Continence Reports最新文献

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.

Introduction

Female urethral strictures are a rare occurrence and patients usually present with lower urinary tract symptoms. This non-specific presentation and rare occurrence pose a challenge to clinicians regarding timely diagnosis and intervention.

Case presentation

A 54-year-old para 3 + 0 postmenopausal patient presented to the clinic with complaints of voiding difficulty, suprapubic pain, a weak urinary stream, dribbling, straining and a sensation of incomplete bladder emptying. She had been previously managed twice for similar symptoms with urethral dilatation. Intermittent catheterization was utilized on the second episode with improvement of her symptoms.

During this third episode, micturating cystourethrogram demonstrated a urethral stricture and uroflowmetry revealed a reduced Qmax.

She underwent a dorsal urethroplasty with no intraoperative complications. Her recovery post procedure was unremarkable with resolution of her symptoms and an improvement of her Qmax on repeat uroflowmetry.

Conclusion

Urethroplasty is a viable and definitive management option for female urethral strictures. Timely diagnosis of urethral strictures requires a high index of suspicion and appropriate investigations. Post-menopausal atrophic vaginal mucosa offers a suitable alternative for graft harvesting.

Purpose:

Patients with permanent urethral catheterization for chronic urinary retention frequently experience several complications, such as bladder stones and/or urinary tract infections. In this study, we performed vesicostomy in adult patients with urinary retention who developed complications during long-term indwelling catheterization.

Methods:

Patients with a permanent bladder catheter for urinary retention, and bladder stones and/or urinary tract infection between April 2019 and October 2021 were enrolled in this retrospective study. Vesicostomy and additional surgeries, such as vesicolithotomy, were performed if necessary. Residual urine volume was measured with computed tomography 7 days after the operation. We followed-up all patients 3 months postoperatively to identify complications.

Results:

Nine patients were included in this study; eight were male and one was female. The median age at operation was 65 (range, 23–92) years. Concurrent operations were lithotomy in five, cystostomy closure in one, removal of a bladder foreign body in one, and nephrectomy in one. The postoperative median residual urine volume in the bladder was 32 (range, 5–51) ml. Perioperative complications comprised delirium (Clavien–Dindo grade II) in two patients and stomal bleeding (Clavien–Dindo grade II) in one patient. There were no complications of bladder stones, febrile urinary tract infection, or stomal stenosis postoperatively.

Conclusions:

Vesicostomy for adult patients with urinary retention was useful and safe. Our results suggest that vesicostomy could be a bladder drainage option for select adult patients who are not candidates for permanent indwelling catheterization.

Aims:

Previous studies have indicated that the intravesical placement of an air-filled balloon alleviates much of the symptoms caused by stress urinary incontinence (SUI) in women. However, the exact working mechanisms behind this therapy are not yet fully understood. The current study aims to elucidate the potential physiological mechanisms underlying this minimally invasive intervention.

Methods:

We have evaluated video urodynamic data in women undergoing this therapy (n = 5), during which participants were asked to cough with increasing intensity. For each participant, we have videos before insertion of the balloon and one week following insertion. We identified a frame in a resting situation in which the maximum horizontal and vertical bladder dimensions were measured. We expressed the maximum vertical diameter as a ratio of the maximum horizontal diameter. We then used custom-written scripts to identify the bladder and balloon in each frame of the video urodynamic investigation and subtracted information regarding the location of the bladder neck and diameters of the balloon. We then used this information to plot the displacement of the bladder neck and size of the balloon during coughing.

Results:

The diameters of the balloon were significantly decreased during coughing (p $\le$ 0.05). We found a significant increase of the maximum vertical diameter expressed as a ratio of the maximum horizontal diameter before and after insertion of the intravesical balloon (p $\le$ 0.05). The maximum displacement of the caudal bladder limit increased significantly after placement of the intravesical balloon was (p $\le$ 0.05).

Conclusions:

Our results imply that the balloon compresses in response to increases in abdominal pressure, and the bladder obtains a significantly more vertically oriented shape after placement of the balloon. Moreover, it appears that placement of the balloon significantly increases the mobility of the bladder neck. The balloon is indicated to absorb some of the increases in intravesical pressure during episodes of high abdominal pressure. We propose that the balloon inwardly pushes the bladder wall upwards, causing the organ to acquire a more vertically oriented shape. Additionally, we postulate that this change in bladder shape will increase the mobility of the bladder neck, thereby increasing the kinking capability of the urethra.

