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LUTS in Older Adults: Definitions, Comorbidity Impact, Patient Priorities, and Treatment Strategies for Managing Daytime and/or Nighttime Symptoms - ICI-RS 2024. 老年人的 LUTS:日间和/或夜间症状的定义、并发症影响、患者优先事项和治疗策略 - ICI-RS 2024。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-11 DOI: 10.1002/nau.25624
Andries Van Huele, Karel Everaert, William Gibson, Adrian Wagg, Paul Abrams, Alan Wein, Wendy F Bower

Introduction: Lower urinary tract symptoms (LUTS) are prevalent among older adults, a population that faces multiple medical challenges, with frailty being a major concern. Despite the high prevalence of LUTS, current treatment strategies for older adults are often inadequate. This paper aims to address these issues by defining daytime and/or nighttime LUTS and examining the impact of comorbid conditions on these symptoms. We will identify the priorities of older patients regarding LUTS management and propose treatment strategies to improve outcomes in this vulnerable population.

Methods: This review is based on discussions at the ICI-RS 2024 meeting in Bristol, UK, alongside an extensive literature review examining LUTS in older adults. The review explores distinctions between daytime and nighttime symptoms, the impact of frailty, patient priorities, treatment strategies and the role of comorbidities.

Results: LUTS in older adults present a complex and multifaceted challenge, with notable differences between daytime and nighttime manifestations, which may coexist. Clear definitions are needed. There is a lack of evidence that treating associated comorbidities will improve LUTS or urinary incontinence. Personalized care approaches, integrated into broader geriatric health strategies, are essential for addressing these symptoms. An ideal treatment strategy is proposed, focusing on daytime, nighttime or combined day- and nighttime LUTS. Further research is needed to refine treatment pathways and optimize outcomes for this population.

Conclusions: A comprehensive, individualized approach is necessary to address LUTS in older adults. Future research should focus on refining diagnostic definitions, exploring the interplay between comorbidities and LUTS, and developing patient-centered treatment strategies that account for both daytime and nighttime (or combined) symptoms.

导言:下尿路症状(LUTS)在老年人中非常普遍,老年人面临着多种医疗挑战,其中体弱是一个主要问题。尽管下尿路症状的发病率很高,但目前针对老年人的治疗策略往往不足。本文旨在通过定义日间和/或夜间 LUTS 并研究合并症对这些症状的影响来解决这些问题。我们将确定老年患者在 LUTS 治疗方面的优先事项,并提出治疗策略,以改善这一弱势群体的治疗效果:本综述基于在英国布里斯托尔举行的 ICI-RS 2024 会议上的讨论,以及对老年人 LUTS 的大量文献综述。综述探讨了日间和夜间症状的区别、虚弱的影响、患者的优先权、治疗策略以及合并症的作用:结果:老年人的 LUTS 是一项复杂而多方面的挑战,白天和夜间的表现存在明显差异,而且可能同时存在。需要明确的定义。目前尚无证据表明治疗相关合并症可改善尿失禁或尿失禁。将个性化护理方法融入更广泛的老年健康策略中,对于解决这些症状至关重要。我们提出了一种理想的治疗策略,主要针对日间、夜间或日夜结合的 LUTS。需要进一步开展研究,以完善治疗路径,优化这一人群的治疗效果:结论:要解决老年人的 LUTS 问题,必须采取全面、个性化的方法。未来的研究应侧重于完善诊断定义、探索合并症与 LUTS 之间的相互作用,以及制定以患者为中心、同时考虑白天和夜间(或合并)症状的治疗策略。
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引用次数: 0
Can We Better Understand, Diagnose, and Treat Ketamine-Induced Uropathy, and Can It Be Reversed? ICI-RS 2024. 我们能否更好地理解、诊断和治疗氯胺酮诱发的尿病?ICI-RS 2024.
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-11 DOI: 10.1002/nau.25612
François Hervé, Patrik Aronsson, D Carolina Ochoa, Gommert Van Koeveringe, Giovanni Mosiello, Marcio Augusto Averbeck, George Bou Kheir, Michel Wyndaele, Paul Abrams

Introduction: Ketamine, a versatile anesthetic, has seen increased recreational use, leading to significant health issues, including ketamine-induced uropathy (KIU). KIU manifests with lower urinary tract symptoms (LUTS) and can involve the upper urinary tract. This study aims to provide a comprehensive overview of KIU, addressing its pathophysiology, diagnostic strategies, and treatment options; and to define/identify future research priorities.

