LUTS: Lower Urinary Tract Symptoms最新文献_第6页

Hygiene management of intermittent self-catheterization using reusable silicone catheters in people with spinal cord lesions: A cross-sectional Internet survey in Japan 脊髓病变患者使用可重复使用的硅胶导管进行间歇性自我导尿的卫生管理:日本的一项横断面互联网调查

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-06-10 DOI: 10.1111/luts.12490

Ryosuke Takahashi, Noritoshi Sekido, Mihoko Matsuoka, Atsushi Sengoku, Masashi Nomi, Fujio Matsuyama, Tatsunori Murata, Takeya Kitta, Takahiko Mitsui

Objectives

To investigate hygiene management and catheter maintenance of reusable silicone catheters for intermittent self-catheterization (ISC) in Japan and examine their relationship with symptomatic urinary tract infection (sUTI).

Methods

We conducted a cross-sectional Internet survey of people performing ISC using reusable silicone catheters owing to spinal cord lesions in Japan. Hygiene management and catheter maintenance of reusable silicone catheters and the incidence and frequency of sUTI were evaluated. We also examined the significant risk factors for sUTI.

Results

Of 136 respondents, 62 (46%), 41 (30%), and 58 (43%) washed hands with water, washed hands with soap, and cleaned or disinfected the urethral meatus every time or most of the time before ISC, respectively. No significant difference was observed in the incidence and frequency of sUTI between respondents who adhered to these procedures and those who did not. There were no significant differences in the incidence and frequency of sUTI in respondents who changed their catheters every month and in those who changed their preservation solution within 2 days compared with those who did not. In multivariate analysis, pain during ISC, inconvenience of indoor mobility, bowel management problems, and participants' feeling of never having received instruction on catheter replacement were significant risk factors for sUTI.

Conclusions

There are individual differences in hygiene management and catheter maintenance of reusable silicone catheters, but the influence of these differences on the incidence and frequency of sUTI is not clear. Pain during ISC, bowel management problems, and inadequate instruction on catheter maintenance procedures are factors associated with sUTI.

目的探讨日本可重复使用的硅导管用于间歇性自导管插入术（ISC）的卫生管理和导管维护，并探讨它们与症状性尿路感染（sUTI）的关系。方法我们对日本因脊髓损伤而使用可重复使用的硅胶导管进行ISC的患者进行了横断面互联网调查。对可重复使用的硅胶导管的卫生管理和导管维护以及sUTI的发生率和频率进行了评估。我们还研究了sUTI的重要危险因素。结果在136名受访者中，分别有62人（46%）、41人（30%）和58人（43%）在ISC前每次或大部分时间用水洗手、用肥皂洗手和清洁或消毒尿道口。在坚持这些手术的受访者和不坚持这些程序的受访者之间，sUTI的发生率和频率没有观察到显著差异。在每月更换导管的受访者和在2个月内更换保存液的受访者中，sUTI的发生率和频率没有显著差异与那些没有的人相比。在多变量分析中，ISC期间的疼痛、室内活动不便、肠道管理问题以及参与者从未接受过导管更换指导的感觉是sUTI的重要风险因素。结论可重复使用的硅胶导管在卫生管理和导管维护方面存在个体差异，但这些差异对sUTI发生率和频率的影响尚不清楚。ISC期间的疼痛、肠道管理问题和导管维护程序指导不足是导致sUTI的因素。

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引用次数: 0

Predictive factors for the success of trial without catheter for men with urinary retention 男性尿潴留无导尿管试验成功的预测因素

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-06-05 DOI: 10.1111/luts.12492

Masato Takanashi, Hiroki Ito, Takeshi Fukazawa, Hiroki Takizawa, Mari Hioki, Risa Shinoki, Takashi Kawahara, Kazuki Kobayashi

Objective

To investigate the trial of spontaneous urination without catheter (TWOC) outcomes for men with acute urinary retention, determine successful TWOC predictors, and evaluate the impact of add-on medication therapy on TWOC.

Methods

This retrospective study included men with acute urinary retention and post-void residual (PVR) >250 mL who underwent TWOC between July 2009 and July 2019. Patients were divided into a medicated group who received alpha1 blocker on urinary retention diagnosis and a naïve group who did not. The trial was defined as unsuccessful if the PVR was >150 mL or if the patient experienced difficulty emptying their bladder with abdominal discomfort or pain, and a transurethral catheter was reinserted.

