Continence Reports最新文献_第2页

Reliability of endoanal ultrasound interpretation following Obstetric Anal Sphincter Injury (OASI) with and without patients’ clinical data 产科肛门括约肌损伤（OASI）后肛门内超声解释的可靠性，有无患者的临床资料

IF 0.5

Continence Reports

Pub Date : 2025-10-25 DOI: 10.1016/j.contre.2025.100094

Alexandre Cuérel , Fabien Romito , Estelle Abbet , Chahin Achtari

Obstetric anal sphincter injury (OASI) occurs in approximately 3 % of vaginal births. OASI can cause long-term sequelae, such as dyspareunia, perineal pain, and incontinence to gas and stool. Endoanal ultrasound (EAUS) is the gold standard for diagnosing OASI.

The first aim of this study is to compare the accuracy of the interpretation of EAUS without knowledge of the clinical context (EchoA), with the interpretation of EAUS with knowledge of the clinical context (such as the grade of OASI observed immediately after delivery and the symptoms presented by the patient) (EchoC).

The second aim of this study is to describe the different characteristics of the patients and patients’ delivery and compare them to the existing literature.

The third objective of this study focuses on comparing interpretations from clinical ultrasound and anonymized ultrasound with the anorectal symptoms reported by patients during the postpartum consultation, during which the ultrasounds were performed.

We included 165 patients, reviewed postpartum several weeks after delivery at the urogynecology unit of the Centre universitaire Vaudois (CHUV) between January 1, 2014, and December 31, 2019, who experienced an OASI following childbirth at CHUV and the same examiner interpreted the printed ultrasound with clinical context (EchoC) and without clinical context (EchoA), in two different times.

A high level of agreement was observed in the assessment of the internal anal sphincter (IAS), with 90 % concordance between the two interpretations.

However, for the evaluation of the external anal sphincter (EAS), particularly in identifying the presence of an injury, agreement between the two interpretations was notably lower (<50 %).

Clinical context remains necessary for accurately interpreting EAS injuries, but not necessarily for IAS evaluation.

We note the presence of several biases that limit the interpretation of the results, such as the possibility of over diagnosis of OASI at the time of delivery, undetected lesions on EAUS because of healing, or the involvement of only one examiner. We need new studies to confirm our results.

产科肛门括约肌损伤（OASI）发生在约3%的阴道分娩。OASI可引起长期后遗症，如性交困难、会阴疼痛、大小便失禁等。肛管超声（EAUS）是诊断OASI的金标准。本研究的第一个目的是比较不了解临床背景的EAUS （EchoA）与了解临床背景（如分娩后立即观察到的OASI等级和患者表现的症状）的EAUS （EchoC）的解释准确性。本研究的第二个目的是描述患者和患者分娩的不同特征，并将其与现有文献进行比较。本研究的第三个目的是比较临床超声和匿名超声的解释与产后咨询期间进行超声检查的患者报告的肛门直肠症状。我们纳入了165名患者，在2014年1月1日至2019年12月31日期间，在瓦尔多瓦大学（CHUV）的泌尿妇科（CHUV）分娩后几周进行了产后检查，这些患者在CHUV分娩后经历了OASI，同一名检查人员在两个不同的时间解释了有临床背景（EchoC）和无临床背景（EchoA）的打印超声。在评估内肛门括约肌（IAS）时观察到高度一致，两种解释之间有90%的一致性。然而，对于外肛门括约肌（EAS）的评估，特别是在识别损伤的存在时，两种解释之间的一致性明显较低（50%）。临床背景对于准确解释EAS损伤仍然是必要的，但对于IAS评估则不一定。我们注意到存在一些偏差，这些偏差限制了结果的解释，例如在分娩时过度诊断OASI的可能性，由于愈合而未检测到EAUS上的病变，或者只有一名检查人员参与。我们需要新的研究来证实我们的结果。

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引用次数: 0

The change in urodynamic parameters in young men with bladder neck obstruction following surveillance periods 监测期后膀胱颈梗阻青年男性尿动力学参数的变化

IF 0.5

Continence Reports

Pub Date : 2025-09-25 DOI: 10.1016/j.contre.2025.100091

Ross Stephens, Sachin Malde, Arun Sahai, Eskinder Solomon

Objective

To evaluate the change in bladder dysfunction in men diagnosed with bladder neck obstruction (BNO) < 50 years of age following surveillance periods.

Methods

We retrospectively analysed changes in urodynamic parameters in men <50 years of age diagnosed with BNO during video urodynamics (VUDS) from initial presentation to subsequent investigations following a minimum surveillance period of 2 years.

