Radiation-induced vesicovaginal fistulae represent one of the most challenging complications of pelvic surgery because irradiated tissues exhibit severe fibrosis, ischemia, and impaired healing. Among various surgical techniques, Martius flap repair is widely employed because it provides a well-vascularized tissue buttress and enhances closure rates. However, while most reports have focused on anatomical success, little attention has been paid to the long-term bladder function after closure.
We describe the case of a 50-year-old woman who developed a radiation-induced vesicovaginal fistula after chemoradiotherapy for cervical cancer. The fistula was successfully closed using a Martius flap, and no further vaginal leakage was observed. Nevertheless, during follow-up, she developed persistent bladder dysfunction, characterized by reduced compliance, detrusor overactivity, and nocturnal urinary leakage, which was confirmed by serial urodynamic evaluations.
This case illustrates a discrepancy between anatomical closure and functional outcomes. Even after technically successful repairs, latent bladder dysfunction may persist and place patients at risk of upper urinary tract deterioration. Our report emphasizes the importance of incorporating systematic urodynamic follow-up into postoperative care, particularly for complex or irradiated fistulas, to ensure anatomical and functional success.
{"title":"Persistent bladder dysfunction after Martius flap repair for a radiation-induced vesicovaginal fistula: A case report","authors":"Rie Yoshimura , Nobutaka Shimizu , Mio Togo , Yoshitaka Kurano , Kaya Atagi , Tomoya Nao , Hideo Fukuhara , Satoshi Fukata , Takashi Karashima , Motoaki Saito , Keiji Inoue","doi":"10.1016/j.contre.2025.100104","DOIUrl":"10.1016/j.contre.2025.100104","url":null,"abstract":"<div><div>Radiation-induced vesicovaginal fistulae represent one of the most challenging complications of pelvic surgery because irradiated tissues exhibit severe fibrosis, ischemia, and impaired healing. Among various surgical techniques, Martius flap repair is widely employed because it provides a well-vascularized tissue buttress and enhances closure rates. However, while most reports have focused on anatomical success, little attention has been paid to the long-term bladder function after closure.</div><div>We describe the case of a 50-year-old woman who developed a radiation-induced vesicovaginal fistula after chemoradiotherapy for cervical cancer. The fistula was successfully closed using a Martius flap, and no further vaginal leakage was observed. Nevertheless, during follow-up, she developed persistent bladder dysfunction, characterized by reduced compliance, detrusor overactivity, and nocturnal urinary leakage, which was confirmed by serial urodynamic evaluations.</div><div>This case illustrates a discrepancy between anatomical closure and functional outcomes. Even after technically successful repairs, latent bladder dysfunction may persist and place patients at risk of upper urinary tract deterioration. Our report emphasizes the importance of incorporating systematic urodynamic follow-up into postoperative care, particularly for complex or irradiated fistulas, to ensure anatomical and functional success.</div></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"17 ","pages":"Article 100104"},"PeriodicalIF":0.5,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145885714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-23DOI: 10.1016/j.contre.2025.100102
F.W.M. Schlatmann , M.L. van Poelgeest–Pomfret , M.R. van Balken
In functional urology, efficiency is sought by asking patients to complete questionnaires before their appointment to evaluate their symptoms. This is difficult for a large number of patients, according to research on the IPSS and bladder diaries. In this review article, we describe the threats to the validity and thus the usability of these questionnaires. Making questionnaires easier to understand and involving the target group in the development of the questionnaires can improve the quality of information from the patient to the medical professional.
