Continence Reports最新文献

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.

The COVID-19 has been a great challenge for healthcare providers all over the world which overwhelmed patients and healthcare providers by postponing many outpatient appointments and surgical procedures for months. Interestingly, COVID-19 can cause de novo lower urinary tract symptoms (LUTS) in some affected patients or exacerbate underlying LUTS in others although the most prevalent symptoms are respiratory symptoms. Understanding the effects of COVID-19 on LUTS is crucial for establishing bladder inflammation. In this review, we are focusing on how the lower urinary tract would be affected by COVID-19, considering the pathophysiology, and clinical implication of COVID-19-associated LUTS.

Purpose:

Proteinuria is used to track down patients with intrinsic renal disease and increased risk of renal function decline and is seen in up to 5% in the general population. The aim of this study is to investigate the prevalence and clinical relevance of proteinuria regarding renal function in patients with a urinary diversion.

Methods:

Data was collected of patients with a urinary diversion who had a follow-up appointment (T1) in the Urology Department of the University Hospital Utrecht in 2021. Patients were divided into a proteinuria and no proteinuria group. Proteinuria was determined through dipstick urinalysis at T1. Glomerular filtration rate and renal imaging were analysed at T1 and after 11–30 months follow-up (T2).

Results:

A research population of 84 patients was identified, median age was 38 years, 39.3% was male. At T1, 43% had proteinuria. There was no association between proteinuria and glomerular filtration rate nor abnormalities on renal imaging at T1 or T2. No statistically significant difference was seen in the glomerular filtration rate decline after 11–30 months between the group with and without proteinuria, determined at T1 (respectively 1.3 ± 6.9 ml/min/1.73 m² vs 2.3 ± 9.5 ml/min/1.73 m²; $p$-value 0.63).

Conclusion:

The prevalence of proteinuria in patients with a urinary diversion is high. Proteinuria was not associated with renal function or renal function decline over time. These findings illustrate the limitations of proteinuria screening to identify individuals at risk for renal function decline among this population.