Results

Ten men (mean age 33 ± 14 years) with a mean surveillance period of 4.8 ± 1.9 years were recruited. 5/10 men were taking alpha blockers during this period. 7/10 demonstrated detrusor overactivity (DO) during initial urodynamics. There was a mean (±SD) increase in DO peak pressure of 11.9(±75.1)

c m H_{2} O

(p = 0.648). There was a mean (±SD) reduction in bladder compliance of 23.84

m l / c m H_{2} O

(±31.1

m l / c m H_{2} O)

(p = 0.067). There was no change in cystometric capacity (p = .998), detrusor pressure at maximum flow

(P_{\det . Q m a x})

(p = .211), bladder outlet obstruction index (BOOI) (p = .227) or post void residual (PVR) (p = .707). There was a moderate correlation between BOOI and

P_{\det . Q m a x}

at initial urodynamics with the change in compliance over the surveillance period (0.56 and 0.49 respectively). The peak DO pressure at baseline correlates most with the reduction in

Q_{\max}

during surveillance period (−0.6).

Conclusion

The rate of change of bladder dysfunction appears variable in men with BNO. However, our study indicates a trend of worsening loss of compliance and Qmax over a mean period of ∼5 years which appears moderately correlated with the BOOI and DO peak pressures measured at initial urodynamics.

目的探讨膀胱颈梗阻（BNO）患者膀胱功能障碍的变化。方法回顾性分析50岁诊断为BNO的男性患者在视频尿动力学（VUDS）中从最初的表现到随后的调查，经过至少2年的监测期，尿动力学参数的变化。结果纳入男性10例，平均年龄33±14岁，平均监测期4.8±1.9年。在此期间，5/10的男性服用了α受体阻滞剂。7/10在初始尿动力学中表现为逼尿肌过度活动（DO）。DO峰值压力平均（±SD）增加11.9（±75.1）cmH2O （p = 0.648）。膀胱顺应性平均（±SD）降低23.84 ml/cmH2O（±31.1 ml/cmH2O）（p = 0.067）。膀胱容量无变化（p = .998），最大流量时逼尿肌压力(Pdet。Qmax （p = .211）、膀胱出口阻塞指数（BOOI）（p = .227）或膀胱后残留（PVR）（p = .707）。BOOI与Pdet之间存在中度相关性。初始尿动力学Qmax随监测期间依从性的变化（分别为0.56和0.49）。基线处DO压力峰值与监测期间Qmax的降低相关度最大（- 0.6）。结论BNO患者膀胱功能障碍的变化率不同。然而，我们的研究表明，在平均约5年的时间内，依从性丧失和Qmax的恶化趋势似乎与初始尿动力学测量的BOOI和DO峰值压力有一定的相关性。

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引用次数: 0

Sacral nerve stimulation in sacral agenesis using 3D printing and intraoperative navigation: report of two cases and narrative review 应用3D打印和术中导航技术刺激骶神经治疗骶骨发育不全2例报告并叙述复习

IF 0.5

Continence Reports

Pub Date : 2025-09-24 DOI: 10.1016/j.contre.2025.100093

Sara Nunes-Sequeira , Filipe Abadesso Lopes , Mafalda Franco Carneiro , Lia Lucas-Neto , Ricardo Pereira E Silva , Alexandre Rainha Campos

Introduction

Caudal Regression Syndrome (CRS) is a rare malformation characterized by lumbosacral deformities and gastrointestinal/genitourinary and/or lower limb abnormalities. Sacral neuromodulation (SNM) is an effective therapy for refractory gastrointestinal/genitourinary symptoms but lead implantation near the S3 roots is challenging in patients with sacral deformities due to the absence of standard fluoroscopic landmarks.

Research question and case description

We describe a method for percutaneous lead implantation in patients with sacral deformities, using preoperative 3D-printed anatomical replicas combined with intraoperative navigation. Our first two cases are reported.

Case report

Two CRS patients with sacral agenesis and refractory neurogenic lower urinary tract dysfunction underwent this procedure. Preoperative imaging was processed to create a 3D-printed sacrum, and the sacral roots were replicated using silicone threads. These models enabled anatomical analysis, target identification, and planning of the foramen entry point and introducer angle. The plan was integrated into the NN system, and awake surgery was performed with neurophysiological monitoring.

Results

Intraoperatively, navigation allowed real-time visualization of the introducer's position and placement of the electrode at the desired location and depth. Correct positioning was confirmed by stimulation with a typical S3 response (hallux flexion and bellows reflex) and fluoroscopy. Both patients proceeded to permanent generator implantation with clinical improvement.

Discussion and conclusion

The presence of a 3D replica improves the spatial understanding of sacral anatomy. Together with navigation, it can be used to overcome the technical challenge of placing SNM electrodes in patients with bony deformities.

