LUTS: Lower Urinary Tract Symptoms最新文献

Objectives

We aimed to investigate success rates and predictive factors for midurethral slings (MUS) in women with mixed urinary incontinence (MUI).

Methods

Women with MUI (urodynamically diagnosed detrusor overactivity and stress urinary incontinence) treated with MUS between 2013 and 2020 were retrospectively investigated. Prior to MUS, all participants completed bladder diary and questionnaires and underwent a urodynamic study. Six months after surgery, patients were evaluated for lower urinary tract symptoms with pelvic examination, pad test, and the 8-item Overactive Bladder Questionnaire (OAB-V8) and the International Consultation on Incontinence Questionnaire-Short-Form (ICIQ-SF). Success rates after MUS were determined separately according to the predominant component of MUI. In addition, multivariable logistic regression analysis was used to determine the most important independent variables affecting the surgical outcome.

Results

There were 117 participants. The overall MUI cure rate was 73.5%, but surgical success in the presence of postoperative urgency was 60.7%. Moreover, MUS success rate was 84.8% in those with preoperative stress-dominant MUI. However, the success rates for equally and urgency-dominant MUI were both 29.4%. Preoperative OAB-V8 score, symptom duration >9.5 years, and preoperative anticholinergic medication were risk factors for persistent urgency and urgency urinary incontinence (UUI) postoperatively (p < .05). In addition, diabetes mellitus (DM) for persistent urgency and voiding frequency (daily) for persistent UUI were predictive factors (p < .05).

Conclusions

MUS may be offered to women with stress-dominant MUI. However, postoperative urgency might change a patient's perception of treatment despite successful incontinence treatment. MUS does not appear to be a good option when MUI patients have a high OAB-V8 score, symptom duration >9.5 years, DM, or use of anticholinergic medication preoperatively.

Objectives

To investigate the age-specific effect of transurethral holmium laser enucleation of the prostate (HoLEP) on overactive bladder (OAB).

Methods

A total of 186 consecutive patients who underwent HoLEP were included. They were divided into three groups: patients aged less than 65 years, between 65 and 74, and 75 or older. The OAB symptom score as well as other relevant variables of lower urinary tract symptoms and function were assessed before and 1, 3, 6, and 12 months after surgery. Age-specific prevalence of OAB, the proportion of resolution of OAB, and de novo OAB were evaluated.

Results

The mean age of patients was 70.7 years, and the mean total prostate volume was 75.8 ml. The mean OAB symptom scores before surgery of patients aged less than 65 years, between 65 and 74, and 75 or older were 6.0, 5.2, and 5.7, respectively. At 12 months after surgery, the scores for the respective groups had significantly decreased to 2.1, 2.5, and 3.5. The prevalence of OAB based on the score in the respective groups was 45.8%, 56.9%, and 54.0% (p = .6391) preoperatively and 9.1%, 11.3%, and 15.8% at 12 months after the surgery (p = .7613). Of those with preoperative OAB, 75.0%, 79.2%, and 75.0% of the respective groups showed resolution of OAB at 12 months postoperatively (p = .9427).

Conclusions

In candidates for surgical deobstruction of benign prostatic hyperplasia, HoLEP has potential to improve OAB symptoms regardless of age.

Objectives

To reveal the histopathological and immunological outcomes of intravesical treatment with tarantula cubensis extract (TCE) in a rat model of interstitial cystitis.

Methods

A total of 30 female Wistar albino rats were divided into three groups: group 1 (control group), group 2 (disease group), and group 3 (treatment group). The rat model of interstitial cystitis was created by biweekly intraperitoneal administration of cyclophosphamide (CYP). In group 3, TCE (a venom extracted from a brown spider known as tarantula cubensis) was administered intravesically after the model had been created. Urothelial degeneration, necrosis, ulcer, bleeding, edema, inflammation and mast cell count, interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha), myeloperoxidase (MPO), and hydroxyproline parameters were evaluated. Statistical analysis was performed using one-way analysis of variance, chi-square tests, and Kruskal–Wallis tests.

Results

All parameters were found to be lower in the rats in group 1 than in the other groups, and IL-6 and MPO values were found to be higher in group 2 (p < .001). The mean TNF-alpha value was highest in group 2 (p = .078). No difference was found between all groups regarding ulcer (p = .087). Urothelial degeneration, necrosis, edema, inflammation, hemorrhage and fibroblast proliferations, and hydroxyproline values were higher in group 3 (p < .001).

Conclusions

Intravesical TCE instillation produces an anti-inflammatory effect by reducing the levels of inflammatory parameters such as IL-6, TNF-alpha, and MPO in bladder tissue. It also accelerates tissue healing by increasing hydroxyproline and fibroblast proliferation.

Objectives

This study was planned to evaluate the effectiveness of game-based core exercises in children diagnosed with non-neuropathic bladder dysfunction and compare this effectiveness to that of the biofeedback treatment method.