Results

Among 576 men with urinary retention, 269 (46.7%) constituted the medicated group and 307 (53.3%) the naïve. The naïve group comprised more elderly patients (P = 0.010) with higher Eastern Cooperative Oncology Group performance status (PS) (P = 0.001) and smaller prostate volume (P = 0.028) than the other. In the medicated group, 153 men received additional oral medication before TWOC to increase the success rate. There were significant age differences (P = 0.041) in the medicated group and significant median PS differences (P = 0.010) in the naïve group between the successful and unsuccessful outcomes of TWOC. The multivariate logistic regression model demonstrated that age <80 years in medicated patients (P = 0.042, odds ratio [OR] 1.701) and PS <2 in naïve patients (P = 0.001, OR 2.710) were significant independent predictors of successful TWOC outcomes.

Conclusions

This is the first study classifying patients with urinary retention according to medication status. Both medicated and naïve groups had different patient backgrounds and TWOC outcome predictors, suggesting a discrepant etiology behind urinary retention. Hence, acute urinary retention management in men should vary based on medication status for male lower urinary tract symptoms when urinary retention is diagnosed.

目的探讨男性急性尿潴留患者无导管自然排尿(TWOC)结局的临床试验，确定成功的TWOC预测因素，并评估附加药物治疗对TWOC的影响。方法回顾性研究2009年7月至2019年7月期间接受TWOC治疗的急性尿潴留和膀胱后残留(PVR) >250 mL的男性患者。患者被分为两组，一组在尿潴留诊断时使用α 1阻滞剂，另一组不使用naïve。如果PVR为150 mL，或者患者因腹部不适或疼痛而排尿困难，则重新插入经尿道导管，则试验被定义为不成功。结果576例尿潴留患者中，给药组269例(46.7%)，naïve组307例(53.3%)。naïve组老年患者较多(P = 0.010)，东部肿瘤合作组表现状态(PS)较高(P = 0.001)，前列腺体积较小(P = 0.028)。在药物组中，153名男性在TWOC前接受了额外的口服药物以提高成功率。治疗组与不治疗组的年龄差异有统计学意义(P = 0.041)， naïve组的中位PS差异有统计学意义(P = 0.010)。多因素logistic回归模型显示，用药患者的年龄<80岁(P = 0.042，比值比[OR] 1.701)和naïve患者的年龄<2岁(P = 0.001, OR 2.710)是TWOC成功结局的显著独立预测因子。结论根据用药情况对尿潴留患者进行分类的研究尚属首次。药物组和naïve组都有不同的患者背景和TWOC结果预测因子，提示尿潴留背后的病因不同。因此，男性急性尿潴留的处理应根据诊断出尿潴留时男性下尿路症状的药物状况而有所不同。

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引用次数: 0

Risk factors for a failed trial without catheter following convective water vapor thermal therapy (CWVTT-Rezum) 对流水蒸气热疗法(CWVTT-Rezum)后无导管试验失败的危险因素

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-05-26 DOI: 10.1111/luts.12483

Michael D. Felice, Kaylin Kim, Sarang Janakiraman, Gaurav Pahouja, William Adams, Erin Fruth, Ahmer Farooq, Kevin T. McVary

Objectives

Convective water vapor thermal therapy (CWVTT-Rezum) is a minimally invasive surgical therapy that is being increasingly utilized for bladder outlet obstruction. Most patients leave the site of care with a Foley catheter in place for a mean reported duration of 3–4 days. A minority of men will fail their trial without catheter (TWOC). We aim to identify the frequency of TWOC failure following CWVTT and its associated risk factors.

Methods

Patients who underwent CWVTT at a single institution from October 2018 to May 2021 were retrospectively identified and pertinent data extracted. The primary endpoint was TWOC failure. Descriptive statistics were performed, and rate of TWOC failure was determined. Potential risk factors for failed TWOC were assessed through univariate and multivariate logistic regression.

Results

A total of 119 patients were analyzed. Seventeen percent (20/119) had a failed TWOC on their first attempt. Of those, 60% (12/20) failed in a delayed fashion. In patients who failed, the median number of total TWOC attempts required for success was two (interquartile range [IQR] = 2–3). All patients eventually had a successful TWOC. The median preoperative postvoid residual for successful and failed TWOC was 56 mL (IQR = 15–125) and 87 mL (IQR = 25–367), respectively. Preoperative elevated postvoid residual (unadjusted odds ratio [OR] 1.02, 95% CI: 1.01–1.04; adjusted OR 1.02, 95% CI: 1.01–1.04) was associated with TWOC failure.

Conclusions

Seventeen percent of patients failed their initial TWOC after CWVTT. Elevated postvoid residual was associated with TWOC failure.

