Continence Reports最新文献

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.

Objective:

To investigate the functional and molecular alterations in detrusor underactivity (DU) in a rat model of bilateral pelvic nerve crush injury.

Methods:

This study included 39 female Sprague-Dawley rats separated into three groups (sham, 2-week DU, and 4-week DU), with 13 rats in each group. A bilateral pelvic nerve crush injury was induced in each group to develop a DU model. Similarly, the sham group was identically prepared but without crushing nerves. Awake continuous cystometry was performed two weeks post-surgery in the sham and 2-week DU groups and four weeks post-surgery in the 4-week DU group (n = 7/each group). In another group of rats (n = 6/each group), the bladders were harvested for western blotting, and the expression of moesin, ezrin, and transthyretin in the bladders was evaluated.

Results:

On cystometry, voided volume, post-void residual urine volume, bladder capacity, and number of non-voiding contractions were significantly higher in the 2- and 4-week DU groups than in the sham group. Furthermore, voiding efficiency was significantly decreased in the 2- and 4-week DU groups compared to that in the sham group.

The expression of moesin in the bladder was significantly higher in the 2-week DU group than that in the sham group. The expression of transthyretin in the bladder was significantly higher in the 2- and 4-week DU groups than that in the sham group.

Conclusion:

The significant increase in the expression of moesin and transthyretin in the bladder in bilateral pelvic nerve crush injuries may be related to the pathophysiology of DU.

Aims:

Urethral sphincter botulinum toxin injections is an alternative treatment for urinary retention in women with Fowler’s syndrome and when access to health services were curtailed during the Covid19 pandemic, we continued to offer treatment to prevent increased demand on catheter services due to a recurrence of urinary retention. We describe our experience delivering safe and timely treatment during this period of lockdowns and restricted access to healthcare.

Methods:

We retrospectively reviewed the records of all women with Fowler’s syndrome treated with transperineal urethral sphincter botulinum toxin injection between 23rd March 2020 and 31st December 2021 in a tertiary university hospital and clinical outcomes were recorded.

Results:

15 women (mean age 35.6 ± 10.1 years) received 100U OnabotulinumtoxinA injected into the external urethral sphincter as an out-patient procedure adopting hospital infection control guidelines. 41 injections were administered in total, and 8 (53%) patients received more than 1 injection (median 2 injections/patient, median inter-injection interval 108.5 days). 10 (66.7%) patients reported improvements in urinary symptoms across 31/41 (75.6%) of injections. Side effects were reported after 21.4% of injections which were mild and transient. No patients developed Covid19 within 4 weeks of the hospital visit.

Conclusion:

Real-world data shows that transperineal urethral sphincter botulinum toxin injections could be continued safely and effectively during the Covid19 pandemic. This essential outpatient service played an important role in treatment and quality of life for women with Fowler’s syndrome, and avoided an additional burden on the NHS at the time of a health crisis.

Introduction:

The diverticulum of the female urethra is a sac-like protrusion of the urethral mucosa into the adjacent tissue. The classic clinical presentation includes the ‘three Ds’: post-void dribbling, dyspareunia and dysuria. However, these symptoms are rarely encountered. The diverticula affect 0.02%–6% of women worldwide and they are presented between 30 and 60 years old, with a mean age of diagnosis of 36 years. The aim is to present a rare case of acute urinary retention due to a large urethral diverticulum. According to the literature review, no similar case has been reported since 2000.

Materials & Methods:

A 47-year-old woman with an unremarkable past medical history and one childbirth presented to the Emergency Department with acute urinary retention. The physical examination revealed a palpable, mobile, soft mass in the anterior vaginal wall. The urodynamic study demonstrated voiding dysfunction due to bladder outlet obstruction. A T2-weighted pelvic MRI showed a contrast-enhanced large (4 × 3, 1 centimeters), horseshoe, cystic mass, that surrounded the urethra. During rigid cystourethroscopy, the ostium of the diverticulum was identified in the left lateral wall (4 o’clock) of the anterior urethra.

Results:

The patient underwent transvaginal diverticulectomy and reconstruction of the urethra. The postoperative course was uneventful and she was discharged on postoperative day 2. The urethral catheter was removed at the postoperative week 3 and the patient voided successfully.

Conclusions:

Due to the variety of symptoms, the diagnosis is difficult and a high index of suspicion is frequently required. In the majority of cases the investigation is based on imaging and MRI is considered the imaging test of choice. The natural evolution of asymptomatic diverticula left untreated remains unknown, but complications such as carcinogenesis and stone formation have been reported.

Introduction:

A universal mobile application (WeShare URO by Symptelligence Medical Informatics, LLC) was developed to allow patients to provide diary and symptom information to the provider prior to the visit and to aid in the tracking of treatment progress. The purpose of the present study is to validate that the app correctly calculates the values required for the proper evaluation of a patients’ symptoms.

Materials and Methods:

Data from paper diaries of men with lower urinary tract symptoms (LUTS) was entered into the app. Total urine volume (TUV), total voids, actual number of nightly voids (ANV), nocturnal urine volume (NUV), maximum voided volume (MVV), nocturia index (Ni), nocturnal polyuria index (NPi), predicted number of nightly voids (PNV), and nocturnal bladder capacity index (NBCi) were calculated. Correlations between manual (Manual and Quickhand) and automatic (App) values were calculated using Spearman’s nonparametric rank coefficient.

Results:

The study included 66 paper diaries completed by a total of 51 male patients (median age = 68, IQR = 6) evaluated for LUTS. After applying exclusion criteria, 35 diaries were left for analysis (median age = 68, IQR = 0). Manual calculations were similar to those calculated by the app (0% - 2% difference). Comparison between Quickhand and App calculations had a higher difference (0% – 27%).

Conclusions:

Bladder diary applications can improve LUTS care through accurate calculations via an automated scaling equation. The error rate of “Quickhand” (calculations done by a clinician as a back-of-the-envelope method) supports the claim that these calculations are inaccurate and that an automated scaling equation provides more specific values critical to therapeutic decision-making.