Continence Reports最新文献

Introduction:

Advice for women with pelvic organ prolapse (POP) often includes lying down to decrease the effects of gravity on the pelvic floor. The aim of this study was to compare pelvic floor morphometry before and after 30 min of supine lying in women with symptomatic POP.

Methods:

Pelvic floor morphometry was assessed in vaginally parous, premenopausal women with symptomatic POP $\ge$ stage 1. The modified Pelvic Organ Prolapse Quantification system was used in supine to assess points Ba (anterior vaginal wall), Bp (posterior vaginal wall), and C (cervix). Transperineal ultrasound imaging was used in supine and standing to assess the following measures at rest and bearing down: bladder neck position, bladder position, rectal ampulla position, levator plate angle, anorectal angle, levator anteroposterior distance, and levator hiatal area. Measures taken before and after 30 min of supine lying were compared.

Results:

Twenty-one women (median (range) age: 39 (29–50) years) with varied stages of POP (33% stage 1, 57% stage 2, and 10% stage 3) were included. Most measures of pelvic floor morphometry were unchanged after 30 min of supine lying compared to before lying. Participants had greater resting levator hiatal area in supine and levator anteroposterior distance at rest and bearing down in supine after lying down (p $\le$ 0.001), suggesting reduced pelvic floor muscle activity.

Conclusion:

Findings suggest that a 30-min period of supine lying does not improve support of the pelvic organs.

Emptying an overfilled bladder has been a severe medical problem in mankind since ancient times. This review presents highlights the main historical milestones in the development and use of urine catheters. Some of the most famous designers and makers are also commented. Besides, the historic role of urinals, both as sanitary elements and sometimes as therapeutic devices for male incontinence, is presented.

Tuberculosis has become an infrequent disease in Western society, hence has tuberculosis of the bladder. However, when tuberculosis was prevalent, urogenital tuberculosis and tuberculosis of the bladder could be the consequence if untreated, and were responsible for severe bladder dysfunction. Before antibiotic treatment became available, chronic bladder tuberculosis caused irreversible damage and often necessitated bladder reconstruction or even cystectomy. The specific antibiotic treatment of tuberculosis eradicated bladder dysfunction caused by tuberculosis. We aim to review the history of urogenital tuberculosis and the consequent dysfunction of the bladder based on existing literature.

Periurethral injection of bulking agents is a technique used to treat urinary incontinence due to stress incontinence, preferably caused by intrinsic sphincter deficiency. The variety of the nature of existing bulking agents leads to different success rates and complications. This case report describes the formation of pseudo-abscesses after periurethral injections with a bioresorbable implant consisting of synthetic polycaprolactone microspheres suspended in a carboxymethylcellulose gel carrier.

Introduction:

The aim of this study is to develop a new simple and practical classification of male urinary incontinence (UI) based on the clinical features and type of urinary incontinence.

Materials & methods:

MI-CRONS classification is a system based on severity of incontinence and patients’ characteristics. Clinical evaluation of incontinence severity is based on preservation of voiding, proportion of void/lost urine, absorbable device usage, level of physical efforts that causes urine loss and nocturnal incontinence. Following patients’ characteristics of patients were included in classification system: history of radical prostatectomy, history of pelvic radiation, surgery for prostatic obstruction, neurogenic or non-neurogenic bladder disorders, and urethral strictures and disorders. This MI-CRONS classification system uses five uppercase Latin letters as follows: Male Incontinence — Cancer, Radiation, Obstruction, Neurogenic, Stricture. The classification could be used for stress, urgency, and mixed UI forms.

Results:

The new MI-CRONS classification system was applied to 85 of 86 patients evaluated in this retrospective study. Patients were classified by MI-CRONS to estimate an inclusiveness and complicity of proposed classification only. One patient was not classified using the new MI-CRONS classification due to history of bladder exstrophy and augmentation cystoplasty. Most of the men studied had a stress form of urinary incontinence and the most common types were 2 (n = 18) and 3 (n = 17) after radical prostatectomy.

Conclusion:

The MI-CRONS has demonstrated prompt potential for classifying male incontinence of any type. The classification is a simple tool to describe these patients and could be useful for daily practice and clinical trials. Although further multicenter studies are needed to evaluate the predictive value of this tool. A Delphi consensus would be proposed with international experts for the further development of MI-CRONS.

Objective:

The OT-Balloon Catheter is a novel urethral catheter designed for intermittent balloon catheterization. It has a filter permeable to gases but not liquids, enabling patients to confirm adequate catheterization without the flow of urine. This study examined the characteristics of the filter cap for OT-Balloon Catheter by repeatedly exposing filters to urine samples in 2 different conditions.

Methods:

Urine samples were collected from 10 patients who required clean intermittent catheterization and visited Okayama University Hospital in 2023. Filters of the cap for OT-Balloon Catheter were exposed to urine samples for 30 times under 2 conditions, as follows: condition A, filters were rinsed with running water after exposure to urine; condition B, filters were never rinsed throughout the experiment. The permeability of the filters during and after the exposure was examined. The filter surface was also analyzed by stereomicroscopy.

Results:

None of the filters were blocked after treatment in condition A. More than 50% of the filters remained permeable after 20 and 30 exposures even in condition B. Long-term storage did not lead to increased rates of blockage. Microscopic examination found minimal urine stains on the surface of filters under condition B.

Conclusion:

The filter cap for OT-Balloon Catheter was resistant to blockage and maintained permeability after exposure to urine when adequately rinsed, and also when never rinsed after exposure to most samples. The durable permeability of the filter enables patients to achieve rapid, safe, and easy intermittent balloon catheterization.

A 42-year-old woman was referred by neurology colleagues to our outpatient urology clinics. She presented with a non-monosymptomatic secondary enuresis, which started at 20 years of age When she was twenty-two she presented a single episode of a generalised tonic-clonic seizure, and she was treated with Carbamazepine (CBZ) with resolution of enuresis that reappeared when CBZ was stopped. Therefore, a video-EEG was performed, which documented an episode of enuresis during stage 1 of non-REM sleep without epileptic discharges and made it difficult for the patient to reach the deeper stages of sleep. According to these findings, the epileptic genesis of the enuresis was ruled out. A urodynamic invasive study was performed, and a normal active bladder associated with sleep disturbances was diagnosed as the combined cause of the non-monosymptomatic secondary nocturnal enuresis.

Behavioural therapy and/or antimuscarinic treatments, alone or in combination, were used without success. Then the patient restarted CBZ at a low dose (200 mg/day), and a significant reduction of enuresis episodes (1 wet night every 9–10) was obtained with no changes in the bladder diary.

CBZ effectiveness in such a case on an overactive bladder (OAB) could depend on its modulating effect in the central nervous system.

A 74-year-old female patient five month after radical robot assisted cystectomy (RC) with ileal conduit (IC) presented to our department with stage 4 symptomatic vaginal prolapse and anterior enterocele (AE). In the medical history 43 years ago radical hysterectomy (Piver 3) was revealed followed by postoperative irradiation and brachytherapy, due to invasive cervical cancer. A total colpocleisis was carried out as a first line therapy. A recurrence occurred 8 months after the first surgery. We used a customized single-incision vaginal mesh for the relapse operation. The patient has been symptomless for 50 months. We believe that vaginal irradiation is a rare but significant risk factor for the development of anterior enterocele after RC with IC and single-incision tailored vaginal mesh insertion for symptomatic anterior enterocele after radical cystectomy and radical hysterectomy with irradiation may be a long-term surgical solution.