a low antibiotic prescribing threshold within the NH culture. CONCLUSIONS AND IMPLICATIONS Lowered internal validity may have reduced the study effect. Attention should be paid to the feasibility of the intervention in residents with dementia and urinary incontinence. Improvement opportunities for implementation were higher nursing staff involvement and repeated intervention offering.
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Affiliation(s)
- Jeanine J S Rutten
- Department of Medicine for Older People, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Martin Smalbrugge
- Department of Medicine for Older People, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Laura W van Buul
- Department of Medicine for Older People, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Jorna van Eijk
- Department of Medicine for Older People, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Suzanne E Geerlings
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Stephanie Natsch
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Philip D Sloane
- Department of Family Medicine, School of Medicine, and the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Johannes C van der Wouden
- Department of General Practice, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Cees M P M Hertogh
- Department of Medicine for Older People, Amsterdam University Medical Centers, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Debby L Gerritsen
- Department of Primary and Community care, Radboudumc Alzheimer Center, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
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Costa SMB, Hallur RLS, Reyes DRA, Floriano JF, de Barros Leite Carvalhaes MA, de Carvalho Nunes HR, Sobrevia L, Valero P, Barbosa AMP, Rudge MCV. Role of dietary food intake patterns, anthropometric measures, and multiple biochemical markers in the development of pregnancy-specific urinary incontinence in gestational diabetes mellitus. Nutrition 2024; 117:112228. [PMID: 37948994 DOI: 10.1016/j.nut.2023.112228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/04/2023] [Accepted: 09/16/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES The aim of this study was to assess maternal dietary food intake patterns, anthropometric measures, and multiple biochemical markers in women with gestational diabetes mellitus and pregnancy-specific urinary incontinence and to explore whether antedating gestational diabetes mellitus environment affects the pregnancy-specific urinary incontinence development in a cohort of pregnant women with gestational diabetes mellitus and pregnancy-specific urinary incontinence. METHODS Maternal dietary information and anthropometric measurements were collected. At 24 wk of gestation, with a fasting venipuncture sample, current blood samples for biochemical markers of hormones, vitamins, and minerals were analyzed. The groups were compared in terms of numerical variables using analysis of variance for independent samples followed by multiple comparisons. RESULTS Of the 900 pregnant women with complete data, pregnant women in the gestational diabetes mellitus pregnancy-specific urinary incontinence group had higher body mass index during pregnancy, arm circumference, and triceps skinfold than the non-gestational diabetes mellitus continent and non-gestational diabetes mellitus pregnancy-specific urinary incontinence groups, characterizing an obesogenic maternal environment. Regarding dietary food intake, significant increases in aromatic amino acids, branched-chain amino acids, dietary fiber, magnesium, zinc, and water were observed in pregnancy-specific urinary incontinence group compared with the non-gestational diabetes mellitus continent group. Serum vitamin C was reduced in the gestational diabetes mellitus pregnancy-specific urinary incontinence group compared with the non-gestational diabetes mellitus pregnancy-specific urinary incontinence group. CONCLUSIONS This study emphasizes the necessity for a comprehensive strategy for gestational diabetes mellitus women with pregnancy-specific urinary incontinence in terms of deviation in maternal adaptation trending toward obesity and maternal micronutrients deficiencies.
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Affiliation(s)
- Sarah Maria Barneze Costa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil
| | - Raghavendra Lakshmana Shetty Hallur
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil; College of Biosciences and Technology, Pravara Institute of Medical Sciences (DU), Loni-413736, Rahata Taluka, Ahmednagar District, Maharashtra State, India
| | - David Rafael Abreu Reyes
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil
| | - Juliana Ferreira Floriano
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil
| | | | | | - Luis Sobrevia
- Botucatu Medical School, São Paulo State University, São Paulo, Brazil; Cellular and Molecular Physiology Laboratory, Division of Obstetrics and Gynecology, Department of Obstetrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, Australia; Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Institute for Obesity Research, School of Medicine and Health Sciences, Monterrey Institute of Technology and Higher Education, Monterrey, Mexico
| | - Paola Valero
- Botucatu Medical School, São Paulo State University, São Paulo, Brazil; Faculty of Health Sciences, Universidad de Talca, Talca, Chile
| | - Angélica Mércia Pascon Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil; Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University, Marília, Brazil
| | - Marilza Cunha Vieira Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu, Brazil.