{"title":"Making things difficult for patients, to make things easy for the doctor? The problems functional urology patients experience in providing information ahead of their doctor's appointment","authors":"F.W.M. Schlatmann , M.L. van Poelgeest–Pomfret , M.R. van Balken","doi":"10.1016/j.contre.2025.100102","DOIUrl":"10.1016/j.contre.2025.100102","url":null,"abstract":"<div><div>In functional urology, efficiency is sought by asking patients to complete questionnaires before their appointment to evaluate their symptoms. This is difficult for a large number of patients, according to research on the IPSS and bladder diaries. In this review article, we describe the threats to the validity and thus the usability of these questionnaires. Making questionnaires easier to understand and involving the target group in the development of the questionnaires can improve the quality of information from the patient to the medical professional.</div></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"17 ","pages":"Article 100102"},"PeriodicalIF":0.5,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-17DOI: 10.1016/j.contre.2025.100103
Dana S. Sawan , Abdulrahman M. Alkudsi , Renad M. Abualsaud , Ghalia W. Edrees , Felwa F. Althaher
Background
Ionizing radiation from medical imaging poses health risks to patients and healthcare professionals. Awareness of these risks is critical for safe practice, especially in Obstetrics and Gynecology, where fetal exposure must be minimized.
Objectives
This study aimed to evaluate the knowledge and awareness of ionizing radiation among consultants, specialists, resident doctors, interns, and radiographers at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia.
Methods
A cross-sectional survey was conducted between 2022 and 2024 among 146 out of 160 invited healthcare professionals in the OB/GYN department (response rate: 91.3 %). Participants completed a structured questionnaire assessing knowledge of radiation doses, associated risks, and safety practices. Knowledge scores (0–14) were categorized as poor (<60 %) or good (≥60 %). Data were analyzed using SPSS version 26, and associations between professional title and knowledge level were assessed using Chi-squared tests. Missing data were handled using pairwise deletion.
Results
The mean knowledge score was 2.41 ± 2.17, with only 3/146 participants (2.1 %) demonstrating good knowledge and 143/146 (97.9 %) showing poor understanding. Interns correctly identified the radiation dose for abdominal ultrasound in 45/95 (47.4 %) and abdominal MRI in 18/95 (18.9 %) (p < 0.05). Only 23/146 (15.8 %) recognized that a single abdominal CT in childhood increases lifetime cancer risk, and only 20/146 (13.6 %) reported routinely informing patients about radiation risks before ordering imaging exams.
Conclusions
A substantial knowledge gap exists among OB/GYN professionals at KAUH regarding ionizing radiation risks. Targeted education, policy changes, and improved patient communication are essential to enhance safety. Future research should evaluate the impact of educational interventions on improving radiation awareness and clinical decision-making.
背景：医学成像产生的电离辐射对患者和医疗保健专业人员构成健康风险。对这些风险的认识对安全实践至关重要，特别是在产科和妇科，必须尽量减少胎儿接触。目的本研究旨在评估沙特阿拉伯吉达阿卜杜勒阿齐兹国王大学医院（KAUH）的会诊医师、专家、住院医师、实习生和放射技师对电离辐射的知识和意识。方法于2022 ~ 2024年对160名受邀的妇产科医护人员中的146人进行横断面调查，回复率为91.3%。参与者完成了一份结构化问卷，评估辐射剂量、相关风险和安全措施的知识。知识得分（0-14）分为差（60%）和好（≥60%）。数据采用SPSS version 26进行分析，职称与知识水平的相关性采用卡方检验。缺失数据使用两两删除处理。结果平均知识得分为2.41±2.17分，仅有3/146（2.1%）人知识较好，143/146（97.9%）人知识较差。实习生正确识别腹部超声（45/95）和腹部MRI（18/95）的辐射剂量（18.9%）（p < 0.05）。只有23/146（15.8%）的人认识到儿童时期单次腹部CT会增加终生癌症风险，只有20/146（13.6%）的人报告在安排影像学检查前常规告知患者辐射风险。结论KAUH妇产科专业人员对电离辐射风险的认识存在较大差距。有针对性的教育、政策变化和改善患者沟通对于加强安全至关重要。未来的研究应评估教育干预对提高放射意识和临床决策的影响。