目的:对流水蒸汽热疗法(CWVTT-Rezum)是一种微创手术治疗，越来越多地用于膀胱出口梗阻。大多数患者离开护理地点时，Foley导管放置到位，平均报告持续时间为3-4天。少数男性在没有导管(TWOC)的情况下会失败。我们的目的是确定CWVTT后TWOC失效的频率及其相关的危险因素。方法回顾性分析2018年10月至2021年5月在同一医院接受CWVTT治疗的患者，并提取相关资料。主要终点为TWOC失败。进行描述性统计，并确定TWOC失败率。通过单因素和多因素logistic回归评估TWOC失败的潜在危险因素。结果共分析119例患者。17%(20/119)的人第一次尝试TWOC失败。其中，60%(12/20)以延迟方式失败。在失败的患者中，成功所需的总两次oc尝试的中位数为2次(四分位数间距[IQR] = 2-3)。所有患者最终都成功进行了TWOC。成功和失败的TWOC术前空隙后残留中位数分别为56 mL (IQR = 15-125)和87 mL (IQR = 25-367)。术前空腔后残留升高(未调整优势比[OR] 1.02, 95% CI: 1.01-1.04;调整OR 1.02, 95% CI: 1.01-1.04)与TWOC失败相关。结论:17%的患者在CWVTT后未能完成最初的TWOC。空隙后残留升高与TWOC失败有关。

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引用次数: 0

Mirabegron is better tolerated than solifenacin in Sjogren's syndrome patients with overactive bladder symptoms—A randomized controlled trial 一项随机对照试验表明，Mirabegron对伴有膀胱过度活动症状的干燥综合征患者的耐受性优于索利那新

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-05-16 DOI: 10.1111/luts.12481

Hao Xiang Chen, Shih-Hsin Chang, Der-Yuan Chen, Joung-Liang Lan, Kai-Jieh Yeo, Po-Hao Huang, Chung-Ming Huang, Chi-Ping Huang, Eric Chieh-Lung Chou, Po-Chang Wu

Objectives

This study investigates the efficacy and adverse events of beta-3 agonists and antimuscarinic agents for managing overactive bladder syndrome in Sjogren syndrome.

Methods

Sjogren's syndrome patients with an Overactive Bladder Symptom Score (OABSS) >5 were enrolled and were randomly assigned to mirabegron 50 mg/day or solifenacin 5 mg/day. Patients were evaluated on the recruitment day and reassessed at Week 1, 2, 4, and 12. The study's primary endpoint was to have a significant change in OABSS at Week 12. The secondary endpoint was the adverse event and crossover rate.

Results

A total of 41 patients were included in the final analysis, with 24 in the mirabegron group and 17 in the solifenacin group. The study's primary outcome was a change of the OABSS at Week 12. We found that both mirabegron and solifenacin significantly reduce patients' OABSS after 12 weeks of treatment. The evolution of the OABSS was −3.08 for mirabegron and −3.71 for solifenacin (p = .56). Six out of 17 patients from the solifenacin group crossed over to the mirabegron arm due to severe dry mouth or constipation, while none from the mirabegron arm crossed over to the solifenacin group. Sjogren's syndrome-related pain was also improved in the mirabegron group (4.96–1.67, p = .008) compared to the solifenacin group (4.39–3.4, p = .49).

Conclusions

Our study showed that mirabegron is equally effective as solifenacin in treating Sjogren's syndrome patients with overactive bladder. Mirabegron is superior to solifenacin in terms of treatment-related adverse events.

目的探讨-3受体激动剂和抗毒蕈碱类药物治疗干燥综合征患者膀胱过度活动综合征的疗效和不良反应。方法入选膀胱过度活动症状评分(OABSS) >5分的干燥综合征患者，随机分配米拉米格隆50 mg/d或索利那新5 mg/d。在招募当天对患者进行评估，并在第1、2、4和12周重新评估。该研究的主要终点是在第12周时OABSS发生显著变化。次要终点是不良事件和交叉率。结果共纳入41例患者，其中美瑞比龙组24例，索利那新组17例。该研究的主要结果是第12周时OABSS的变化。我们发现mirabegron和solifenacin治疗12周后显著降低患者OABSS。mirabegron的OABSS演化为- 3.08,solifenacin的OABSS演化为- 3.71 (p = 0.56)。索非那新组的17名患者中有6名由于严重的口干或便秘而转到米拉比格龙组，而米拉比格龙组没有患者转到索非那新组。与索利那新组(4.39-3.4,p = 0.49)相比，mirabegron组干燥综合征相关疼痛(4.96-1.67,p = 0.008)也得到了改善。结论:我们的研究表明，mirabegron与索利那新治疗干燥综合征伴膀胱过度活动的患者同样有效。Mirabegron在治疗相关不良事件方面优于索利那新。