尾侧退行综合征（CRS）是一种罕见的畸形，以腰骶畸形和胃肠道/泌尿生殖系统和/或下肢异常为特征。骶骨神经调节（SNM）是一种治疗难治性胃肠道/泌尿生殖系统症状的有效方法，但由于缺乏标准的透视标志，骶骨畸形患者在S3根附近植入铅具有挑战性。研究问题和病例描述我们描述了一种通过术前3d打印解剖复制品结合术中导航，经皮植入骶骨畸形患者的方法。我们报告了头两个病例。2例伴有骶骨发育不全和难治性神经源性下尿路功能障碍的CRS患者接受了该手术。术前成像处理后生成3d打印的骶骨，并用硅胶线复制骶骨根。这些模型可以用于解剖分析、目标识别和孔进入点和引入角的规划。将该方案整合到神经网络系统中，在神经生理监测下进行清醒手术。结果在手术中，导航可以实时显示引线器的位置和电极在所需位置和深度的放置。通过典型的S3反应刺激（拇屈曲和波纹反射）和透视检查确认正确定位。两例患者均在临床改善后进行了永久性发电机植入。讨论与结论三维模型的存在提高了对骶骨解剖的空间理解。与导航一起，它可以用来克服在骨骼畸形患者中放置SNM电极的技术挑战。

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引用次数: 0

The safety and patients satisfaction of the urinary automatic catheter valve, Mirovalve® in patients with urinary catheter: A randomized clinical trial study 导尿管患者使用自动导尿管阀Mirovalve®的安全性和患者满意度：一项随机临床试验研究

IF 0.5

Continence Reports

Pub Date : 2025-09-17 DOI: 10.1016/j.contre.2025.100092

Hadi Mostafaei , Sepideh Kiani , Zahra Sheikhalipour , Hamidreza Ashayeri , Hanieh Salehi-Pourmehr , Sakineh Hajebrahimi

Background

Urinary tract infections (UTIs) are a significant concern for catheterized patients. Catheter valves have been explored as an alternative to traditional drainage bags, with some studies suggesting improved comfort and a potential reduction in UTIs. This study investigated the Mirovalve®, an automatic catheter valve, in a randomized controlled trial. Our objective was to compare the safety, patient satisfaction, and UTI incidence between the Mirovalve® and standard drainage bags.

Methods

This randomized clinical trial involved 65 patients with urinary retention requiring catheterization, who were also using diapers due to their underlying condition. The study was conducted in the urology clinics of Tabriz University of Medical Sciences after obtaining informed consent from eligible participants. Patients were randomly assigned to either the control group (urinary catheter connected to a drainage bag) or the therapy group (urinary catheter connected to the Mirovalve® automatic catheter valve). The primary outcomes were safety, assessed by urine culture results at the end of the three-week intervention, and patient satisfaction. Secondary outcomes included the incidence and nature of adverse events. A negative urine culture was confirmed before the study commenced.

Results

All 65 participants completed the three-week follow-up. Patient satisfaction was significantly higher in the Mirovalve® group compared to the drainage bag group (P < 0.001). A large majority of Mirovalve® users (73.6 %) reported being "very" or "extremely" satisfied, versus only 9.7 % of the drainage bag users. The overall incidence of adverse events was similar between the groups, although two patients in the Mirovalve® group experienced temporary acute urinary retention. The incidence of symptomatic UTIs was significantly lower in the Mirovalve® group (12.9 %) compared to the drainage bag group (46.2 %) (P = 0.025).

Conclusion

Our findings indicate that the Mirovalve® automatic catheter valve is associated with significantly higher patient satisfaction and a lower incidence of UTIs compared to standard drainage bags. While both methods showed similar short-term safety profiles, the improved satisfaction with the Mirovalve® highlights its potential to enhance patient quality of life. These results suggest that the Mirovalve® is a valuable option for catheter-dependent patients, though further research is needed to confirm these findings over a longer duration and in more diverse populations.

背景尿路感染（uti）是尿路导尿患者非常关注的问题。导尿管瓣膜已被探索作为传统引流袋的替代品，一些研究表明可以改善舒适性并可能减少尿路感染。本研究在一项随机对照试验中研究了自动导管瓣膜Mirovalve®。我们的目的是比较microvalve®引流袋和标准引流袋的安全性、患者满意度和UTI发生率。方法本随机临床试验纳入65例需要导尿的尿潴留患者，这些患者由于其潜在疾病也使用尿不湿。在获得符合条件的参与者的知情同意后，该研究在大不里士医科大学泌尿科诊所进行。患者被随机分配到对照组（导尿管连接引流袋）或治疗组（导尿管连接Mirovalve®自动导尿管阀）。主要结果是安全性，在三周干预结束时通过尿液培养结果评估，以及患者满意度。次要结局包括不良事件的发生率和性质。在研究开始前确认尿培养阴性。结果65例患者均完成了为期3周的随访。与引流袋组相比，Mirovalve®组患者满意度显著提高（P < 0.001）。绝大多数Mirovalve®用户（73.6%）表示“非常”或“非常”满意，而排水袋用户只有9.7%。尽管Mirovalve®组中有2例患者出现暂时性急性尿潴留，但两组间不良事件的总体发生率相似。症状性尿路感染的发生率在Mirovalve®组（12.9%）显著低于引流袋组（46.2%）（P = 0.025）。结论我们的研究结果表明，与标准引流袋相比，Mirovalve®自动导管阀显著提高了患者满意度，降低了尿路感染的发生率。虽然这两种方法显示出相似的短期安全性，但对Mirovalve®满意度的提高凸显了其提高患者生活质量的潜力。这些结果表明，Mirovalve®是导管依赖患者的一个有价值的选择，尽管需要进一步的研究来证实这些发现在更长的持续时间和更多样化的人群中。