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Hafron J, Breyer BN, Joshi S, Smith C, Kaufman MR, Okonski J, Chancellor MB. Intravesical liposomal tacrolimus for hemorrhagic cystitis: a phase 2a multicenter dose-escalation study. Int Urol Nephrol 2024; 56:87-96. [PMID: 37725274 PMCID: PMC10776496 DOI: 10.1007/s11255-023-03783-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/01/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Hemorrhagic cystitis (HC) is an inflammatory disease of the bladder with sustained hematuria for which there is currently no approved drug treatment. We evaluated a liposomal tacrolimus preparation (LP-10) in patients with refractory moderate to severe sterile HC. METHODS This phase 2a dose-escalation study assessed the safety and efficacy of up to 2 intravesical instillations of LP-10 (2, 4, or 8 mg tacrolimus) in 13 patients with HC. Primary efficacy outcomes were changes from baseline in the number of bleeding sites on cystoscopy, microscopic urine analysis for red blood cells (RBCs), and hematuria on dipstick. Additional efficacy measures included urinary incontinence, frequency, and urgency on a 3-day diary and cystoscopy global response assessment (GRA). Blood samples for pharmacokinetic (PK) assessment were obtained in all patients. RESULTS Intravesical LP-10 was well tolerated, with no treatment-related severe or serious adverse events (AEs) and only 3 drug-related AEs (artificial urinary sphincter malfunction, dysuria, and bladder spasms). LP-10 blood levels showed short durations of minimal systemic uptake. Treatment resulted in significant improvements in bleeding on cystoscopy, RBC counts in urine, hematuria on dipstick, and urinary incontinence. Bleeding on cystoscopy and urinary incontinence showed dose-dependent improvements that were more pronounced in the 4 mg and 8 mg dose groups. All dose groups showed a significant improvement in cystoscopy GRA. CONCLUSION LP-10 was well tolerated, with clinically relevant efficacy seen in improvements in cystoscopic bleeding, hematuria, and urinary incontinence. The benefit-risk profile supports the further clinical development of LP-10 at a tacrolimus dose of 4 mg.
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van Schaik J, Witt D, Albers L, Wever J, Elzevier H, Hamming J. Pilot Study on Feasibility and Outcome of a Nerve-Preserving Aortoiliac Exposure Technique. Ann Vasc Surg 2024; 98:388-397. [PMID: 37390965 DOI: 10.1016/j.avsg.2023.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Dysfunctional ejaculation is a common complication following open aortoiliac aneurysm surgery. It may occur in 49-63% of patients and is caused by iatrogenic damage to the sympathetic lumbar splanchnic nerves and superior hypogastric plexus. A nerve-preserving operative technique based on a unilateral right-sided approach to the abdominal aorta, was implemented in clinical practice. The aim of this pilot study was to establish the safety and feasibility of the technique, and whether a sympathetic pathway and ejaculatory function was preserved. METHODS Patients were asked to fill out questionnaires preoperatively, and 6 weeks, 6 months, and 9 months postoperatively. The International Index of Erectile Function, Cleveland Clinic Incontinence Score (CCIS), Patient assessment of constipation symptoms (Pac-Sym), and International Consultation on Incontinence Questionnaire on male lower urinary tract symptoms were used. Surgeons were asked to complete a technical feasibility questionnaire. RESULTS Twenty-four patients undergoing aortoiliac aneurysm surgery were included. The nerve-sparing phase of the procedure added an average of 5-10 min of operating time and was technically feasible in twenty-two patients. No major complications occurred during nerve-sparing exposure. Fifteen of twenty-four patients were sexually active at some point throughout the study. No postoperative loss of ejaculation was seen in sexually active patients. CCIS, Pac-sym, International Index of Erectile Function, and Incontinence Questionnaire on male lower urinary tract symptoms scores remained similar throughout the study. CONCLUSIONS Nerve-preserving aortoiliac reconstruction surgery is safe and feasible. Ejaculatory function is preserved. Given the low number of patients in the study, further research is needed to provide robust data.