{"title":"Mirabegron is better tolerated than solifenacin in Sjogren's syndrome patients with overactive bladder symptoms—A randomized controlled trial","authors":"Hao Xiang Chen, Shih-Hsin Chang, Der-Yuan Chen, Joung-Liang Lan, Kai-Jieh Yeo, Po-Hao Huang, Chung-Ming Huang, Chi-Ping Huang, Eric Chieh-Lung Chou, Po-Chang Wu","doi":"10.1111/luts.12481","DOIUrl":"10.1111/luts.12481","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study investigates the efficacy and adverse events of beta-3 agonists and antimuscarinic agents for managing overactive bladder syndrome in Sjogren syndrome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Sjogren's syndrome patients with an Overactive Bladder Symptom Score (OABSS) >5 were enrolled and were randomly assigned to mirabegron 50 mg/day or solifenacin 5 mg/day. Patients were evaluated on the recruitment day and reassessed at Week 1, 2, 4, and 12. The study's primary endpoint was to have a significant change in OABSS at Week 12. The secondary endpoint was the adverse event and crossover rate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 41 patients were included in the final analysis, with 24 in the mirabegron group and 17 in the solifenacin group. The study's primary outcome was a change of the OABSS at Week 12. We found that both mirabegron and solifenacin significantly reduce patients' OABSS after 12 weeks of treatment. The evolution of the OABSS was −3.08 for mirabegron and −3.71 for solifenacin (<i>p</i> = .56). Six out of 17 patients from the solifenacin group crossed over to the mirabegron arm due to severe dry mouth or constipation, while none from the mirabegron arm crossed over to the solifenacin group. Sjogren's syndrome-related pain was also improved in the mirabegron group (4.96–1.67, <i>p</i> = .008) compared to the solifenacin group (4.39–3.4, <i>p</i> = .49).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study showed that mirabegron is equally effective as solifenacin in treating Sjogren's syndrome patients with overactive bladder. Mirabegron is superior to solifenacin in terms of treatment-related adverse events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":18028,"journal":{"name":"LUTS: Lower Urinary Tract Symptoms","volume":"15 4","pages":"139-147"},"PeriodicalIF":1.3,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10119133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Efficacy and safety of the Rezum system for the treatment of catheter-dependent urinary retention: Three-year real-world outcomes in a multimorbid, multiethnic population Rezum系统治疗导尿管依赖性尿潴留的有效性和安全性:在多疾病、多种族人群中的三年真实结果

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-05-15 DOI: 10.1111/luts.12482

Mustufa Babar, Zaki Masoud, Kevin Labagnara, Justin Loloi, Rahman Sayed, Sandeep Singh, Kevin Tang, Umar Syed, Michael Ciatto

Objectives

To evaluate the long-term real-world efficacy and safety of Rezum for the treatment of catheter-dependent urinary retention in a multimorbid, multiethnic population.

Methods

A single-office, retrospective study was conducted on patients treated with Rezum between 2017 and 2019. Patients were included if they had catheter-dependent urinary retention prior to treatment and at least one follow-up within 36 months postoperatively. Patient demographics, procedural characteristics, adverse events (AEs), and outcome measures, including benign prostate hyperplasia (BPH) medication usage and postvoid residual (PVR), were collected at 3, 6, 12, and/or 36 months postoperatively. Regret was assessed at 36 months using the 5-item Decisional Regret Scale (DRS).

Results

A total of 27 patients met the inclusion criteria, with the majority being Asian (29.6%), followed by non-Hispanic Black (26.0%) and Hispanic (22.2%). Most patients (77.8%) had at least one comorbidity. Trial of void (TOV) was attempted at a median of 8 days (7, 13). Fourteen patients (51.9%) failed their initial TOV. Median time until catheter independence was 13.5 days (8.5, 28.8). Common AEs included urinary retention (51.9%), urinary tract infections (UTIs) (25.9%), and dysuria (25.9%). All cases of UTIs (7/7) and most cases of dysuria (6/7) occurred in patients who failed their initial TOV. At 36 months, there was a significant median percentage change in PVR (−100.0% [−100.0, −36.7], p = .049), and 40.4% of patients discontinued their BPH medications (p = .001). Of the 11 patients who filled out the DRS, 10 (90.9%) agreed/strongly agreed that they made the right decision. By 36 months, 4 patients (14.8%) underwent reoperation and 24 (88.9%) remained catheter-independent.