{"title":"The safety and patients satisfaction of the urinary automatic catheter valve, Mirovalve® in patients with urinary catheter: A randomized clinical trial study","authors":"Hadi Mostafaei , Sepideh Kiani , Zahra Sheikhalipour , Hamidreza Ashayeri , Hanieh Salehi-Pourmehr , Sakineh Hajebrahimi","doi":"10.1016/j.contre.2025.100092","DOIUrl":"10.1016/j.contre.2025.100092","url":null,"abstract":"<div><h3>Background</h3><div>Urinary tract infections (UTIs) are a significant concern for catheterized patients. Catheter valves have been explored as an alternative to traditional drainage bags, with some studies suggesting improved comfort and a potential reduction in UTIs. This study investigated the Mirovalve®, an automatic catheter valve, in a randomized controlled trial. Our objective was to compare the safety, patient satisfaction, and UTI incidence between the Mirovalve® and standard drainage bags.</div></div><div><h3>Methods</h3><div>This randomized clinical trial involved 65 patients with urinary retention requiring catheterization, who were also using diapers due to their underlying condition. The study was conducted in the urology clinics of Tabriz University of Medical Sciences after obtaining informed consent from eligible participants. Patients were randomly assigned to either the control group (urinary catheter connected to a drainage bag) or the therapy group (urinary catheter connected to the Mirovalve® automatic catheter valve). The primary outcomes were safety, assessed by urine culture results at the end of the three-week intervention, and patient satisfaction. Secondary outcomes included the incidence and nature of adverse events. A negative urine culture was confirmed before the study commenced.</div></div><div><h3>Results</h3><div>All 65 participants completed the three-week follow-up. Patient satisfaction was significantly higher in the Mirovalve® group compared to the drainage bag group (P < 0.001). A large majority of Mirovalve® users (73.6 %) reported being \"very\" or \"extremely\" satisfied, versus only 9.7 % of the drainage bag users. The overall incidence of adverse events was similar between the groups, although two patients in the Mirovalve® group experienced temporary acute urinary retention. The incidence of symptomatic UTIs was significantly lower in the Mirovalve® group (12.9 %) compared to the drainage bag group (46.2 %) (P = 0.025).</div></div><div><h3>Conclusion</h3><div>Our findings indicate that the Mirovalve® automatic catheter valve is associated with significantly higher patient satisfaction and a lower incidence of UTIs compared to standard drainage bags. While both methods showed similar short-term safety profiles, the improved satisfaction with the Mirovalve® highlights its potential to enhance patient quality of life. These results suggest that the Mirovalve® is a valuable option for catheter-dependent patients, though further research is needed to confirm these findings over a longer duration and in more diverse populations.</div></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"16 ","pages":"Article 100092"},"PeriodicalIF":0.5,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145159056","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}

引用次数: 0

Robotic-assisted sacrocolpopexy (RASC) in a renal transplant patient with Ehlers-Danlos syndrome (EDS), case report and literature review of perioperative considerations 机器人辅助骶colpopexy （RASC）治疗肾移植患者ehers - danlos综合征（EDS），病例报告及围手术期注意事项的文献回顾

IF 0.5

Continence Reports

Pub Date : 2025-08-21 DOI: 10.1016/j.contre.2025.100090

Dina El-Hamamsy , Bénedicte Persyn , Steven E. Schraffordt Koops

With aging populations and advances of healthcare, patients with complex medical histories are more likely to present to our Urogynaecological practices. Similarly, with surgical advances, robotic-assisted surgery is currently gaining momentum with a view to improving surgical precision and potentially patient outcomes. Here, we present the first robotic-assisted sacrocolpopexy in a renal transplant patient with Ehlers-Danlos syndrome, and review the literature for perioperative considerations in these patients.

Our 51 year old patient presented with obstructive micturition due to advanced pelvic organ prolapse (POP). A pre-operative diagnostic laparoscopy was performed to evaluate abdominal accessibility and aid decision regarding surgical approach for prolapse repair. An uncomplicated robotic assisted sacrocolpopexy was performed with uneventful postoperative recovery, no prolapse recurrence and improved quality of life at 1 year follow-up.

When surgical repair is indicated in patients with POP after renal transplantation, in most cases vaginal approach will be chosen for primary surgery. Patients at high risk of recurrence of POP, such as the case described here, may benefit from abdominal approach. However, there is limited evidence on safety, feasibility and long-term outcomes following minimally-invasive abdominal POP repair in these cases. We conclude that robotic-assisted approach is feasible and could improve patient outcomes. However, more evidence needs to be generated to support such practice in high-risk patients. We call upon specialist societies to utilize surgical databases to support such cause.

