Neurourology and Urodynamics最新文献

Introduction: The reoperation rate for artificial urinary sphincters (AUS) in men is about 25%, with poorer survival rates when reimplantation occurs after urethral erosion or infection. Data on the outcomes of second AUS implants are rare, and no data exist for third AUS implants. We aimed to evaluate the functional and survival outcomes of a third AUS after two previous explantations.

Methods: The records of all patients implanted with a third AUS between 2006 and 2023 in seven French university hospitals were reviewed retrospectively. Only AUS implants following two previous AUS cuff explantations or revisions were included. The primary endpoint was the reoperation-free survival of the third AUS. Secondary endpoints included functional outcomes at 6 months and at the last follow-up, and overall functional outcomes after possible subsequent AUS implants, as well as reoperations.

Results: A total of 75 patients were included. Early complications occurred in 16.7% of patients. Median follow-up was 11 months (1-122), 28 explantations were required (37.3%). The 5-year reoperation-free survival rate was 34.8%. The only significant predictive factor for explantation was smoking. At 6 months, 66.2% of patients were socially continent (0-1 protection per day), 10.8% were improved, and 23% were unchanged or worsened. At the last follow-up of the third AUS, these results were 40%, 5.3%, and 54.7%, respectively. However, at the last overall follow-up (median 12 months, 1-183), social continence was 54.8%, improvement 9.6%, and failure 35.6%, with 23 patients (30.7%) receiving a fourth or fifth AUS.

Conclusion: Early functional outcomes of a third AUS are similar to primary AUS, but survival rates and late functional outcomes are inferior. Predictive factors for outcomes were related to patients, not the surgery itself. A third AUS may be suitable for motivated patients with limited therapeutic options. Further studies are needed to refine patient selection and assess the impact of reimplantation techniques on outcomes.

Aims: The goal of this study is to better understand the mechanisms and phenotypes of urinary urgency through the analysis of voiding patterns of clinical patients recorded in their bladder diaries.

Methods: A recently introduced, powerful dynamic analysis approach was used to analyze bladder diaries of a heterogeneous cohort of 227 patients treated in a single clinical practice. Individual voiding patterns were examined by performing intra-subject correlation analyzes of bladder diary variables and creating multivariable linear regression models. Individuals were clustered based on the characteristics of their voiding patterns.

Results: Five clusters of patients were identified based on their voiding patterns. Strong intra-subject correlations between bladder filling rate and urinary urge growth rate were demonstrated, indicating that bladder filling rate was the main driver of urinary frequency and of the intensity of the urge to void in most of the patients in each of the five clusters and in the whole heterogeneous clinical cohort.

Conclusions: Bladder filling rate was shown to be a driver of urinary urgency and frequency. Further studies are needed to explore the causes of the peaks of bladder filling rate and of the most beneficial behavioral modifications and treatments to reduce them, and therefore to minimize urinary urgency and frequency.

Introduction: There is an increasing recognition of the impact of ageing on pelvic floor health and the consequences in populations with rising proportions of women over the age of 65 years. A think tank was held at the ICI-RS 2024 to discuss the evidence to support the personalisation of women's pelvic floor health during the perinatal and perimenopausal period.

Methods: Data was collected and presented on the evidence to support the development of tools to personalise pelvic floor health care. Epidemiological, imaging, patient-reported outcomes, and evidence of tool development questionnaires were discussed. The current evidence and research gaps for potential intervention to prevent the pelvic floor disorders of pelvic organ prolapse, overactive bladder, urinary incontinence and faecal incontinence during the perinatal and perimenopasual time periods were discussed and identified.

Results: Epidemiological studies highlight that vaginal delivery and in particular operative vaginal delivery is the single biggest modifiable risk factor for the future development of pelvic floor dysfunction. The oestrogen depletion resulting from the perimenopause and menopause can lead to the development of Genitourinary syndrome of menopause (GSM) which is associated with the risk of developing pelvic floor dysfunction. Ultrasound is a useful technique for assessing the pelvic floor and has been used to assess bladder neck mobility, distensibility of the puborectalis muscle and the striated urethral sphincter volume antenatally with some studies reporting a correlation between these measurements and the need for Caesarean section and development of postpartum stress urinary incontinence. Further studies are needed to standardise these measurements. There are no patient reported outcome questionnaires validated for use in the perinatal and postmenopausal period. The UR- choice tool has been developed to counsel women on the risk of postpartum pelvic floor disorders occurring. However, further evaluation in larger numbers is required.