Conclusions

At long-term follow-up, Rezum effectively treated catheter-dependent urinary retention with minimal decisional regret. In patients with urinary retention, urologists should consider delaying TOV until 2 weeks postoperatively to maximize the likelihood of a successful TOV and minimize the risk of AEs.

目的评价Rezum在多疾病、多种族人群中治疗导尿管依赖性尿潴留的长期疗效和安全性。方法对2017 - 2019年接受Rezum治疗的患者进行单室回顾性研究。如果患者在治疗前有导尿管依赖性尿潴留，且术后36个月内至少有一次随访，则纳入研究。在术后3、6、12和/或36个月收集患者人口统计学、手术特征、不良事件(ae)和结局指标，包括良性前列腺增生(BPH)药物使用和术后残留(PVR)。在36个月时使用5项决策后悔量表(DRS)评估后悔。结果符合纳入标准的患者共27例，以亚裔(29.6%)居多，其次是非西班牙裔黑人(26.0%)和西班牙裔(22.2%)。大多数患者(77.8%)至少有一种合并症。无效试验(TOV)的中位数为8天(7,13)。14例(51.9%)患者首次TOV失败。到导管独立的中位时间为13.5天(8.5天，28.8天)。常见的ae包括尿潴留(51.9%)、尿路感染(25.9%)和排尿困难(25.9%)。所有尿路感染病例(7/7)和大多数排尿困难病例(6/7)发生在首次TOV失败的患者中。在36个月时，PVR的中位百分比变化显著(- 100.0% [- 100.0，- 36.7]，p = 0.049)， 40.4%的患者停止了BPH药物治疗(p = 0.001)。在填写DRS的11名患者中，10名(90.9%)同意或强烈同意他们做出了正确的决定。36个月时，4例患者(14.8%)再次手术，24例患者(88.9%)保持导管独立。结论:在长期随访中，Rezum有效地治疗了导尿管依赖性尿潴留，决策后悔最小。对于有尿潴留的患者，泌尿科医生应考虑延迟TOV至术后2周，以最大限度地提高TOV成功的可能性，并尽量减少不良反应的风险。

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引用次数: 1

Mirabegron versus vibegron in previously untreated female patients with overactive bladder: A randomized, single-clinic, open-label trial Mirabegron与vibegron在未经治疗的女性膀胱过动症患者中的疗效:一项随机、单诊所、开放标签试验

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-05-04 DOI: 10.1111/luts.12480

Hirotaka Sato, Shota Otsuka, Sachiyuki Tsukada

Objectives

This study aimed to assess the efficacy and safety of mirabegron compared with vibegron (both 50 mg once daily) in Japanese female patients with symptoms of overactive bladder (OAB).

Methods

This prospective, 12-week, two-arm, parallel-group, open-label randomized trial (UMIN000038288) was conducted at a single clinic from December 2019 to September 2022. The primary efficacy outcome measure was the change in mean total overactive bladder symptom scores (OABSSs) from baseline to end of treatment (EOT) (Week 12). The secondary efficacy outcome measures were changes in mean International Prostate Symptom Score from baseline to EOT, the ratio of patients who achieved a minimal clinically important change (MCIC) of total OABSS, and individual domains of the King's Health Questionnaire. Safety assessments, such as adverse events (AEs), postvoid residual volume, and patient-reported incidences, were recorded at every visit.

Results

There was no statistically significant adjusted mean difference between mirabegron and vibegron in terms of the primary outcome of the mean change from baseline to EOT in the total OABSS. The difference in the percentage of patients in the mirabegron and vibegron groups achieving an MCIC on the total OABSS was not statistically significant but appeared to be clinically important. The incidence of treatment-related AEs was significantly higher for the vibegron group (38.5%) than the mirabegron group (19.1%) (p = .047).

Conclusions

These results showed that both drugs were effective in female OAB patients, with no significant differences in terms of efficacy. However, the safety of vibegron requires further investigation.