{"title":"Ionizing radiation awareness among consultants, specialists, resident doctors, interns, and radiographers in a university hospital obstetrics and gynecology department","authors":"Dana S. Sawan , Abdulrahman M. Alkudsi , Renad M. Abualsaud , Ghalia W. Edrees , Felwa F. Althaher","doi":"10.1016/j.contre.2025.100103","DOIUrl":"10.1016/j.contre.2025.100103","url":null,"abstract":"<div><h3>Background</h3><div>Ionizing radiation from medical imaging poses health risks to patients and healthcare professionals. Awareness of these risks is critical for safe practice, especially in Obstetrics and Gynecology, where fetal exposure must be minimized.</div></div><div><h3>Objectives</h3><div>This study aimed to evaluate the knowledge and awareness of ionizing radiation among consultants, specialists, resident doctors, interns, and radiographers at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted between 2022 and 2024 among 146 out of 160 invited healthcare professionals in the OB/GYN department (response rate: 91.3 %). Participants completed a structured questionnaire assessing knowledge of radiation doses, associated risks, and safety practices. Knowledge scores (0–14) were categorized as poor (<60 %) or good (≥60 %). Data were analyzed using SPSS version 26, and associations between professional title and knowledge level were assessed using Chi-squared tests. Missing data were handled using pairwise deletion.</div></div><div><h3>Results</h3><div>The mean knowledge score was 2.41 ± 2.17, with only 3/146 participants (2.1 %) demonstrating good knowledge and 143/146 (97.9 %) showing poor understanding. Interns correctly identified the radiation dose for abdominal ultrasound in 45/95 (47.4 %) and abdominal MRI in 18/95 (18.9 %) (p < 0.05). Only 23/146 (15.8 %) recognized that a single abdominal CT in childhood increases lifetime cancer risk, and only 20/146 (13.6 %) reported routinely informing patients about radiation risks before ordering imaging exams.</div></div><div><h3>Conclusions</h3><div>A substantial knowledge gap exists among OB/GYN professionals at KAUH regarding ionizing radiation risks. Targeted education, policy changes, and improved patient communication are essential to enhance safety. Future research should evaluate the impact of educational interventions on improving radiation awareness and clinical decision-making.</div></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"17 ","pages":"Article 100103"},"PeriodicalIF":0.5,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145940059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-11DOI: 10.1016/j.contre.2025.100100
Rowan Klein Nulend , Mohan Arianayagam , Audrey Wang
We present the case of a 29-year-old male who developed new-onset overactive bladder (OAB) symptoms shortly after commencing oral isotretinoin for acne. No alternative cause was identified, and urodynamics revealed no detrusor overactivity. Isotretinoin, a vitamin A-derived retinoid, is associated with multiple side effects; rare urological complications include urethritis, haematuria, and nephritis, but OAB has not been reported. Animal studies demonstrate retinoid-induced detrusor overactivity, reversible with anticholinergics. Proposed mechanisms include polydipsia, urothelial irritation, and altered acetylcholine-mediated detrusor stimulation. This case highlights a novel association warranting further investigation into retinoid effects on bladder function.
{"title":"Isotretinoin induced overactive bladder – a novel case and review of literature","authors":"Rowan Klein Nulend , Mohan Arianayagam , Audrey Wang","doi":"10.1016/j.contre.2025.100100","DOIUrl":"10.1016/j.contre.2025.100100","url":null,"abstract":"<div><div>We present the case of a 29-year-old male who developed new-onset overactive bladder (OAB) symptoms shortly after commencing oral isotretinoin for acne. No alternative cause was identified, and urodynamics revealed no detrusor overactivity. Isotretinoin, a vitamin A-derived retinoid, is associated with multiple side effects; rare urological complications include urethritis, haematuria, and nephritis, but OAB has not been reported. Animal studies demonstrate retinoid-induced detrusor overactivity, reversible with anticholinergics. Proposed mechanisms include polydipsia, urothelial irritation, and altered acetylcholine-mediated detrusor stimulation. This case highlights a novel association warranting further investigation into retinoid effects on bladder function.</div></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"17 ","pages":"Article 100100"},"PeriodicalIF":0.5,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patient-centered communication (PCC) is a vital component of high-quality medical care, fostering respectful, responsive interactions that align clinical decisions with patient values. Despite its recognized importance, its consistent implementation remains challenging in daily clinical practice. Medical societies, as key stakeholders in healthcare, are uniquely positioned to promote and institutionalize PCC.