Conclusion: There is significant interest in developing tools to counsel women on the risks of developing pelvic floor dysfunction post partum and after the menopause. Further evaluation of the UR-choice tool was considered a research priority. The timepoint of cervical screening for research into interventions such as pelvic floor health education, lifestyle optimisation and perimenopausal vaginal oestrogen supplementation was identified.

BACKGROUND : Adverse childhood experiences (ACE) are associated with later psychological and somatic problems, including the emotional sequelae of adverse events (depression, anxiety, and catastrophizing) and outcomes such as chronic pain intensity and pain-related functioning. ACE have rarely been studied in women with pelvic, urogenital, and/or bladder pain (PUBP).

Aims: Thus, we examined how childhood adversities are related to psychological and pain-related outcomes in adult women. We also tested whether negative affect and pain catastrophizing mediated the relationship between ACE and pain-related outcomes.

Methods: A consecutive series of 310 adult women who presented at a tertiary urology center and reported PUBP completed an intake packet, which included the ACE Questionnaire as well as measures of psychological mediators and pain-related outcomes.

Results: Elevated ACEs were significantly associated with higher pain interference and vaginal insertion pain, as well as significantly related to negative affect (depression and anxiety) and pain catastrophizing. Both negative affect and pain catastrophizing were found to mediate the relationship of ACE to pain intensity and interference; however, only pain catastrophizing mediated the relationship between ACE and vaginal insertion pain.

Conclusions: These results suggest that ACEs may impact some pain-related outcomes in women with PUBP by influencing negative affect and pain catastrophizing. Thus, these processes are important targets for intervention in individuals with PUBP and a history of adverse childhood events.

Trial registration: This study does not require a clinical trial registration because it is not a clinical trial.

Introduction: Physician shortages are expected to worsen, especially in subspecialties like Urogynecology and Reconstructive Pelvic Surgery (URPS). To meet increasing demand, our study compares clinic visits and surgeries/procedures in URPS by reviewing clinical logs to understand practice pattern nuances.

Methods: URPS clinical logs from 2013 to 2021 were obtained from the American Board of Urology. Encounters were organized into URPS diagnostic groups, and the proportion of clinic visits to corresponding procedures was calculated. Multilevel mixed-effects logistic regression evaluated variability between surgeons, accounting for surgeon gender, age, certification status, and patient age.

Results: Three hundred seventy URPS urologists submitted 383 424 clinic and 323 929 procedural encounters, with 49% being URPS-related. Urinary incontinence (UI) was the most common URPS-diagnosis. The overall proportion of clinic visit encounters to procedural/surgical encounters was 3.9:1, ranging from 1.5:1 to 111:1, depending on the diagnosis. The proportion decreases to 1.1:1 when diagnostic procedures are included in surgeries. Multilevel regression identified that 14% of the variance in our proportion was explained by variation between physicians' practice (interclass correlation, clustering of patients under a physician). In regression models we found that female surgeons had greater than 20% increased odds of evaluating patients in the clinic (vs. procedure) for the diagnoses of overactive bladder (OAB; OR = 1.27, 95% CI = 1.09-1.48, p = 0.002), stress UI (OR = 1.29, 95% CI = 1.07-1.56, p = 0.008), UI (OR = 1.32, 95% CI = 1.15-1.54, p < 0.001), and pelvic organ prolapse (POP; OR = 1.94, 95% CI = 1.56-2.41, p < 0.001).

Conclusion: Urologists applying for URPS certification perform 3.9 clinic visits for every 1 surgery, and 1.1:1 clinic visits for every procedure. We found variation was attributed to clustering under physicians (practice patterns) but also found physician gender to influence the odds of performing surgeries with women surgeons seeing more clinic patients and performing less surgeries for OAB, UI, and POP. Taken together our findings show that clinic encounters and diagnostic procedures represent a substantial portion of URPS practice.

Clinical trials: This article is not presenting data from a clinical trial nor does it use human subjects. The data set is a deidentified retrospective log of cases.