Methods: During the 2024 meeting of the International Consultation on Incontinence Research Society (ICI-RS) in Bristol, a dedicated Proposal (P) convened to explore KIU. This initiative involved a thorough review of existing literature, expert presentations, and consensus-driven discussions. The methodology ensured a comprehensive exploration of KIU from both clinical and pre-clinical perspectives, leading to actionable research recommendations.

Results: Understanding the mechanisms of KIU is crucial for developing effective treatment options targeting specific pathophysiological pathways. Key findings include bladder fibrosis driven by transforming growth factor-β1 (TGF-β1), elevated purinergic responses and upregulated P2X1 purinoceptor expression, decreased barrier function due to increased expression of antiproliferative factor (APF), and functional loss of the bladder through Cav1.2 channel blockade. Research indicates that fibrosis, typically considered irreversible, may be mitigated. However, the exact timing and extent of fibrosis initiation and its impact on long-term outcomes require further research. LUTS typically improve after ketamine cessation but relapse upon resumption, indicating a hypersensitivity mechanism involving elevated serum IgE levels. Advanced stages of KIU do not always correlate with LUTS severity, shedding light on potential systemic effects and the need for evaluating liver enzymes. Furthermore, psychological dependency on ketamine, due to its positive perceptive and mood-altering effects, complicates cessation efforts. Long-term management requires a holistic approach, integrating medical treatments and supportive measures to help patients navigate life with potentially irreversible complications.

Conclusion: This comprehensive review spans from fundamental pathology to practical clinical management, addressing both urological and systemic complications, and bridging insights from animal models to human applications. Developing effective treatment strategies necessitates addressing both the physical and psychological aspects of ketamine dependency.

简介:氯胺酮是一种用途广泛的麻醉剂,越来越多的人在娱乐中使用氯胺酮,这导致了严重的健康问题,包括氯胺酮诱发的尿病(KIU)。KIU 表现为下尿路症状(LUTS),也可累及上尿路。本研究旨在全面概述 KIU,探讨其病理生理学、诊断策略和治疗方案,并确定/识别未来的研究重点:方法:在 2024 年于布里斯托尔召开的尿失禁研究学会(ICI-RS)国际磋商会议期间,召集了一个专门的提案(P)来探讨 KIU。该倡议包括对现有文献、专家发言和共识驱动型讨论的全面回顾。该方法确保了从临床和临床前角度对 KIU 进行全面探讨,从而提出可操作的研究建议:结果:了解 KIU 的发病机制对于开发针对特定病理生理途径的有效治疗方案至关重要。主要发现包括转化生长因子-β1(TGF-β1)驱动的膀胱纤维化、嘌呤能反应升高和 P2X1 嘌呤受体表达上调、抗增殖因子(APF)表达增加导致的屏障功能下降,以及通过 Cav1.2 通道阻断导致的膀胱功能丧失。研究表明,通常被认为不可逆转的纤维化可能会得到缓解。然而,纤维化开始的确切时间和程度及其对长期疗效的影响还需要进一步研究。氯胺酮停用后,尿路症状通常会有所改善,但复用后又会复发,这表明存在血清 IgE 水平升高的超敏机制。KIU 的晚期并不总是与 LUTS 的严重程度相关,这说明了潜在的全身影响以及评估肝酶的必要性。此外,由于氯胺酮具有积极的感知和情绪改变作用,对氯胺酮的心理依赖也使戒毒工作变得更加复杂。长期管理需要采取综合方法,将医学治疗和支持性措施结合起来,帮助患者在可能出现不可逆并发症的情况下渡过难关:本综述从基础病理学到实际临床管理,涉及泌尿系统和全身并发症,并将动物模型的见解与人体应用相结合。要制定有效的治疗策略,就必须从生理和心理两方面解决氯胺酮依赖问题。
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引用次数: 0
Re: Khullar V, Lemmon B, Acar O, Abrams P, Vahabi B. Does COVID-19 Cause or Worsen LUT Dysfunction, What Are the Mechanisms and Possible Treatments? ICI-RS 2023 Neurourol Urodyn 2024 Aug; 43(6):1458-1463 doi: 101002/nau25441 Epub 2024 Mar 20 PMID: 38506116. 关于Khullar V, Lemmon B, Acar O, Abrams P, Vahabi B. COVID-19 会导致或加重 LUT 功能障碍吗?ICI-RS 2023 Neurourol Urodyn 2024 Aug; 43(6):1458-1463 doi: 101002/nau25441 Epub 2024 Mar 20 PMID: 38506116.
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-11 DOI: 10.1002/nau.25586
Salvatore Butticè, Rosa Pappalardo, Emre T Sener, Emanuele Caldarera
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引用次数: 0
Constrictive versus compressive bladder outflow obstruction in men: Does it matter? 男性收缩性膀胱流出道梗阻与压迫性膀胱流出道梗阻:这重要吗?
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-06-07 DOI: 10.1002/nau.25520
Wouter van Dort, Peter F W M Rosier, Thomas R F van Steenbergen, Bernard J Geurts, Laetitia M O de Kort