随着人口老龄化和医疗保健的进步，有复杂病史的患者更有可能来到我们的泌尿妇科诊所。同样，随着外科手术的进步，机器人辅助手术目前正在获得动力，以提高手术精度和潜在的患者预后。在这里，我们介绍了首例机器人辅助的骶髋固定术治疗肾移植患者Ehlers-Danlos综合征，并回顾了这些患者围手术期注意事项的文献。我们的51岁病人提出梗阻性排尿由于晚期盆腔器官脱垂（POP）。术前诊断腹腔镜检查评估腹部可达性和辅助决定脱垂修复手术入路。一个简单的机器人辅助骶colpop固定术，术后恢复平稳，无脱垂复发，1年随访生活质量提高。当肾移植后POP患者需要手术修复时，大多数情况下会选择阴道入路进行原发性手术。对于POP复发风险高的患者，如本文所述的病例，可能会受益于腹部入路。然而，在这些病例中，微创腹部POP修复的安全性、可行性和长期结果的证据有限。我们得出结论，机器人辅助方法是可行的，可以改善患者的预后。然而，需要更多的证据来支持高风险患者的这种做法。我们呼吁专科学会利用外科数据库来支持这一事业。

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引用次数: 0

Multidisciplinary conferences to enhance care for pelvic floor dysfunction: A descriptive study at a tertiary center 多学科会议加强对骨盆底功能障碍的护理：三级中心的描述性研究

IF 0.5

Continence Reports

Pub Date : 2025-08-15 DOI: 10.1016/j.contre.2025.100089

Nouf Yahya Akeel , Leila Neshatian , Vipul Sheth , Ekene Enemchukwu , Sydni Au Hoy , Brooke H. Gurland , Stanford Pelvic Health Center Workgroup, Diana Atashroo , Yosef Chodakiewitz , Jimmy Dinh , Haddas Elisha , Patricia A. Garcia , Jennifer M. Hah , Ruth Hicks , Negaur Iranpour , Karen Jazmin , Zaineh Khalil , Michelle J. Khan , Natalie N. Kirilcuk , Kavita Mishra , Molly O'Brien-Horn

Purpose/background

The multidisciplinary approach to pelvic floor disorders has been shown to improve patient care outcomes but remains underutilized. This study aims to assess the utility of multidisciplinary meetings for pelvic floor patients by prospectively evaluating their impact on diagnosis, management, and treatment planning. The specific objectives are to improve diagnostic accuracy, optimize treatment plans, and facilitate efficient resource allocation.

Methods/interventions

This is a descriptive study conducted at a tertiary referral academic center. Multidisciplinary conferences were held monthly by a collaborative clinical team. The meetings aimed to: 1. Comprehensively review radiological findings. 2. Develop individualized care plans. 3. Optimize surgical plans and combined surgery. The patients were identified from the pelvic floor multidisciplinary database. "Utility" will be measured by metrics including: 1) Rate of amendment to radiology reports, indicating improved diagnostic accuracy; 2) Frequency of recommended further assessment or workup, reflecting enhanced care pathway definition; and 3) Documentation of changes to the initial treatment plan based on multidisciplinary discussion, showing impact on management.

Results/outcomes

Nineteen multidisciplinary meetings were conducted between August 2021 and May 2023, discussing 101 cases. The patients were categorized into prolapse (n = 41), functional disorders (n = 38), and miscellaneous (n = 22) groups. The prolapse group was classified into combined rectal and pelvic organ prolapse (n = 22), and isolated rectal prolapse (n = 19). After each case discussion, a comprehensive review note was created and incorporated into the patient's chart, facilitating the initiation of follow-up plans and the coordination of services. Radiology reports were amended in 18 cases (18 %), with the majority of revisions related to rectal prolapse (n = 15, 83 %). Further assessment and workup were recommended in 17 cases (17 %): prolapse (n = 5), miscellaneous (n = 9), and motility (n = 3).

Conclusion/discussion

This study suggests that multidisciplinary meetings are beneficial in complex pelvic health conditions. They correlate clinical assessment with radiological findings and inform individualized treatment plans, as evidenced by the rates of amended radiology reports and recommended further assessment/workup. Further research is needed to quantitatively assess the long-term clinical outcomes and cost-effectiveness of this approach.