目的:本研究旨在评估mirabegron与vibegron(均为50 mg，每日1次)在日本女性膀胱过动症(OAB)患者中的疗效和安全性。该前瞻性、为期12周、平行组、开放标签随机试验(UMIN000038288)于2019年12月至2022年9月在一家诊所进行。主要疗效指标是平均膀胱过度活动症状评分(OABSSs)从基线到治疗结束(EOT)(第12周)的变化。次要疗效指标包括从基线到EOT的平均国际前列腺症状评分的变化，达到最小临床重要变化(MCIC)的总OABSS的患者比例，以及King's健康问卷的各个领域。安全性评估，如不良事件(ae)、空隙后残留量和患者报告的发生率，在每次就诊时都被记录下来。结果mirabegron和vibegron在总OABSS从基线到EOT的平均变化的主要结局方面没有统计学上的显著差异。美瑞比龙组和威比龙组在总OABSS上达到MCIC的患者百分比差异无统计学意义，但似乎具有重要的临床意义。vibegron组治疗相关不良事件发生率(38.5%)显著高于mirabegron组(19.1%)(p = 0.047)。结论两种药物对女性OAB患者均有效，且疗效无显著差异。然而，威必荣的安全性需要进一步调查。

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引用次数: 1

The efficacy of antibiotic and alpha-blocker combination therapy versus antibiotic monotherapy in chronic prostatitis/chronic pelvic pain syndrome: A systematic review 抗生素和α受体阻滞剂联合治疗与抗生素单药治疗慢性前列腺炎/慢性盆腔疼痛综合征的疗效:系统综述

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-04-02 DOI: 10.1111/luts.12477

Fina Widia, Widi Atmoko, Natanael Parningotan Agung, Harrina Erlianti Rahardjo, Nur Rasyid, Ponco Birowo, Akmal Taher

Objectives

This study attempted to explore the efficacy of a combination of alpha-blockers and antibiotics compared with antibiotic monotherapy in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Methods

We searched PubMed/MEDLINE, Cochrane/CENTRAL, EBSCOHost/CINAHL, ProQuest, and Scopus on January 2020. Randomized controlled trials comparing antibiotic monotherapy with combination therapy of antibiotics and alpha-blockers in CP/CPPS patients lasting at least 4 weeks were included. The study eligibility assessment, data extraction, and study quality assessment were carried out by each author independently and in duplication.

Results

A total of six low- to high-quality studies with 396 patients were included in the study. Two reviews reported lower National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total scores in the monotherapy arm at Week 6. Only one study reported otherwise. On Day 90, the NIH-CPSI score was found to be lower in the combination group. In the pain, urinary, and quality-of-life domain, most studies agree that combination therapy is not superior to monotherapy. However, on Day 90, all domains were found to be lower in the combination therapy. Responder rates were found to vary between studies. Only four out of six studies reported a response rate. Responder rates were lower in the combination group at 6 weeks of observation. On Day 90, responder rates were found to be better in the combination group.

Conclusions

The combination therapy of antibiotics and alpha-blockers is not substantially better than antibiotic monotherapy in the first 6 weeks of treatment for CP/CPPS patients. This might not be applicable to a longer duration of treatment.

目的探讨α -受体阻滞剂联合抗生素治疗慢性前列腺炎/慢性盆腔疼痛综合征(CP/CPPS)的疗效，并与抗生素单药治疗进行比较。方法于2020年1月检索PubMed/MEDLINE、Cochrane/CENTRAL、EBSCOHost/CINAHL、ProQuest和Scopus。在CP/CPPS患者中，比较抗生素单药治疗与抗生素和α受体阻滞剂联合治疗持续至少4周的随机对照试验。研究合格性评估、数据提取和研究质量评估由每位作者独立完成，并重复进行。结果本研究共纳入6项低质量到高质量的研究，共纳入396例患者。两篇综述报道，在第6周，单药治疗组的美国国立卫生研究院慢性前列腺炎症状指数(NIH-CPSI)总分较低。只有一项研究与此相反。在第90天，发现联合组的NIH-CPSI评分较低。在疼痛、泌尿和生活质量方面，大多数研究一致认为联合治疗并不优于单一治疗。然而，在第90天，发现联合治疗的所有域都较低。研究发现应答率在不同的研究中有所不同。六项研究中只有四项报告了反应率。观察6周时，联合用药组的应答率较低。在第90天，发现联合组的应答率更好。结论在CP/CPPS患者治疗的前6周，抗生素与α受体阻滞剂联合治疗并不明显优于抗生素单药治疗。这可能不适用于较长时间的治疗。

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引用次数: 0

Lower urinary tract symptoms are elevated with depression in Japanese women 日本女性的下尿路症状随着抑郁症而升高

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-03-30 DOI: 10.1111/luts.12478

Sahoko Ninomiya, Takashi Kawahara, Sohgo Tsutsumi, Hiroki Ito, Kazuhide Makiyama, Hiroji Uemura

Objectives

Depression might worsen lower urinary tract symptoms (LUTS), but the correlation is still disputed. This study examined the influence of depression on LUTS in Japanese women.

