대한배뇨장애요실금학회

Urinary Lignans Are Associated With Decreased Incontinence in Postmenopausal Women

Wed, 30 Sep 2015 10:33:43 +0000

Publication date: October 2015
Source:Urology, Volume 86, Issue 4
Author(s): Evgeniy I. Kreydin, Michelle M. Kim, Glen W. Barrisford, Dayron Rodriguez, Alejandro Sanchez, Yahir Santiago-Lastra, Dicken S.C. Ko
Objective To examine the association between urinary phytoestrogens and self-reported urinary incontinence in postmenopausal women in the United States using a large, cross-sectional, population-based cohort survey. Methods Data were analyzed for 1789 postmenopausal women aged 50 years or older who participated in one of the 2001-2010 cycles of National Health and Nutrition Examination Survey and underwent measurement of 4 isoflavone (soy derived) and 2 lignan (flax derived) phytoestrogens in their urine. Incontinence was defined as self-reported stress, urge, other, or mixed incontinence. Urine phytoestrogen concentrations were examined in weighted, multivariate logistic regression models for association with each of the lower urinary tract symptoms. All models were adjusted for age, body mass index, diabetes, race, smoking, and parity. Results Increasing urine concentrations of the lignan phytoestrogen enterodiol was associated with decreased likelihood of urge (odds ratio [OR], 0.92; 95% confidence interval [CI], 0.85-0.99), mixed (OR, 0.90; 95% CI, 0.82-0.98), and other (OR, 0.90; 95% CI, 0.81-0.99) incontinence, whereas increasing urine concentrations of the lignan phytoestrogen enterolactone was associated with decreased likelihood of urge (OR, 0.92; 95% CI, 0.86-0.99) and mixed (OR, 0.91; 95% CI, 0.84-0.99) incontinence. No association was observed between any isoflavone phytoestrogens and types of incontinence. Conclusion This study demonstrates that lignan phytoestrogens may have a protective effect against incontinence in postmenopausal women. Prospective clinical and laboratory studies are warranted to investigate the mechanism of this relationship.

An Unusual Etiology for Hematospermia and Treatments That Were Successful

Wed, 30 Sep 2015 10:33:43 +0000

Publication date: October 2015
Source:Urology, Volume 86, Issue 4
Author(s): Hu Han, Xiao-guang Zhou, Dong-dong Fan, Long Tian, Xiao-dong Zhang
Objective To describe the unusual etiology and effective treatments of intractable hematospermia from posterior urethral hemangioma. Methods The ages, disease duration, syndromes, urinary routine, pathologic findings, immunohistochemical staining results, and postoperative complications of 5 patients were recorded. Four patients had a transurethral resection for total removal of lesions, and 1 patient was treated with transurethral fulguration. Results The 5 patients involved were middle aged with an average age of 46.2 years and average disease duration of 8.8 years. The clinical features of their hematospermia were as follows: break outs repeatedly after ejaculation in large quantities, no obvious mixing with the seminal plasma, urine after the first ejaculation or second in the morning is hematuria and is even accompanied by blood clots, and urethrorrhagia after sexual excitation, and there is no significant effect of various positive anti-inflammatory treatments. Cystourethroscopy found that the solitary varicosities were located between the distal end of the verumontanum and the external urethral sphincter. The varicose lesion was removed by transurethral resection for posterior urethral lesions, and the surrounding tissue was removed with fulguration. Vessel formation was confirmed by CD31 and CD34 immunohistochemical staining. Finally, the presence of posterior urethral hemangioma was verified in 4 patients by pathologic examination combined with immunohistochemistry, but 1 patient did not have any specimens available. Conclusion The possibility of posterior urethral hemangioma should be considered for patients with repeated intractable hematospermia. Cystourethroscopy is recommended for examination throughout patient services, and transurethral resection, fulguration, or laser cutting methods can also be performed.

Urinary Bother as a Predictor of Postsurgical Changes in Urinary Function After Robotic Radical Prostatectomy

Wed, 30 Sep 2015 10:33:43 +0000

Publication date: October 2015
Source:Urology, Volume 86, Issue 4
Author(s): Gregory Murphy, Peter Haddock, Hoyt Doak, Max Jackson, Ryan Dorin, Anoop Meraney, Stuart Kesler, Ilene Staff, Joseph R. Wagner
Objective To characterize changes in indices of urinary function in prostatectomy patients with presurgical voiding symptoms. Methods A retrospective analysis of our prostate cancer database identified robot-assisted radical prostatectomy patients between April 2007 and December 2011 who completed pre- and postsurgical (24 months) Expanded Prostate Cancer Index Composite-26 surveys. Gleason score, margins, D'Amico risk, prostate-specific antigen, radiotherapy, and nerve-sparing status were tabulated. Survey questions addressed urinary irritation/obstruction, incontinence, and overall bother. Responses were averaged to calculate a urinary sum (US) score. Patients were stratified according to the severity of their baseline urinary bother (UB), and changes in urinary indices determined at 24 months. Results A total of 737 patients were included. Postsurgical improvement in urinary obstruction, bother, and sum score was related to baseline UB ( P <.001). Men with severe baseline bother had the greatest improvement in US (+9.3), whereas those with asymptomatic baseline UB experienced a decline in US (−2.8). All patients experienced a decline in urinary incontinence of 6.3-8.3 that was independent of baseline bother ( P = .507). Patients with severe UB experienced positive outcomes, whereas those at asymptomatic baseline experienced negative US outcomes. Negative urinary incontinence outcomes were unrelated to baseline UB. Age, radiotherapy, and nerve-sparing status were not associated with improved UB ( P = .029). However, baseline UB was significantly associated with improvement in postsurgical UB ( P = .001). Conclusion Baseline UB is a predictor of postsurgical improvement in urinary function. These data are helpful when counseling a subset of robot-assisted laparoscopic radical prostatectomy patients with severe preoperative urinary symptoms.

Cardiovascular Safety of β3-adrenoceptor Agonists for the Treatment of Patients with Overactive Bladder Syndrome

Sat, 26 Sep 2015 02:30:02 +0000

Abstract

Context

Mirabegron, the first β₃-adrenoceptor agonist in clinical practice, is approved for treatment of overactive bladder (OAB) syndrome symptoms. Because β₃-adrenoceptors are expressed in cardiovascular (CV) tissues, there are concerns that OAB treatment with β₃-adrenoceptor agonists may affect the heart and vasculature.

Objective

To provide a summary of CV effects of β₃-adrenoceptor agonists in clinical studies.

Evidence acquisition

A systematic literature search from inception until November 2014 was performed on studies in PubMed and Medline.

Evidence synthesis

Twenty papers, published between 1994 and 2014, were identified: mirabegron (16), solabegron (2), AK-677 (1), and BRL35135 (1). More detailed CV data from mirabegron studies were available in online regulatory documents filed with the US Food and Drug Administration and the UK National Institute for Health and Care Excellence.

Conclusions

The CV safety of mirabegron appears to be acceptable at therapeutic doses and comparable with that of antimuscarinic agents, currently first-line therapy for OAB.

Patient summary

In this review we looked at the cardiovascular (CV) effects of β₃-adrenoceptor agonists used for the treatment of overactive bladder (OAB). The CV safety of mirabegron (the only clinically approved β₃-adrenoceptor agonist) appears to be acceptable at therapeutic doses and comparable with that of antimuscarinic agents, the current first-line therapy for OAB.

Take Home Message

Mirabegron is the first in a new class of β₃-adrenergic agonists for the treatment of overactive bladder. Cardiovascular safety of mirabegron appears acceptable at therapeutic doses, with no contraindication for use with β-blockers.

Keywords: β3-Adrenoceptor agonist, Cardiovascular, Overactive bladder, Safety.

Footnotes

^a IRCCS AOU San Martino – University of Genoa, Genoa, Italy

^b Department of Urology, NYU Langone Medical Center, New York, NY, USA

^c Division of Geriatric Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

^d Astellas Pharma Europe Ltd, Chertsey, Surrey, UK

^e Department of Urology, Royal Hallamshire Hospital, Sheffield, UK

⁎ Corresponding author. Department of Urology, Royal Hallamshire Hospital, Glossop Road, Sheffield, S10 2JF, UK Tel. +44 0114 279 7841; Fax: +44 0114 271 1901.

Article information

PII: S0302-2838(15)00864-7
DOI: 10.1016/j.eururo.2015.09.007
© 2015 European Association of Urology, Published by Elsevier B.V.

Estimating the Prevalence of Hematuria, Urinary Retention, and Incontinence in Nepalese Men by Using a Cluster Randomized Survey

Wed, 23 Sep 2015 02:40:19 +0000

Footnotes

^a Epidemiology and Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

^b University of Washington School of Medicine, Seattle, WA, USA

^c James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA

^d Department of Surgery, Kathmandu Medical College, Kathmandu Nepal

⁎ Corresponding author. 1136B 15^th Avenue, Seattle, WA 98122, USA. Tel. +1 425 280 7283; Fax: +1 410 502 7711.

Article information

PII: S0302-2838(15)00775-7
DOI: 10.1016/j.eururo.2015.08.030
© 2015 European Association of Urology, Published by Elsevier B.V.

Can We Improve the Functional Outcomes of Orthotopic Diversion in Women?

Wed, 30 Sep 2015 22:00:00 +0000

Refers to article:

Orthotopic Ileal Bladder Substitution in Women: Factors Influencing Urinary Incontinence and Hypercontinence

Tobias Gross, Susan D. Meierhans Ruf, Claudia Meissner, Katharina Ochsner and Urs E. Studer

Accepted 9 May 2015

October 2015 (Vol. 68, Issue 4, pages 664 - 671)

Abstract Full Text Full-Text PDF (1,2 MB)

Footnotes

Department of Urology, Stanford University, Stanford, CA, USA

⁎ Corresponding author. Department of Urology, Stanford University, 300 Pasteur Drive, Suite S287, Stanford, CA 94305, USA. Tel. +1 650 724 3332.

Article information

PII: S0302-2838(15)00454-6
DOI: 10.1016/j.eururo.2015.05.048
© 2015 European Association of Urology, Published by Elsevier B.V.

Orthotopic Ileal Bladder Substitution in Women: Factors Influencing Urinary Incontinence and Hypercontinence

Wed, 30 Sep 2015 22:00:00 +0000

Abstract

Background

Urinary incontinence or the inability to void spontaneously after ileal orthotopic bladder substitution is a frequent finding in female patients.

Objective

To evaluate how hysterectomy and nerve sparing affect functional outcomes and whether these relate to pre- and postoperative urethral pressure profile (UPP) results.

Design, setting, and participants

Prospectively performed pre- and postoperative UPPs of 73 female patients who had undergone cystectomy and bladder substitution were correlated with postoperative voiding and continence status.

Outcome measurements and statistical analysis

Outcome analyses were performed with the Kruskal-Wallis test, Wilcoxon-Mann-Whitney, or two-group post hoc testing with the Bonferroni correction. Chi-square or Fisher exact tests were applied for the categorical data.

Results and limitations

Of postoperatively continent or hypercontinent patients, 22 of 43 (51.2%) had the uterus preserved; of incontinent patients, only 4 of 30 (13.3%, p < 0.01) had the uterus preserved. Of postoperatively continent or hypercontinent patients, 27 of 43 patients (62.8%) had bilateral and 15 of 43 (34.9%) had unilateral attempted nerve sparing. In incontinent patients, 11 of 30 (36.7%) had bilateral and 16 of 30 (53.3%) had unilateral attempted nerve sparing (p = 0.02). When compared with postoperatively incontinent patients, postoperatively continent patients had a longer functional urethral length (median: 32 mm vs 24 mm; p < 0.001), a higher postoperative urethral closing pressure at rest (56 cm H₂O vs 35 cm H₂O; p < 0.001) as well as a higher preoperative urethral closing pressure at rest (74 cm H₂O vs 47.5 cm H₂O; p = 0.01). The main limitation was the limited number of patients.

Conclusions

In female patients undergoing radical cystectomy and bladder substitution, preservation of the uterus and attempted nerve sparing results in better functional outcomes. The preoperative UPPs correlate with postoperative voiding and continence status and may predict which patients are at a higher risk of functional failure after bladder substitution.

Patient summary

If preservation of the urethra's innervation is not possible during cystectomy, poor functional results with bladder substitutes are likely.

Take Home Message

In female patients with an ileal orthotopic bladder substitute, the functional results (urinary continence, spontaneous residual-free voiding) are significantly better if the uterus is preserved and if bilateral nerve-sparing cystectomy is attempted.

Keywords: Orthotopic ileal bladder substitution, Urethral pressure profile, Hysterectomy, Nerve sparing, Incontinence, Hypercontinence.

Footnotes

Department of Urology, University of Bern, Bern, Switzerland

⁎ Corresponding author. Department of Urology, Inselspital, University Hospital Bern, CH-3010 Bern, Switzerland. Tel. +41 31 632 36 21; Fax: +41 31 632 21 80.

☆ Please visit www.eu-acme.org/europeanurology to read and answer questions on-line. The EU-ACME credits will then be attributed automatically.

Article information

PII: S0302-2838(15)00417-0
DOI: 10.1016/j.eururo.2015.05.015
© 2015 European Association of Urology, Published by Elsevier B.V.

Prospective, Randomized, Multinational Study of Prostatic Urethral Lift Versus Transurethral Resection of the Prostate: 12-month Results from the BPH6 Study

Wed, 30 Sep 2015 22:00:00 +0000

Abstract

Background

Transurethral resection of the prostate (TURP) is considered the gold standard for male lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). However, TURP may lead to sexual dysfunction and incontinence, and has a long recovery period. Prostatic urethral lift (PUL) is a treatment option that may overcome these limitations.

Objective

To compare PUL to TURP with regard to LUTS improvement, recovery, worsening of erectile and ejaculatory function, continence and safety (BPH6).

Design, setting, and participants

Prospective, randomized, controlled trial at 10 European centers involving 80 men with BPH LUTS.

Intervention

PUL or TURP.

Outcome measurements and statistical analysis

The BPH6 responder endpoint assesses symptom relief, quality of recovery, erectile function preservation, ejaculatory function preservation, continence preservation, and safety. Noninferiority was evaluated using a one-sided lower 95% confidence limit for the difference between PUL and TURP performance.

Results and limitations

Preservation of ejaculation and quality of recovery were superior with PUL (p < 0.01). Significant symptom relief was achieved in both treatment arms. The study demonstrated not only noninferiority but also superiority of PUL over TURP on the BPH6 endpoint. Study limitations were the small sample size and the inability to blind participants to enrollment arm.

Conclusions

Assessment of individual BPH6 elements revealed that PUL was superior to TURP with respect to quality of recovery and preservation of ejaculatory function. PUL was superior to TURP according to the novel BPH6 responder endpoint, which needs to be validated in future studies.

Patient summary

In this study, participants who underwent prostatic urethral lift responded significantly better than those who underwent transurethral resection of the prostate as therapy for benign prostatic hyperplasia with regard to important aspects of quality of life.

Trial registration

ClinicalTrials.gov NCT01533038.

Take Home Message

Assessment using a composite measure of effectiveness, quality of recovery, sexual function, continence, and safety revealed significantly better patient responses for prostatic urethral lift than for transurethral resection of the prostate as benign prostatic hyperplasia therapy. The new BPH6 study endpoint for lower urinary tract symptoms incorporates important aspects of quality of life.

Keywords: Benign Prostatic Hyperplasia, Quality of Life, Ejaculation, Minimally-Invasive, TURP.

Footnotes

^a Department of Urology, Herlev Hospital, Herlev, Denmark

^b Frimley Park Hospital NHS Foundation Trust, Surrey, UK

^c Department of Urology, Taunton and Somerset NHS Trust, Taunton, UK

^d PAN Klinik Köln, Köln, Germany

^e Department of Urology, University Hospital Freiburg, Freiburg, Germany

^f City Hospitals Sunderland, Sunderland, UK

^g University Clinic of Lübeck, Lübeck, Germany

^h Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

ⁱ Urology Division, Instituto San Rafaele, Milan, Italy

^j Department of Urology, Ludwig-Maximilians University, Munich, Germany

⁎ Corresponding author. Department of Urology, Ludwig-Maximilians University, Marchioninistrasse 15, Munich 81377, Germany. Tel. +49 89 440072971; Fax: +49 89 440078733.

Article information

PII: S0302-2838(15)00326-7
DOI: 10.1016/j.eururo.2015.04.024
© 2015 European Association of Urology, Published by Elsevier B.V.

Essential Role of Transient Receptor Potential M8 (TRPM8) in a Model of Acute Cold-induced Urinary Urgency

Wed, 30 Sep 2015 22:00:00 +0000

Abstract

Background

Acute exposure of part of the skin to cold stimuli can evoke urinary urgency, a phenomenon termed acute cold-induced urgency (ACIU). Despite its high prevalence, particularly in patients with overactive bladder, little is known about the mechanisms that induce ACIU.

Objective

To develop an animal model of ACIU and test the involvement of cold-activated ion channels transient receptor potential (TRP) M8 and TRPA1.

Design, setting, and participants

Intravesical pressure and micturition were monitored in female mice (wild-type C57BL/6J, Trpa1^−/−, Trpm8^+/+, and Trpm8^−/−) and Sprague Dawley rats.

Interventions

An intravesical catheter was implanted. Localized cooling of the skin was achieved using a stream of air or topical acetone. The TRPM8 antagonist (N-(3-aminopropyl)-2-{[(3-methylphenyl) methyl]oxy}-N-(2-thienylmethyl)benzamide (AMTB) or vehicle was injected intraperitoneally.

Outcome measurements and statistical analysis

Frequencies of bladder contractions and voids in response to sensory stimuli were compared using the Mann-Whitney or Kruskal-Wallis test.

Results and limitations

Brief, innocuously cold stimuli applied to different parts of the skin evoked rapid bladder contractions and voids in anesthetized mice and rats. These responses were strongly attenuated in Trpm8^−/− mice and in rats treated with AMTB. As rodent bladder physiology differs from that of humans, it is difficult to directly extrapolate our findings to human patients.

Conclusions

Our findings indicate that ACIU is an evolutionarily conserved reflex rather than subconscious conditioning, and provide a useful in vivo model for further investigation of the underlying mechanisms. Pharmacological inhibition of TRPM8 may be useful for treating ACIU symptoms in patients.

Patient summary

Brief cold stimuli applied to the skin can evoke a sudden desire to urinate, which can be highly bothersome in patients with overactive bladder. We developed an animal model to study this phenomenon, and found that it depends on a specific molecular cold sensor, transient receptor potential M8 (TRPM8). Pharmacological inhibition of TRPM8 may alleviate acute cold-induced urinary urgency in humans.