Methods
A systematic review was conducted using PubMed in March 2025, applying the key terms ‘medical societies', ‘patient-centered communication', and ‘patient-centered care'. Articles published in English from 2020 onward were included, along with relevant earlier publications identified via backward citation searches. Two independent reviewers screened articles, with a senior reviewer resolving disagreements. The review adhered to PRISMA guidelines.
Results
Medical societies contribute significantly to PCC through the development of communication models, educational initiatives, validation of measurement tools, and digital engagement. Examples include simulation-based training, co-produced curricula, and online patient education platforms. Barriers such as cultural variability, organizational inertia, and lack of policy support hinder widespread PCC adoption. Medical societies address these challenges by advocating for systemic change and promoting culturally adaptable models.
Conclusions
The role of medical societies in advancing PCC is both substantial and evolving. By integrating PCC into professional education, endorsing validated tools, and leveraging digital health innovations, these organizations can drive systemic transformation toward more equitable and humanistic healthcare. Collaborative efforts across policy, education, and practice domains are essential to ensure PCC becomes a standard of care.
{"title":"Medical societies and patient-centered communication: A review of current practices and future directions","authors":"Filippos Nikitakis , Aikaterini Tsionga , Vasileios Tatanis , Konstantinos Gkialas , Ioannis Glykas , Markos Karavitakis , Theodoros Paizis , Christos Roidos , Theodoros Spinos , Christos Zampaftis , Michael Samarinas","doi":"10.1016/j.contre.2025.100099","DOIUrl":"10.1016/j.contre.2025.100099","url":null,"abstract":"<div><h3>Introduction</h3><div>Patient-centered communication (PCC) is a vital component of high-quality medical care, fostering respectful, responsive interactions that align clinical decisions with patient values. Despite its recognized importance, its consistent implementation remains challenging in daily clinical practice. Medical societies, as key stakeholders in healthcare, are uniquely positioned to promote and institutionalize PCC.</div></div><div><h3>Methods</h3><div>A systematic review was conducted using PubMed in March 2025, applying the key terms ‘medical societies', ‘patient-centered communication', and ‘patient-centered care'. Articles published in English from 2020 onward were included, along with relevant earlier publications identified via backward citation searches. Two independent reviewers screened articles, with a senior reviewer resolving disagreements. The review adhered to PRISMA guidelines.</div></div><div><h3>Results</h3><div>Medical societies contribute significantly to PCC through the development of communication models, educational initiatives, validation of measurement tools, and digital engagement. Examples include simulation-based training, co-produced curricula, and online patient education platforms. Barriers such as cultural variability, organizational inertia, and lack of policy support hinder widespread PCC adoption. Medical societies address these challenges by advocating for systemic change and promoting culturally adaptable models.</div></div><div><h3>Conclusions</h3><div>The role of medical societies in advancing PCC is both substantial and evolving. By integrating PCC into professional education, endorsing validated tools, and leveraging digital health innovations, these organizations can drive systemic transformation toward more equitable and humanistic healthcare. Collaborative efforts across policy, education, and practice domains are essential to ensure PCC becomes a standard of care.</div></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"17 ","pages":"Article 100099"},"PeriodicalIF":0.5,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145842319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urinary incontinence (UI) is defined as any complaint of involuntary urine leakage. In the Democratic Republic of Congo (DRC), no community-based data on UI prevalence among adult women are currently available. This study aims to determine the UI prevalence, the associated discomfort, and the risk factors among adult women in the DRC.
Methods
A community-based cross-sectional study was conducted between 2021 and 2023, involving 507 adult women across six provinces of the DRC. A multistage, geographically and ethnolinguistically stratified sampling approach was used. Pregnant or postpartum women ≤6 months, survivor of sexual violence and those with vesicovaginal fistulas were excluded. Data collection included the ICIQ-FLUTS questionnaire to assess urinary symptoms. Binary logistic regression was performed to identify the risk factors of UI (p < 0.05).