Methods

The study included 48 children, aged 6–13 years, who were diagnosed with non-neuropathic bladder dysfunction. The children satisfying the inclusion criteria were selected by drawing lots from the population with the method of nonprobability random sampling. The patients were divided into three groups: group I, “game-based core stabilization exercise training”; group II, “biofeedback program”; and group III, “game-based core stabilization exercise training in addition to the biofeedback program.” The Dysfunctional Voiding and Incontinence Symptom Scale (DVISS) scores and uroflowmetry values of the patients were evaluated before and after the treatment.

Results

The mean age of the participants was 8.81 ± 2.08 years. There was a statistically significant difference between the pretreatment and post-treatment DVISS scores in all three groups (p < .05). However, no significant difference was found among the groups. There was no statistically significant difference in the uroflowmetry results of the patients in group I and II before and after the treatment. In group III, the time to maximum flow rate after treatment was significantly reduced, and the average flow rate was significantly increased.

Conclusions

According to the results of this study, the use of game-based exercises along with biofeedback treatment may reduce DVISS scores in children with non-neuropathic bladder dysfunction. A combination of the two methods may have positively affected the uroflowmetry results of the patients. We think that game-based exercises will contribute to the literature as a new treatment option in the treatment of non-neuropathic bladder dysfunction.

Objectives

In this study, we aimed to analyze scientific quality and content of female urethroplasty videos on YouTube.

Methods

We searched YouTube using the “female urethroplasty”, “female urethral stricture”, and “urethroplasty” keywords on February 22, 2022. The quality and content of videos were analyzed using the Global Quality Score (GQS) and Female Urethroplasty-Specific Checklist Score (FUSCS) which was developed by our clinic. Video analysis was performed by two independent urologists. The relationship between the video characteristics and GQS and FUSCS was examined.

Results

A total of 38 videos were analyzed. Fourteen (36.8%) videos were uploaded by academic sources such as urology societies and universities/hospitals, while 24 (63.2%) videos were uploaded by urologists. The median GQS was 3 (range, 2–4) and the median FUSCS was 8 (range, 5–9) for all videos. The Cohen's kappa was 0.834 for GQS and 0.899 for FUSCS, indicating a high level of agreement between the observers. The median GQS was 4 (range, 4–5) and the median FUSCS was 9 (range, 8–10) for academic videos, indicating a statistically significantly higher scores than the urologists videos (p = .002 and p < .001, respectively).

Conclusion

Academic videos on female urethroplasty on YouTube have adequate scientific quality and content for both patients and healthcare professionals. The number of videos by academic sources on female urethroplasty should be increased and individuals should be encouraged to search such videos on search engines.

Objectives

There is a functional relationship between the hip joint and the pelvic floor muscles. In patients with secondary osteoarthritis of the hip, urinary incontinence is also seen. Research has shown that total hip arthroplasty (THA) surgery improves the symptoms of urinary incontinence. This prospective cross-sectional study without a control group was performed on THA candidates with urinary incontinence and secondary osteoarthritis with the aim of investigating the effect of THA with a direct lateral approach and subsequent routine physiotherapy on the symptoms of urinary incontinence.

Methods

Sampling was performed using a simple method among those referred to orthopedic clinics in the private sector. Data were collected in all patients before and 3 months after THA using demographic, International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and hip range of motion record tables. The results are presented as mean with standard deviation.

Results

In this study, 16 men with a mean age of 76.75 years (±4.65) and 8 women with a mean age of 72.75 years (±7.32) participated. Before THA, stress urinary incontinence (54.16%) and urgency urinary incontinence (20.83%) had the highest frequency. However, after THA, the frequency of stress and urgency urinary incontinence decreased (16.66% and 8.33%, respectively). According to the results of the ICIQ, complete improvement of urinary incontinence symptoms was observed in up to 62.5% of the subjects. After THA, there was a significant difference between the mean total score obtained from the WOMAC questionnaire compared to before surgery. There was a significant improvement in the range of motion of the hip joint in all directions.

Conclusions

THA and routine hip physiotherapy in patients with urinary incontinence and secondary hip osteoarthritis have a significant positive effect on improving symptoms of urinary incontinence and hip function. In addition, it significantly improves the ICIQ and WOMAC questionnaire scores.

Case

A 75-year-old man presented with mixed obstructive and storage lower urinary tract symptoms (LUTS). He had undergone transurethral resection of the prostate (TURP) 5 years and laparoscopic inguinal hernia repair 20 years ago. He had a stone adherent to the bladder wall and an occlusive prostate.

Outcome

He underwent a re-do TURP and stone removal. Stone removal revealed an underlying metal coil straddling the bladder wall, which had served as a nidus for stone formation. The metal ring was a ProTack staple from previous hernia surgery, which had detached and wandered into the bladder. At follow-up after 12 weeks, the patient was asymptomatic, and his urine was sterile. Therefore, he chose to be treated conservatively for the ProTack and was started on periodic follow-up and cystoscopic surveillance. Shortly after review, he developed intestinal obstruction, which resolved spontaneously and was thought to be secondary to adhesions from other tacks that had migrated into the peritoneal cavity.

Conclusion

We have reported a case of a ProTack from a previous hernia repair migrating into the bladder and also causing intestinal obstruction. The case is very rare because of the combination of complications. Clinicians should beware of delayed complications and damage to other organs due to metallic hernia staples.