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Affiliation(s)
- Jan van Schaik
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
| | - Daniël Witt
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - Leonore Albers
- Department of Urology and Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jan Wever
- Department of Surgery, Haga Teaching Hopsital, The Hague, The Netherlands
| | - Henk Elzevier
- Department of Urology and Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jaap Hamming
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands
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Grigoriadis T, Kalantzis C, Zacharakis D, Kathopoulis N, Prodromidou A, Xadzilia S, Athanasiou S. Platelet-Rich Plasma for the Treatment of Stress Urinary Incontinence-A Randomized Trial. Urogynecology (Phila) 2024; 30:42-49. [PMID: 37493287 DOI: 10.1097/spv.0000000000001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
IMPORTANCE Urinary incontinence affects millions of women worldwide. OBJECTIVE The aim of the current study was to evaluate the efficacy and safety of periurethral platelet-rich plasma (PRP) injections in women with stress urinary incontinence (SUI). STUDY DESIGN This was a single-center, double-blind, randomized sham-controlled trial. Fifty participants with SUI and urodynamic stress incontinence were randomized in 2 equally sized groups. Women in the PRP group received 2 PRP injections at 3 levels of the urethra at 4- to 6-week intervals. Women in the sham group were injected with sodium chloride 0.9%. At baseline, participants underwent urodynamic studies and a 1-hour pad test and completed the International Consultation on Incontinence Questionnaire-Female Lower Urinary Tract Symptoms (ICIQ-FLUTS), the Patient Global Impression Scale of Improvement, and the King's Health Questionnaire. At follow-up visits (1, 3, and 6 months), women underwent the 1-hour pad test and completed the King's Health Questionnaire and the ICIQ-FLUTS. Primary outcome was the subjective evaluation as indicated by the response to question 11a of the ICIQ-FLUTS questionnaire. Secondary outcomes included scores of questionnaires and urine loss assessed on the 1-hour pad test. The level of discomfort during injections and any adverse events were also evaluated. RESULTS During follow-up, the mean score of the 11a question decreased significantly in the PRP group compared with sham. Subjective cure was significantly higher in the PRP group (32% vs 4%, P < 0.001). A significant reduction of urine loss assessed on the 1-hour pad test was observed in the PRP group compared with the sham group at 6-month follow-up. No adverse events were observed. CONCLUSIONS Periurethral PRP injections were superior to sham injections in improving SUI symptoms with an excellent safety profile.
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Affiliation(s)
- Themos Grigoriadis
- From the 1st Department of Obstetrics and Gynecology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Brandt CH, Yamolaei M, Wu C, Hansen UD, Rasch V. Adherence to support pessary in the treatment of pelvic organ prolapse: a retrospective study conducted among 1,371 women. Int Urogynecol J 2024; 35:69-75. [PMID: 37548745 PMCID: PMC10810921 DOI: 10.1007/s00192-023-05616-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate the adherence to pessary treatment in women with pelvic organ prolapse (POP) who were found eligible for this treatment by the urogynecologist, at the first visit at the Department of Gynecology and Obstetrics, Odense University Hospital. METHODS Data were extracted from the women's medical records. Frequency tabulations were performed to describe the women's reasons for pessary discontinuation by age group. Binominal logistic regression analysis was conducted to investigate how women's age, POP characteristics, urogynecological history, and their pessary experience and management were associated with continued pessary use. RESULTS This study included 1,371 women treated with support pessary. Of these, 850 women continued pessary treatment and 521 women underwent surgical treatment. A history of hysterectomy (OR: 0.68, 95% CI: 0.51-0.90, p = 0.008), urinary incontinence (OR: 0.71, 95% CI: 0.56-0.89, p = 0.003), and previous pessary use (OR: 0.75, 95% CI: 0.56-0.99, p = 0.047) were significant factors associated with discontinuation. Further, women aged 81-99 years were significantly more likely to continue pessary treatment (OR: 1.77, 95% CI: 1.15-2.74, p = 0.009). "POP surgery," "prolapse stage," and "prolapse predominant compartment" were not associated with discontinuation. Approximately 38% of women aged 26-54 years discontinued owing to personal preference. CONCLUSIONS Hysterectomy, incontinence, and previous pessary use are significant predictors of pessary discontinuation. Increasing age is significantly associated with pessary continuation.