Results
The prevalence of UI was 31 % (95 % CI: 27–35.2 %), with 51 % of affected women reporting associated discomfort. Urgency urinary incontinence (63.7 %; 95 % CI: 55.7–71.2) was more frequently reported than stress urinary incontinence (11.5 %; 95 % CI: 6.9–17.5). UI was independently associated with occupations involving high-intensity physical activity (aOR: 1.71; 95 % CI: 1.06–2.74), body mass index (aOR: 1.06; 95 % CI: 1.01–1.11), constipation (aOR: 2.64; 95 % CI: 1.48–4.70), episiotomy (aOR: 1.80; 95 % CI: 1.11–2.89), perineal tears (aOR: 1.77; 95 % CI: 1.01–3.20), and the practice of labia minora elongation (aOR: 2.29; 95 % CI: 1.23–4.28).
Conclusion
UI is a multifactorial condition that affects one-third of adult women in the DRC and causes discomfort in nearly half of those affected.
{"title":"Prevalence and determinants of urinary incontinence among adult women in the Democratic Republic of Congo: a community-based cross-sectional study","authors":"Andy-Muller Luzolo Nzinga , Tara Reman , Raha Maroyi , Denis Mukwege , Véronique Feipel , Jeanne Bertuit","doi":"10.1016/j.contre.2025.100098","DOIUrl":"10.1016/j.contre.2025.100098","url":null,"abstract":"<div><h3>Background</h3><div>Urinary incontinence (UI) is defined as any complaint of involuntary urine leakage. In the Democratic Republic of Congo (DRC), no community-based data on UI prevalence among adult women are currently available. This study aims to determine the UI prevalence, the associated discomfort, and the risk factors among adult women in the DRC.</div></div><div><h3>Methods</h3><div>A community-based cross-sectional study was conducted between 2021 and 2023, involving 507 adult women across six provinces of the DRC. A multistage, geographically and ethnolinguistically stratified sampling approach was used. Pregnant or postpartum women ≤6 months, survivor of sexual violence and those with vesicovaginal fistulas were excluded. Data collection included the ICIQ-FLUTS questionnaire to assess urinary symptoms. Binary logistic regression was performed to identify the risk factors of UI (p < 0.05).</div></div><div><h3>Results</h3><div>The prevalence of UI was 31 % (95 % CI: 27–35.2 %), with 51 % of affected women reporting associated discomfort. Urgency urinary incontinence (63.7 %; 95 % CI: 55.7–71.2) was more frequently reported than stress urinary incontinence (11.5 %; 95 % CI: 6.9–17.5). UI was independently associated with occupations involving high-intensity physical activity (aOR: 1.71; 95 % CI: 1.06–2.74), body mass index (aOR: 1.06; 95 % CI: 1.01–1.11), constipation (aOR: 2.64; 95 % CI: 1.48–4.70), episiotomy (aOR: 1.80; 95 % CI: 1.11–2.89), perineal tears (aOR: 1.77; 95 % CI: 1.01–3.20), and the practice of labia minora elongation (aOR: 2.29; 95 % CI: 1.23–4.28).</div></div><div><h3>Conclusion</h3><div>UI is a multifactorial condition that affects one-third of adult women in the DRC and causes discomfort in nearly half of those affected.</div></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"16 ","pages":"Article 100098"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.contre.2025.100096
Eden Park , Angela Gao , Camille Haudebert , Helen Moore , Eva Fong
Background
Stress urinary incontinence (SUI) surgery has evolved through successive techniques, with synthetic mid-urethral slings dominating since the early 2000s [1]. The re-emergence of autologous fascial slings, due to mesh-related complications [2], has revived interest in non-mesh alternatives. Fascial slings carry a higher risk of post-operative voiding dysfunction [3, 4]. Ultrasound may offer a non-invasive method to evaluate sling morphology and position, aiding clinical decision-making.
Methods
We developed a standardized perineal ultrasound protocol for evaluating fascial sling position, morphology, and dynamic function. Examinations were performed using a GE Voluson E10 with linear, curved, 3D/4D, and transvaginal probes. Parameters measured included urethral length, sling location relative to urethra and bladder neck, sling morphology, sling-pubis and sling-lumen gaps, bladder neck position and mobility, urethral rotation, and bladder volumes. Dynamic manoeuvres (valsalva/coughing) were routinely performed.