Objective

To investigate the outcome, determine the predictors for the success of, and evaluate the efficacy of pharmacokinetic therapy on trial catheter removal for women with urinary retention.

Methods

Inclusion criteria were female patients with acute urinary retention defined as painful, palpable, or percussive bladder, when the patient is unable to pass any urine, accompanied by postvoid residual (PVR) > 250 ml, and who underwent trial catheter removal between July 2009 and July 2019. Before trial catheter removal, alpha-blockers alone or alpha-blockers and parasympathomimetics (bethanechol or distigmine bromide) were used to facilitate spontaneous voiding in some cases.

Results

Fifty-nine of 104 (56.7%) women with urinary retention were catheter-free post trial. There was no significant difference between successful and non-successful trials in average age (p = .392), median ECOG (Eastern Cooperative Oncology Group) performance status (p = .374), diabetes mellitus (p = .842), dementia (p = .801), previous history of cerebrovascular events (p = .592), or intrapelvic surgery (p = .800). Oral medications were administered for 39/59 (66.1%) in the success group and 30/45 (66.7%) patients in the non-success groups (p = .598).

Serum albumin (3.2 ± 0.7 g/dl and 2.8 ± 0.8 g/dl, p = .039) and total protein values (6.5 ± 0.8 g/dl and 6.0 ± 1.0 g/dl, p = .038) at diagnosis of urinary retention were higher in the success group than the non-success group, respectively.

Multivariate logistic regression found that a serum albumin >3 g/dl was an independent predictor of successful trial catheter removal for women with urinary retention (p = .030, odds ratio [OR] 3.3, 95% confidence interval [CI] of OR 1.1–9.9). Age < 70 years old was a likely predictor of successful trial catheter removal (p = .066, OR 4.8, 95% CI of OR 0.9–25.0).

Conclusions

This is the first retrospective study to investigate the predictive factors for successful trial catheter removal in women with urinary retention. A serum albumin value >3 mg/dl at diagnosis of urinary retention was a significant independent predictor of catheter-free status after trial catheter removal, and age < 70 years-old was a possible contributor. There was no evidence that oral medication contributed to catheter-free status.

Objective

To evaluate the national trends in minimally invasive surgical therapies (MIST) for overactive bladder (OAB) in Australia over the past decade.

Methods

Annual MIST data were extracted using the Australian Medicare Benefit Schedule (MBS) on intravesical botulinum toxin (BTX), sacral nerve modulators (SNM) and percutaneous tibial nerve stimulators (PTNS) performed between 2010 and 2021. Population-adjusted rates of these procedures were compared in relation to individual states and against the introduction of various OAB drugs during the intervening years.

Results

The overall national utilization of MIST for OAB has increased over the last decade. The data reflect a rapid uptake in PTNS over the last 2 years following its introduction compared to the relatively steady increase in BTX and SNM over the past decade. There was minimal difference in SNM lead and generator placement, suggesting perhaps the conversion of trial SNM to permanent SNM has been relatively stable across the years. In contrast, there was an increase in PTNS maintenance in the following years following the initial rise in the PTNS treatment initiation. The introduction of various OAB drugs in the market did not seem to significantly affect the pattern of MIST uptake.

Conclusion

Despite the introduction of various OAB drugs, the overall MIST has increased steadily over the last decade, especially with PTNS. Further exploration into the motivators for specific MIST and cost–benefit analysis of these MIST for OAB is warranted.

Objectives

Pharmacological treatment options for underactive bladder (UAB) syndrome are limited. Urapidil is the only alpha₁-adrenoceptor (AR) antagonist that can be used for urinary disorders in women in some countries. However, no studies have directly verified the effects of alpha₁-AR antagonists on the female urethra and UAB-like dysfunctions. We investigated the effects of silodosin (alpha_1A-AR antagonist) and urapidil (nonselective alpha₁-AR antagonist) on the voiding function in female rats with diabetes mellitus (DM).

Methods

Changes in intraurethral pressure (IUP) induced by midodrine (alpha₁-AR agonist) and mean blood pressure (MBP) were continuously measured in normal female rats to verify the pharmacological profiles of the drugs. To establish a DM model, rats were administered streptozotocin (STZ; 50 mg/kg, intravenous). Eight weeks after STZ administration, drugs were subcutaneously delivered through an osmotic pump. Four weeks after drug administration, emptied bladder blood flow (BBF), intravesical pressure, and the micturition volume were measured.

Results

Both silodosin and urapidil inhibited the midodrine-induced increase in IUP and decreased MBP in a dose-dependent manner. Silodosin had a more substantial effect on the lower urinary tract than on MBP. Twelve weeks after STZ administration, DM rats exhibited UAB-like dysfunction (increased bladder capacity/bladder weight and residual volume and decreased bladder voided efficiency) and decreased BBF. Both drug treatments controlled this dysfunction.

Conclusions

Alpha₁-AR antagonists induced dose-dependent urethral relaxation in female rats. These drugs ameliorated UAB-like dysfunction in STZ-induced DM rats. In addition, alpha_1A-AR antagonists such as silodosin, which have limited effects on blood pressure, appear to be useful for treating UAB.