目的/背景骨盆底疾病的多学科方法已被证明可以改善患者的护理结果，但仍未得到充分利用。本研究旨在通过前瞻性评估多学科会议对盆底患者的诊断、管理和治疗计划的影响来评估多学科会议对盆底患者的效用。具体目标是提高诊断准确性，优化治疗计划，促进有效的资源分配。方法/干预措施本研究是在某三级转诊学术中心进行的描述性研究。多学科会议每月由一个合作临床小组举行。这些会议的目的是：全面复查放射检查结果。2. 制定个性化护理计划。3. 优化手术方案及联合手术。从盆底多学科数据库中确定患者。“效用”将通过以下指标来衡量：1)放射学报告的修改率，表明诊断准确性的提高；2)建议进一步评估或检查的频率，反映强化的护理途径定义；3)基于多学科讨论的初始治疗计划变更的文件化，显示对管理的影响。结果/结果在2021年8月至2023年5月期间举行了19次多学科会议，讨论了101例病例。将患者分为脱垂组（n = 41）、功能障碍组（n = 38）和杂项组（n = 22）。脱垂组分为直肠盆腔联合器官脱垂22例和孤立性直肠脱垂19例。在每个病例讨论之后，创建了一份全面的审查笔记，并将其纳入患者的图表，促进后续计划的启动和服务的协调。18例（18%）的放射学报告被修改，其中大多数与直肠脱垂有关（n = 15, 83%）。17例（17%）建议进一步评估和随访：脱垂（n = 5），杂项（n = 9）和运动（n = 3）。结论/讨论本研究提示多学科会议对复杂盆腔健康状况有益。它们将临床评估与放射检查结果联系起来，并为个性化治疗计划提供信息，这可以通过修改放射报告的比率和建议的进一步评估/检查来证明。需要进一步的研究来定量评估这种方法的长期临床结果和成本效益。

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引用次数: 0

Trifecta outcomes in surgical treatment of male stress urinary incontinence 手术治疗男性压力性尿失禁的三合一效果

Continence Reports

Pub Date : 2025-07-17 DOI: 10.1016/j.contre.2025.100088

Andrey Tomilov , Bagrat Grigoryan , George Kasyan , Evgeniy Veliev , Dmitry Pushkar

Introduction and objective

Stress urinary incontinence (SUI) remains a significant challenge in male patients, particularly following prostate surgery. Despite advancements in surgical techniques and technologies, a standardized method for evaluating treatment success remains under discussion. This study aims to propose a conceptual and comprehensive model that incorporates three key outcomes: quality of life, urinary leakage control, and safety, to provide a structured approach to the assessment of surgical interventions for SUI.

Evidence acquisition

A literature review was conducted, focusing on clinical guidelines and outcome measures used in studies of SUI treatment. Key parameters were selected based on their relevance to patient satisfaction, clinical practice, and international standards, including the International Continence Society (ICS) and patient-reported outcomes (PROs).

Results

The proposed trifecta model includes three essential criteria: (1) Quality of life, assessed by the Visual Numeric Scale (VNS) with scores of 0–2 indicating significant improvement; (2) Urinary leakage control, defined as “social continence” (use of 0–1 pad per day), reflecting practical success; and (3) Safety, evaluated by the absence of complications within 90 days postoperatively, aligning with standard follow-up timelines. This model addresses both objective and subjective outcomes. While it does not encompass long-term results, the trifecta is adaptable for extended evaluations at 1, 5, and 10 years and serves as a conceptual framework requiring future clinical validation.

Conclusion

The proposed trifecta model suggests a patient-centered framework to evaluate the outcomes of surgical interventions for SUI. By addressing critical domains, it offers a structured method for clinical and research assessment. However, its clinical applicability requires confirmation through prospective validation in diverse patient cohorts.

简介与目的压力性尿失禁（SUI）在男性患者中仍然是一个重大挑战，特别是在前列腺手术后。尽管外科技术和技术取得了进步，但评估治疗成功的标准化方法仍在讨论中。本研究旨在提出一个概念性的综合模型，该模型包含三个关键结果：生活质量、尿漏控制和安全性，为SUI的手术干预评估提供一个结构化的方法。证据获取进行了文献综述，重点是SUI治疗研究中使用的临床指南和结果测量。关键参数的选择是基于它们与患者满意度、临床实践和国际标准的相关性，包括国际尿失禁协会（ICS）和患者报告的结果（PROs）。结果提出的三要素模型包括三个基本标准：(1)生活质量，用视觉数字量表（VNS）评估，0-2分表示显著改善；(2)尿漏控制，定义为“社交节制”（每天使用0-1块尿垫），反映实际成功；(3)安全性，通过术后90天内无并发症评估，与标准随访时间一致。这个模型同时处理了客观和主观的结果。虽然它不包括长期结果，但三联疗法适用于1年、5年和10年的扩展评估，并作为需要未来临床验证的概念框架。结论提出的三联体模型提供了一个以患者为中心的框架来评估SUI手术干预的结果。通过解决关键领域，它为临床和研究评估提供了一个结构化的方法。然而，其临床适用性需要通过不同患者队列的前瞻性验证来确认。

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引用次数: 0

Efficacy of intra-vaginal diazepam for pelvic floor hypertonic disorder: A systematic review and meta-analysis 阴道内使用地西泮治疗盆底高渗症的疗效：一项系统回顾和荟萃分析