Results
Twenty patients underwent ultrasound, with successful sling visualization in all cases. Morphological variations and abnormal sling positioning (e.g., embedding in urethra or bladder neck) were observed in patients with voiding dysfunction or persistent SUI. Sling-lumen and sling-pubis gap values varied between asymptomatic patients and those with obstruction or treatment failure. While preliminary findings suggest associations between ultrasound parameters and clinical outcomes, no definitive cut-off values can yet be established due to small case volume.
Conclusions
This standardized ultrasound protocol reliably identifies fascial slings and provides reproducible measurements of sling morphology and position. There are potential correlations with clinical outcomes, particularly in differentiating between effective sling function, obstruction, or treatment failure. Rather than defining cut-off values, this early work supports ultrasound as a useful adjunct to clinical and urodynamic assessment following fascial sling placement. Larger studies are required to establish validated thresholds for clinical application.
{"title":"Application for high performance linear probe for transperineal ultrasound increases anatomic depiction of fascial slings","authors":"Eden Park , Angela Gao , Camille Haudebert , Helen Moore , Eva Fong","doi":"10.1016/j.contre.2025.100096","DOIUrl":"10.1016/j.contre.2025.100096","url":null,"abstract":"<div><h3>Background</h3><div>Stress urinary incontinence (SUI) surgery has evolved through successive techniques, with synthetic mid-urethral slings dominating since the early 2000s [1]. The re-emergence of autologous fascial slings, due to mesh-related complications [2], has revived interest in non-mesh alternatives. Fascial slings carry a higher risk of post-operative voiding dysfunction [3, 4]. Ultrasound may offer a non-invasive method to evaluate sling morphology and position, aiding clinical decision-making.</div></div><div><h3>Methods</h3><div>We developed a standardized perineal ultrasound protocol for evaluating fascial sling position, morphology, and dynamic function. Examinations were performed using a GE Voluson E10 with linear, curved, 3D/4D, and transvaginal probes. Parameters measured included urethral length, sling location relative to urethra and bladder neck, sling morphology, sling-pubis and sling-lumen gaps, bladder neck position and mobility, urethral rotation, and bladder volumes. Dynamic manoeuvres (valsalva/coughing) were routinely performed.</div></div><div><h3>Results</h3><div>Twenty patients underwent ultrasound, with successful sling visualization in all cases. Morphological variations and abnormal sling positioning (e.g., embedding in urethra or bladder neck) were observed in patients with voiding dysfunction or persistent SUI. Sling-lumen and sling-pubis gap values varied between asymptomatic patients and those with obstruction or treatment failure. While preliminary findings suggest associations between ultrasound parameters and clinical outcomes, no definitive cut-off values can yet be established due to small case volume.</div></div><div><h3>Conclusions</h3><div>This standardized ultrasound protocol reliably identifies fascial slings and provides reproducible measurements of sling morphology and position. There are potential correlations with clinical outcomes, particularly in differentiating between effective sling function, obstruction, or treatment failure. Rather than defining cut-off values, this early work supports ultrasound as a useful adjunct to clinical and urodynamic assessment following fascial sling placement. Larger studies are required to establish validated thresholds for clinical application.</div></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"16 ","pages":"Article 100096"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.contre.2025.100095
Stefan De Wachter , Eduard Van Beeck Morales , Gunter De Win
Home uroflowmetry (HUF) is a non-invasive method for assessing the lower urinary tract function by measuring urine flow rate and voided volume in a patient's home, outside of a clinical setting. For this narrative review, relevant studies were identified through a targeted PubMed search and complemented by the authors' clinical and research expertise. This review describes the innovational journey of HUF, from early funnel-based devices to the development of connected medical devices integrating artificial intelligence (AI) and digital bladder diaries. It also highlights how repeated measurements capture intra-individual variability in voiding, influenced by circadian rhythm and bladder filling, and compares the reliability and acceptability of home versus clinic-based testing. The review further outlines the potential clinical value of HUF in diagnosis and treatment decision-making, while noting the limited availability of outcome-based validation studies. Finally, the prospective directions are outlined, including technological advancements and the next steps required to achieve widespread clinical implementation.