Introduction: Bladder outflow obstruction (BOO) is a urethral resistance (UR) at a level above a clinically relevant threshold. UR is currently graded in terms of the existence and severity of the BOO based on maximum flowrate and associated detrusor pressure only. However, the pressure-flow relation throughout the course of voiding includes additional information that may be relevant to identify the type of BOO. This study introduces a new method for the distinction between the provisionally called compressive and constrictive types of BOO and relates this classification to underlying patient and urodynamic differences between those BOO types.

Methods: In total, 593 high-quality urodynamic pressure-flow studies in men were included in this study. Constrictive BOO was identified if the difference Δp between the actual minimal urethral opening pressure (pmuo) and the expected pmuo according to the linearized passive urethral resistance relation (linPURR) nomogram was >25 cmH2O. Compressive BOO is identified in the complementary case where the pressure difference Δp ≤ 25 cmH2O. Differences in urodynamic parameters, patient age, and prostate size were explored.

Results: In 81 (13.7%) of the cases, constrictive BOO was found. In these patients, the prostate size was significantly smaller when compared to patients diagnosed with compressive BOO, while displaying a significantly lower maximum flowrate, higher detrusor pressure at maximal flowrate and more postvoid residual (PVR).

Conclusion: This study is an initial step in the validation of additional subtyping of BOO. We found significant differences in prostate size, severity of BOO, and PVR, between patients with compressive and constrictive BOO. Subtyping of voiding-outflow dynamics may lead to more individualized management in patients with BOO.

导言:膀胱流出道梗阻(BOO)是指尿道阻力(UR)超过临床相关阈值的水平。目前仅根据最大流量和相关的逼尿肌压力对膀胱流出道梗阻的存在和严重程度进行分级。然而,整个排尿过程中的压力-流量关系包含了可能与识别 BOO 类型相关的其他信息。本研究介绍了一种新方法,用于区分暂时称为压迫型和收缩型的 BOO,并将这种分类与这些 BOO 类型之间潜在的患者和尿动力学差异联系起来:本研究共纳入了 593 例高质量男性尿动力压力-流量研究。如果实际最小尿道开口压力(pmuo)与根据线性化被动尿道阻力关系(linPURR)提名图得出的预期pmuo之间的差值Δp>25 cmH2O,则可确定为收缩性BOO。在压力差 Δp ≤ 25 cmH2O 的补充情况下,可确定为压迫性 BOO。研究还探讨了尿动力学参数、患者年龄和前列腺大小的差异:结果:81 例(13.7%)患者发现了收缩性 BOO。这些患者的前列腺体积明显小于压迫性 BOO 患者,同时最大尿流率明显降低,最大尿流率时的逼尿肌压力升高,排尿后残余尿量(PVR)增加:这项研究是验证其他BOO亚型的第一步。我们发现,压迫性和收缩性 BOO 患者在前列腺大小、BOO 严重程度和 PVR 方面存在明显差异。对排空-流出动力学进行亚型分析,可能会为BOO患者提供更个性化的治疗方案。
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引用次数: 0
A theoretical model for brisk walking- and running-induced lower urinary tract symptoms (BRUTS) and the development of the BRUTS-questionnaire (BRUTS-Q): A focus group and Delphi study. 快走和跑步诱发下尿路症状(BRUTS)的理论模型和 BRUTS 问卷(BRUTS-Q)的开发:焦点小组和德尔菲研究。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-20 DOI: 10.1002/nau.25523
Olena Klahsen, Stéphanie Thibault-Gagnon, Linda McLean