Methods

This study used a web-based questionnaire to evaluate the mental status of depression and LUTS. The mental status of depression was evaluated using the Quick Inventory of Depressive Symptomatology-Japanese version (QIDS-J), and LUTS was assessed based on the Overactive Bladder Symptom Score (OABSS) and responses to the International Consultation on Incontinence Questionnaire-Short Form.

Results

A total of 4151 of 5400 (76.9%) women responded to the questionnaire. The mean age was 48.3 ± 13.8 years. The OABSS gradually increased with the QIDS-J score. The incidence of overactive bladder (OAB) and urgency urinary incontinence (UUI) also increased along with the QIDS-J score. In the younger age group (20–39 years old), the risks of OAB and UUI were higher than in the elderly group (7.42 for OAB and 7.44 for UUI).

Conclusions

This study revealed that worsening of LUTS was correlated with depression.

目的抑郁症可能加重下尿路症状(LUTS)，但其相关性仍有争议。本研究考察了抑郁对日本女性LUTS的影响。方法采用基于网络的问卷调查方法，对抑郁症和LUTS患者的精神状态进行评估。采用抑郁症状快速量表-日本版(QIDS-J)评估抑郁的精神状态，根据膀胱过度活动症状评分(OABSS)和对失禁国际咨询问卷-短表的反应评估LUTS。结果5400名受访女性中有4151名(76.9%)回复了问卷。平均年龄48.3±13.8岁。OABSS随QIDS-J评分逐渐升高。膀胱过动症(OAB)和急迫性尿失禁(UUI)的发生率也随着QIDS-J评分的增加而增加。在年轻年龄组(20-39岁)，OAB和UUI的风险高于老年组(OAB为7.42,UUI为7.44)。结论LUTS的恶化与抑郁相关。

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引用次数: 1

Anatomic outcomes of sacrohysteropexy without posterior mesh placement in patients with asymptomatic grade 1 and 2 rectoceles: Is a rectouterine mesh really necessary? 无症状1级和2级直肠前突患者骶子宫切除术不放置后路补片的解剖结果:直肠后突补片真的有必要吗?

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-03-30 DOI: 10.1111/luts.12479

Adem Sancı, Khaled Obaid, Murat Topcuoglu, Mehmet İlker Gokce, Evren Süer, Ömer Gülpinar

Objectives

To present the anatomic outcomes of sacrohysteropexy surgery without posterior mesh placement in patients with asymptomatic grade 1 and 2 rectoceles.

Methods

The patients who underwent abdominal sacrohysteropexy without posterior mesh placement for the treatment of symptomatic grade 3 and 4 anterior/apical prolapse + asymptomatic grade 1 and 2 rectocele between May 2015 and January 2021 were evaluated retrospectively. The success rate, the anatomic outcomes (for anterior, apical, and posterior pelvic organ prolapse [POP]), and perioperative data of the surgical procedure were assessed. The objective failure criteria after surgery included the presence of grade 1 or higher in any compartment (anatomical criteria), recurrent POP requiring an operation, and/or usage of pessaries. Perioperative adverse events were categorized according to the Clavien–Dindo classification.

Results

Fifty-one patients underwent sacrohysteropexy without posterior mesh. The mean age of the patients was 56.8 ± 10 years. The success rates (anatomical outcomes) for the anterior/apical and posterior POP in the study group were 60.7%, 54.9%, and 58.8%, respectively, at a median follow-up time of 40.24 (24–71) months. The median hospital stay was 3.1 (2–6) days. The mean estimated blood loss was 127.6 (80–150) mL. The mean operation time was 114 (90–156) min. The mean urethral and catheter removal times were 1.3 (1, 2) and 2.1 (2–4) days, respectively. The mean recovery time of gastrointestinal motility was 14.4 h (11–35).

Conclusions

Sacrohysteropexy without posterior mesh placement might be associated with less pain, shorter operative time, and shorter recovery time of gastrointestinal motility, without compromising the anatomic success.