Take Home Message

Localized cold stimuli evoke acute bladder contractions and voids in anesthetized mice and rats. These cold-induced bladder responses are dependent on the cold-sensitive ion channel TRPM8. Pharmacological inhibition of TRPM8 may be useful in suppressing acute cold-induced urgency in humans.

Keywords: Urinary urgency, Cold sensing, TRPM8.

Footnotes

^a Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium

^b Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium

^c TRP Research Platform Leuven (TRPLe), Leuven, Belgium

⁎ Corresponding author. Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49 bus 802, B-3000 Leuven, Belgium. Tel. +32 16 330217; Fax: +32 16 345991.

^† These authors contributed equally.

Article information

PII: S0302-2838(15)00257-2
DOI: 10.1016/j.eururo.2015.03.037
© 2015 European Association of Urology, Published by Elsevier B.V.

Preservation of the Neurovascular Bundles Is Associated with Improved Time to Continence After Radical Prostatectomy But Not Long-term Continence Rates: Results of a Systematic Review and Meta-analysis

Wed, 30 Sep 2015 22:00:00 +0000

Abstract

Context

The aetiology of urinary incontinence following radical prostatectomy (RP) is incompletely understood. In particular, it is unclear whether there is a relationship between neurovascular bundle (NVB) sparing and post-RP urinary continence.

Objective

To review systematically the association of NVB sparing in RP with postoperative urinary continence outcomes and synthesise the results in a meta-analysis.

Evidence acquisition

This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. PubMed, Medline, and Cochrane Central Register of Controlled Trials were searched (December 2013), yielding 3413 unique records. A total of 27 longitudinal cohort studies were selected for inclusion. Studies were evaluated using a predefined criteria adapted from the Cochrane Tool to Assess Risk of Bias in Cohort Studies.

Evidence synthesis

Data from 13 749 participants in 27 studies were synthesised in a meta-analysis. An assessment of the study methodology revealed a high risk of bias due to differences in baseline characteristics, outcome assessment, and the likely presence of unreported confounding factors such as meticulous apical dissection. Meta-analysis demonstrated that nerve sparing (NS) compared with non–nerve sparing (NNS) resulted in improved early urinary continence rates up to 6 mo postoperatively. Beyond this time, no significant difference was observed. This effect was seen most clearly for bilateral NS compared with NNS. A sensitivity analysis of prospective cohort studies revealed consistent results.

Conclusions

This analysis demonstrates an association between NS and improved urinary continence outcomes up to 6 mo postoperatively. NS in men with poor preoperative erectile function should be considered in the context of oncologic risk stratification because it may improve time to continence recovery. The underlying cause of the relationship between NS and continence is unknown. It may represent preservation of the intrapelvic somatic nerves supplying the rhabdosphincter or the influence of other confounding factors. Future research should be directed towards improving understanding of the anatomy of urinary continence and the pathophysiology of post-RP incontinence.

Patient summary

We found that avoiding damage to the nerves around the prostate improves urinary continence in the first 6 mo after surgery. After this time, there is no difference in continence between men who had these nerves removed and those who had them saved. This finding could be due to a true effect of saving these nerves or to a number of other factors affecting the research.

Take Home Message

There is an association between preservation of the neurovascular bundles in radical prostatectomy and improved urinary continence rates up to 6 mo postoperatively. The underlying cause of this relationship is unknown.

Keywords: Radical prostatectomy, Prostate cancer, Nerve sparing, Incontinence.

Footnotes

^a Departments of Urology and Surgery, Royal Melbourne Hospital and the University of Melbourne, Melbourne, Australia

^b Epworth Prostate Centre, Epworth Healthcare, Melbourne, Australia

^c Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia

^d Department of Urology, Frankston Hospital, Melbourne, Australia

⁎ Corresponding author. Department of Urology, Royal Melbourne Hospital, Level 3 Centre, Grattan Street, Parkville, Victoria 3050, Australia. Tel. +61 39342 7294; Fax: +61 39342 8928.

Article information

PII: S0302-2838(14)01034-3
DOI: 10.1016/j.eururo.2014.10.020
© 2014 European Association of Urology, Published by Elsevier B.V.

Economic analyses of stress urinary incontinence surgical procedures in women

Wed, 30 Sep 2015 14:33:25 +0000

Introduction To evaluate the quality of economic analysis (EA) of surgical procedures for stress urinary incontinence (SUI) in women. Methods A MEDLINE search on EA for SUI surgical procedures for the years 2000–2014 included the MeSH terms “tension-free vaginal tape,” “TVT,” “trans-obturator tape,” “TOT,” “Burch colposuspension” (BC), “stress urinary incontinence,” “economic analysis,” and “cost-effectiveness analysis.” Important criteria for evaluating articles were selected from panels that set out criteria to evaluate EA [Scales CD, Jr., Christopher SS, American Urological Association 32:121–128, 2013], [Hsieh MH, Maxwell MV, J Urol 178 1867–1874, 2007], [Wu JM, Catherine CM, Conover MM, et al., Obstet Gynecol 123 1201–1206, 2014]. Results Thirteen articles were identified: TVT compared to BC (6), to other surgical procedures for SUI (1), to TOT (3) and to the mini-sling (1); open BC compared to laparoscopic BC (1), and analysis of various slings and meshes for various types of incontinence (1). Articles originated from: United States (3), Europe (4), United Kingdom (4), and Canada (2). Eight described cost-effectiveness analysis (CEA), two cost-utility analysis, and three cost comparison. Follow-up time for patients ranged from 6 to 24 months in eight articles, with four having a minimum of 24 months follow-up. Studies mostly adhered to the criteria, however indirect costs, sensitivity analysis, and efficacy parameters varied. Long-term synthetic sling-related complications were not included. Conclusion Although CEA for SUI surgery is a burgeoning field, study comparisons remain difficult due to some variability, including health care delivery systems. As women live longer, long-term data will become critical as complications and reoperations can affect the real cost of SUI corrective procedures. Neurourol. Urodynam. 9999:XX–XX, 2015. © 2015 Wiley Periodicals, Inc.

Dynamics of pelvic floor muscle functional parameters and their correlations with urinary incontinence in men after radical prostatectomy

Wed, 30 Sep 2015 14:32:59 +0000

Aims To evaluate the dynamics of pelvic floor muscle strength, endurance, and urinary incontinence in a 6-month period in men after radical prostatectomy and to determine correlations between pelvic floor muscle strength, endurance, and urinary incontinence. Methods Forty-two men with prostate cancer treated with radical prostatectomy participated in the study. Pelvic floor muscles parameters were evaluated using the anal perineometer. An 8-hour pad test was used with the catheter removed. Results The greatest change in strength occurred during the last 3 months, i.e., from the third to the sixth month following surgery (P ≤ 0.05). The average amount of urinary incontinence on the day of catheter removal was approximately 311 g per 8 hr. Urinary incontinence decreased by 93.6% from the day of catheter removal 6 months later. A strong correlation (P ≤ 0.001) of reverse dependence was determined between pelvic floor muscle strength before surgery and the amount of urinary incontinence 6 months following surgery. Conclusion The greatest change of pelvic floor muscles strength and endurance occurred during the third to the sixth month following surgery. The greatest change in urinary incontinence occurred during the first month following surgery. Pelvic floor muscle strength causes a greater decrease in urinary incontinence than endurance. The greater the pelvic floor muscle strength before surgery, the lower the amount of urinary incontinence. Age also affects pelvic floor muscle strength and endurance; this relation gradually weakens and with age disappears. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Predictive factors of adverse events after intravesical suburothelial onabotulinumtoxina injections for overactive bladder syndrome—A real-life practice of 290 cases in a single center

Mon, 28 Sep 2015 20:21:13 +0000

Aims Patients often experience adverse events (AEs) after intravesical onabotulinumtoxinA (BoNT-A) treatment for overactive bladder refractory to antimuscarinic agents. We investigated the prevalence and predictive factors of AEs in such patients. Methods A total of 290 patients underwent intravesical BoNT-A (100 U) suburothelial injection. The age, gender, overactive bladder subtypes, medical co-morbidities, and neurological diseases of the patients were recorded. The maximum flow rate (Qmax), voided volume, post-void residual (PVR) volume, and voiding efficiency (VE) at baseline were analyzed to identify adverse events within 3 months after treatment. Results Acute urinary retention (AUR) developed in 24 patients (8.3%), and urinary tract infection (UTI) occurred in 44 (15.2%) within 3 months of treatment. Large PVR volume (>200 ml) occurred in 81 (27.9%), 68 (24.3%), and 49 (18.4%) patients 1, 3, and 6 months after treatment, respectively. AUR developed significantly more often in men, patients >61 years old, those with a baseline Qmax ≤15 ml/sec, PVR ≥100 ml, and VE <90%. Patients older than 61 years had a higher incidence of large PVR 1 month after treatment. Female gender and a baseline PVR volume ≥100 ml had a greater incidence of UTI. Age >61 years, low Qmax, low voiding efficiency, and large PVR at baseline were also risk factors for adverse events. Conclusion AUR, UTI, and large PVR volume are common AEs after BoNT-A treatment. Patients with overactive bladders that are at risk of developing AEs after BoNT-A injection should be informed of the possible AEs. Neurourol. Urodynam. 9999:XX–XX, 2015. © 2015 Wiley Periodicals, Inc.

The role of the pubococcygeus muscle in the urethrogenital reflex of male rats

Mon, 28 Sep 2015 19:45:31 +0000

Aim To determine the response of the pubococcygeus muscle (Pcm) during the urethrogenital reflex (UGR). Methods Urethane-anesthetized male rats (n = 20) were used to describe the gross anatomy of the Pcm (n = 3), the effect of the electrical stimulation of the Pcm on the urethral pressure (n = 3), and the reflex activity of the Pcm due to the mechanical stimulation of the urethra (n = 3) and during penile and urethrogenital reflexes (n = 11). The urethral pressure (UP) was recorded as a response to penile stimulation (brushing, extension, and occlusion) and during the UGR; the electromyographic activity of the Pcm was simultaneously evaluated. The role of the Pcm was assessed by measuring urethral pressure variables before and after denervation of this muscle. Results The Pcm is innervated by the caudal branch of the somatomotor branch of the pelvic nerve. The electrically induced contraction of the Pcm increased the UP. The mechanical stimulation of the urethra during the induced micturition caused the reflex activity of the Pcm. The different penile stimuli caused bursts of activity of the Pcm. During the UGR, the Pcm exhibited a tonic activity. The transection of the caudal branch of the Smb reduced the maximal UP during the penile stimulation. The same was true regarding the duration of the UGR, the pressure that triggers the UGR, and the highest pressure observed during the UGR. Conclusion Our results suggest that the activation of the Pcm is relevant for the UGR in male rats. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Left-colon antegrade enema (LACE): Long-term experience with the Macedo-Malone approach

Mon, 28 Sep 2015 19:40:09 +0000

Aims We evaluated the long-term results with a left antegrade continence enema (LACE) approach: “Macedo–Malone (MM) procedure” to define parameters such as clinical durability of the technique and patients' compliance with the method. Methods We reviewed the medical records of all patients that underwent the MM procedure in our institution since 2001 and conducted a telephonic interview to investigate the use of the enema and satisfaction with the procedure. Results Thirty-five MM procedures were performed, but eight patients lost to follow-up were excluded. Fifteen patients (55%) were female. Myelomeningocele was the clinical diagnoses in 25 (93%). Mean age at surgery was 9 years (3–27 years) and mean follow-up was 75 months (median: 56 months). The indication for LACE was clinically intractable constipation with fecal leakage. Most patients still used the stoma regularly to do the enema (74%). Mean washout time was 27 min (2–90 min). The revision rate due to stenosis was 22.2% (6/27) and all underwent suprafascial revision. We performed one classical MACE by infrafascial approach as a salvage procedure. Overall reoperation rate was 25.8% and fecal continence was 89%. There were no reports of leakage through the stoma. Among patients who still used the stoma, 74% were satisfied with surgery and would strongly recommend the procedure to another patient. Conclusions The MM procedure is a straightforward procedure, which can be performed in 15–20 min, avoids additional entero–entero anastomosis, precludes the use of the appendix, and has shown comparable results to either “classical” MACE or other LACE variants. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Re: Drossaerts J, Vrijens D, Leue C, Schilders I, Van Kerrebroeck P, Van Koeveringe G. Screening for depression and anxiety in patients with storage or voiding dysfunction: A retrospective cohort study predicting outcome of sacral neuromodulation treatment. Neurourol Urodyn. 2015

Wed, 23 Sep 2015 16:21:48 +0000

Long-term complications of continent cutaneous urinary diversion in adult spinal cord injured patients

Wed, 23 Sep 2015 14:33:45 +0000

Objective To report the long-term complications of continent cutaneous urinary diversion(CCUD) in spinal cord injured(SCI) patients unable to perform intermittent self-catheterization(ISC) through the urethra. Materials and Methods Between July 2001 and January 2012, adult SCI patients with a neurogenic bladder who underwent CCUD according to Mitrofanoff's/Monti's/Casale's principle were enrolled. A concomitant supratrigonal and augmentation enterocystoplasty were performed because of refractory detrusor overactivity or low bladder compliance. Early postoperative complications were reported according to Clavien-Dindo classification. Long-term complications, stomal and urethral continence, renal function, urodynamic parameters and quality-of-life were assessed. Results Overall, 29 consecutive SCI patients were included, median age 35 years (IQR 26–46). Median follow-up time was 66 months (IQR 50–80). Two post-operative severe complications (grade III–IV) were reported. One patient had a stomal stenosis and another patient a tube stenosis. Both were treated by dilation. Two patients developed fistulae between the tube and the skin and required a surgical treatment. Three patients had bladder stones managed with endoscopy. Two patients had remnant stress urine leakage through the urethra, which was treated surgically: one received periurethral balloons(ACTTM) and one a tension-free vaginal tape. Creatinine clearance remained stable postoperatively. Urodynamic parameters were significantly improved. At last follow-up, 100% of patients had a catheterizable continent stoma and urethral continence was achieved in 96%. An improvement of quality-of-life was reported by 90% of patients. Conclusions CCUD allowed these patients to keep ISC as a voiding pattern and to be continent without any appliance. The main complications were related to the tube and to bladder enlargement; thus, annual monitoring is required. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Systematic review of surgical treatment of post radical prostatectomy stress urinary incontinence

Wed, 23 Sep 2015 13:39:32 +0000

Context Stress urinary incontinence (SUI) after radical prostatectomy (RP) continues to be a significant problem with several implications including patient quality of life and other critical postoperative outcomes. Objectives To report the results in terms of efficacy (pad count, 24 hr pad test, QOL questionnaires) and safety (complication rate and type of complications) of all surgical devices approved for the treatment of SUI after RP. Evidence Acquisition A systematic review was conducted in accordance with the PRISMA Statement. A literature search was carried out through the PubMed/Medline, SCOPUS, and Web of Science databases using the keywords “incontinence,” “radical prostatectomy,” and “‘treatment”. Inclusion criteria were: number of patients higher than 30, mean follow up longer than 12 months and definition of a successful outcome as the use of 0 to 1 safety pads a day. Evidence Synthesis 113 papers underwent primary review. 51 papers met the inclusion criteria with a total sample size of 4022 patients. Efficacy (0–1 safety pads) was on average 65.7% for AUS, 48.2% for Invance Sling, 48.8% for Advance Sling, 64.2% for ProACT. Twenty four hour pad test and QOL questionnaires were respectively available only in 4 and 18 studies. The overall complication rate was 19.43% for AUS, 7.4% for Invance Sling, 12.3% for Advance Sling, 12.3% for ProACT. Authors' Conclusions Due to the poor overall quality of available studies, it was impossible to identify or refute clinically important differences between the alternative surgical procedures. Although our data seems to suggest that AUS has the highest efficacy in the treatment of SUI following RP it is also associated with the highest complication rate, but this may be due to the longest follow up. Larger rigorous trials are needed in order to support this evidence.

Pelvic floor muscle training for female stress urinary incontinence: Five years outcomes

Wed, 23 Sep 2015 13:37:18 +0000

Aim To evaluate the clinical status, lower urinary tract symptoms (LUTS) and quality of life (QOL) 5 years after completion of a pelvic floor muscle training (PFMT) program for female stress urinary incontinence (SUI). Methods Two hundred and eight consecutive women who underwent a guided PFMT program as first-line management of SUI were invited to participate in a questionnaire-based outcome study 5 years after treatment. Primary outcome measures comprised of adherence to PFMT, interim surgery for SUI, and patients’ self-assessment of LUTS and QOL. Results One hundred and thirty-two (63%) women completed all questionnaires, 55 of whom (41.7%, mean age 52.1 ± 10.8) reported adherence to PFMT, 75 (56.8%, mean age 49.8 ± 10.8) discontinued training, and two (1.5%) underwent surgery. Further analysis of the 76 non-responders revealed six more patients who underwent surgery. Thus, overall, eight patients (3.8% of the original cohort) underwent surgery within 5 years after completion of the training program. Except for those who underwent surgery, almost all women reported SUI, however their ICIQ-UI scores for frequency and amount of leakage were low (2.2 ± 0.9, 1.18 ± 1.04, respectively) and I-QOL score was high (96.2 ± 13.6). All investigated parameters and domains, in each of the three questionnaires and among all women, consistently demonstrated low severity of LUTS and relatively high continence-associated QOL. There were no statistically significant differences in favor of adherence to PFMT. Conclusions Although relatively high rates of 5-year adherence to training were demonstrated among our patients, this adherence was not associated with superior treatment outcomes. Further studies are needed to establish the long-term efficacy of PFMT for SUI. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Urological disturbance and its neuroanatomical correlate in patients with chronic brainstem stroke

Wed, 23 Sep 2015 13:36:33 +0000

Aims Few studies have depicted urological disturbances among patients with chronic brainstem stroke, and little is known about the exact location of the micturition center or its role in humans. The aim of the present study was to retrospectively investigate urological disturbances and their neuroanatomical correlates among consecutively admitted patients with chronic brainstem stroke. Methods Urodynamic studies, brain images, and urological symptoms questionnaires were reviewed from consecutive patients suffering from brainstem stroke, who had been admitted to a stroke unit at a rehabilitation hospital between June 1, 2013 and January 31, 2015. For further comparison, consecutive data from urodynamic studies of patients with upper cervical spinal cord injury (admitted to a hospital between January 1, 2008 and January 31, 2015) were reviewed. Results Patients with chronic pontine stroke manifested more frequent detrusor underactivity, lower maximal detrusor pressure, and higher compliance than patients with upper cervical spinal cord injury. The most frequently involved lesions associated with detrusor underactivity were located around the central portion of the bilateral pons along the entire sagittal level. Urinary incontinence and symptoms associated with lower urinary tract dysfunction were reported in 10% and 95% of patients with brainstem stroke, respectively. No difference was found between genders or stroke subtypes in patients with brainstem stroke. Conclusions The present study identified a relationship between chronic pontine stroke and detrusor underactivity. Thus, detrusor underactivity might be associated with lesions localized to central portions of the bilateral pons. The prevalence of lower urinary tract symptoms was also revealed to be high among patients with chronic brainstem stroke. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Stress urinary incontinence and endogenous sex steroids in postmenopausal women

Fri, 18 Sep 2015 15:18:24 +0000

Aims Urinary incontinence in general is a major cause of quality of life impairment, morbidity and hospitalization. Its onset is strongly linked to the menopause. Our study aimed to elucidate the possible relationship between endogenous circulating estrogens and the onset and development of stress urinary incontinence (SUI). Methods One hundred and thirty eight peri- and postmenopausal women with SUI were matched 1:1 with continent women based on age and BMI. Morning fasting blood samples were drawn from all subjects for assessment of estradiol (E2), FSH, LH, Testosterone, Δ4-Androstendione (Δ4Α), DHEAS, prolactin, SBHG as well as a biochemical profile (glucose, insulin, triglycerides, cholesterol, HDL, LDL, ApoA1, ApoB). Hormone and biochemical parameters were compared between continent and incontinent women. Results Incontinent women had significantly lower serum estradiol levels compared to those in the control group (17.30 ± 8.16 vs. 24.22 ± 8.99, P < 0.001). Furthermore, the same association was observed for serum Δ4Α (146.07 ± 52.63 vs. 159.99 ± 42.62, P = 0.017). These associations remained significant after controlling for age, menopausal age, BMI, and number of deliveries. Conclusions These results may indicate that within the postmenopausal range, endogenous sex hormones may be associated with the presence of SUI in women not on menopausal hormone therapy. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Have we been led astray by the NGF biomarker data?