Aims: Existing questionnaires provide limited information on the nature, severity and context surrounding lower urinary tract symptoms (LUTS) experienced during running, jogging and brisk walking. The aims of this study were to develop a theoretical model of the experience of LUTS by females participating in gait-based exercise activities and to use this model to generate a questionnaire to evaluate the presence, symptoms and bother associated with LUTS experienced by females during gait-based activities.

Methods: A theoretical model was developed through a review of the literature and refined through a focus group consultation including pelvic health physiotherapists, females who experienced leakage during exercise and academic researchers who studied female LUTS. A draft questionnaire was developed using key constructs identified in the model by the focus group. A new expert panel was recruited, which included physiotherapists, women with self-reported gait-induced LUTS and urogynecologists. This panel followed a DELPHI process to evaluate the relevance and completeness of the constructs within the questionnaire.

Results: Two rounds of consultation were required to reach consensus on the completeness of included constructs as well as the inclusion and wording of questions. The resulting questionnaire contains questions related to five key constructs: physical activity characteristics, symptoms of urgency, urgency urinary incontinence, stress urinary incontinence experienced during exercise and management/mitigation strategies adopted by respondents.

Conclusions: The content validity of the brisk walking- and running-induced lower urinary tracts symptoms questionnaire has been established. The next steps are to ensure that the questionnaire has adequate comprehensibility, followed by adequate measurement properties.

研究目的:现有的调查问卷只能提供跑步、慢跑和快走过程中出现的下尿路症状(LUTS)的性质、严重程度和相关情况的有限信息。本研究的目的是为参与步态运动活动的女性所经历的下尿路症状建立一个理论模型,并利用该模型编制一份问卷,以评估女性在步态活动中经历的下尿路症状的存在、症状和相关困扰:方法:通过查阅文献建立了一个理论模型,并通过焦点小组咨询(包括骨盆健康理疗师、在运动过程中出现漏尿的女性以及研究女性尿失禁的学术研究人员)完善了该模型。利用焦点小组在模型中确定的关键结构,编制了一份问卷草案。我们招募了一个新的专家小组,其中包括物理治疗师、自述有步态引起的 LUTS 的女性和泌尿妇科专家。该专家小组采用 DELPHI 流程对问卷中的构念的相关性和完整性进行评估:结果:需要经过两轮磋商,才能就所包含结构的完整性以及问题的包含和措辞达成共识。最终形成的调查问卷包含与五个关键要素相关的问题:体育锻炼特征、尿急症状、尿急尿失禁、运动过程中出现的压力性尿失禁以及受访者采取的处理/缓解策略:结论:快走和跑步引起的下尿路症状问卷的内容效度已经确定。下一步工作是确保问卷具有足够的可理解性,以及足够的测量特性。
{"title":"A theoretical model for brisk walking- and running-induced lower urinary tract symptoms (BRUTS) and the development of the BRUTS-questionnaire (BRUTS-Q): A focus group and Delphi study.","authors":"Olena Klahsen, Stéphanie Thibault-Gagnon, Linda McLean","doi":"10.1002/nau.25523","DOIUrl":"10.1002/nau.25523","url":null,"abstract":"<p><strong>Aims: </strong>Existing questionnaires provide limited information on the nature, severity and context surrounding lower urinary tract symptoms (LUTS) experienced during running, jogging and brisk walking. The aims of this study were to develop a theoretical model of the experience of LUTS by females participating in gait-based exercise activities and to use this model to generate a questionnaire to evaluate the presence, symptoms and bother associated with LUTS experienced by females during gait-based activities.</p><p><strong>Methods: </strong>A theoretical model was developed through a review of the literature and refined through a focus group consultation including pelvic health physiotherapists, females who experienced leakage during exercise and academic researchers who studied female LUTS. A draft questionnaire was developed using key constructs identified in the model by the focus group. A new expert panel was recruited, which included physiotherapists, women with self-reported gait-induced LUTS and urogynecologists. This panel followed a DELPHI process to evaluate the relevance and completeness of the constructs within the questionnaire.</p><p><strong>Results: </strong>Two rounds of consultation were required to reach consensus on the completeness of included constructs as well as the inclusion and wording of questions. The resulting questionnaire contains questions related to five key constructs: physical activity characteristics, symptoms of urgency, urgency urinary incontinence, stress urinary incontinence experienced during exercise and management/mitigation strategies adopted by respondents.</p><p><strong>Conclusions: </strong>The content validity of the brisk walking- and running-induced lower urinary tracts symptoms questionnaire has been established. The next steps are to ensure that the questionnaire has adequate comprehensibility, followed by adequate measurement properties.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"2185-2194"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141731323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
A better understanding of basic science may help our management of LUTS/LUTD in older persons with nocturnal polyuria and nocturia: ICI-RS 2024. 更好地了解基础科学有助于我们管理夜间多尿和夜尿症老年人的 LUTS/LUTD:ICI-RS 2024。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-25 DOI: 10.1002/nau.25565
Anthony Kanai, Karel Everaert, Apostolos Apostolidis, Christopher Fry, Pradeep Tyagi, Andries Van Huele, Bahareh Vahabi, Wendy Bower, Alan Wein, Paul Abrams