{"title":"Home uroflowmetry – Looking beyond the single flow test","authors":"Stefan De Wachter , Eduard Van Beeck Morales , Gunter De Win","doi":"10.1016/j.contre.2025.100095","DOIUrl":"10.1016/j.contre.2025.100095","url":null,"abstract":"<div><div>Home uroflowmetry (HUF) is a non-invasive method for assessing the lower urinary tract function by measuring urine flow rate and voided volume in a patient's home, outside of a clinical setting. For this narrative review, relevant studies were identified through a targeted PubMed search and complemented by the authors' clinical and research expertise. This review describes the innovational journey of HUF, from early funnel-based devices to the development of connected medical devices integrating artificial intelligence (AI) and digital bladder diaries. It also highlights how repeated measurements capture intra-individual variability in voiding, influenced by circadian rhythm and bladder filling, and compares the reliability and acceptability of home versus clinic-based testing. The review further outlines the potential clinical value of HUF in diagnosis and treatment decision-making, while noting the limited availability of outcome-based validation studies. Finally, the prospective directions are outlined, including technological advancements and the next steps required to achieve widespread clinical implementation.</div></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"16 ","pages":"Article 100095"},"PeriodicalIF":0.5,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-11DOI: 10.1016/j.contre.2025.100097
M. Gubbiotti , A. Zucchi , E. Rubilotta , S. Rosadi
Sacral neuromodulation (SNM) is a well-established therapy for non-obstructive urinary retention and overactive bladder. However, long-term complications and optimal management of nonfunctioning tined leads remain underreported. We present the case of a 54-year-old woman with a history of neurogenic bladder secondary to encephalomyelitis. Over a 10-year period, she underwent three SNM lead implantations (S3/S4 bilaterally) at different institutions, with progressive loss of therapeutic benefit and development of pelvic and lumbar pain, sensory deficits, and lower limb myoclonus. Imaging confirmed lead integrity, but clinical symptoms persisted. In a single-stage procedure, all three previous leads were removed, and a new tined lead was implanted at the left S3 foramen and connected to a new InterStim II generator. Postoperative results were excellent, with resolution of neuropathic symptoms and restoration of spontaneous voiding. The patient remained symptom-free at 12-month follow-up. This case supports the feasibility and efficacy of single-stage explantation of multiple SNM leads and reimplantation in patients with chronic SNM-related complications and device failure. Early consideration of simultaneous lead removal and reimplantation may prevent prolonged morbidity.
{"title":"Single-stage removal of three nonfunctioning sacral neuromodulation leads and reimplantation in a patient with chronic urinary retention: A case report","authors":"M. Gubbiotti , A. Zucchi , E. Rubilotta , S. Rosadi","doi":"10.1016/j.contre.2025.100097","DOIUrl":"10.1016/j.contre.2025.100097","url":null,"abstract":"<div><div>Sacral neuromodulation (SNM) is a well-established therapy for non-obstructive urinary retention and overactive bladder. However, long-term complications and optimal management of nonfunctioning tined leads remain underreported. We present the case of a 54-year-old woman with a history of neurogenic bladder secondary to encephalomyelitis. Over a 10-year period, she underwent three SNM lead implantations (S3/S4 bilaterally) at different institutions, with progressive loss of therapeutic benefit and development of pelvic and lumbar pain, sensory deficits, and lower limb myoclonus. Imaging confirmed lead integrity, but clinical symptoms persisted. In a single-stage procedure, all three previous leads were removed, and a new tined lead was implanted at the left S3 foramen and connected to a new InterStim II generator. Postoperative results were excellent, with resolution of neuropathic symptoms and restoration of spontaneous voiding. The patient remained symptom-free at 12-month follow-up. This case supports the feasibility and efficacy of single-stage explantation of multiple SNM leads and reimplantation in patients with chronic SNM-related complications and device failure. Early consideration of simultaneous lead removal and reimplantation may prevent prolonged morbidity.</div></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"16 ","pages":"Article 100097"},"PeriodicalIF":0.5,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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