Fri, 18 Sep 2015 14:51:33 +0000

ICS teaching module: Artefacts in urodynamic pressure traces (basic module)

Tue, 15 Sep 2015 16:32:50 +0000

Aims To present the ICS Teaching Module on artefacts in urodynamics pressure traces. Methods Slides from three urodynamics centres were assembled. Descriptions and labels were agreed by the authors and the module presented at the ICS Annual Scientific Meeting in Brazil 2014. Results Ten artefacts that should be recognized while using water-filled urodynamic systems are presented and remedial action described. Conclusions This manuscript serves as scientific background for the slide set made available on the ICS website. By following the guidelines in this teaching module, good quality urodynamics can be more readily achieved. Neurourol. Urodynam. 9999:1–2, 2015. © 2015 Wiley Periodicals, Inc.

Endoplasmic reticulum stress is involved in apoptosis of detrusor muscle in streptozocin-induced diabetic rats

Mon, 14 Sep 2015 18:47:09 +0000

Aims Endoplasmic reticulum stress (ERS) has been proven to be associated with apoptosis and plays a critical role in the development of many diabetic complications. In the pathogenesis of diabetic cystopathy (DCP), the role of ERS is still unclear. Our study is aimed at the investigation of the involvement of ERS-associated detrusor muscle apoptosis in streptozocin (STZ)-induced diabetic rats. Methods At different timepoints (4, 8, 12, and 16 weeks after induction of type 1 diabetic rat models), hematoxylin & eosin (H&E) staining was performed to assess the histological changes of the diabetic detrusor; the sub-cellular ultrastructure, especially the zone of endoplasmic reticulum (ER), was observed by transmission electron microscopy (TEM), and the terminal deoxynucleotidyl transferase-mediated DNA nick-end labeling (TUNEL) staining was used to identify the enhanced apoptosis. Moreover, the expression of three hallmarks of ERS-associated apoptosis, including glucose-regulated protein 78 (GRP78), CCAAT/enhancer-binding protein homologous protein (CHOP), and caspase12, was detected by quantitative real-time polymerase chain reaction (qRT-PCR) and Western blot. Results Light microscopic impairments of histology, including progressive loosely packed muscle bundles and increased fibrous tissue, can be seen; the ultrastructural changes featuring the swollen and fused cisternaes in ER zone and deformed nucleus were also observed in the detrusor smooth muscle (DSM). Increased apoptosis and elevated expression of GRP78, CHOP, and caspase12 at both protein and mRNA levels in a time-dependent fashion were detected. Conclusions The occurrence of ERS-associated apoptosis may be involved in the development of DCP and may contribute to the diabetic detrusor impairment. Neurourol. Urodynam. 9999:XX–XX, 2015. © 2015 Wiley Periodicals, Inc.

Incontinence in children, adolescents and adults with Williams syndrome

Mon, 14 Sep 2015 18:44:46 +0000

Aims Williams Syndrome (WS) is a microdeletion syndrome (chromosome 7q11.23) characterized by typical facial features, cardiovascular disease, behavioural symptoms, and mild intellectual disability (ID). The aim of this study was to assess the rates of incontinence and psychological problems in persons with WS. Methods 231 individuals with WS were recruited through the German parent support group (52.0% male, mean age 19.4 years). Faecal incontinence (FI) was diagnosed from the age of 4 years and nocturnal enuresis (NE) and daytime urinary incontinence (DUI) of 5 years onwards. The Parental Questionnaire: Enuresis/Urinary Incontinence, the International-Consultation-on-Incontinence-Questionnaire–Pediatric LUTS (ICIQ-CLUTS), as well as the Developmental Behavior Checklist for parents (DBC-P) or for adults (DBC-A) were filled out by parents or caregivers. Results 17.8% of the sample had NE, 5.9% DUI and 7.6% FI. NE was present in 44.9% of children (4–12 years), 13.5% of teens (13–17y), 3.3% of young adults (18–30y) and in 3.6% of adults (> 30y). DUI (and FI) decreased from 17.9% (21.4%) in children to 0% in adults. 3.5% of the sample had an ICIQ-CLUTS score in the clinical range. 30.5% of children and 22.1% of adults had a clinical DBC score. Children and teens with clinically relevant DBC-P-scores had significantly higher DUI rates. Conclusions Children with WS have high rates of incontinence and LUTS, which decrease with age. Most adults are continent. NE is the most common subtype. Except for DUI in children, incontinence is not associated with behavioural problems. Screening, assessment and treatment of incontinence in individuals with WS is recommended. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Use of best-worst scaling to assess patient perceptions of treatments for refractory overactive bladder

Mon, 14 Sep 2015 18:44:18 +0000

Aims Refractory overactive bladder (OAB) treatments, including sacral neuromodulation (SNM), onabotulinumtoxin A (OnabotA), and percutaneous tibial nerve stimulation (PTNS), differ considerably. Best-Worst Scaling (BWS) was used to assess patient preferences for these treatments. Methods A cross-sectional Web survey, based on findings from qualitative interviews with 23 OAB patients and 7 clinical experts, was conducted with idiopathic OAB patients in the US and UK. The BWS exercise involved prioritizing subsets of 13 attributes across 13 choice tasks, where patients identified the attribute they considered as best and as worst in each task. Attribute BWS scores, ranging from −1.0 (worst) to 1.0 (best) were calculated based on the rates that each attribute was chosen. Attitudes toward the attributes also were assessed via like/dislike Likert scales, and questions regarding the percentage likelihood (0–100%) of trying each treatment, based on standardized treatment descriptions. Results The sample included 245 patients (118 US, 127 UK); 79% female, mean age 50 ± 7.8 years. All 13 attribute BWS scores were significantly positive or negative. “Lasting improvement” (0.82), “minimal side effects” (0.67), and “sends signals between bladder and brain” (0.35)' were rated most favorably, and “complications with implant” (−0.65), and “be willing to self-catheterize” (−0.53) were rated worst. All but one of the attribute BWS scores were significantly correlated with the respective like/dislike scores and the percentage likelihood estimates for trying one of the three treatments. Conclusion BWS was successful in assessing the magnitude of patient preferences for key attributes associated with substantially different refractory OAB therapies. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Use of preoperative factors including urodynamic evaluations and nerve-sparing status for predicting urinary continence recovery after robot-assisted radical prostatectomy: Nerve-sparing technique contributes to the reduction of postprostatectomy incontinence

Wed, 09 Sep 2015 14:23:59 +0000

Aims To examine which preoperative factors, including urodynamic evaluations, and operative procedures could predict continence status after robot-assisted radical prostatectomy (RARP) in this study. Materials and Methods Univariate and multivariate logistic regression analyses of preoperative factors such as age, body mass index, prostate-specific antigen level before biopsy, prostate size before surgery, membranous urethral length measured using magnetic resonance imaging (MRI), bladder compliance and maximum urethral closure pressure (MUCP) measured by urodynamic study (UDS), and nerve-sparing (NS) status predicting 24-hr pad test >2 g/day at 1 year after RARP were examined in 111 patients enrolled in this study. Results The number of patients with incontinence at 1 year after RARP was 39 (35.1%). The only predictive factor for urinary continence was NS grades. To investigate the contribution of NS to urinary continence, 84 patients underwent UDS three times; before, immediately after, and 1 year after RARP. Chronological UDS revealed that recovery patterns of storage and voiding functions were the same among non-NS, unilateral-NS, and bilateral-NS groups, and that higher degrees of NS contributed to lesser decreases in MUCP and longer functional urethral length (FUL) after RARP. Conclusion Preoperative factors, including the results of UDS, could not predict continence 1 year after RARP. The NS procedure contributed to continence status. NS favorably affected MUCP and FUL; however, it did not affect bladder function after RARP. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Screening for depression and anxiety in patients with storage or voiding dysfunction: A retrospective cohort study predicting outcome of sacral neuromodulation

Wed, 09 Sep 2015 14:23:36 +0000

Aims It has been reported that somatic treatment in patients with affective symptoms has a higher risk of failure. The aim was to investigate whether affective symptoms could predict the outcome of sacral neuromodulation (SNM) for lower urinary tract symptoms (LUTS). Methods All patients that underwent a SNM evaluation between 2006 and 2013 and filled out a Hospital Anxiety and Depression Score (HADS) before treatment, were included. Chi-square analysis and bivariate logistic regression were used to assess associations and predictive value. Results Eighty-six patients were included, 65 females and 21 males. Most patients, 66, had overactive bladder syndrome (OAB). The remaining 20 patients suffered from non-obstructive urinary retention (NOR). Thirty-nine OAB patients and 17 NOR patients, had a normal total HADS score before treatment. Significantly more patients showed abnormal HADS-D (P = 0.047) and HADS-A (P = 0.015) scores in the OAB group compared to the NOR group. Success of SNM could not be predicted by the HADS score P = 0.464 (after 1 year P = 0.446). Subsequent analysis revealed that an abnormal HADS score was not related to the occurrence of SNM adverse events. Conclusions The present study did not reveal a significant relationship between an abnormal HADS score and failure of the SNM test period in a mixed group of OAB and NOR patients. However, differences between OAB and NOR patients concerning affective symptoms were present. It is known that psychological factors play a role in the severity of LUTS, but they may not predict SNM outcome. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Microvascular complications and prevalence of urgency incontinence in Japanese patients with type 2 diabetes mellitus: The dogo study

Wed, 09 Sep 2015 14:23:10 +0000

Aims Diabetes was significantly positively associated with urgency incontinence in several epidemiological studies. We examine the association between diabetic neuropathy, which we defined based on neuropathic symptoms, the absence of the Achilles reflex, and/or abnormal vibration perception, and urgency incontinence among Japanese patients with type 2 diabetes mellitus. Methods Study subjects were 742 Japanese patients with type 2 diabetes mellitus, aged 19–70 years, who had undergone blood tests at our institutions. A self-administered questionnaire was used to collect information on the variables under study. Urgency incontinence was defined as present when a subject answered “once a week or more” to the question: “Within one week, how often do you leak urine because you cannot defer the sudden desire to urinate ?”. Diabetic neuropathy was diagnosed if the patients showed two or more of the following three characteristics: neuropathic symptoms, the absence of the Achilles reflex, and/or abnormal vibration perception. Adjustment was made for sex, age, body mass index, duration of type 2 diabetes mellitus, current smoking, hypertension, dyslipidemia, glycated hemoglobin, stroke, coronary artery disease, insulin therapy, diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. Results The prevalence of urgency incontinence was 8.6%. Diabetic neuropathy was independently positively associated with urgency incontinence: the adjusted OR was 2.20 (95%CI: 1.16–4.36). Associations between diabetic retinopathy or nephropathy and the prevalence of urgency incontinence were not significant. Conclusions In Japanese patients with type 2 diabetes mellitus, only diabetic neuropathy was independently positively associated with urgency incontinence. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Long term sustained therapeutic effects of percutaneous posterior tibial nerve stimulation treatment of neurogenic overactive bladder in multiple sclerosis patients: 12-months results

Wed, 09 Sep 2015 14:20:44 +0000

Aims The aim of this study is to determine the sustained therapeutic efficacy and treatment intervals for PTNS in NOAB with MS, offering periodic additional treatments during 1 year in patients who completed an initial course of 12 consecutive weekly sessions. Methods A total of 34 patients enrolled to the PTNS treatment and 21 patients completed the 1 year PTNS treatment with a tapering protocol of 6, 9, and 12 months of therapy, respectively. After 12 weeks of therapy, PTNS was applied at 14 day intervals for 3 months, 21 day intervals for 3 months, and 28 day intervals for 3 months. The patients completed a 3-day voiding diary at 3rd, 6th, 9th, and 12th month. The patients requested to complete validated questionnaires (ICIQ-SF, OAB-V8, OAB-q SF) were carried out within 3-month intervals thereafter during their enrolment in the study. Results A total of 21 patients were enrolled in the study. Of these 5 (23.8%) were men and 16 (76.2%) women. The improvements for all voiding diary parameters were significant in the 6th, 9th, and 12th months when compared with baseline. Mean values between baseline and 12 month parameters suggested that daytime frequency decreased by 5.4 voids daily, urge incontinence decreased by 3.4 episodes daily, urgency episodes decreased by 7.4 episodes daily, nocturia decreased by 2.6 voids, and voided volume improved by a mean of 72.1 cc. Conclusion These results have demonstrated NOAB symptom improvement in MS patients can be achieved with 12 weekly PTNS treatments which show excellent durability over 12 months. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Differences in motor learning of pelvic floor muscle contraction between women with and without stress urinary incontinence: Evaluation by transabdominal ultrasonography

Wed, 09 Sep 2015 14:20:07 +0000

Aims To evaluate differences in motor learning of pelvic floor muscle (PFM) contraction between women with and without stress urinary incontinence (SUI) under transabdominal ultrasonography (TAUS)-guided PFM training. Methods Postpartum women received an intensive 3-month PFM training program from 3 to 6 months postpartum. The program consisted of home exercises and weekly group sessions with individual TAUS-guided training. Motor learning progress of PFM contraction was evaluated with TAUS at each weekly session. We regarded a woman who contracted her PFM correctly more than 9 times out of the 10 repetitions as having achieved the associative stage of motor learning. Women were evaluated before and after a 12-week intervention for PFM and SUI by using transperineal ultrasonography and questionnaire, respectively. Results Seventy-three women were included: 44 primiparous women (60.3%) and 64 vaginal deliveries (87.7%). Of 73 women, 22 (30.1%) were classified as the SUI group. By the fifth session, the proportion of women who could correctly contract their PFM > 9 out of the 10 repetitions had increased significantly more in the non-SUI group than in the SUI group (90.0% vs. 58.8%, P = 0.011). The proportion of women achieving the associative stage of correct PFM contraction was not different between the two groups after the sixth session. PF morphology and SUI were improved after intervention (P < 0.05). Conclusions The proportion of women achieving the associative stage in women with SUI was less than that in women without SUI in the early phase of the combination of group and home PFM training with TAUS-guided training. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Predictors for a positive outcome of adapted clinical dry bed training in adolescents and adults with enuresis

Wed, 09 Sep 2015 14:19:14 +0000

Aims Adapted Dry Bed Training (Adapted DBT) has been shown to be effective in therapy-resistant adolescents and adults with enuresis. Given the substantial impact of enuresis and the time-consuming nature of Adapted DBT, we investigated which patients benefited most from Adapted DBT. Therefore, we identified predictors for a successful treatment response to Adapted DBT in this population. Methods Retrospective cohort study in 907 consecutive patients, aged 11–42 years, subjected to in-hospital Adapted DBT in our Dry Bed Center between January 2003 and July 2013. Outcome was defined as treatment success after six months (primary outcome) and six weeks. Results of logistic regression analyses are presented in odds ratios and 95% confidence intervals. Results Predictors for a successful treatment response to Adapted DBT in adolescents and adults with enuresis after six months are: gender (female), initial degree of enuresis (mild: 0–3 nights/week), current diaper use, never used anticholinergics in the past, and degree of enuresis six weeks after training. Predictors for successful treatment response after six weeks are: gender and initial degree of enuresis only. Limitation The low explained variance of our model, showing that many other factors, not included in our study, could be of interest in the prediction of success. Conclusions Several factors that predicted a successful treatment response of Adapted DBT after six weeks and six months were identified. However, the low explained variance of our model suggests that other non-identified factors are also important in predicting outcome. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Impact of childhood and recent traumatic events on the clinical presentation of overactive bladder

Tue, 01 Sep 2015 12:21:57 +0000

Aims (1) To describe the Prevalence of childhood and recent trauma in patients with overactive bladder (OAB), and (2) assess the impact of traumatic events on the clinical presentation and the severity of OAB symptoms, quality of life, and psychosocial health. Methods Patients diagnosed with OAB (n = 51) and age-matched healthy controls (n = 30) were administered the Childhood Traumatic Events Scale and Recent Traumatic Events Scale, assessing exposure and perceived impact of common traumatic events. Among OAB patients, validated instruments were administered to correlate traumatic exposure to evaluate adult urinary symptoms (ICIQ-UI, ICIQ-OAB, OAB-q, UDI-6, IIQ-7, USS), mood dysregulation (HADS), sleep and fatigue (PROMIS), and Psychological stress (PSS). Results Childhood sexual trauma was more prevalent in patients with OAB compared to controls (29.4% vs. 6.7%, P = 0.041). OAB patients also rated their childhood sexual exposure as more traumatic compared to controls (mean ratings of 1.7 vs. 0.4, P = 0.050). There was no difference in childhood deaths (P = 0.24), parental upheaval (P = 0.87), violence (P = 0.099), illness/injury (P = 0.683), or any recent traumatic events between OAB and control subjects. Childhood trauma predicted worse bladder pain (P = 0.005), worse non-urologic pain (P = 0.017), poorer mood (P = 0.001), higher anxiety (P = 0.029), higher physical symptom burden (P < 0.001), and higher psychological stress (P < 0.039). However, childhood trauma did not correlate with the severity of OAB symptoms (urgency, frequency, incontinence). Conclusions Thirty percent of OAB patients reported childhood sexual trauma. These patients report more pain symptoms, poorer mood, and greater somatic burden. These data highlight the potentiating role of psychosocial stressors from childhood in the adult suffering from OAB. Neurourol. Urodynam. © 2015 Wiley periodicals, Inc.