Polypropylene (PP) has been widely used as a mesh for the surgical treatment of pelvic organ prolapse (POP). However, PPs have been shown to cause complications, including tissue invasion, chronic pain, and infection; therefore, regulatory agencies deemed PP mesh was not inappropriate for use in transvaginal pelvic floor reconstruction surgery, which led to a recall of mesh products. In Japan, transvaginal mesh (TVM) surgery is still being performed using ORIHIME®, a Japanese mesh made of polytetrafluoroethylene (PTFE), which has been available since 2017. In this study, we performed each histopathological examination of tissue fragments collected from recurrent cases of TVM surgery using PP and PTFE meshes. Histopathological findings showed that PTFE had less fibrosis with the surrounding tissue than PP, and no extensive infiltrative extension of inflammatory changes was observed. These results suggest that PTFE may be one of the most suitable mesh materials for pelvic floor reconstruction.

Introduction and hypothesis:

Nocturia is the frequency that an individual passes urine during their main sleep period, according to the ICS. For the majority of adults, nocturia is multi-etiological and this may require a multicomponent intervention to optimize improvement. Therefore. Wearing knee-length graduated compression stockings (GCS) during the day may be beneficial in improving nocturia by increasing venous return and reducing edema in the lower extremities. This study evaluated the effects of GCS and non-GCS use.

Methods:

This online, randomized, double-blind, placebo-controlled trial was conducted in Japan. A total of 170 participants with nocturia aged 40–79 years were prospectively recruited and randomly assigned to the GCS (n $=$ 85) and non-GCS (placebo, n $=$ 85) groups to undergo a 14-day intervention after a 7-day observation period. Outcome measures included percent change in nighttime frequency between the GCS and non-GCS groups baseline, earlier intervention, and later intervention periods, Nocturia Quality of Life Questionnaire (N-QoL) score, and adverse events.

Results:

There were 168 participants were included in the analysis. The GCS and non-GCS groups had a similar mean $\pm$ standard deviation age (58.1 ± 9.6 vs. 60.2 ± 8.4 years) and similar causes of nighttime frequency. The mean baseline nighttime frequency was 1.2 ($\pm$0.7) and 1.2 ($\pm$0.7) time/night for the GCS and non-GCS groups, respectively. The GCS group showed a 54.3% reduction in the nighttime frequency from baseline to the later periods, which is significantly better than the 30.5% reduction in the non-GCS group (p $=$ 0.004). Nighttime frequency decreased significantly from baseline to the earlier and later periods in both the GCS group (1.2 ± 0.7 to 0.8 ± 0.5 to 0.5 ± 0.5 times/night, p $<$ 0.001) and the non-GCS group (1.2 $\pm$ 0.7 to 0.8 ± 0.6 to 0.8 ± 0.7 times/night, p $<$ 0.001). The total N-QoL score did not differ between the two groups, with both groups showing significant improvements in QoL during the baseline period and the end of the intervention (p $<$ 0.001). No adverse events were reported in either group.

Conclusion:

Both GCS and non-GCS can be considered safe and effective interventions for nocturia, with GCS being the more effective option.

Introduction:

Voiding dysfunction following mid-urethral synthetic sling surgery is a well-recognized complication with an established treatment algorithm.

Our case series describes patients with clinically significant voiding dysfunction where a decision to proceed to early sling release (<12 months) was made and operatively attempted but subsequent presentation shows the sling was not successfully divided.

Methods:

Retrospective case series of 16 women from a database of 330 women who underwent treatment for mid-urethral synthetic sling (MUSS) complications between 2014 and 2023 in Aotearoa New Zealand and Australia.

Results:

We found 16 patients with unrecognized unsuccessful sling division, from database of 330 mesh complications Initially, after sling implantation, these patients presented with characteristic obstructive symptoms including 8/16 having post-operative retention with failed TROC and prolonged catheterization or CIC.

The median time to first sling division for symptoms of bladder outlet obstruction was 9 months. Median time from implantation to the second (or definitive division) was 82 months.

Urodynamic findings after first unsuccessful division were median Qmax of 12 mls/s and median Pdet@max of 32cmh20.

Comparison of pre- and post-operative findings after delayed successful sling division showed significant improvement in recurrent UTIs (from 10/14 to 1/14). However, there was little improvement in pelvic pain/dyspareunia (from 9 to 7/14) and overactive bladder symptoms (9 to 6/14). One patient had a critical outcome, requiring cystectomy for pelvic pain and bladder pain following successful division.

Discussion:

This case series is the first to describe unrecognized, unsuccessful sling division for post-operative voiding dysfunction documented by subsequent objective radiologic and/or operative findings.

The clinical course shows significant urinary and pelvic pain morbidity after the failed division although it is difficult to ascribe causation with a retrospective lens.

These findings suggest that a high index of suspicion and low threshold for investigation should be maintained where clinical symptoms persist after a sling division.