Aims: To discuss the role of autocrine/paracrine signaling of urothelial arginine vasopressin (AVP) on mammalian bladder capacities and micturition thresholds, impact of distension on water/urea reabsorption from the bladder, review of the literature to better characterize the central/peripheral effects of AVP, desmopressin (dAVP) toxicity, and urine biomarkers of nocturia.

Methods: This review summarizes discussions during an International Consultation on Incontinence-Research Society 2024 think tank with respect to the role of urothelial AVP in aged individuals with nocturnal polyuria, impact of solute and water reabsorption by the bladder on uninterrupted sleep, central effects of AVP, pharmacological basis of dAVP toxicity, and biomarkers in nocturia/lower urinary tract dysfunction (LUTD) with neurological diseases.

Results: Consensus recognized AVP function and pathways in the central nervous system (CNS), pre-proAVP localized using immunohistochemistry in bladder sections from adult/aged noncancerous human punch biopsies and rodent bladder sections is likely to accelerate the systemic uptake of water and urea from the bladder of anesthetized mice instilled with 3H-water and 14C-urea. Mechanisms for charged and uncharged solutes and water transport across the bladder, mechanism of dAVP toxicity, and utility of urine biomarkers in those with neurological diseases/nocturia were determined from literature reviews.

Conclusion: Pre-proAVP is present in human/rodent bladders and may be involved in water reabsorption from bladder that prevents the sensation of fullness for uninterrupted sleep in healthy adults. The mechanism of action of AVP in the CNS was discussed, as was electrolyte/water transport across the bladder, the basis for dAVP toxicity, and feasibility of urine biomarkers to identify nocturia/LUTD with neurological diseases.

目的:讨论尿道精氨酸加压素(AVP)的自分泌/旁分泌信号对哺乳动物膀胱容量和排尿阈值的作用、胀气对膀胱水/尿素重吸收的影响、为更好地描述AVP的中枢/外周效应而进行的文献综述、去氨加压素(dAVP)毒性以及夜尿的尿液生物标志物:本综述总结了尿失禁国际咨询会-2024 研究会智囊团的讨论内容,涉及尿道 AVP 在老年夜尿多症患者中的作用、膀胱对溶质和水的重吸收对不间断睡眠的影响、AVP 的中枢效应、dAVP 毒性的药理学基础以及夜尿/下尿路功能障碍(LUTD)与神经系统疾病的生物标志物:结果:一致公认 AVP 在中枢神经系统(CNS)中的功能和通路,使用免疫组化方法在成年/老年非癌症人体冲孔活检膀胱切片和啮齿动物膀胱切片中定位的前 AVP 可能会加速从灌注 3H 水和 14C 尿素的麻醉小鼠膀胱中全身吸收水和尿素。根据文献综述确定了带电和不带电溶质及水在膀胱中的转运机制、dAVP 的毒性机制以及尿液生物标志物对神经系统疾病/夜尿症患者的作用:结论:前AVP存在于人类/啮齿动物的膀胱中,可能参与了膀胱对水的重吸收,从而阻止了健康成年人不间断睡眠的饱胀感。会议讨论了 AVP 在中枢神经系统中的作用机制,以及电解质/水在膀胱中的转运、dAVP 毒性的基础和尿液生物标志物识别夜尿/LUTD 与神经系统疾病的可行性。
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引用次数: 0
Case log trends of urogynecology and reconstructive pelvic surgery fellows: A comparison of urology- and gynecology-based fellowship programs. 泌尿妇科和盆腔整形外科研究员的病例记录趋势:泌尿科和妇科研究员项目的比较。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-06-27 DOI: 10.1002/nau.25533
Alexandra L Tabakin, Rohan Sawhney, Adam M Daily, Harvey A Winkler, Dara F Shalom, Justina Tam, Wai Lee