Erratum

Tue, 25 Aug 2015 09:22:20 +0000

Atherosclerosis as a predictor of delayed recovery from lower urinary tract dysfunction after robot-assisted laparoscopic radical prostatectomy

Fri, 21 Aug 2015 23:52:23 +0000

Aims The aim of the present study was to investigate whether atherosclerosis could be associated with lower urinary tract dysfunction in the early postoperative period after robot-assisted laparoscopic radical prostatectomy (RARP). Methods Eighty consecutive patients undergoing RARP were investigated. The severity of atherosclerosis was evaluated by the cardio-ankle vascular index (CAVI) before RARP. Patients were divided into two groups, the atherosclerotic group (CAVI ≥9.0) and the control group (CAVI <9.0). International Prostate Symptom Score (IPSS), quality of life (QOL) index, uroflowmetry, post-void residual urine volume (PVR), frequency–volume charts, and the 1-hr pad test were compared between the two groups. Assessments were performed before RARP, and then at 1, 3, and 6 months after RARP. Results Preoperative subjective and objective parameters were not significantly different between the two groups. The voiding symptom score of the IPSS and the QOL index was significantly higher in the atherosclerotic group at 3 months after RARP (P = 0.035, P = 0.001, respectively). The maximum flow rate was consistently lower in the atherosclerotic group, reaching a significant difference at 6 months after RARP (P = 0.027). IPSS total and storage symptom scores, PVR, frequency, and urine loss were not significantly different between the groups after RARP. Conclusions Atherosclerosis delayed the improvement of both voiding symptoms and voiding function after RARP, leading to aggravation of QOL in the early postoperative period. Atherosclerosis may be a predictor of slower recovery from transient lower urinary tract dysfunction immediately after RARP. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

The prevalence of fecal incontinence and associated risk factors in older adults participating in the SABE study

Fri, 21 Aug 2015 23:51:19 +0000

Aims To assess the prevalence of fecal incontinence (FI) and associated factors in older adults. Methods The prevalence and factors associated with FI in older adults were studied by means the SABE study (Health, Well-being, and Aging). A group of 1,345 subjects were interviewed during the third wave of the SABE study performed in Sao Paulo, in 2010. The study included 64.3% females; the mean age of the participants was 70.4 years. The dependent variable was the positive answer for the question “In the last 12 months, have you ever lost control of bowel movements or stools?”. Descriptive analysis and hierarchical logistic regression were performed. The independent variables were as follows: (a) demographics: gender, age and (b) clinical characteristics: self-reported chronic diseases, presence of cognitive and/or functional decline, depression and urinary incontinence symptoms, and nutritional status. Results The overall prevalence of FI was 11,7%, being 8.3% and 13.2% for males and females respectively. Among male subjects, the presence of malnutrition was associated with FI and thus presented a high relative risk index for its occurrence. Among female subjects, age group 70–74 years and some self-reported diseases or conditions such as mild depression, heart disease, urinary incontinence, and polypharmacy were associated with FI. For the first time in literature, polypharmacy appeared as an associated factor for FI for female older adults. Conclusions The prevalence of FI in older adults was 11.7% and was mainly associated with advanced age and presence of heart disease, symptoms of depression, polypharmacy and urinary incontinence and malnutrition. Neurourol. Urodynam. 9999:1–6, 2015. © 2015 Wiley Periodicals, Inc.

Linking the evidence between urinary retention and antipsychotic or antidepressant drugs: A systematic review

Wed, 19 Aug 2015 12:09:09 +0000

Aims Urinary retention (UR) occurs in patients on antipsychotic and antidepressant medication despite no apparent underlying urological cause. This review was undertaken to ascertain which of these medications are associated with UR and how often. Methods A systematic literature search for evidence on antipsychotic and antidepressant medications and UR was completed in June 2015 using Scopus, Pubmed, Web of Science, and the Cochrane library. Search terms included urinary retention, antidepressants and antipsychotics as well as individual drug names. Filters used were: humans and English language. PRISMA guidelines were employed. Results Out of 614 articles initially identified, one meta-analysis, five RCT's, five cohort studies and 27 case reports were finally included. There was a wide range of definitions of UR. Studies which appropriately defined UR revealed it occurred in 1/21 patients on ziprasidone (an atypical antipsychotic), 17.6% of those on imipramine but only 0.1% of those on all tricyclic antidepressants analysed together. It was not reported in any of the 1,139 patients given duloxetine (a combined serotonin and noradrenaline reuptake inhibitor). It was reported in 0.025% of patients on selective serotonin reuptake inhibitors. UR was also reported in patients on typical antispychotics, selective noradrenaline reuptake inhibitors but the studies did not define UR. The majority of case reports reported an improvement in UR on discontinuation or dose reduction. Conclusion Antipsychotics and antidepressants interact with the urinary system in many ways. Clinicians treating acute UR need to keep in mind the role of antipsychotic and antidepressants as a precipitating cause. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Authors’ response re: Shek KL & Dietz H. Letter to the Editor Re: ‘Do ultrasound findings of levator ani “Avulsion” correlate with anatomical findings: A multicenter cadaveric study’

Wed, 19 Aug 2015 11:46:41 +0000

Patient-reported outcomes with the β3-adrenoceptor agonist mirabegron in a phase III trial in patients with overactive bladder

Wed, 19 Aug 2015 11:44:01 +0000

Aims To assess patient-reported outcomes (PROs) in patients with overactive bladder (OAB) receiving the novel β3-adrenoceptor agonist mirabegron. Methods Data from a randomised, double-blind, controlled phase III trial in 1,987 patients aged ≥18 years with OAB symptoms for ≥3 months were analysed. Patients received placebo, mirabegron 50 or 100 mg/day, or tolterodine extended release (ER) 4 mg orally once daily for 12 weeks after a 2-week placebo run-in. Prespecified analysis of PROs (changes in OAB Questionnaire [OAB-q], Patient Perception of Bladder Condition [PPBC], and Work Productivity and Activity Impairment: Specific Health Problem [WPAI-SHP] instrument) in patients treated with mirabegron 50 mg/day, tolterodine ER 4 mg/day or placebo is reported. Post-hoc analyses of OAB-q, PPBC and the Treatment Satisfaction-Visual Analogue Scale (TS-VAS) in patients who were incontinent at baseline are also reported. Results Significant improvements over placebo in OAB-q coping and concern from baseline to final visit were observed with mirabegron 50 mg/day. No significant improvements in these parameters were observed with tolterodine ER 4 mg/day. Mirabegron 50 mg/day significantly increased the proportion of patients showing a PPBC improvement over placebo. Mirabegron 50 mg/day also produced greater improvements in WPAI-SHP presenteeism and greater reductions in absenteeism and overall work impairment than placebo or tolterodine ER 4 mg/day. The impact of mirabegron 50 mg/day treatment on PROs in the incontinent population appears to be greater than that in the overall OAB population. Conclusions At the approved dose of 50 mg/day, mirabegron significantly improves OAB patients' perception of disease and quality of life, independent of whether they are incontinent at baseline. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Relationship between pelvic floor muscle and hormone levels in polycystic ovary syndrome

Wed, 19 Aug 2015 11:43:37 +0000

Aims To evaluate the electrical activity of the pelvic floor muscles (PFM) in women with polycystic ovary syndrome. Methods Forty-two women with polycystic ovary syndrome (PCOS group) and 13 premenopausal women (control group) were recruited in this cross-sectional study. Total testosterone and estradiol were measured and muscle tone and maximum voluntary contraction (MVC) of PFM were determined by surface electromyography. Results There was a difference in muscle tone (PCOS = 59.9 µV and Control group = 25.5 µV; P < 0.0001) and MVC (PCOS = 159.7 µV and Control group = 63.7 µV; P < 0.0002) between groups. The concentration of estradiol and testosterone showed a strong correlation with tone (r = 0.9, r = 0.8 respectively) and MVC (r = 0.9, r = 0.9 respectively) in women with PCOS. The control group exhibited a strong correlation between testosterone and muscle tone (r = 0.9) and MVC (r = 0.9). Conclusion Women with PCOS display higher electromyographic values than those in premenopause. Moreover, electrical activity showed a positive relation with estradiol and testosterone concentrations. Although PCOS is a heterogeneous disorder affecting young women, it is suggested that the hyperandrogenic state associated with PCOS is a protective factor for PFM. Neurourol. Urodynam. 99:XX–XX, 2015. © 2015 Wiley Periodicals, Inc.

Ba-Wei-Di-Huang-Wan through its active ingredient loganin counteracts substance P-enhanced NF-κB/ICAM-1 signaling in rats with bladder hyperactivity

Wed, 19 Aug 2015 11:43:16 +0000

Overt bladder afferent activation may exacerbate endogenous substance P (SP) release to induce intercellular adhesion molecule-1 (ICAM-1)-mediated inflammation and reactive oxygen species (ROS) production leading to hyperactive bladder. Ba-Wei-Die-Huang-Wan (BWDHW), a traditional Chinese medicine, has been used to treat lower urinary tract symptoms in patients by undefined mechanisms. We explored the possible mechanisms and the active components of BWDHW on exogenous SP-induced bladder hyperactivity. BWDHW contained six major components: loganin, paeoniflorin, 5-hydroxymethylfurfural, cinnamic acid, cinnamaldehyde, and paeonol by high-performance liquid chromatography. In urethane-anesthetized female Wistar rats, we evaluated transcystometrogram, pelvic afferent nerve activity by electrophysiologic recording techniques, ICAM-1 expression by Western blot and immunohistochemistry, ROS amount by an ultrasensitive chemiluminescence method and possible ROS sources from the different leukocytes by specific stains in SP-treated bladder. BWDHW and its major component loganin dose-dependently inhibited H2O2 and HOCl activity in vitro. Intragastrical BWDHW (250 mg/kg) and loganin (5 mg/kg) twice daily for 2 weeks did not affect the baseline micturition parameters. Intra-arterial SP (20 µg/rat) through neurokinin-1 receptor activation increased voiding frequency (shortened intercontraction intervals), pelvic afferent nerve activity, bladder NF-κB/ICAM-1 expression, bladder ROS amount, neutrophils adhesion to venous endothelium, CD68 (monocyte/macrophage), and mast cell infiltration in the inflamed bladder. BWDHW and loganin pretreatment significantly depressed SP-enhanced pelvic afferent nerve activity, bladder NF-κB/ICAM-1 expression, leukocyte infiltration, and ROS amount, and subsequently improved bladder hyperactivity. In conclusion, our results suggest that BWDHW and its active component loganin improves bladder hyperactivity via inhibiting SP/neurokinin-1 receptor signaling and depressing NF-κB/ICAM-1 mediated oxidative injury and inflammation. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Walking speed, not muscle mass, is associated with urinary incontinence in community-dwelling old Taiwanese

Fri, 14 Aug 2015 12:05:01 +0000

Re: Da Silva AS, Digesu GA, Dell'Utri C, Fritsch H, Piffarotti P, Khullar V. Do ultrasound findings of levator ani “Avulsion“ correlate with anatomical findings? A multicenter cadaveric study. Neurourol Urodyn. 2015. doi: 10.1002/nau.22781

Fri, 14 Aug 2015 12:04:35 +0000

Author's response re: Finazzi-Agrò E. Prevalence of “uncomplicated” stress urinary incontinence in female patients prior to surgery. Neurourol Urodyn 2015

Fri, 14 Aug 2015 12:03:46 +0000

Activity of the external urethral sphincter evoked by genital stimulation in male rats

Fri, 07 Aug 2015 05:33:56 +0000

Aims To determine whether the external urethral sphincter (EUS) fasciculi of male rats respond to the mechanical stimulation of genital structures and to characterize the pattern of the electromyographic (EMG) activity of the three regions of the EUS: the cranial (CrEUS), the medial (MeEUS) and the caudal (CaEUS). Methods Electromyographic signals were recorded from the CrEUS, MeEUS and CaEUS regions of the male rat's EUS, before, during and after the mechanical stimulation of the urogenital structures. Results The CrEUS, MeEUS and CaEUS regions responded when brushing and squeezing the foreskin and glans as well as to penile and prostatic urethral distension. The CaEUS EMG amplitude (P < 0.01) and frequency (P < 0.05) were lower in comparison to the CrEUS and MeEUS responses to the mechanical stimulation. In addition, the CaEUS was characterized by a short or no afterdischarge. In contrast, the CrEUS and MeEUS responded by presenting a long discharge after the penile or prostatic urethral distension. Conclusions The activity of the EUS is modulated by both, cutaneous and visceral genitourinary stimuli, with motor units being activated by mechanoreceptors located in the foreskin, glans, bladder, and urethra. The CrEUS, MeEUS and CaEUS have differential EMG patterns, indicating that the EUS consists of three anatomically and functionally different regions. Precise coordination in the muscular activity of these regions may be crucial for the control of male expulsive urethral functions, i.e., during voiding and ejaculation. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Effect of concomitant single incision vaginal surgery on mid urethral sling success

Fri, 07 Aug 2015 05:25:09 +0000

Aims The aim of this study was to assess medium-term outcomes of the single anterior vaginal wall incision technique with concomitant mid-urethral sling (MUS) procedure. Methods Patients suffering from stress urinary incontinence and who desired surgical correction for their incontinence were divided into two groups according to MUS surgery alone or MUS surgery with anterior vaginal wall surgery. Concomitant surgery was performed via single large anterior vaginal wall incision. Primary outcome was treatment success 12 months after surgery. Urodynamic and baseline factors that may be associated with surgery failure were analyzed. Results Single incision anterior colporrhaphy with MUS was performed in 180 patients, 62 patients underwent only MUS procedure. Success rate was 87.1% in sling surgery alone and 83.9% in single incision concomitant surgery group (P = 0.5). Detrusor overactivity (DO) was present on UDS in 23 of 37 women (62.2%) with MUS failure, 81 of 205 women (39.7%) with no stress test positivity with the cough stress test (P < 0.05). Total continence rate in patients who underwent vaginal hysterectomy was 60.6% (P < 0.001). Conclusion Concurrent cystocele repair with MUS operations through a single anterior wall incision is a safe and effective method for SUI. This study demonstrated an increased risk of surgery failure for those who underwent a concurrent hysterectomy for pelvic organ prolapse. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Age-related changes in bladder function with altered angiotensin II receptor mechanisms in rats

Fri, 07 Aug 2015 05:24:22 +0000

Aims To examine alterations in expression of angiotensin II type 1 receptors (AT1R) which induce organ tissue remodeling, angiotensin II type 2 receptors (AT2R) which protect against it, and related molecules in the bladder of matured rats with bladder dysfunction. Methods Female SD rats of three different ages were used: 8 weeks old (8W; n = 5), 9 months old (9M; n = 5), and 15 months old (15M; n = 5). After cystometry, the expression levels of AT1R, connexin43 (Cx43), MAP kinase (MAPK), collagen1, AT2R, PPAR-γ, adiponectin (Adipo), and adiponectin receptor (Adipo-R) were investigated in the bladder. Results Pressure threshold, post-void residual volume and the number of non-voiding contractions were significantly increased in 15M versus 8W rats (P < 0.01). Maximum voiding pressure was significantly decreased in 15M versus 8W rats (P < 0.05). There was no significant difference in CMG parameters between 8W and 9M rats. In the bladder, the mRNA expression of AT1R, Cx43, MAPK, collagen 1, AT2R, PPAR-γ, Adipo, and Adipo-R were significantly higher in 15M than in 8W rats. The relative expression ratio of AT1R protein against AT2R protein in the mucosa and detrusor was significantly increased in 15M versus 8W rats. Conclusions These results indicate that matured rats exhibit not only bladder overactivity but also impaired voiding, which are associated with upregulation of AT1R. The upregulation of AT2R also may play a significant role in the suppressing of AT1R induced remodelling. However, because AT1R upregulation is more dominant than AT2R increases, AT2R activation may not be sufficient to suppress AT1R stimulation in matured rats. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Hypothyroidism modifies morphometry and thyroid-hormone receptor expression in periurethral muscles of female rabbits

Fri, 07 Aug 2015 05:10:52 +0000

Aim To evaluate the morphometry and thyroid-hormone receptor (TR) expression in pelvic (pubococcygeus, Pcm) and perineal (bulbospongiosus, Bsm) muscles of control and hypothyroid female rabbits. Methods Hypothyroidism was induced administering 0.02% methimazole in the drinking water for one month. Hematoxylin-eosin stained muscle sections were used to evaluate the fiber cross-sectional area (CSA) and the number of peripheral myonuclei per fiber. Immunohistochemistry was used to calculate the proportion of TR immunoreactive nuclei per fiber. Significant differences were considered at a P ≤ 0.05. Results As compared to control rabbits, hypothyroidism increased the averaged fiber CSA and the myonuclei per fiber in the Bsm. Although the myonuclei number per fiber was also increased in the Pcm, the effect concerning the fiber CSA was only observed in a fraction of the Pcm fibers. Both TRα and TRβ were similarly expressed in the Pcm and Bsm. Hypothyroidism increased the expression of the TRα in the Bsm. Meanwhile, the expression of TR isoforms in the Pcm was not altered. Conclusion Our findings support that the TR signaling is directly involved in morphometrical changes induced by hypothyroidism in the Pcm and Bsm. The effect of hypothyroidism on the Pcm and Bsm could be related to the different type of fiber and metabolism that these muscles have. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Simultaneous in vivo comparison of water-filled and air-filled pressure measurement catheters: Implications for good urodynamic practice

Fri, 07 Aug 2015 05:09:58 +0000

Aims This study aimed to evaluate whether the pressure readings obtained from air-filled catheters (AFCs) are the same as the readings from simultaneously inserted water-filled catheters (WFCs). It also aimed to make any possible recommendations for the use of AFCs to conform to International Continence Society (ICS) Good Urodynamic Practices (GUP). Methods Female patients undergoing urodynamic studies in a single center had water-filled and air-filled catheters simultaneously measuring abdominal and intravesical pressure during filling with saline and during voiding. The pressures recorded by each system at each event during the test were compared using paired t-test and Bland-Altman analyses. Results 62 patients were recruited, of whom 51 had pressures that could be compared during filling, and 23 during voiding. On average, the pressures measured by the two systems were not significantly different during filling and at maximum flow, but the values for a given patient were found to differ by up to 10 cmH2O. Conclusions This study shows that AFCs and WFCs cannot be assumed to register equal values of pressure. It has further shown that even when the pdet readings are compared with their value at the start of a test, a divergence of values of up to 10 cmH2O remains. If AFCs are used, care must be taken to compensate for any pdet variations that occur during patient movement. Before AFCs are adopted, new normal values for resting pressures need to be developed to allow good quality AFC pressure readings to be made. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Repair of complex vesicovaginal fistulas by combining a rotational bladder flap and full thick vascular peritoneal interposition

