Continence Reports最新文献

Since 2017, polytetrafluoroethylene (PTFE) mesh ORIHIME® has been available in Japan for pelvic organ prolapse surgery. PTFE mesh is a potential material for the reconstruction of pelvic floor, however, there have not been any report on the LSC using PTFE mesh. The aim of the study is to confirm the feasibility of LSC with PTFE mesh by investigating the mid-term outcomes of LSC with this mesh. The materials were ORIHIME® and 30 patients with POP who underwent LSC using ORIHIME® in 2018. All cases underwent double mesh LSC, and subtotal hysterectomy was carried out concomitantly. Mean operation time was 145 min. We experienced no intraoperative complication. The patients were to be followed up to 3 years after operation. But only 19 patients were able to be followed up to 3 years. We experienced no mesh related complication. Stress urinary incontinence was seen in 8 patients (27%). As for recurrence of POP, we saw 3 cases (10%). Considering the results, LSC with PTFE mesh may have potential in reconstructing the female pelvic floor of POP patients.

Overactive bladder (OAB) affects around 12% of the adult population and is the subject of thousands of studies. Qualitative studies of OAB are less common and the patient voice is rarely heard. This protocol outlines the theoretical framework underpinning the study and defines the methodology that will be used to investigate the lived experience of OAB and choices regarding treatment options. This study will reference the patient experience of receiving acupuncture for OAB symptoms, a novel treatment with a growing evidence base. This is the first study to address patient experience related to acupuncture for OAB and may produce information of use to people with OAB, clinicians and those developing new pathways of care.

Aims:

To estimate costs, number of encounters, and adherence and persistence, among overactive bladder (OAB) patients initiating mirabegron (MIRA) and antimuscarinic (AM) combination therapy.

Methods:

In this retrospective cohort study using US claims data, incident combination therapy users (identification period: April 2018–March 2019) were followed for one year from first observed combination therapy fill (index) and stratified into four treatment pathways based on subsequent treatments used: continued combination therapy, switched to monotherapy, discontinued combination therapy or transitioned to OAB procedures (e.g., onabotulinumtoxinA injection). Outcomes were all-cause and OAB-related healthcare per-patient-per-month (PPPM) costs, number of encounters, treatment persistence and adherence. The cohort was weighted to align with the age distribution of the population of interest.

Results:

Patients (n=761) were 69% female; mean age was 67.8 years. Median (interquartile range [IQR]) all-cause PPPM costs ranged from $1,432 ($785, $2,914) for the combination therapy group to $2,335 ($1,482, $5,152) for the procedures group. OAB-related costs were lowest for the discontinuers ($362 [$222, $522]) and highest for those receiving procedures ($810; [$512, $1,433]). The median (IQR) PPPM number of OAB-related outpatient services encounters was 0.2 (0.1, 0.3; similar across treatment pathway groups). Treatment persistence was 167 (83, 300) days; adherence through day 365 was 26%.

Conclusions:

Monthly all-cause healthcare costs were similar among all patients except for those that transitioned to receive an OAB procedure, which was associated with higher costs. Persistence on combination therapy was similar to published persistence estimates for MIRA monotherapy and was potentially higher than published reports of AM persistence, though adherence may be lower.

Uncomplicated urinary tract infection (UTI) is common, resulting in a wide range of expenses and disturbing quality of life, especially in women.

Clinicians should take patients’ complete history and physical examination to determine the cause of recurrent UTI, and should consider further investigation in patients who are suspected of having complicated UTI. A urine culture is mandatory for recurrent UTI in every episode of symptomatic infection, before starting treatment. The antibiotic can be nitrofurantoin, TMP-SFX, or fosfomycin, for no longer than 7 days, to treat episodic uncomplicated infection patients. Post-coital prophylaxis show efficacy for recurrent UTI associated with sexual activity in premenopausal women. Non-antibiotic prophylaxis and low dose antibiotic prophylaxis can be used for patients who have frequent recurrent UTIs. Vaginal estrogen has efficacy to treat recurrent UTIs for post-menopausal women. Good hygiene is generally advised, despite limited data to support it. The vaccine for recurrent cystitis has opened a new door for the treatment of women with recurrent cystitis, however, long tern data are needed to confirm the efficacy.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection can cause multiple systemic and neurological complications, including Guillain–Barrè Syndrome (GBS). In this report we describe for the first time, urinary dysfunction in a patient with COVID-19. We reported a 41-years-old female patient with complaints of an increased generalized muscular weakness associated with progressive difficulty in walking. Four days earlier, patient complained of fever, diarrhea, and general weakness, and the RT-PCR was positive for COVID-19 infection. Due to the worsening of neurological symptoms, a neurophysiological examination on nervous conduction was performed and the diagnosis was suggestive of GBS. Two weeks later, patient developed two consecutive episodes of acute urinary retention that requested the placement of indwelling transurethral catheter. Patient started assuming selective alpha-1 adrenergic antagonist in association with 4 clean intermittent catheterization/die. Four months later, women continued the therapy and the ultrasound evaluation revealed non-pathologic post-void residual volume. Therefore, patient started to void spontaneously again and alpha-blockers were discontinued. We report for the first time a case of severe voiding disorder in a patient with COVID-19 associated GBS. Timely bladder drainage should be adopted to avoid irreversible detrusor damage.

Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is characterized by bladder pain and lower urinary tract symptoms without obvious causes. A subset of patients with IC/BPS present with Hunner lesions (HL), which are focal regions of gross inflammation on the bladder wall. It has been previously proposed that cell populations within HL are enriched in B- and T-cells, suggesting that this form of IC/BPS may be caused by reaction to a specific antigen within the lesions. Alternatively, B-cell enrichment in the HL might be caused by generalized inflammatory processes. Here, we distinguished between these hypotheses by using single-cell sequencing to identify B-cell clonotypes in the HL and the bladder of IC/BPS patients. We identified a clonotype that is shared in two patients with IC/BPS and that represented a significant subpopulation of total immune cells within the lesions. This finding is strong evidence that B-cells in the patients’ bladders are reacting to a specific antigen. Further studies of this specific B-cell clonotype can identify the antigen, helping to define the pathophysiology for IC/BPS with HL.

Introduction:

Overactive bladder (OAB) is a prevalent disease that may affect up to 16% of the population. Barriers to health care exist in the Chinese patient population due to language and cultural differences. Our aim was to create a validated Chinese Overactive Bladder Symptom Score (OABSS) which could capture the full range of OAB symptoms, quantify OAB severity, and be administered both in the clinic and remotely in the wake of the telehealth surge during COVID-19.

Methods:

The English version of the OABSS was translated into Chinese. The 5th question in the survey served as a proxy for OAB status (OAB-positive and OAB-negative). A hybrid and remote model were created in our translation and validation efforts. In the hybrid model, patients were seen in clinic and called over the phone to readminister the survey. In the remote model, patients were called twice to administer the survey. Internal validity was calculated using Cronbach’s coefficient alpha, test-retest reliability was measured using Spearman’s correlation, and t-test was used to assess discriminant validity between groups and between visits.

Results:

A total of 63 patients and 73 patients were included in the final analysis of the hybrid and remote models, respectively. An acceptable degree of internal validity was appreciated in both hybrid and remote models by Cronbach’s alpha score of 0.79 and 0.75, respectively. There were strong associations between responses from visit 1 to visit 2 in both models. Spearman’s coefficients ranged from 0.43 to 0.91, with all 7 questions and total OAB score showing statistically significant associations ($p$ < 0.001). In both models, no significant differences in total OAB score were seen between visits 1 and 2 in both OAB-positive and OAB-negative groups. However, the OAB-positive group had significantly higher mean OAB scores in both visits 1 and 2 compared to the OAB-negative group.

Conclusion:

Through several methods of determining survey validity, the Chinese version of the OABSS proved to be a useful tool in assessing OAB severity and gives providers an opportunity to assess Chinese speaking patients remotely. As telehealth visits increase in frequency, OAB symptoms can continue to be monitored adequately.

Stress urinary incontinence (SUI) is a prevalent and bothersome condition. In patients with moderate to severe SUI, midurethral sling surgery, as compared to first line physiotherapy, results in higher rates of subjective improvement and objective cure. Several types of mid-urethral slings have been developed. Single-incision midurethral slings (SIMS) have been developed to decrease surgery-related discomfort, without compromising efficacy. SIMS are very different from each other and should not be evaluated as a single category of slings, like retropubic of transobturator midurethral slings. Altis®(Coloplast, Minneapolis) SIS has unique design characteristics that provide solutions for many clinical challenges specific for repeatable and reliable surgical correction of SUI. Although quantification of the added value from each technical characteristic is not realistic, it is clear that the high cure rate and consistent outcomes are a reflection of unique and intentional engineering. In this manuscript we explain how designing technical characteristics of a mid-urethral sling to meet clinical needs, results in a unique engineered medical device, that has discriminatory performance in the surgical treatment of stress urinary incontinence. For physicians it is important to understand the background of a product design in order to optimize the clinical use of it.

Introduction:

Symptoms of either female sexual dysfunction (FSD) or urinary incontinence (UI) after breast cancer treatment are reported to be common. Despite this, the prevalence and severity of FSD in women who experience UI after breast cancer treatment has not been investigated. The aim of this study was to compare the prevalence and severity of FSD in women with and without breast cancer who experience UI.

Methods:

A secondary analysis of data from a larger cross-sectional study was undertaken. 21 pairs of sexually active women with and without breast cancer who experienced UI were matched according to age, body-mass index and parity. The severity of FSD was assessed using the Female Sexual Function Index (FSFI). Participant demographics, prevalence of FSD, and FSFI scores were reported descriptively. Differences in prevalence rate of FSD and FSFI scores between women with and without breast cancer and UI were analysed using Wilcoxon signed-rank or McNemar’s tests.

Results:

Participants with breast cancer who experienced UI reported significantly higher rates of FSD ($n$$=$ 19/21, 90%) compared to participants without breast cancer with UI ($n$$=$ 10/21, 48% p $=$ 0.0028). Participants with breast cancer and UI had a significantly lower overall FSFI score (median $=$ 18.8, IQR $=$ 12.5) compared to those without breast cancer with UI (median $=$ 25.9, IQR $=$ 10, p $=$ 0.0096). They also reported lower arousal, less lubrication, lower satisfaction and more pain during sexual activity compared to participants without breast cancer who experienced UI.

Conclusion:

Participants with breast cancer who experienced UI had a higher prevalence and severity of FSD than participants without breast cancer with UI. They reported having lower arousal, lubrication, satisfaction and more pain during sexual activity. These preliminary results suggest larger studies to investigate sexual function in women with breast cancer and UI are warranted.