Continence Reports

Pub Date : 2025-07-10 DOI: 10.1016/j.contre.2025.100087

Dana Sawan , Mersal Almanasif , Sarah Alharshan , Rasha Alanazi , Sadeen Fallatah , Wasan Alanazi , Nora Aloufi

Background

High-tone pelvic floor dysfunction (HTPFD) is a neuromuscular disorder characterized by involuntary spasms of the levator ani muscles, often resulting in pelvic pain, dyspareunia, and bladder or bowel dysfunction. It is frequently associated with syndromes such as vulvodynia, interstitial cystitis, and pelvic myofascial pain. Current treatment options, including pelvic floor physical therapy and pharmacologic interventions, have limited evidence supporting their efficacy.

Objective

To assess the effectiveness of intra-vaginal diazepam suppositories in reducing pelvic floor muscle tone and alleviating associated symptoms in women with HTPFD.

Methods

A triple-blinded, randomized, placebo-controlled trial was conducted per PRISMA guidelines and registered in PROSPERO. Women aged ≥18 years with EMG-confirmed HTPFD were randomized to receive either 10 mg of diazepam or placebo vaginal suppositories nightly for 28 days. Primary outcomes included changes in resting pelvic floor electromyography (EMG). Secondary outcomes evaluated sexual function, pain levels, and quality of life via validated questionnaires.

Results

Twenty-one women were enrolled; 14 completed the trial (7 per arm). No statistically significant differences were observed between groups in resting EMG readings or subjective symptom scores. Both groups reported minor, non-significant improvements in pain and quality of life.

Conclusion

Current evidence is insufficient to determine the efficacy of intra vaginal diazepam for high tone pelvic floor dysfunction. Further large, well powered randomized controlled trials are needed to clarify its therapeutic role.

背景：高音调盆底功能障碍（HTPFD）是一种以提肛肌不自主痉挛为特征的神经肌肉疾病，常导致盆腔疼痛、性交困难、膀胱或肠功能障碍。它常伴有外阴痛、间质性膀胱炎和盆腔肌筋膜疼痛等综合征。目前的治疗方案，包括盆底物理治疗和药物干预，支持其疗效的证据有限。目的评价阴道内使用地西泮栓剂降低HTPFD患者盆底肌张力及缓解相关症状的效果。方法按照PRISMA指南进行三盲、随机、安慰剂对照试验，并在PROSPERO注册。年龄≥18岁的经肌电图证实HTPFD的女性随机接受10毫克地西泮或安慰剂阴道栓剂，每晚服用28天。主要结局包括静息盆底肌电图（EMG）的变化。次要结果通过有效问卷评估性功能、疼痛程度和生活质量。结果共纳入21名女性；14人完成了试验（每组7人）。两组间静息肌电图读数和主观症状评分无统计学差异。两组患者在疼痛和生活质量方面都有轻微的、不显著的改善。结论阴道内注射地西泮治疗高强度盆底功能障碍的疗效尚不明确。需要进一步的大型、有力的随机对照试验来阐明其治疗作用。

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引用次数: 0

Parameters which predict detrusor overactivity after adjustable trans obturator male system (ATOMS) implant. 可调节的男性经闭孔系统（ATOMS）植入后预测逼尿肌过度活动的参数。

Continence Reports

Pub Date : 2025-05-13 DOI: 10.1016/j.contre.2025.100084

Miguel Vírseda-Chamorrro , Sonia Ruiz-Graña , Jesús Salinas-Casado , Javier Angulo Cuesta

Aims:

To evaluate which parameters predicted the presence of detrusor overactivity after ATOMS implant in patients who had post prostatectomy urinary incontinence (PPI).

Method:

We carried out a prospective study in 56 patients submitted to ATOMS implant for PPI. The study consisted of a clinical and urodynamic record before and after ATOMS implantation. We built a multivariate model to find out which variables independently influenced postoperative DO and a ROC curve to decide the best cut-off value.

Results:

We found that the preoperative variables were age, detrusor pressure at maximum flow rate (PQmax) the urethral resistance parameter URA and the bladder contractility index (BCI) and the postoperative variables were, the number of ATOMS adjustments, cystometric bladder capacity, bladder compliance, maximum detrusor pressure, PQmax, bladder outflow obstruction index, URA and the presence of acontractile detrusor. The multivariate model showed that the only independent variables were age (inversely related with the presence of postoperative DO), and URA (directly related). The cut-off point of URA was established at 10. 5 cm H2O.

Conclusions:

the degree of postoperative resistance measured by the URA parameter and age were the two factors that independently influenced the presence of postoperative DO. It is possible that these parameters are related to the reaction of detrusor muscle to the increase in postoperative urethral resistance.