Fri, 31 Jul 2015 15:18:01 +0000

Purpose To present the experience of repairing iatrogenic vesicovaginal fistulas (VVFs) using a rotational bladder flap and peritoneal interposition technique. Methods Between January 2009 and June 2014, a total of 18 patients (mean age, 44.0 years; age range, 29–51 years) with VVFs were treated using a transperitoneal approach. All VVFs were complications of gynecologic procedures. Twelve patients experienced recurrent VVFs and one patient had a concomitant rectovaginal fistula after radiotherapy. The fistula was approached transabdominally. The peritoneum covering the bladder was isolated to expose the bladder and prepare for the interposition. The bladder was opened along the sagittal plane to the fistula and a bladder flap was rotated downward to fill the fistula defect. The vaginal defect was closed, then a flap using the isolated peritoneum was interposed and fixed between the vagina and bladder. A ureteral re-implantation was performed in one patient. All VVF procedures were performed by one urologist (SW). Repair of the rectovaginal fistula was performed by a general surgeon at the same time. Results Seventeen patients (success rate = 94% [100% for primary cases and 92% for recurrent cases]) had no evidence of recurrent VVF at a mean follow-up of 20 months (range, 6–36 months). The only patient who had previously undergone a repair procedure failed. Conclusions A transperitoneal approach with the use of a rotational bladder flap and peritoneal interposition might be a feasible and reliable procedure for surgical management of iatrogenic VVFs, especially in complicated cases. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Unravelling detrusor underactivity: Development of a bladder outlet resistance—bladder contractility nomogram for adult male patients with lower urinary tract symptoms

Fri, 31 Jul 2015 15:17:39 +0000

Aims Voiding dysfunction in adult men may be caused by bladder outlet obstruction (BOO) and/or detrusor underactivity (DU). Until now, it is only possible to classify BOO and DU by pressure-flow analysis. Low values of the maximum Watts factor (Wmax) indicate DU but thresholds for the diagnosis have not been established. Purpose of this study was to construct a nomogram using bladder outlet resistance and detrusor contractility in order to classify BOO and DU simultaneously. Methods Treatment naïve men aged ≥40 years with uncomplicated lower urinary tract symptoms (LUTS) were prospectively evaluated. Patients were assessed with IPSS, prostate volume, uroflowmetry, post-void residual, and pressure-flow measurement. The bladder outlet obstruction index (BOOI) was used to determine BOO-grade and Wmax to calculate detrusor contractility. Individual BOOI-Wmax values were plotted in a graph. Linear interpolation was applied to determine the 10th, 25th, 50th, 75th, and 90th percentiles. Results Retrospective analysis of 822 male patients with means of 64 years, IPSS 16, and prostate volume of 40 cc. Patient and clinical parameters of the <25th percentile groups were significantly different compared to the 25th–50th percentiles: age (66 vs. 63 years, P = 0.006), bladder capacity (503 vs. 442 ml, P = 0.009), post-void residual urine (167 vs. 116 ml, P = 0.001), and voiding efficiency (67% vs. 73%, P = 0.015). Conclusions The nomogram quantifies the relationship between detrusor contractility and BOO in men with LUTS. A measurement value <25th percentile correlates with clinical indicators of DU and is proposed as a cut-off value for DU-diagnosis. Higher age, bladder capacity, and PVR as well as lower voiding efficiency indicate DU. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Re: Petros P. A critical analysis of the trampoline test for diagnosis of SUI. Re: Rimstad L, Larsen ES, Schiotz HA, Kulseng-Hansen S, Pad tests with increasing load for the diagnosis of stress incontinence, Neurourol Urodyn. 2014;33:1135–39

Fri, 31 Jul 2015 15:16:58 +0000

Prevalence of “uncomplicated” stress urinary incontinence in female patients prior to surgery. Re: Norton PA, Nager CW, Brubaker L, Lemack GE, Sirls LT, Holley R, Chai TC, Kraus SR, Zyczynski H, Smith B, Stoddard A; for the Urinary Incontinence Treatment Network. The cost of preoperative urodynamics: A secondary analysis of the ValUE trial. Neurourol Urodyn. 2014 Oct 18

Fri, 31 Jul 2015 15:16:37 +0000

The role of serotonergic mechanism in the rat prefrontal cortex for controlling the micturition reflex: an in vivo microdialysis study

Thu, 30 Jul 2015 12:01:16 +0000

Aims To investigate the role of the PFC in the micturition reflex using an in vivo microdialysis study in rats. Methods Adult female Sprague-Dawley rats were used and microdyalysis in the PFC and cystometrography (CMG) were performed under consciousness and free movement in the present study. Experiment 1: Samples including extracellular neurotransmitters were collected by microdyalysis and analyzed by high performance liquid chromatography. At the same time, CMG were performed to measure intercontraction interval (ICI) and maximum voiding pressure (MVP). Experiment 2: SSRI (citalopram, 1 µM) was administered into the PFC, and microdyalysis and cystometrography (CMG) were performed simultaneously. Experiment 3: Following SSRI administration, 5-HT1A agonist (8-OH-DPAT, 300 µM), which has the effect of decreasing the level of serotonin (5-HT) in the PFC, was administered into the PFC, and microdyalysis and CMG were performed simultaneously. Results Experiment 1: Extracellular level of 5-HT in the PFC significantly increased during micturition reflex (P < 0.05), whereas levels of glutamate or dopamine were not significantly changed. Experiment 2: Local administration of SSRI in the PFC increased the 5-HT level up to approximate 600% of the basal level. It also significantly increased ICI (P < 0.05), whereas no significant change was found in MVP. Experiment 3: The extracellular level of 5-HT gradually decreased after local administration of 5-HT1A agonist, thereby ICI significantly decreased (P < 0.05). Conclusions The results of the present study suggest that the PFC has a suppressive effect on neural control of the micturition reflex via serotonin. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Interventions to decrease pain and anxiety in patients undergoing urodynamic testing: A randomized controlled trial

Thu, 30 Jul 2015 11:54:18 +0000

Aims To determine if music (at 60 beats/min) or watching a pre-procedure educational video decreases pain and anxiety in women undergoing multichannel urodynamic testing compared to usual care. Methods Women undergoing multichannel urodynamic testing at a tertiary care center were randomized to one of three groups: usual care (UC), music (M), in which music was played throughout the urodynamic test, or video (V), in which subjects watched an informational video on the procedure prior to undergoing the test. Visual analog scales (VAS) were used to measure patient's pain and anxiety before and after the test. Demographic information was obtained and five-item Likert questionnaires were given to assess information seeking behavior, preparedness, embarrassment, and privacy. Results 98 subjects were included in this analysis. In the overall group, mean perceived pain on the pre-test VAS was significantly higher than the post-test VAS with pre-test mean (SD) 47(±30) and post-test mean (SD) 26(±23), P = 0.0001. Overall the anxiety pre-test VAS was significantly greater than post-test VAS with pre-test mean (SD) 46.9(±29) and post-test mean 17.9(±18), P = 0.0001. There were no differences in pain and anxiety scores between the two intervention groups and usual care. Patients who were randomized to usual care or the video arm felt more prepared for the test compared to patients who were randomized to the music arm, with (mean ± SD): usual care (42 ± 8), video (43 ± 9), music (37 ± 11), P = 0.002. Conclusions Music and an educational video do not decrease pain or anxiety in subjects undergoing multichannel urodynamics compared to usual care. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Reliability and validity of urinary nerve growth factor measurement in women with lower urinary tract symptoms

Thu, 30 Jul 2015 11:50:59 +0000

Introduction and Hypothesis The validity and reliability of measurement of urinary NGF as a diagnostic biomarker in women with lower urinary tract dysfunction (LUTD) is uncertain. We aimed to evaluate both the diagnostic and discriminant validity, and the test–retest reliability of urinary NGF measurement in women with LUTD. Methods Urinary NGF was measured in women with LUTD (n = 205) and asymptomatic subjects (n = 31). Urinary NGF was assayed using an ELISA method and normalized against urinary creatinine. NGF/creatinine ratios were compared between symptom subgroups using Mann–Whitney U test, and between different urodynamic diagnoses using the Kruskal–Wallis test. Receiver Operator Characteristic (ROC) analysis was employed to evaluate the diagnostic performance of urinary NGF. Test–retest reliability of NGF measurement was assessed using intra-class correlation (ICC). Results Urinary NGF was significantly but non-specifically increased in symptomatic patients when compared to controls (13.33 vs. 2.05 ng NGF/g Cr, P < 0.001). On multivariate logistic regression NGF was a good predictor of patients having OAB or not, however, the adjusted odds ratio only 1.006. ROC analysis demonstrated poor discriminant ability between different symptomatic groups and urodynamic groups. Using a cut off of 13.0 ng NGF/g creatinine the test provides a sensitivity of 81%, but a specificity of only 39% for overactive bladder. The assays demonstrated good test-retest reliability with ICC of 0.889. Conclusions Although urinary NGF can be reliably assayed, and is increased in various LUTDs, it discriminates poorly between these disorders therefore has very limited potential as a biomarker. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Neurochemical and neuroendocrine correlates of overactive bladder at first demyelinating episode

Thu, 30 Jul 2015 11:50:38 +0000

Aims Bladder dysfunction is frequent during the course of multiple sclerosis (MS), observed in up to 75% of patients. Urinary symptomatology can be a feature of the first episode of MS in a minority of cases, and most often shows characteristics of an overactive bladder (OAB), with voiding symptoms seen less frequently, often in combination with OAB. The neural control of micturition is complex, involving systems located in the brain, spinal cord, and periphery, and implicating central noradrenergic, serotonergic, and dopaminergic activities. Urinary disorders are also linked to anxiety and depression, conditions connected to hypothalamus–pituitary–adrenal axis activity. In this study we aimed to investigate neurochemical and neuroendocrine correlates of bladder dysfunction in early MS. Methods We included 101 patients at first demyelinating episode suggestive of MS that were drug-free at assessment. We evaluated the presence of urinary symptomatology and estimated CSF levels of the main metabolites of noradrenaline, serotonin, and dopamine, as well CSF-ACTH and serum cortisol. Results In total, 15 patients (15%) reported urinary dysfunction suggestive of OAB. Four of these had coexistent voiding symptomatology. The serotonin metabolite 5-HIAA was significantly reduced (P = 0.017) in patients with OAB syndrome, while there were no differences in the metabolites of noradrenaline (MHPG) and of dopamine (HVA). Additionally, significantly lower serum cortisol (P = 0.009) and borderline lower CSF-ACTH (P = 0.08) were found in patients with OAB. Conclusions MS patients with OAB syndrome at the first demyelinating episode show reductions in central serotonergic activity and stress hormones. Whether the same changes persist at later disease stages remains to be investigated. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Acute length adaptation and adjustable preload in the human detrusor

Thu, 30 Jul 2015 10:49:43 +0000

Aims The biomechanical properties of length adaptation and adjustable preload have been previously identified in detrusor smooth muscle in animal models. This in vitro study aims to show that human detrusor smooth muscle exhibits length adaptation and adjustable preload tension which could play an important role in both overactive bladder and detrusor underactivity. Methods In order to demonstrate length adaptation, human detrusor smooth muscle strips are stretched and contracted beyond an optimum length and then contracted three times at the previous optimum length to determine if maximum active tension could be re-established. To demonstrate adjustable preload (Tap), human detrusor smooth muscle strips are subjected to a pre-defined loading–unloading (strain softening) sequence to reduce preload. Then, tissues are contracted and the sequence is repeated to determine if this active process restored preload. Results Nine patients (average age, 62) provide tissue: 89% are men with urothelial carcinoma and a minority (22%) also have neurogenic bladder dysfunction. In the length adaptation protocol, contractions show progressive increases in active tension (P < 0.05). In the Tap protocol, a significant amount of preload is lost to strain softening (P < 0.05) and is restored after active contraction (P = 0.50). Exposure to the rho-kinase inhibitor, H-1152, prevents the restoration of preload (P < 0.05). Conclusions This study demonstrates that human detrusor smooth muscle displays both length adaptation and Tap. Furthermore, Tap may be regulatable through a rho-kinase pathway. These biomechanical processes may be important in the pathophysiology of both overactive bladder and detrusor underactivity. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

High definition urethral pressure profilometry: Evaluating a novel microtip catheter

Fri, 24 Jul 2015 08:37:42 +0000

Introduction Urethral pressure profilometry (UPP) is used in the diagnosis of stress urinary incontinence (SUI). SUI is a significant medical, social, and economic problem, affecting about 12.5% of the population. A novel microtip catheter was developed for UPP featuring an inclination sensor and higher angular resolution compared to systems in clinical use today. Therewith, the location of each measured pressure sample can be determined and the spatial pressure distribution inside the urethra reconstructed. In order to assess the performance and plausibility of data from the microtip catheter, we compare it to data from a double balloon air charged system. Materials and Methods Both catheters are used on sedated female minipigs. Data from the microtip catheter are processed through a signal reconstruction algorithm, plotted and compared against data from the air-charged catheter. Results The microtip catheter delivers results in agreement with previous comparisons of microtip and air-charged systems. It additionally provides a new level of detail in the reconstructed UPPs which may lead to new insights into the sphincter mechanism of minipigs. Conclusions The ability of air-charged catheters to measure pressure circumferentially is widely considered a main advantage over microtip catheters. However, directional pressure readings can provide additional information on angular fluctuations in the urethral pressure distribution. It is shown that the novel microtip catheter in combination with a signal reconstruction algorithm delivers plausible data. It offers the opportunity to evaluate urethral structures, especially the sphincter, in context of the correct location within the anatomical location of the pelvic floor. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Urodynamics for incontinence after midurethral sling removal

Fri, 24 Jul 2015 08:37:16 +0000

Introduction We reviewed the role of urodynamics (UDS) in the management of women with incontinence following mid-urethral sling removal (MUSR). Methods Following IRB approval, women from a longitudinal database who had persistent or recurrent urinary incontinence (UI) after MUSR, desired further therapy, and subsequently underwent UDS were reviewed. Women with neurogenic bladder, obstructive symptoms without UI, urethra-vaginal fistula, anterior compartment prolapse >Stage 2, or those who had concomitant autologous sling surgery at the time of MUSR were excluded. Interval time between MUSR and UDS, UDS findings, and UI management after UDS were recorded. Results From 2006 to 2013, 71 of 246 women had UDS after MUSR for persistent or recurrent UI. For the 54 women in the final analysis, mean time between tape removal and UDS was 12.4 months (range: 4–65). UDS demonstrated incontinence in 78% of patients: stress urinary incontinence (SUI) in 19 (35%), detrusor overactivity incontinence (DOI) in 6 (11%), and mixed urinary incontinence (MUI) in 17 (32%). On pressure-flow studies, the following voiding patterns were demonstrated: normal voiding (39), valsalva voiding (6), obstruction (2), underactive detrusor (1), no voiding records (6). UDS storage and emptying data were used in subsequent symptom-based patient counseling for treatment planning. Urethral bulking agent was the most commonly chosen management (43%). Conclusion Our current guidelines for UDS in women after incontinence procedures and MUSR are currently based on a low level of evidence. This study reinforces the role of UDS to guide therapy for UI after MUSR. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Predictive modeling and threshold scores for care seeking among women with urinary incontinence: The short forms of the Pelvic Floor Distress Inventory and Urogenital Distress Inventory

Fri, 24 Jul 2015 08:36:53 +0000

Aims To further the interpretability of the Pelvic Floor Distress Inventory (PFDI-20) and Urogenital Distress Inventory (UDI-6) by (i) evaluating the ability of these measures to distinguish between women with urinary incontinence who do and do not seek care, (ii) defining PFDI-20 and UDI-6 threshold scores above which women with urinary incontinence seek care, and (iii) developing a predictive model for incontinence care seeking. Methods An observational study was conducted with two groups of women with urinary incontinence: 256 who had not sought care and 90 seeking initial care at a tertiary center. Sample sizes were based upon the prevalence of care seeking for urinary incontinence and the number of potential predictors for care seeking. Wilcoxon rank-sum tests, receiver operating characteristics, and multivariable logistic regression were use to achieve the study aims. Results Women with urinary incontinence who sought care had higher median PFDI-20 and UDI-6 scores compared to non-care seekers (73.96 vs. 16.67, P < 0.0001, and 41.67 vs. 8.33, P < 0.0001). A PFDI-20 score of 33.33 (83.33% sensitivity and 79.30% specificity) had very good discriminatory accuracy in distinguishing care and non-care seekers (AUC 0.886 ± 0.019 [95%CI 0.8518, 0.9254] P < 0.0001). A UDI-6 score of 25.00 (83.33% sensitivity and 83.59% specificity) had excellent discriminatory accuracy in distinguishing care and non-care seekers (AUC 0.9025 ± 0.0190 [95%CI 0.8653, 0.9398] P < 0.0001). A multivariable predictive model accurately identified 82.4% of care and non-care seekers. Conclusions A PFDI-20 score of 33.33 and UDI-6 score of 25.00 provide meaningful benchmarks for care seeking among women with urinary incontinence.