目的探讨无症状1级和2级直肠前突的骶宫闭术无后置补片的解剖效果。方法回顾性分析2015年5月至2021年1月间行无后置补片腹骶宫闭术治疗症状性3级和4级前/根尖脱垂+无症状性1级和2级直肠前突的患者。评估手术的成功率、解剖结果(前、顶、后盆腔器官脱垂[POP])和围手术期数据。手术后的客观失败标准包括任何隔室存在1级或更高级别(解剖学标准)，需要手术的复发性POP，和/或使用子宫托。围手术期不良事件按照Clavien-Dindo分类进行分类。结果51例患者行无后路补片骶子宫切除术。患者平均年龄56.8±10岁。在中位随访时间40.24(24-71)个月期间，研究组前/根尖和后侧POP的成功率(解剖学结果)分别为60.7%，54.9%和58.8%。中位住院时间为3.1(2-6)天。平均估计失血量为127.6 (80-150)mL，平均手术时间为114 (90-156)min，平均拔尿时间分别为1.3(1,2)天和2.1(2 - 4)天。胃肠运动恢复时间平均为14.4 h(11-35)。结论骶宫闭术后置补片可减轻疼痛，缩短手术时间，缩短胃肠运动恢复时间，不影响解剖成功。

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引用次数: 0

TOT in combination with solifenacin or intravaginal prasterone in postmenopausal women with mixed urinary incontinence: A retrospective analysis in 112 patients TOT联合索利那新或阴道内普酮治疗绝经后混合性尿失禁112例回顾性分析

IF 1.3 4区医学 Q3 UROLOGY & NEPHROLOGY

LUTS: Lower Urinary Tract Symptoms

Pub Date : 2023-03-04 DOI: 10.1111/luts.12476

Federica Sala, Melania Loggia, Giorgia Cardella, Claudia Morgani, Giovanni Grossi, Marzio Angelo Zullo, Herbert Carmelo Carlo Valensise, Pier Luigi Palazzetti, Michele Carlo Schiavi

Objectives

The aim of this study was to compare the efficacy of the transobturator tape (TOT) procedure combined with solifenacin (TOT-S) or prasterone (TOT-P) in postmenopausal women affected by mixed urinary incontinence (MUI) with a predominant stress urinary incontinence component.

Methods

This is a retrospective analysis including 112 patients: 60 patients of the TOT-S group and 52 patients of the TOT-P group. Physical examination, 3-day voiding diary, urodynamic tests, and Vaginal Health Index (VHI) were compared at the beginning of the analysis and after 12 weeks of follow-up (FU). Specific questionnaires were administered to indagate the impact on women's quality of life and sexual function.

Results

After 12 weeks of FU, the detrusor's peak flow pressure was significantly different between the two groups (p = .02). Detrusor overactivity decreased only in the TOT-P group (p = .05). At the end of FU, 58 patients (96.7%) of the TOT-S group and 50 patients (96.2%) of the TOT-P group were dry at the stress test. A significative group difference was observed in urge urinary incontinence (24 h) (p = .01) but not in the mean number of voids (24 h) and urgent micturition events (24 h). VHI improved only in the TOT-P group (12.57 ± 3.80 vs. 19.75 ± 4.13, p < .0001). The questionnaires and Patient Global Index of Improvement (PGI-I) scores showed comparable improvements, while the Female Sexual Function Index improved especially in the TOT-P group (p < .001).

Conclusions

In postmenopausal women with MUI, TOT-P demonstrated the same effectiveness as TOT-S in reducing urinary symptoms. In addition, TOT-P increased VHI and sexual function scores compared with TOT-S.

目的本研究的目的是比较经通气带(TOT)手术联合索利那新(TOT- s)或普睾酮(TOT- p)对绝经后妇女混合性尿失禁(MUI)的疗效，其中主要是压力性尿失禁成分。方法对112例患者进行回顾性分析，其中TOT-S组60例，TOT-P组52例。比较分析开始时和随访12周后的体格检查、3天排尿日记、尿动力学试验和阴道健康指数(VHI)。通过具体的问卷调查来显示对女性生活质量和性功能的影响。结果FU治疗12周后，两组逼尿肌峰值血流压力差异有统计学意义(p = 0.02)。只有TOT-P组逼尿肌过度活动减少(p = 0.05)。FU结束时，58例(96.7%)TOT-S组和50例(96.2%)TOT-P组在压力测试中处于干燥状态。急尿失禁(24 h)组间差异有统计学意义(p = 0.01)，平均排尿次数(24 h)和紧急排尿事件(24 h)组间差异无统计学意义(p = 0.01)。VHI仅在TOT-P组得到改善(12.57±3.80 vs. 19.75±4.13,p < 0.0001)。问卷调查和患者整体改善指数(PGI-I)评分显示出类似的改善，而女性性功能指数改善，特别是在TOT-P组(p < .001)。结论在绝经后MUI妇女中，TOT-P与TOT-S在减轻泌尿系统症状方面表现出相同的效果。此外，与TOT-S相比，TOT-P可提高VHI和性功能评分。

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引用次数: 0