目的：评价在前列腺切除术后尿失禁（PPI）患者植入ATOMS后，哪些参数可以预测逼尿肌过度活动的存在。方法：我们对56例接受ATOMS植入治疗PPI的患者进行了前瞻性研究。研究包括原子植入前后的临床和尿动力学记录。我们建立了一个多变量模型，找出哪些变量独立影响术后DO，并绘制ROC曲线以确定最佳截断值。结果：术前变量为年龄、最大流速下逼尿肌压力（PQmax）、尿道阻力参数URA和膀胱收缩指数（BCI），术后变量为ATOMS调整次数、膀胱容量、膀胱顺应性、最大逼尿肌压力、PQmax、膀胱流出阻塞指数、URA和是否存在收缩性逼尿肌。多变量模型显示，唯一的自变量是年龄（与术后DO的存在呈负相关）和URA（直接相关）。市建局的分界点定在10点。5cm H2O。结论：URA参数测量的术后阻力程度和年龄是影响术后DO存在的独立因素。这些参数可能与逼尿肌对术后尿道阻力增加的反应有关。

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引用次数: 0

Detrusor underactivity is the main reason for persistent symptoms after transurethral resection of the prostate 逼尿肌活动不足是经尿道前列腺切除术后症状持续的主要原因

Continence Reports

Pub Date : 2025-05-13 DOI: 10.1016/j.contre.2025.100085

Esther Martinez-Cuenca, Miguel Á. Bonillo, Eduardo Morán, Salvador Arlandis

Introduction:

Transurethral resection of the prostate has been considered the gold standard for surgical management of benign prostatic enlargement. Despite its high success rate, a percentage of patients (20%–40%) do not improve afterward. Our purpose is to determine the underlying lower urinary tract dysfunction of patients with persistent symptoms after transurethral resection of the prostate (TURP).

Material and methods:

We queried our prospectively maintained database to identify male patients with lack of symptoms improvement after TURP for benign condition. Patients with neurological condition and prostate cancer were excluded.

Evaluation included symptoms assessment, prostate volume, uroflowmetry, maximum cystometric capacity, bladder compliance, detrusor overactivity and urodynamic stress urinary incontinence. We considered obstruction if Bladder Outlet Obstruction Index (BOOI)

\geq

40, no obstruction if BOOI < 20. We considered detrusor underactivity if Bladder Contractility Index (BCI) < 100.

Results:

219 patients had complete urodynamic study. Complete data were obtained from 107 patients, the mean (SD) age was 65.6 (8.2) years. Median (IQR) prostatic volume was 40 (31)cc. After surgery, storage symptoms were the most prevalent (73.8% of the patients). Urodynamic findings were: detrusor underactivity in 75 of 107 patients (70.1%), detrusor overactivity in 54 (50.5%), obstruction in 26 (24.3%).

The only correlation found was between the pre-surgery voided volume in uroflowmetry and detrusor overactivity in the urodynamic study (rho: −0.28, p

=

0.033). No difference regarding Qmax before and after TURP was observed in the detrusor underactivity group (p

=

0.481). Unfavorable outcome after previous prostate surgery might be explained by detrusor underactivity rather than obstruction.

Conclusions:

The most common persistent symptoms after TURP are storage, and the most common urodynamic finding is detrusor underactivity. In this scenario urodynamic study is advisable.

经尿道前列腺切除术被认为是良性前列腺肿大手术治疗的金标准。尽管成功率很高，但仍有一部分患者（20%-40%）在手术后没有好转。我们的目的是确定经尿道前列腺切除术（TURP）后持续症状的患者潜在的下尿路功能障碍。材料和方法：我们查询了我们前瞻性维护的数据库，以确定良性情况下经TURP后症状没有改善的男性患者。排除有神经系统疾病和前列腺癌的患者。评估包括症状评估、前列腺体积、尿流量、最大膀胱容量、膀胱顺应性、逼尿肌过度活动和尿动力应激性尿失禁。膀胱出口阻塞指数(BOOI)≥40考虑梗阻，BOOI≥40不考虑梗阻；20.。如果膀胱收缩指数（BCI） <；One hundred.。结果：219例患者完成尿动力学研究。完整资料来自107例患者，平均（SD）年龄为65.6（8.2）岁。前列腺体积中位数（IQR）为40 (31)cc。术后以积存症状最为常见（73.8%）。尿动力学结果为：107例患者中75例（70.1%）逼尿肌活动不足，54例（50.5%）逼尿肌过度活动，26例（24.3%）梗阻。在尿动力学研究中，唯一发现的相关性是术前尿流测量中的排尿量与逼尿肌过度活动之间的相关性（rho: - 0.28, p = 0.033）。逼尿肌活动不足组在TURP前后Qmax无差异（p = 0.481）。既往前列腺手术后的不良结果可能由逼尿肌活动不足而不是梗阻来解释。结论：TURP术后最常见的持续性症状是尿潴留，最常见的尿动力学表现是逼尿肌活动不足。在这种情况下，尿动力学研究是可取的。

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引用次数: 0