Extradural implantation of sacral anterior root stimulator in spinal cord injury patients

Fri, 24 Jul 2015 08:30:19 +0000

Aims To evaluate the efficacy and complications of extradural sacral anterior root stimulation (SARS) implantation in patients with neurogenic detrusor overactivity (NDO) resulting from spinal cord injury (SCI). Materials and methods A retrospective study was conducted between 2009 and 2013, on consecutive patients with NDO associated with SCI that underwent SARS implantation. We evaluated those factors related to clinical symptoms such as urinary infection rate, erections, and episodes of autonomic dysreflexia. Data from cystometric bladder capacity (CBC) and post-void residual (PVR) volume were also analyzed. Results Of the 104 patients included in the study, 95 (91%) patients were men with a mean (standard deviation) (SD) age of 38 (10) years. Mean (SD) time between the onset of SCI and the SARS was 78.2 (59.0) months. At baseline, 95 (91%) patients had urinary infections as compared with 16 (15%) after treatment, P < 0.001. The percentage of patients that had urinary incontinence was significantly higher at baseline than that observed after SARS, 100% versus 14%, respectively, P < 0.001. Similar results were obtained regarding dysreflexia, P < 0.001. After SARS, the mean (SD) bladder capacity was 362 (108) ml and 98 (94%) patients had a bladder capacity greater than 400 ml. As regard to the adverse effects, six patients (6%) required a suburethral mesh implant and two (2%) patients had an infection, 4 and 5 months after SARS, respectively. Conclusions Extradural implantation of SARS seems to be an effective and safe procedure in patients with spinal cord injury and neurogenic detrusor overactivity. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Hydrodistension with or without fulguration of hunner lesions for interstitial cystitis: Long-term outcomes and prognostic predictors

Fri, 24 Jul 2015 08:29:09 +0000

Aims Hydrodistension of the bladder, with optional fulguration of Hunner lesions, is one of the recommended therapies for interstitial cystitis (IC). The aims of this study are to evaluate long-term outcomes of hydrodistension and identify outcome predictors. Methods The study cohort was 191 newly diagnosed IC patients (155 women and 36 men) who underwent hydrodistension with fulguration of Hunner lesions if detected between 2007 and 2013 at our institution. The primary outcome was therapeutic failure, which was defined as repeat hydrodistension, bladder instillation therapy, or narcotic use for pain control. Clinical features, including comorbidities and endoscopic findings, were analyzed along with the outcome. Results The cohort comprised 126 patients of Hunner type IC and 65 patients of non-Hunner type IC. The mean time to therapeutic failure was 28.5 months in Hunner type IC and 25.2 months in non-Hunner type IC. The therapeutic failure rate was higher in non-Hunner type IC at 17.3 months; however, the long-term outcomes reversed thereafter. The mean time to therapeutic failure was shorter in patients with lumbar spinal stenosis (LSS) or irritable bowel syndrome (IBS). Multivariate analysis identified LSS as a predictor for failure in Hunner type IC and non-Hunner type IC (HR = 18.8, P = 0.001; HR = 3.8, P = 0.028, respectively) and IBS in non-Hunner type IC (HR = 18.0, P = 0.008). Conclusions Bladder hydrodistension, with fulguration of the Hunner lesions, improved IC symptoms. The outcome was worse in non-Hunner type IC shortly after hydrodistension but eventually comparable across the two types. Concomitant LSS and IBS were predictors for poor outcome. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Bladder wall thickness in women with symptoms of overactive bladder and detrusor overactivity: Results from the randomised, placebo-controlled shrink study

Tue, 21 Jul 2015 13:20:02 +0000

Aims Measurement of bladder wall thickness (BWT) by transvaginal ultrasound (TVUS) may be a less invasive method to diagnose overactive bladder (OAB) or detrusor overactivity (DO) and monitor response to therapy. This study assessed whether treatment with solifenacin affects BWT. Methods This was a double-blind, randomised, placebo-controlled, phase 4 study. Adult women with OAB symptoms received solifenacin 5 or 10 mg or placebo once daily for 12 weeks. The co-primary endpoints were change from baseline to Week 12 in TVUS-measured BWT and urinary nerve growth factor. Only results for BWT are presented here. Results Overall, 547 patients were randomised, 501 patients had a baseline BWT measurement, and change from baseline could be calculated for 478 patients. Mean BWT at baseline was 5.08 mm (range 2.2–11.1, SD = 1.14) and was normally distributed. A significant reduction in BWT from baseline to 12 weeks versus placebo was observed with solifenacin 5 mg (–0.42 vs. –0.16 mm, P = 0.03), but not with the 10 mg dose or with pooled solifenacin, considered the primary comparison. Both solifenacin doses were associated with improvements in efficacy and patient satisfaction endpoints versus placebo. Solifenacin was well tolerated, with dry mouth being the most common adverse event. Conclusions There was no consistent effect of solifenacin on BWT in women with OAB/DO, despite improvements in efficacy endpoints. This study suggests that routine clinical assessment of BWT with TVUS for monitoring the effects of OAB/DO treatment is not clinically useful. Neurourol. Urodynam. 9999:1–7, 2015. © 2015 Wiley Periodicals, Inc.

Quality of life after suprapubic catheter placement in patients with neurogenic bladder conditions

Tue, 21 Jul 2015 13:19:37 +0000

Aims To evaluate quality of life in patients with neurogenic bladder (NGB) conditions who have elected to undergo suprapubic catheterization (SPC), as well as assess adverse events (AEs) related to the procedure. Methods This is a retrospective review from a database of NGB patients from 1/1/2003 to 6/30/2013. Patients who underwent SPC placement were invited to complete a validated, single item Patient Global Impression of Improvement (PGI-I) questionnaire. Success or positive response was defined as 1 or 2 on a scale of 1–7. All patients were included in the assessment of AEs. Results Of the 128 patients who underwent SPC, 89 patients (54 female, 35 male) met inclusion criteria. Response rate to the PGI-I questionnaire was 65.2% (58/89). Mean age at the time of SPC placement was 54.4 years (± 14.4). The mean time from SPC placement to PGI-I questionnaire was 48.3 months (Range 4.4–128.4). Overall, success was seen in 49/58 patients (84.5%). Only 5.2% (3/58) patients reported a negative PGI-I (score 5/7). There was an 18.8% rate of short term complications, with the majority of these being classified as Clavien I. There was one Clavien IIIb complication (0.8%), which consisted of a small bowel perforation. Conclusions SPC is an effective bladder management in carefully selected NGB patients who have failed other options. Over 80% considered the SPC to have improved their urological quality of life with a mean time to questionnaire of 4 years. Severe AEs are rare, though can be particularly serious in this group of neurologically impaired patients. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Provision of information leaflet before urodynamic study reduces the pre-examination anxiety level

Tue, 21 Jul 2015 13:02:56 +0000

Aims To find out if information leaflets reduce anxiety levels before urodynamic studies (UDS). Methods One hundred and four patients (age 60 ± 15 years) who were referred for multichannel UDS were prospectively recruited and randomized into 2 groups: (1) received a leaflet containing detailed information regarding the examination; (2) did not receive a leaflet. Patients who were unable to complete the questionnaire due to mental disorders and patients who had previously undergone UDS were excluded. The leaflets were mailed to the patients in group 1 one month before the examination. This leaflet included information on how the examination would be performed, its purpose, recommended preparation, potential complications, and common events that might occur in association with the examination, such as incontinence. Emotional distress was measured by the State Anxiety Inventory (SAI)—a validated questionnaire composed of 20 items measuring anxiety. These measures are divided into two psychological domains: (1) positive well being; (2) psychological distress. Patients filled out the SAI immediately before entering the examination room. Results Demographics and clinical and psychological co-morbidities were similar between the groups. The “psychological distress“ score was significantly lower in group 1 (13.1 ± 2.9 vs. 24.8 ± 5.8, P < 0.001), whereas there was no difference in the “positive well being“ score. Conclusions We recommend providing patients with an information leaflet on UDS since it significantly reduces anxiety levels. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Intravesical treatment with cis-urocanic acid improves bladder function in rat model of acute bladder inflammation

Tue, 14 Jul 2015 09:20:21 +0000

Aims The aim was to study the effect of intravesically instilled cis-urocanic acid (cis-UCA) on bladder function in an experimental rat model of acute bladder inflammation. Hyaluronic acid (HA) was used as a comparator compound. Methods Bladder irritation was induced in female rats by intravesical hydrochloric acid (HCl) infusion. Vehicle, 0.5% HA, or 2% cis-UCA solutions were infused intravesically twice a day for three consequent days. On the fourth day, urodynamical measurements were performed, the animals were sacrificed, and the bladders were removed for histopathological assessment. Results HCl treatment caused significant impairment of bladder function indicated by decreased micturition intervals and voided urine volumes and induced severe voiding dysfunction observed as occurrence of overflow incontinence. These functional changes were accompanied by increased bladder weight, hemorrhage, and infiltration of inflammatory cells into the urothelium. Intravesical cis-UCA treatment recovered bladder function by significantly prolonging the micturition interval, increasing the voided volume, and reducing the occurrence of overflow incontinence. All these changes were comparable to the effects of HA. Conclusions Intravesical administration of cis-UCA was able to partially recover bladder function impaired by chemical irritation. Cis-UCA may offer a novel intravesical treatment option in some inflammatory conditions of the bladder. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Comparison of retropubic synthetic mid-urethral slings to fascia pubovaginal slings following failed sling surgery

Tue, 14 Jul 2015 09:20:19 +0000

Aims Mid-urethral slings are considered first-line surgical treatment of stress urinary incontinence. However, there is a paucity of data regarding the use of mid-urethral slings (MUS) for patients who have failed a prior sling procedure. Materials and Methods After receiving IRB approval, a multi-institutional retrospective review of 224 consecutive patients undergoing placement of a retropubic MUS (n = 153) or autologous rectus fascia (ARF) pubovaginal sling (n = 71) for prior failed sling surgery is conducted. Pre- and post-operative pad use is recorded for all patients in addition to completion of four validated questionnaires pre- and post-operatively: SEAPI-QMM incontinence classification system (stress-related leak, emptying ability, anatomy, protection, inhibition, quality of life, mobility, and mental status), incontinence impact questionnaire (IIQ-7), urogenital distress inventory (UDI-6), and 10-point visual analog score (VAS). Results Median follow-up is 29 months and the overall subjective cure rate was 61.4%. A statistically significant improvement in pad use and in all validated questionnaire outcomes is observed for secondary repair with a retropubic sling. In further sub-analysis between the MUS and the ARF groups, there are no significant differences in subjective cure rates or changes in post-operative questionnaire outcomes. Conclusions Secondary repair with a retropubic sling is a durable and effective procedure for patients who have failed prior sling procedures without differences in outcomes noted between retropubic MUS and ARF slings. Neurourol. Urodynam. 9999:1–4, 2015. © 2015 Wiley Periodicals, Inc.

A quantitative approach to the interpretation of uroflowmetry in children

Tue, 14 Jul 2015 09:20:16 +0000

Purpose We hypothesized that by correcting for volume and creating a flow index (FI) we could develop a reproducible and reliable means to estimate flows in children without the use of a flow nomogram. Our second hypothesis was that this volume corrected FI could define objective parameters for the different flow curves that are described in the ICCS document. Methods Uroflowmetry curves of 1,268 healthy children were analyzed. Quadratic equations using nonlinear regression for both sexes were generated for each set of presumed normal voiders (learning data) (NV). The NV test data were used to verify the equations. Linear regression analysis was used to compare the variance between actual and estimated flow rates. A FI (Actual Qavg/Estimated Qavg) was created and ROC analysis for all flow types was performed. Sensitivity and specificity analysis was performed on all voids to validate the accuracy of the FI to predict flow pattern. Results Analysis of the FI from the first void to the second confirmed the accuracy and reproducibility in both males and females using various means of analysis. ROC analysis shows that there are very strong AUC's for Bell, plateau, and tower flow patterns. Sensitivity and specificity analysis reveals that defined FI parameters are able to predict the flow patterns. Conclusion Our predictive formulas allow for direct comparison of one flow to the next in a single patient when the FI is used. Utilizing the FI, we can predict the type of flow pattern removing subjectivity from the analysis of uroflow patterns. Neurourol. Urodynam. XXXX:XX–XX, 2015.

Is pelvic organ prolapse associated with altered microcirculation of the vaginal wall?

Tue, 14 Jul 2015 09:20:11 +0000

Aims Vascularisation of the vagina is necessary for optimal function and support of the surrounding organs. We evaluated whether vaginal microcirculation, as representative of vascularisation, differs between women with and without pelvic organ prolapse (POP). Methods In 17 women with POP-Q stage ≥2 and 10 women without POP measurements were performed using sidestream dark-field imaging (groups were not matched). POP and non-POP sites were compared in women with a single compartment prolapse (n = 7). Morphology of the microvessels was scored using the microcirculatory architecture and capillary tortuosity scores at four regions of the vaginal wall. Capillary density measurements were performed and microvascular flow was assessed according to the microvascular flow index (MFI) score. Results Architecture and tortuosity scores were similar for each anatomical region between women with and without POP and between the POP and non-POP site. A statistically significant difference in capillary density in the left vaginal wall between women with and without POP was observed (25.8 vs. 34.0, P = 0.049). No significant differences in capillary density were observed between the POP and non-POP site. Average MFI scores revealed a continuous flow for all four regions in patients with and without POP. Conclusions Vaginal microcirculatory architecture, capillary density, and microvascular flow are similar in women with and without POP. Our method to assess the microcirculation of the vaginal wall is consistent in women with POP, which generates an opportunity to assess vaginal microcirculation in the (surgical) treatments of POP. Neurourol. Urodynam. © 2015 Wiley Periodicals, Inc.

Editorial

Wed, 12 Aug 2015 13:09:20 +0000

2014 consensus statement on improving pelvic floor muscle training adherence: International Continence Society 2011 State-of-the-Science Seminar

Thu, 21 May 2015 13:41:26 +0000

Aims To summarize the findings and “expert-panel” consensus of the State-of-the-Science Seminar on pelvic floor muscle training (PFMT) adherence held prior to the 41st International Continence Society scientific meeting, Glasgow, 2011. Methods Summaries of research and theory about PFMT adherence (based on a comprehensive literature search) were presented by subject experts at the 2011 Seminar to generate discussion and guidance for clinical practice and future research. Supplemental research, post-seminar, resulted in, three review papers summarizing: (1) relevant behavioral theories, (2) adherence measurement, determinants and effectiveness of PFMT adherence interventions, and (3) patients' PFMT experiences. A fourth, reported findings from an online survey of health professionals and the public. Results Few high-quality studies were found. Paper I summarizes 12 behavioral frameworks relevant to theoretical development of PFMT adherence interventions and strategies. Findings in Paper II suggest both PFMT self-efficacy and intention-to-adhere predict PFMT adherence. Paper III identified six potential adherence modifiers worthy of further investigation. Paper IV found patient-related factors were the biggest adherence barrier to PFMT adherence. Conclusion Given the lack of high-quality studies, the conclusions were informed by expert opinion. Adherence is central to short- and longer-term PFMT effect. More attention and explicit reporting is needed regarding: (1) applying health behavior theory in PFMT program planning; (2) identifying adherence determinants; (3) developing and implementing interventions targeting known adherence determinants; (4) using patient-centred approaches to evaluating adherence barriers and facilitators; (5) measuring adherence, including refining and testing instruments; and (6) testing the association between adherence and PFMT outcome. Neurourol. Urodynam. 34:???–???, 2015. © 2015 Wiley Periodicals, Inc.

Scoping review of adherence promotion theories in pelvic floor muscle training – 2011 ics state-of-the-science seminar research paper i of iv

Thu, 21 May 2015 14:41:36 +0000

Aims This paper, the first of four emanating from the International Continence Society's 2011 State-of-the-Science Seminar on pelvic-floor-muscle training (PFMT) adherence, aimed to summarize the literature on theoretical models to promote PFMT adherence, as identified in the research, or suggested by the seminar's expert panel, and recommends future directions for clinical practice and research. Methods Existing literature on theories of health behavior were identified through a conventional subject search of electronic databases, reference-list checking, and input from the expert panel. A core eligibility criterion was that the study included a theoretical model to underpin adherence strategies used in an intervention to promote PFM training/exercise. Results A brief critique of 12 theoretical models/theories is provided and, were appropriate, their use in PFMT adherence strategies identified or examples of possible uses in future studies outlined. Conclusion A better theoretical-based understanding of interventions to promote PFMT adherence through changes in health behaviors is required. The results of this scoping review and expert opinions identified several promising models. Future research should explicitly map the theories behind interventions that are thought to improve adherence in various populations (e.g., perinatal women to prevent or lessen urinary incontinence). In addition, identified behavioral theories applied to PFMT require a process whereby their impact can be evaluated. Neurourol. Urodynam. 34:???–???, 2015. © 2015 Wiley Periodicals, Inc.

Pelvic-Floor-Muscle Training Adherence: Tools, Measurements and Strategies—2011 ICS State-of-the-Science Seminar Research Paper II of IV

Thu, 21 May 2015 14:19:47 +0000

Aims This paper on pelvic-floor-muscle training (PFMT) adherence, the second of four from the International Continence Society's 2011 State-of-the-Science Conference, aims to (1) identify and collate current adherence outcome measures, (2) report the determinants of adherence, (3) report on PFMT adherence strategies, and (4) make actionable clinical and research recommendations. Method Data were amassed from a literature review and an expert panel (2011 conference), following consensus statement methodology. Experts in pelvic floor dysfunction collated and synthesized the evidence and expert opinions on PFMT adherence for urinary incontinence (UI) and lower bowel dysfunction in men and women and pelvic organ prolapse in women. Results The literature was scarce for most of the studied populations except for limited research on women with UI. Outcome measures: Exercise diaries were the most widely-used adherence outcome measure, PFMT adherence was inconsistently monitored and inadequately reported. Determinants: Research, mostly secondary analyses of RCTs, suggested that intention to adhere, self-efficacy expectations, attitudes towards the exercises, perceived benefits and a high social pressure to engage in PFMT impacted adherence. Strategies: Few trials studied and compared adherence strategies. A structured PFMT programme, an enthusiastic physiotherapist, audio prompts, use of established theories of behavior change, and user-consultations seem to increase adherence. Conclusion The literature on adherence outcome measures, determinants and strategies remains scarce for the studied populations with PFM dysfunction, except in women with UI. Although some current adherence findings can be applied to clinical practice, more effective and standardized research is urgently needed across all the sub-populations. Neurourol. Urodynam. 34:???–???, 2015. © 2015 Wiley Periodicals, Inc.

Pelvic-floor-muscle-training adherence “modifiers”: A review of primary qualitative studies—2011 ICS State-of-the-Science Seminar research paper III of IV

Thu, 21 May 2015 14:04:19 +0000

Aims This review aims to locate and summarize the findings of qualitative studies exploring the experience of and adherence to pelvic floor muscle training (PFMT) to recommend future directions for practice and research. Methods Primary qualitative studies were identified through a conventional subject search of electronic databases, reference-list checking, and expert contact. A core eligibility criterion was the inclusion of verbatim quotes from participants about PFMT experiences. Details of study aims, methods, and participants were extracted and tabulated. Data were inductively grouped into categories describing “modifiers” of adherence (verified by a second author) and systematically displayed with supporting illustrative quotes. Results Thirteen studies (14 study reports) were included; eight recruited only or predominantly women with urinary incontinence, three recruited postnatal women, and two included women with pelvic organ prolapse. The quality of methodological reporting varied. Six “modifiers” of adherence were described: knowledge; physical skill; feelings about PFMT; cognitive analysis, planning, and attention; prioritization; and service provision. Conclusions Individuals' experience substantial difficulties with capability (particularly knowledge and skills), motivation (especially associated with the considerable cognitive demands of PFMT), and opportunity (as external factors generate competing priorities) when adopting and maintaining a PFMT program. Expert consensus was that judicious selection and deliberate application of appropriate behavior change strategies directed to the “modifiers” of adherence identified in the review may improve PFMT outcomes. Future research is needed to explore whether the review findings are congruent with the PFMT experiences of antenatal women, men, and adults with fecal incontinence. Neurourol. Urodynam. 34:???–???, 2015. © 2015 Wiley Periodicals, Inc.

