Continence Reports最新文献

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.

Background:

Leiomyoma is a benign fibromuscular neoplasm originating from smooth muscle cells. Paraurethral leiomyoma is an extremely rare, benign, hormone-dependent​ growth from the mesenchymal cells in paraurethral space of female urethra. They usually appear in the reproductive age group women, mean age of presentation being approximately 41 years.

Case presentation:

A 22-year-old woman presented with palpable mass at vagina and weak urinary stream. She underwent clinical examination and MRI imaging followed by transvaginal excision of the mass. Histopathological examination confirmed paraurethral leiomyoma.

Conclusion:

Paraurethral leiomyoma make up approximately five percent of urethral tumors. This case depicts the presentation and treatment of a paraurethral leiomyoma in one of the youngest women reported in the literature.

Introduction:

Intermittent catheterization (IC), considered the gold standard for bladder management for individuals with spinal cord injury (SCI) with sufficient dexterity, is usually performed using hydrophilic (HPC) or non-hydrophilic catheters (non-HPC). Currently, there is little evidence on the temporal burden associated with IC in general. Our objective was to compare both catheters regarding their time requirement for IC and participant satisfaction.

Materials and Methods:

Twenty individuals with chronic (>1-year) SCI were randomized to undergo two cross-over assessments within 10 days (i.e., either starting with HPC or non-HPC). We measured the time taken to perform IC using a 13 step pre-determined protocol. Furthermore, we assessed user satisfaction of both catheters using a Likert scale. Time to perform IC and participant satisfaction were compared using non-parametric statistics. Results are presented as median with lower and upper quartiles.

Results:

Participants using an HPC spent significantly less time overall to perform IC [283 s (242; 352) vs. 373 s (249; 441), $p=0.01$] and to prepare a catheter [15 s (10; 20) vs. 41 (20; 69), $p=0.002$, i.e. adjusted for multiple comparisons] compared to non-HPC. No significant differences between both catheters were found with respect to participant satisfaction.

Conclusions:

This crossover RCT revealed that the overall time to perform IC appears to be a significant temporal burden for individuals with SCI independent of the catheter type. Further, we found that the preparation and usage of HPC for IC is faster compared to non-HPC. These findings warrant a larger trial to further assess the temporal burden of IC in this cohort.

Aims:

An unpleasant, inappropriate, and persistent need to urinate (PNU) is a sensory symptom reported by some patients with lower urinary tract symptoms (LUTS). However, no detailed definition of this symptom exists. This study aimed to describe the characteristics of patients reporting PNU and to discuss the pathophysiology and therapeutic approach.

Methods:

The clinical and urodynamic findings of patients presenting with PNU without chronic bladder pain syndrome or neurological or urological conditions between October 2019 and December 2020 were retrospectively reviewed. The treatment efficacy was self-reported at follow-up as “total cure”, “significant improvement” or “no modification”.

Results:

Seventy-nine patients were included (51 women (65%), mean age 49 years (Standard Deviation (SD) 18)). The mean duration of symptoms was 7 years (SD 11). Frequency was commonly associated with PNU (mean interval between voids 103 min (SD 69)) and 50 patients (63%) reported nocturia. Voiding difficulties were described in 33 cases (40%). The mean first desire to void was 112mL (SD 93) with normal maximum cystometric capacity of 397mL (SD 135), and 5 patients had detrusor overactivity. Proposed treatments were tibial nerve stimulation (n=25) with a total cure or significant improvement in 17 cases, alpha-blockers (n=8) with an improvement in 4 patients, antimuscarinics (n=29) with an improvement in only 3 patients, and antidepressant or antiepileptic (n=8) with an improvement in 5 patients.

Conclusion:

PNU is poorly described but could be responsible for LUTS. Further studies to understand the underlying mechanisms and to assess the therapeutic efficacy of the different options are required.

We present a case of a man who developed a neurogenic detrusor acontractility because of too much Vitamin B6 or pyridoxine intake. He developed voiding dysfunction and sensory neuropathy in both legs (numbness). The analysis gave no other explanation for the development of his complaints than the intake of excessive multivitamins, resulting in a supraphysiologic vitamin B6 level associated with neurotoxicity. Multivitamins are not only regarded as healthy but may also cause severe physical complaints, including voiding LUTS. Caretakers should bear that in mind when they encounter patients with voiding difficulties.