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Affiliation(s)
- Cecilie Helstrup Brandt
- Medical Faculty, University of Southern Denmark, 55 Campusvej, 5230, Odense, Denmark.
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.
| | - Mahsa Yamolaei
- Medical Faculty, University of Southern Denmark, 55 Campusvej, 5230, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Chunsen Wu
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ulla D Hansen
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Vibeke Rasch
- Medical Faculty, University of Southern Denmark, 55 Campusvej, 5230, Odense, Denmark
- Department of Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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48
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Cunningham SD, Carandang RR, Boyd LM, Lewis JB, Ickovics JR, Rickey LM. Psychosocial Factors Associated with Lower Urinary Tract Symptoms One Year Postpartum. Int J Environ Res Public Health 2023; 21:40. [PMID: 38248505 PMCID: PMC10815698 DOI: 10.3390/ijerph21010040] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
Pregnancy carries substantial risk for developing lower urinary tract symptoms (LUTSs), with potential lifelong impacts on bladder health. Little is known about modifiable psychosocial factors that may influence the risk of postpartum LUTSs. We examined associations between depressive symptoms, perceived stress, and postpartum LUTSs, and the moderating effects of perceived social support, using data from a cohort study of Expect With Me group prenatal care (n = 462). One year postpartum, 40.3% participants reported one or more LUTS. The most frequent LUTS was daytime frequency (22.3%), followed by urinary incontinence (19.5%), urgency (18.0%), nocturia (15.6%), and bladder pain (6.9%). Higher odds of any LUTS were associated with greater depressive symptoms (adjusted odds ratio (AOR) 1.08, 95% confidence interval (CI) 1.04-1.11) and perceived stress (AOR 1.12, 95% CI 1.04-1.19). Higher perceived social support was associated with lower odds of any LUTS (AOR 0.94, 95% CI 0.88-0.99). Perceived social support mitigated the adverse effects of depressive symptoms (interaction AOR 0.99, 95% CI 0.98-0.99) and perceived stress (interaction AOR 0.97, 95% CI 0.95-0.99) on experiencing any LUTS. Greater depressive symptoms and perceived stress may increase the likelihood of experiencing LUTSs after childbirth. Efforts to promote bladder health among postpartum patients should consider psychological factors and social support.