Health professionals’ and patients’ perspectives on pelvic floor muscle training adherence—2011 ICS State-of-the-Science Seminar research paper IV of IV

Thu, 21 May 2015 13:56:13 +0000

Aims There is scant information on pelvic floor muscle training (PFMT) adherence barriers and facilitators. A web-based survey was conducted (1) to investigate whether responses from health professionals and the public broadly reflected findings in the literature, (2) if responses differed between the two groups, and (3) to identify new research directions. Methods Health professional and public surveys were posted on the ICS website. PFMT adherence barriers and facilitators were divided into four categories: physical/condition, patient, therapy, and social-economic. Responses were analyzed using descriptive statistics from quantitative data and thematic data analysis for qualitative data. Results Five hundred and fifteen health professionals and 51 public respondents participated. Both cohorts felt “patient-related factors” constituted the most important adherence barrier, but differed in their rankings of short- and long-term barriers. Health professionals rated “patient-related” and the public “therapy-related” factors as the most important adherence facilitator. Both ranked “perception of PFMT benefit” as the most important long-term facilitator. Contrary to published findings, symptom severity was not ranked highly. Neither cohort felt the barriers nor facilitators differed according to PFM condition (urinary/faecal incontinence, pelvic organ prolapse, pelvic pain); however, a large number of health professionals felt differences existed across age, gender, and ethnicity. Half of respondents in both cohorts felt research barriers and facilitators differed from those in clinical practice. Conclusions An emphasis on “patient-related” factors, ahead of “condition-specific” and “therapy-related,” affecting PFMT adherence barriers was evident. Health professionals need to be aware of the importance of long-term patient perception of PFMT benefits and consider enabling strategies. Neurourol. Urodynam. 34:???–???, 2015. © 2015 Wiley Periodicals, Inc.

International Children's Continence Society standardization report on urodynamic studies of the lower urinary tract in children

Thu, 21 May 2015 14:42:11 +0000

Aims The objective of this document created by the ICCS standardization subcommittee is to provide a uniform guideline on measurement, quality control and documentation of urodynamic studies in children. Methods This guideline was created using expert opinion and critical review of the published literature on urodynamic studies in children. Currently no standardized guideline or level 1 data exists on the proper technique for this subject matter. Results The document provides a throughout explanation on how to approach a child who presents with lower urinary tract dysfunction, whether it be of neurogenic, anatomic or functional origin. Formation of an urodynamic question after a comprehensive history and physical examination is paramount in selecting the urodynamic study(ies) that will be most appropriate for each child. Appropriate application of each test with careful consideration of the needs of the child and family will provide the most accurate and reproducible results. Recommendations on how to execute each of the components of an urodynamic study as well as interpretation are included in the document. Conclusions Urodynamic studies have become a major tool in evaluating lower urinary tract dysfunction in children. There are many subtleties in performing these studies in children in juxtaposition to adults; therefore, adaptations specific to children must be made to achieve accurate and reproducible results. Uniformity in how the studies are conducted from center to center will allow for healthier transparency and enhanced comparison of results in both clinical and research situations. Neurourol. Urodynam. 34:???–???, 2015. © 2015 Wiley Periodicals, Inc.

Intermittent catheterisation for long-term bladder management (abridged cochrane review)

Fri, 05 Jun 2015 10:40:06 +0000

Aims To review the evidence on strategies to reduce UTI, other complications or improve satisfaction in intermittent catheter (IC) users by comparing: (1) one catheter design, material or technique versus another; (2) sterile technique versus clean; or (3) single-use (sterile) or multiple-use (clean) catheters. Methods We searched Cochrane Incontinence Group Specialised Trials Register, MEDLINE, EMBASE, CINAHL, ERIC, reference lists, and conference proceedings to November 2013. We contacted other investigators for unpublished data or clarification. Trial screening, assessment and data abstraction were all in accordance with the Cochrane handbook. Results Thirty one trials (13 RCTs and 18 randomized crossover trials), addressed the inclusion criteria comparing method or design and UTI/bacteriuria, other complications or participant assessed outcomes. Studies varied widely in follow-up, UTI definition and attrition; in some, data could not be combined. Where there were data, confidence intervals were wide and hence clinically important differences could neither be reliably identified nor ruled out. Conclusions Current research evidence is weak and design issues are significant. It has not yet been established whether incidence of UTI, other complications such as haematuria, or user satisfaction are affected by sterile or clean technique, coated or uncoated catheters, single or multiple-use catheters or by any other strategy. For people using IC, choice of catheter will depend on personal preference, cost, portability, and ease of use. Individuals should discuss the catheter options with their healthcare practitioner. Cost-effectiveness analysis and use of the standard definition of UTI are essential in any proposed clinical trial. Neurourol. Urodynam. 34:???–???, 2015. © 2015 Wiley Periodicals, Inc.

Comparison between laparoscopic sacral hysteropexy and subtotal hysterectomy plus cervicopexy in pelvic organ prolapse: A pilot study

Sun, 29 Jun 2014 14:26:57 +0000

Aims The primary outcome was to evaluate the subjective success rates of two laparoscopic POP operation techniques: uterine-sparing surgery versus a subtotal hysterectomy plus cervicopexy. Methods Prospective cohort of 45 women with symptomatic POP recruited between January and December 2010 who self-selected surgery group: group A (n = 15), sacral laparoscopic hysteropexy was performed and group B (n = 30), laparoscopically conducted subtotal hysterectomy plus cervicopexy. All patients had a positive answer in the “Epidemiology of prolapse and incontinence” questionnaire (EPIQ, question number 35) and also had a POPQ ≥2nd degree. The primary outcome was the subjective success rate, measured by a negative answer to the Q35 of EPIQ: “Do you have a sensation that there is bulge in vagina or that something is falling out from your vagina” and also by rating their symptoms improvement by the “Patient Global Impression of Improvement”. The secondary outcome was the objective success rate assessed by pelvic examination: cure was considered when POPQ <2nd degree in all vaginal compartments at 6 and 12 months. Results Baseline demographic characteristics were similar between groups. Subjective success rate was significantly superior in group B both after 6 and 12 months (P = 0.001). Similarly, objective pelvic examination led to a significantly higher rate of successful apical outcome in group B after 6 and 12 months (P = 0.009 and P = 0.002, respectively). Neither major complications nor vaginal mesh erosions were registered. Conclusions The overall success rate was significantly higher in the laparoscopic subtotal hysterectomy plus cervicopexy group, compared with the laparoscopic sacral hysteropexy group. Neurourol. Urodynam. 34:???–???, 2015. © 2014 Wiley Periodicals, Inc.

Long term safety of sacral nerve modulation in medicare beneficiaries

Fri, 25 Jul 2014 12:23:46 +0000

Aims Sacral nerve stimulation (SNS) is FDA approved as second-line therapy for both urinary and bowel control. However, there is limited evidence regarding long term safety. We determined adverse events associated with SNS among Medicare beneficiaries. Methods We used the 5% national random sample of Medicare claims for 2001–2011 to identify patients. Patients who underwent SNS implantation were identified with Current Procedure Terminology (CPT-4) codes. We determined safety of SNS using analysis of complication occurrences on day of surgery and during 5 years following initial procedure. SAS v9.3 statistical package was used. Results One thousand four hundred seventy-four patients underwent treatment with SNS in the 5% national sample of Medicare patients within the time period. Representative of real-world patients undergoing SNS surgery, comorbidities included hypertension (69.3%), diabetes (29.4%), chronic pulmonary disease (25.5%), hypothyroidism (25.2%), and depression (22.7%). Few complications occurred on day of surgery. At 90 days, 3.2% of patients had bowel complications, 2.0% urological, 9.4% infectious, and 1.5% stroke. Overall, bowel, neurological health event occurrences were consistent with prior year rates, while infectious events decreased. Of 206 patients who were followed for at least 5 years, 17.3% had devices removed and 11.3% replaced, with 26.1% having at least one of those, leaving 73.9% with original devices. Conclusions Urological, infectious, and bowel complication occurrences were low after SNS among Medicare beneficiaries with multiple comorbidities. There were infrequent serious complications like hemorrhage and stroke postoperatively. Although SNS appears safe in this high-risk population, a comprehensive registry will ensure continuous safety. Neurourol. Urodynam. 34:???–???, 2015. © 2014 Wiley Periodicals, Inc.

Image-based simulation of urethral distensibility and flow resistance as a function of pelvic floor anatomy

Sat, 03 May 2014 05:10:38 +0000

Aims The goal of this study is to develop an image-based model of urethral distention and resistance in women with and without SUI. Methods A biomechanical vector force model was created to simulate the mechanical deformation of pelvic floor structures during cough and Valsalva in order to measure urethral distension and predict flow resistance patterns. Dynamic MRI images were used to create a spatial model to construct an accurate representation of tissue thickness and location, which was combined with tissue property values (MATLAB 2011a, MathWorks, Natick, MA). Spatial profiles were created to demonstrate the effects of hypermobility and tissue property variability on distensibility and flow resistance along the urethra. Sensitivity analyses were conducted to demonstrate the relationship between flow resistance and various tissue properties. Results The average distension for incontinent cases (3.8 mm) was significantly greater than that of continent cases (2.6 mm) (t = 3.3083, df = 8, P < 0.01), corresponding to a 70% drop in average resistance to urine flow. Sensitivity analyses demonstrated that the stiffness and contractility of the vagina and urethra had the greatest effect on continence. Conclusions We present a novel, 2-dimensional biomechanical model of female stress urinary incontinence (SUI) that relates the effects of various factors such as tissue elasticity, pelvic floor structure, and muscle activation. A better understanding of the pathophysiology underlying SUI has potential implications for the creation of novel targeted treatments. Neurourol. Urodynam. 34:???–???, 2015. © 2014 Wiley Periodicals, Inc.

Sphincter electromyography in diabetes mellitus and multiple system atrophy

Mon, 07 Jul 2014 20:32:10 +0000

Aims Abnormalities of external anal sphincter electromyography (EAS-EMG) characterize multiple system atrophy (MSA) and focal cauda equina or conus medullaris lesions. This study is designed to determine whether and how diabetic polyneuropathy (DPN) affects EAS as compared to the abnormalities seen in MSA. Methods We conducted multi-motor unit potential (MUP) analysis of EAS in 22 healthy controls, 32 diabetes mellitus (DM) patients without neuropathy, 38 DPN patients, and 68 MSA patients. Results DPN patients had a significant (P < 0.01) increase in MUP mean duration, mean amplitude, percentage of long duration MUPs, and satellite rate, but to a lesser extent than MSA. Mean duration and satellite rate showed the least overlap among different groups in individual value distributions. Conclusions Compared with MSA, DPN affects EAS to a lesser degree as judged by neurogenic MUP abnormalities in EMG. Mean duration and satellite rate may serve as the most discriminating aspects in MUP analysis of EAS. Neurourol. Urodynam. 34:???–???, 2015. © 2014 Wiley Periodicals, Inc.

Urinary retention rates after intravesical onabotulinumtoxinA injection for idiopathic overactive bladder in clinical practice and predictors of this outcome

Sun, 29 Jun 2014 14:29:05 +0000

Aims The purpose of this study was to find the rate of urinary retention in clinical practice after treatment with onabotulinumtoxinA (BTN/A) for refractory overactive bladder (OAB) symptoms and determine factors that predict this outcome. Methods This is a retrospective study of BTN/A for treatment of non-neurogenic, refractory OAB symptoms. Patients were analyzed with respect to their first and second BTN/A injections. The primary outcome measure was postoperative urinary retention. Statistical significance was assessed with multivariate logistic regression. Results Based on inclusion and exclusion criteria, the study population was 160. Mean age was 64 ± 13.2 years and 24% of the patients were men. The rate of urinary retention was 35% (n = 56). For the first BTN/A treatment, multivariate analysis revealed that preoperative PVR (post-void residual volume) (OR 1.27, 95% CI 1.13–1.43, P < 0.001) and preoperative bladder capacity (OR 1.05, 95% CI 1.01–1.08, P = 0.005) were associated with postoperative urinary retention. In patients with a preoperative PVR of ≥100 ml, 94% (n = 17) went into urinary retention. For those who underwent a second BTN/A treatment, preoperative PVR, BTN/A units injected and retention after the first BTN/A were associated with an increased rate of postoperative retention. Conclusions Increased preoperative PVR was associated with urinary retention. The retention rate is higher than that reported in recent clinical trials. The inclusion of patients with a preoperative PVR ≥100 ml and a lower threshold to initiate clean intermittent catheterization contributed to this high rate of retention. Neurourol. Urodynam. 34:???–???, 2015. © 2014 Wiley Periodicals, Inc.

Comparative analysis of the pressure profilometry of vesicocutaneous continent catheterizable conduits between patients with and without rectus abdominis neosphincter (Yachia principle)

Sun, 29 Jun 2014 14:26:54 +0000

Aims To assess whether crossing rectus abdominis muscle strips, as proposed by Yachia, would change urinary catheterizable conduit's pressure profilometry, in static and dynamic conditions. Methods Non-randomized selection of 20 continent patients that underwent Macedo's ileum-based reservoir, 10 including Yachia's technique (Study Group) and 10 without this mechanism of continence (Control Group). Demographics and cystometric data were assessed. Conduit's pressure profilometry was obtained by infusing saline through a multichannel catheter, at rest and during Valsalva maneuver. We assessed the pressure: (a) in the bladder; (b) in conduit's proximal segment; and (c) in conduit's distal segment, which is presumably the abdominal wall and crossed muscle strips site. Results Mean age at surgery was 6.1 years in the Control Group and 7.7 years in the Study Group. There was no statistically significant difference between groups regarding maximum cystometric bladder capacity and leakage point pressure. At rest, the pressure profilometry showed similar results between groups in all segments analyzed. During Valsalva maneuver, pressure profilometry showed similar results between groups in bladder and conduit's proximal segment pressure. In this condition, conduit's distal segment pressure in the Study Group (Mean = 72.9 and Peak = 128.7 cmH2O) was significantly greater (P < 0.05) than conduit's distal segment pressure in the Control Group (Mean = 48.3 and Peak = 65.1 cmH2O). Conclusions Crossing muscle strips over the conduit significantly increases the pressure in its distal segment during contraction of the rectus abdominis muscle, which can be important in moments of sudden increase in abdominal pressure in order to keep continence. Neurourol. Urodynam. 34:???–???, 2015. © 2014 Wiley Periodicals, Inc.

Results of a randomized, double-blind, parallel-group, placebo- and active-controlled, multicenter study of mirabegron, a β3-adrenoceptor agonist, in patients with overactive bladder in Asia

Sun, 17 Aug 2014 19:37:45 +0000

Aims To assess the efficacy and safety of mirabegron 50 mg once daily compared with placebo and the active control, tolterodine extended-release (ER) 4 mg once daily, in patients with symptoms of overactive bladder (OAB) in Taiwan, Korea, China, and India. Methods A 12-week multinational, randomized, double-blind, parallel-group placebo- and active-controlled trial. The primary efficacy endpoint was change from baseline to final visit in mean number of micturitions/24 hr. Secondary endpoints were: mean number of urgency episodes, incontinence episodes and urge incontinence episodes/24 hr, mean number of nocturia episodes per night, mean volume voided per micturition, and quality-of-life (QoL) scores as assessed by the King's Health Questionnaire (KHQ). Results Of 1,126 patients who were randomized to receive double-blind study drug, 921 patients (300, 311, and 310 in the placebo, mirabegron 50 mg, and tolterodine ER 4 mg groups, respectively) completed the treatment period. Demographic characteristics were similar across treatment groups. A statistically significant improvement versus placebo in mean number of micturitions/24 hr was seen with mirabegron 50 mg at all timepoints (P < 0.05) as well as final visit (−0.57 with 95% confidence intervals [CIs] of [−1.04, −0.09], P = 0.019). There was no significant difference between treatment groups in improvement from baseline to final visit in any of the secondary outcome measures except volume voided per micturition. The overall incidence of drug-related adverse events was 17.2%, 15.8%, and 21.3%, in the placebo, mirabegron 50 mg, and tolterodine ER 4 mg groups, respectively. Conclusions Mirabegron 50 mg once daily for 12 weeks was superior to placebo in reducing the frequency of micturitions in patients with symptoms of OAB in Taiwan, Korea, China, and India. Neurourol. Urodynam. 34:???–???, 2015. © 2014 Wiley Periodicals, Inc.

Trends in reoperation for female stress urinary incontinence: A nationwide study

Sun, 27 Jul 2014 20:17:57 +0000

Aims Using the National Health Insurance (NHI) database in Taiwan, the study aimed to evaluate the rates and associated factors for reoperation of female stress incontinence. Methods Records of female patients who had received a primary surgical treatment for stress incontinence from January 2000 to December 2006 were retrieved. Among these, patients who had reoperations during follow-up till December 2010 were identified. The data were analyzed for reoperation rates, surgery methods, patient demography, surgeon, and hospital attributes. Results Among 14,613 patients with a mean follow-up of 86.28 ± 26.76 months, 563 (3.85%) had reoperations, an incidence rate of 54.37 per 10,000 person year (PY). Injection procedures had the highest reoperation rate of 893.30/10,000 PY. The adjusted hazard ratio (HR) of reoperation was higher for mid-urethral sling when compared to pubovaginal sling (HR 1.54, 95% CI 1.16–2.05) or retropubic urethropexy including Burch operation (HR 1.30, 95% CI 1.04–1.61). Surgeons with high service volumes tended to have fewer reoperations. No correlations were noted between the reoperation rate with patient age, surgeon age/gender, year of operation and hospital status. However, urologists had higher reoperation rates than gynecologists. For repeat surgery, the majority of patients chose the same specialty but different surgical types. Mid-urethral sling was used most commonly in 48.85% of reoperations. Conclusions Substantial number of patients need reoperation for stress incontinence. The choice of primary surgery type and surgeon specialty may affect the reoperation rates. Mid-urethral sling is the most common reoperation choice. Neurourol. Urodynam. 34:???–???, 2015. © 2014 Wiley Periodicals, Inc.

Erratum

Wed, 12 Aug 2015 13:09:22 +0000

Urethral atrophy after implantation of an artificial urinary sphincter: fact or fiction?