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Affiliation(s)
- Shayna D Cunningham
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Rogie Royce Carandang
- Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT 06030, USA
| | - Lisa M Boyd
- Virginia Polytechnic Institute, State University, Blacksburg, VA 24061, USA
| | - Jessica B Lewis
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06510, USA
| | - Jeannette R Ickovics
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT 06510, USA
| | - Leslie M Rickey
- Departments of Urology and Obstetrics, Gynecology & Reproductive Services, Yale School of Medicine, New Haven, CT 06510, USA
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49
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Xu CJ, Yu JT, Yang J, Yang S, Zhou ZK, Wen YB, Shang XP, Wen JG. [Influence of disposable diaper dependence on emotional behavior and related factors of preschool-aged children]. Zhonghua Yi Xue Za Zhi 2023; 103:3770-3775. [PMID: 38092554 DOI: 10.3760/cma.j.cn112137-20230310-00367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Objective: To investigate the influence of disposable diaper dependence (DDD) on emotional behavior and related factors of preschool-aged children. Methods: A total of 3 000 preschool-aged children from 16 kindergartens in Zhengzhou of Henan Province from October 2019 to March 2020 were selected and their parents were investigated by using a basic information questionnaire (including usage of disposable diapers), Strengths and Difficulties Questionnaire (SDQ) and Children's Sleep Questionnaire (PSQ). The differences in baseline and clinical data were compared between the DDD children and normal children, and multiple linear regression models were used to analyze the factors associated with emotional behavior in DDD children. Results: A total of 3 000 questionnaires were distributed and 2 775 (92.50%) were valid. The children ranged in age from 3 to 5 years, including 1 438 boys (51.82%) and 1 337 girls (48.18%). There were 98 (3.53%) children in DDD group and 2 677 (96.47%) children in normal group. The proportion of children living in cities in the DDD group was 58.16%, significantly higher than that of 41.84% in the normal children group (P<0.001). The abnormal detection rate of various factors in SDQ in DDD children, from high to low, were hyperactivity (n=14, 14.29%), peer communication problems (n=12, 12.24%), prosocial behavior (n=11, 11.22%), emotional symptoms (n=10, 10.20%) and conduct problems (n=7, 7.14%). The detection rates of abnormal total difficulty scores in DDD group and normal children were 7.14% (7 cases) and 0.78% (21 cases), respectively, with statistically significant differences (P<0.001). The proportions of emotional symptoms and hyperactivity disorder in DDD group were higher than those in normal group, and the differences were statistically significant (P<0.05). The PSQ score of children in DDD group was 3.01±2.02 which was not significantly different from the PSQ score of the normal group (2.71±2.10, P=0.157). The multi-factor analysis showed that caregiver's education level (β=-1.135,95%CI:-1.910 to -0.359), urinary incontinence (β=2.222, 95%CI: 1.105-3.339), fecal incontinence (β=3.833, 95%CI: 2.691-4.975), urinary and fecal incontinence (β=5.522, 95%CI: 4.145-6.899), and recurrent urinary tract infections(β=3.523,95%CI: 1.798-5.248)were the independent influencing factors of emotional behavioral problems in DDD children (P<0.05). Conclusions: Children with DDD are more likely to have emotional behavioral problems than normal children. Caregiver's education level, urinary incontinence and recurrent urinary tract infections were influencing factors of emotional behavioral problems in DDD children.
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Affiliation(s)
- C J Xu
- Department of Breast Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - J T Yu
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Henan Joint International Paediatric Urodynamic Laboratory, Zhengzhou 450052, China
| | - J Yang
- Department of Out-patient, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - S Yang
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Henan Joint International Paediatric Urodynamic Laboratory, Zhengzhou 450052, China
| | - Z K Zhou
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Henan Joint International Paediatric Urodynamic Laboratory, Zhengzhou 450052, China
| | - Y B Wen
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Henan Joint International Paediatric Urodynamic Laboratory, Zhengzhou 450052, China
| | - X P Shang
- Department of Medical Record Management, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - J G Wen
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Henan Joint International Paediatric Urodynamic Laboratory, Zhengzhou 450052, China
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50
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França DCH, Honorio-França AC, Silva KMR, Alves FCB, Bueno G, Costa SMB, Cotrim ACDM, Barbosa AMP, França EL, Rudge MVC, The Diamater Study Group. Serotonin and Interleukin 10 Can Influence the Blood and Urine Viscosity in Gestational Diabetes Mellitus and Pregnancy-Specific Urinary Incontinence. Int J Mol Sci 2023; 24:17125. [PMID: 38138954 PMCID: PMC10742662 DOI: 10.3390/ijms242417125] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/03/2023] [Accepted: 11/07/2023] [Indexed: 12/24/2023] Open
Abstract
Serotonin and interleukin 10 (IL-10) may play a role in gestational diabetes mellitus. Hyperglycemic environment, the detrusor musculature of the bladder and pelvic floor muscles may become damaged, leading to urination problems and urine viscosity in pregnant women with gestational diabetes mellitus and pregnancy-specific urinary incontinence. Urine and blood samples were collected from pregnant women between 24 and 28 weeks of gestation. The serotonin concentration and cytokine IL-10 levels were evaluated in plasma and urine. In the total blood and urine, the viscosity was evaluated in the presence and absence of exogenous serotonin and IL-10. The plasma serotonin levels decreased, while the urine serotonin levels increased in the normoglycemic incontinent (NG-I), hyperglycemic continent (GDM-C), and hyperglycemic incontinent (GDM-I) groups. The IL-10 in the plasma decreased in the GDM-I group and was higher in the urine in the NG-I and GDM-I groups. The blood viscosity was higher, independently of urinary incontinence, in the GDM groups. The serotonin increased the blood viscosity from women with GDM-C and urine in the NG-I, GDM-C, and GDM-I groups. Blood and urine in the presence of IL-10 showed a similar viscosity in all groups studied. Also, no difference was observed in the viscosity in either the blood or urine when in the presence of serotonin and IL-10. These findings suggest that serotonin and IL-10 have the potential to reduce blood viscosity in pregnant women with gestational diabetes and specific urinary incontinence, maintaining values similar to those in normoglycemic women's blood.
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Affiliation(s)
- Danielle Cristina Honório França
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu 05508-070, SP, Brazil; (D.C.H.F.); (F.C.B.A.); (G.B.); (S.M.B.C.); (A.M.P.B.)
| | - Adenilda Cristina Honorio-França
- Biological and Health Sciences Institute, Federal University of Mato Grosso, Barra do Garças 78605-091, MT, Brazil; (K.M.R.S.); (A.C.d.M.C.); (E.L.F.)
| | - Kênia Maria Rezende Silva
- Biological and Health Sciences Institute, Federal University of Mato Grosso, Barra do Garças 78605-091, MT, Brazil; (K.M.R.S.); (A.C.d.M.C.); (E.L.F.)
| | - Fernanda Cristina Bérgamo Alves
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu 05508-070, SP, Brazil; (D.C.H.F.); (F.C.B.A.); (G.B.); (S.M.B.C.); (A.M.P.B.)
| | - Gabriela Bueno
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu 05508-070, SP, Brazil; (D.C.H.F.); (F.C.B.A.); (G.B.); (S.M.B.C.); (A.M.P.B.)
| | - Sarah Maria Barneze Costa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu 05508-070, SP, Brazil; (D.C.H.F.); (F.C.B.A.); (G.B.); (S.M.B.C.); (A.M.P.B.)
| | - Aron Carlos de Melo Cotrim
- Biological and Health Sciences Institute, Federal University of Mato Grosso, Barra do Garças 78605-091, MT, Brazil; (K.M.R.S.); (A.C.d.M.C.); (E.L.F.)
| | - Angélica Mércia Pascon Barbosa
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu 05508-070, SP, Brazil; (D.C.H.F.); (F.C.B.A.); (G.B.); (S.M.B.C.); (A.M.P.B.)
- Department of Physiotherapy and Occupational Therapy, School of Philosophy and Sciences, São Paulo State University, Marilia 17525-900, SP, Brazil
| | - Eduardo Luzía França
- Biological and Health Sciences Institute, Federal University of Mato Grosso, Barra do Garças 78605-091, MT, Brazil; (K.M.R.S.); (A.C.d.M.C.); (E.L.F.)
| | - Marilza Vieira Cunha Rudge
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu 05508-070, SP, Brazil; (D.C.H.F.); (F.C.B.A.); (G.B.); (S.M.B.C.); (A.M.P.B.)
| | - The Diamater Study Group
- Department of Gynecology and Obstetrics, Botucatu Medical School, São Paulo State University, Botucatu 05508-070, SP, Brazil; (D.C.H.F.); (F.C.B.A.); (G.B.); (S.M.B.C.); (A.M.P.B.)
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