Sat, 19 Sep 2015 05:43:34 +0000

Objectives To investigate the concept of urethral ‘atrophy’ which is often cited as a cause of recurrent incontinence after initially successful implantation of an artificial urinary sphincter (AUS); and to investigate the specific cause of the malfunction of the AUS in these patients and address their management. Patients and methods Between January 2006 and May 2013, 50 consecutive patients (mean age 54.3 years) with recurrent incontinence had their AUS (AMS800™) explored for malfunction and replaced with a new device composed of exactly the same size components, unless there was a particular reason to use something different. Average time to replacement of the device was 10.1 years. Mean follow-up after replacement of the device was 24.7 months. All patients without an obvious cause for their recurrent incontinence had preoperative urodynamic evaluation including measurement of the Valsalva leak point pressure (VLPP) and the retrograde cuff occlusive pressure (RCOP). After explantation of the AUS in patients without any apparent abnormality of the device at the time of replacement the pressure generated by the explanted pressure regulating balloon (PRB) was measured manometrically, when this was possible. In a select group of six consecutive patients of this type the fibrous capsule surrounding the old cuff was incised then excised to expose and evaluate the underlying corpus spongiosum. Results In 31 of the 50 (62%) undergoing exploration a specific cause for the malfunction of their AUS was defined. In the other 19 patients (38%) no cause was found, either preoperatively or at the time of exploration, other than a low VLPP and RCOP. A typical ‘waisted’ or ‘hour-glass’ appearance of the underlying corpus spongiosum was demonstrable, to some degree, on explanting the cuff in all cases. In the 6 patients in whom the restrictive sheath surrounding the cuff was excised, the urethral circumference immediately returned to normal after the compressive effect of the sheath was released. Manometry of the explanted PRBs, when this was possible, showed a loss of pressure in all instances. Replacement of the explanted AUS with a new device with the same size cuff and PRB in 14 of these 19 patients was successful in 12 (85.7%). Conclusion These results and other theoretical considerations suggest that recurrent incontinence, years after initially successful implantation of an AUS is because of material failure of the PRB, probably due to age, and consequent loss of its ability to generate the pressure it was designed to produce, and that urethral atrophy does not occur. Simply replacing the old device with a new one with the same characteristics, unless there is a particular reason to do otherwise, is usually successful and avoids the complications of alternatives such as as cuff downsizing or implanting a PRB with a higher pressure range or implantation of a second cuff or transcorporeal cuff placement, all of which have been advocated in these patients. This article is protected by copyright. All rights reserved.

Comparison of the efficacy and safety of tolterodine 2 mg and 4 mg combined with an α-blocker in men with lower urinary tract symptoms (LUTS) and overactive bladder: a randomized controlled trial

Wed, 23 Sep 2015 01:09:11 +0000

Objective To evaluate the efficacy and safety of low-dose (2 mg) tolterodine extended release (ER) with an α-blocker compared with standard-dose (4 mg) tolterodine ER with an α-blocker for the treatment of men with residual storage symptoms after α-blocker monotherapy. Patients and Methods The study was a 12-week, single-blind, randomized, parallel-group, non-inferiority trial that included men with residual storage symptoms despite receiving at least 4 weeks of α-blocker treatment. Inclusion criteria were total International Prostate Symptom Score (IPSS) ≥12, IPSS quality-of-life item score ≥3, and ≥8 micturitions and ≥2 urgency episodes per 24 h. The primary outcome was change in the total IPSS score from baseline. Bladder diary variables, patient-reported outcomes and safety were also assessed. Results Patients were randomly assigned to addition of either 2 mg tolterodine ER (n = 47) or 4 mg tolterodine ER (n = 48) to α-blocker therapy for 12 weeks. Patients in both treatment groups had a significant improvement in total IPSS score (−5.5 and −6.3, respectively), micturition per 24 h (−1.3 and −1.7, respectively) and nocturia per night (−0.4 and −0.4, respectively). Changes in IPSS, bladder diary variables, and patient-reported outcomes were not significantly different between the treatment groups. All interventions were well tolerated by patients. Conclusions These results suggest that 12 weeks of low-dose tolterodine ER add-on therapy is similar to standard-dose tolterodine ER add-on therapy in terms of efficacy and safety for patients experiencing residual storage symptoms after receiving α-blocker monotherapy.

Botulinum toxin (OnabotulinumtoxinA) in the male non-neurogenic overactive bladder: clinical and quality of life outcomes

Wed, 02 Sep 2015 21:41:28 +0000

Objective To assess the efficacy of OnabotulinumtoxinA (BTXA) injections in men with drug-refractory non-neurogenic overactive bladder (NNOAB). Patients and Methods A total of 43 men received BTXA injections for NNOAB from 2004 to 2012. Patient Global Impression of Improvement (PGI-I) score was obtained. For men with wet NNOAB, change in number of pads per day was also assessed. Results Forty-three men with a mean age of 69 (range 37–85) received at least one injection. Of the 43 men, 20 (47%) had prior prostate surgery: 11 had radical prostatectomy (RP) and nine had transurethral resection of prostate (TURP). Overall, average PGI-I score was 2.7. Comparing PGI-I score in men who had prior prostate surgery with men who have not: 2.6 ± 0.5 vs 2.8 ± 0.5 respectively (average ± 95% CI), P = 0.6. Comparing PGI-I score in men who had previous TURP with men who had previous RP: PGI-I score: 3.3 ± 0.8 vs 2.0 ± 0.5 respectively, P < 0.05. Men who had RP experienced a reduction in pad use (from 3.5 ± 1.7 to 1.6 ± 0.9 pads/day, P < 0.05) while this was not the case amongst men who had TURP (from 1.7 ± 1.5 to 1.4 ± 1.5 pads/day, P = 0.4). Conclusion Overall, BTXA injection in men with drug-refractory NNOAB does provide a symptomatic benefit. Amongst men who have had prior prostate surgery, men who have had RP experience a greater benefit than men who have had TURP, both in regards to PGI-I score and pad use.

URB937, a peripherally restricted inhibitor for fatty acid amide hydrolase, reduces prostaglandin E2-induced bladder overactivity and hyperactivity of bladder mechano-afferent nerve fibres in rats

Wed, 19 Aug 2015 06:47:10 +0000

Objective To determine if inhibition of the endocannabinoid-degrading enzyme fatty acid amide hydrolase (FAAH) can counteract the changes in urodynamic variables and bladder afferent activities induced by intravesical prostaglandin E2 (PGE2) instillation in rats. Materials and methods In female Sprague–Dawley rats we studied the effects of URB937, a peripherally restricted FAAH inhibitor, on single-unit afferent activity (SAA) during PGE2-induced bladder overactivity (BO). SAA measurements were made in urethane-anaesthetised rats and Aδ- and C-fibres were identified by electrical stimulation of the pelvic nerve and by bladder distention. Cystometry (CMG) in conscious animals and during SAA measurements was performed during intravesical instillation of PGE2 (50 or 100 μm) after intravenous administration of URB937 (0.1 and 1 mg/kg) or vehicle. In separate experiments, the comparative expressions of FAAH and cannabinoid receptors, CB1 and CB2, in microsurgically removed L6 dorsal root ganglion (DRG) were studied by immunofluorescence. Results During CMG, 1 mg/kg URB937, but not vehicle or 0.1 mg/kg URB937, counteracted the PGE2-induced changes in urodynamic variables. PGE2 increased the SAAs of C-fibres, but not Aδ-fibres. URB937 (1 mg/kg) depressed Aδ-fibre SAA and abolished the facilitated C-fibre SAA induced by PGE2. The DRG nerve cells showed strong staining for FAAH, CB1 and CB2, with a mean (sem) of 77 (2)% and 87 (3)% of FAAH-positive nerve cell bodies co-expressing CB1 or CB2 immunofluorescence, respectively. Conclusion The present results show that URB937, a peripherally restricted FAAH inhibitor, reduces BO and C-fibre hyperactivity in the rat bladder provoked by PGE2, suggesting an important role of the peripheral endocannabinoid system in BO and hypersensitivity.

Association between number of prostate biopsies and patient-reported functional outcomes after radical prostatectomy: implications for active surveillance protocols

Mon, 20 Jul 2015 21:58:46 +0000

Objectives To evaluate whether the number of preoperative prostate biopsies affects functional outcomes after radical prostatectomy (RP). Methods We identified patients treated with RP at our institution between 2008 and 2011. At 6 and 12 months postoperatively, the patients completed questionnaires assessing erectile and urinary function. Patients with preoperative incontinence or erectile dysfunction or who did not complete the questionnaire were excluded. Primary outcomes were urinary and erectile function at 12 months postoperatively. We used logistic regression to estimate the impact of number of prostate biopsies on functional outcomes after adjusting for demographic and clinical factors. Results We identified 2 712 patients treated with RP between 2008 and 2011. Most of the patients (80%) had one preoperative prostate biopsy, 16% had two, and 4% had at least three. On adjusted analysis, erectile function at 12 months was not significantly different for patients with two (odds ratio [OR] 1.25; 95% confidence interval [CI] 0.90, 1.75) or three or more (OR 1.52; 95% CI 0.84, 2.78) biopsies, compared with those with one biopsy. Similarly, urinary function at 12 months was not significantly different for patients with two (0.84, 95% CI 0.64, 1.10) or three or more (0.99, 95% CI 0.60, 1.61) biopsies compared with those with one. Conclusions We did not find evidence that a greater number of preoperative prostate biopsies adversely affected erectile or urinary function at 12 months after RP.

Combination of solifenacin and mirabegron for overactive bladder management

Tue, 08 Sep 2015 21:34:31 +0000

Post-prostatectomy incontinence in the irradiated patient: more than just a drop in the ocean

Tue, 08 Sep 2015 21:34:24 +0000

Diagnosis and treatment of chronic bacterial prostatitis and chronic prostatitis/chronic pelvic pain syndrome: a consensus guideline

Tue, 16 Jun 2015 06:51:21 +0000

Objectives To improve awareness and recognition of chronic bacterial prostatitis (CBP) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) among non-specialists and patients. To provide guidance to healthcare professionals treating patients with CBP and CP/CPPS, in both non-specialist and specialist settings. To promote efficient referral of care between non-specialists and specialists and the involvement of the multidisciplinary team (MDT). Patients and Methods The guideline population were men with CBP or CP/CPPS (persistent or recurrent symptoms and no other urogenital pathology for ≥3 of the previous 6 months). Consensus recommendations for the guidelines were based on a search to identify literature on the diagnosis and management of CBP and CP/CPPS (published between 1999 and February 2014). A Delphi panel process was used where high-quality, published evidence was lacking. Results CBP and CP/CPPS can present with a wide range of clinical manifestations. The four main symptom domains are urogenital pain, lower urinary tract symptoms (LUTS – voiding or storage symptoms), psychological issues and sexual dysfunction. Patients should be managed according to their individual symptom pattern. Options for first-line treatment include antibiotics, α-adrenergic antagonists (if voiding LUTS are present) and simple analgesics. Repeated use of antibiotics, such as quinolones, should be avoided if there is no obvious symptomatic benefit from infection control or cultures do not support an infectious cause. Early use of treatments targeting neuropathic pain and/or referral to specialist services should be considered for patients who do not respond to initial measures. An MDT approach (urologists, pain specialists, nurse specialists, specialist physiotherapists, general practitioners, cognitive behavioural therapists/psychologists, and sexual health specialists) is recommended. Patients should be fully informed about the possible underlying causes and treatment options, including an explanation of the chronic pain cycle. Conclusion Chronic prostatitis can present with a wide variety of signs and symptoms. Identification of individual symptom patterns and a symptom-based treatment approach are recommended. Further research is required to evaluate management options for CBP and CP/CPPS.

A systematic review of experience of 180-W XPS GreenLight laser vaporisation of the prostate in 1640 men

Tue, 02 Jun 2015 07:19:43 +0000

Objective To systematically review the literature regarding clinical outcomes of 180-W XPS GreenLight® laser (GL) vaporisation for the treatment of lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH). Methods Recent publications were identified in the field of 180-W GL vaporisation for the treatment of LUTS due to BPH. We searched for peer-reviewed original articles in the English language. Search items were: ‘180W lithium triborate laser’ or ‘180W greenlight laser’ or ‘180 watt lithium triborate laser’ or ‘180 watt greenlight laser’ or ‘XPS greenlight laser’. In all, 30 papers published between 2012 and 2014 matched this search. Of these, 10 papers were identified dealing with consecutive cohorts of patients treated with the 180-W XPS GL Results The 10 papers included a total experience of 1640 patients. The only randomised controlled trial in this field compares 180-W with transurethral resection of the prostate (TURP). Functional outcomes and prostate volume reduction after GL vaporisation were similar to TURP. Catheterisation time and hospital stay were shorter in patients undergoing 180W XPS GL vaporisation (41 and 66 h vs 60 and 97 h, respectively). Four papers compared the 180-W XPS system to former GL devices showing increased operation time efficiency and comparable postoperative voiding results and adverse events. One paper defined the learning curve to achieve an expert level according to the speed of the procedure and the effectiveness of volume reduction was met after 120 procedures. Conclusion The 180-W XPS GL offers shorter operation times than former devices. In the one randomised controlled trial comparison with TURP, volume reduction and functional results were comparable to those of TURP. Longer term studies are required.

Preoperative predictive model of recovery of urinary continence after radical prostatectomy

Mon, 30 Mar 2015 08:52:41 +0000

Objective To build a predictive model of urinary continence recovery after radical prostatectomy (RP) that incorporates magnetic resonance imaging (MRI) parameters and clinical data. Patients and Methods We conducted a retrospective review of data from 2 849 patients who underwent pelvic staging MRI before RP from November 2001 to June 2010. We used logistic regression to evaluate the association between each MRI variable and continence at 6 or 12 months, adjusting for age, body mass index (BMI) and American Society of Anesthesiologists (ASA) score, and then used multivariable logistic regression to create our model. A nomogram was constructed using the multivariable logistic regression models. Results In all, 68% (1 742/2 559) and 82% (2 205/2 689) regained function at 6 and 12 months, respectively. In the base model, age, BMI and ASA score were significant predictors of continence at 6 or 12 months on univariate analysis (P < 0.005). Among the preoperative MRI measurements, membranous urethral length, which showed great significance, was incorporated into the base model to create the full model. For continence recovery at 6 months, the addition of membranous urethral length increased the area under the curve (AUC) to 0.664 for the validation set, an increase of 0.064 over the base model. For continence recovery at 12 months, the AUC was 0.674, an increase of 0.085 over the base model. Conclusion Using our model, the likelihood of continence recovery increases with membranous urethral length and decreases with age, BMI and ASA score. This model could be used for patient counselling and for the identification of patients at high risk for urinary incontinence in whom to study changes in operative technique that improve urinary function after RP.

Safety and efficacy of mirabegron as ‘add-on’ therapy in patients with overactive bladder treated with solifenacin: a post-marketing, open-label study in Japan (MILAI study)

Thu, 23 Apr 2015 00:50:36 +0000

Objective To examine the safety and efficacy of mirabegron as ‘add-on’ therapy to solifenacin in patients with overactive bladder (OAB). Patients and Methods This multicentre, open-label, phase IV study enrolled patients aged ≥20 years with OAB, as determined by an OAB symptom score (OABSS) total of ≥3 points and an OABSS Question 3 score of ≥2 points, who were being treated with solifenacin at a stable dose of 2.5 or 5 mg once daily for at least 4 weeks. Study duration was 18 weeks, comprising a 2-week screening period and a 16-week treatment period. Patients meeting eligibility criteria continued to receive solifenacin (2.5 or 5 mg once daily) and additional mirabegron (25 mg once daily) for 16 weeks. After 8 weeks of treatment, the mirabegron dose could be increased to 50 mg if the patient's symptom improvement was not sufficient, if he/she was agreeable to the dose increase, and the investigator judged that there were no safety concerns. Safety assessments included adverse events (AEs), laboratory tests, vital signs, 12-lead electrocardiogram, QT corrected for heart rate using Fridericia's correction (QTcF) interval and post-void residual (PVR) volume. Efficacy endpoints were changes from baseline in OABSS total score, OAB questionnaire short form (OAB-q SF) score (symptom bother and total health-related quality of life [HRQL] score), mean number of micturitions/24 h, mean number of urgency episodes/24 h, mean number of urinary incontinence (UI) episodes/24 h, mean number of urgency UI episodes/24 h, mean volume voided/micturition, and mean number of nocturia episodes/night. Patients were instructed to complete the OABSS sheets at weeks −2, 0, 8 and 16 (or at discontinuation), OAB-q SF sheets at weeks 0, 8 and 16 (or at discontinuation) and patient voiding diaries at weeks 0, 4, 8, 12 and 16 (or at discontinuation). Results Overall incidence of drug-related treatment-emergent AEs (TEAEs) was 23.3%. Almost all TEAEs were mild or moderate. The most common TEAE was constipation, with similar incidence in the groups receiving a dose increase to that observed in the groups maintained on the original dose. Changes in PVR volume, QTcF interval, pulse rate and blood pressure were not considered to be clinically significant and there were no reports of urinary retention. Significant improvement was seen for changes in efficacy endpoints from baseline to end of treatment (EOT) in all groups (patients receiving solifenacin 2.5 or 5 mg + mirabegron 25 or 50 mg). Conclusions Add-on therapy with mirabegron 25 mg once daily for 16 weeks, with an optional dose increase to 50 mg at week 8, was well tolerated in patients with OAB treated with solifenacin 2.5 mg or 5 mg once daily. There were significant improvements from baseline to EOT in OAB symptoms with combination therapy with mirabegron and solifenacin. Add-on therapy with mirabegron and an antimuscarinic agent, such as solifenacin, may provide an attractive therapeutic option.

Complications following artificial urinary sphincter placement after radical prostatectomy and radiotherapy: a meta-analysis

Thu, 12 Mar 2015 04:47:47 +0000

Objective To conduct a systematic review and meta-analysis of artificial urinary sphincter (AUS) placement after radical prostatectomy (RP) and external beam radiotherapy (EBRT). Patients and Methods There were 1 886 patients available for analysis of surgical revision outcomes and 949 for persistent urinary incontinence (UI) outcomes from 15 and 11 studies, respectively. The mean age (sd) was 66.9 (1.4) years and the number of patients per study was 126.6 (41.7). The mean (sd, range) follow-up was 36.7 (3.9, 18–68) months. A systematic database search was conducted using keywords, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Published series of AUS implantations were retrieved, according to the inclusion criteria. The Newcastle–Ottawa Score was used to ascertain the quality of evidence for each study. Surgical results from each case series were extracted. Data were analysed using CMA® statistical software. Results AUS revision was higher in RP + EBRT vs RP alone, with a random effects risk ratio of 1.56 (95% confidence interval [CI] 1.02–2.72; P < 0.050; I2 = 82.0%) and a risk difference of 16.0% (95% CI 2.05–36.01; P < 0.080). Infection/erosion contributed to the majority of surgical revision risk compared with urethral atrophy (P = 0.020). Persistent UI after implantation was greater in patients treated with EBRT (P < 0.001). Conclusions Men receiving RP + EBRT appear at increased risk of infection/erosion and urethral atrophy, resulting in a greater risk of surgical revision compared with RP alone. Persistent UI is more common with RP + EBRT.