Aims: Urogynecology and Reconstructive Pelvic Surgery (URPS) fellowship can be pursued after completion of either a urology (URO) or obstetrics and gynecology (GYN) residency. Our aim is to determine differences in graduating fellow cohort (GFC) case logs between URO- and GYN-based URPS programs.

Methods: Accreditation Council for Graduate Medical Education case logs for URPS GFCs in both GYN- and URO-based programs were analyzed for the 2019-2023 academic years (AY). Unpaired t-tests with Welch's correction were used to compare annual mean logged cases between URO- versus GYN-based GFCs for select surgical categories and the top 11 most logged index cases.

Results: GYN-based GFCs logged more cases for all pelvic organ prolapse (POP) categories including surgery on apical POP, anterior wall POP, and posterior wall POP (all p < 0.01), while URO-based GFCs logged more cases for surgery on the urinary system (p = 0.03). For the top 11 logged procedures, URO-based GFCs logged more sacral neuromodulation cases (p = 0.02), whereas GYN-based GFCs logged more slings, vaginal hysterectomies, minimally-invasive hysterectomies, vaginal apical POP, vaginal posterior POP, vaginal anterior POP, and minimally-invasive apical POP cases (all p < 0.01). There was no difference between URO- and GYN-based GFCs for complex urodynamics, cystoscopy with botox injection, or periurethral injection cases.

Conclusions: URO-based URPS fellows tend to graduate with more surgery on the urinary system and sacral neuromodulation cases, while GYN-based fellows perform more slings, hysterectomies, and POP surgery. These findings may help fellowships better understand potential differences in training among graduates from URO- and GYN-based programs and encourage collaboration to lessen these discrepancies.

目的:泌尿妇科与盆腔整形外科(URPS)研究员可在完成泌尿外科(URO)或妇产科(GYN)住院医师培训后继续深造。我们的目的是确定泌尿外科和妇产科URPS项目毕业研究员队列(GFC)病例记录的差异:方法:分析了2019-2023学年(AY)基于妇产科和URO项目的URPS GFC的病例日志。使用韦尔奇校正的非配对t检验比较了URO与GYN项目GFC在选定手术类别和前11个记录最多的指标病例方面的年度平均记录病例:结果:在所有盆腔器官脱垂(POP)类别中,妇科GFC记录的病例数更多,包括顶端POP、前壁POP和后壁POP手术(均为P 结论:妇科GFC的病例数更多:以泌尿外科为基础的URPS研究员在毕业时往往会进行更多的泌尿系统手术和骶神经调节手术,而以妇产科为基础的研究员则会进行更多的吊带、子宫切除和POP手术。这些发现可以帮助研究员更好地了解泌尿外科和妇科专业毕业生在培训方面的潜在差异,并鼓励他们开展合作以减少这些差异。
{"title":"Case log trends of urogynecology and reconstructive pelvic surgery fellows: A comparison of urology- and gynecology-based fellowship programs.","authors":"Alexandra L Tabakin, Rohan Sawhney, Adam M Daily, Harvey A Winkler, Dara F Shalom, Justina Tam, Wai Lee","doi":"10.1002/nau.25533","DOIUrl":"10.1002/nau.25533","url":null,"abstract":"<p><strong>Aims: </strong>Urogynecology and Reconstructive Pelvic Surgery (URPS) fellowship can be pursued after completion of either a urology (URO) or obstetrics and gynecology (GYN) residency. Our aim is to determine differences in graduating fellow cohort (GFC) case logs between URO- and GYN-based URPS programs.</p><p><strong>Methods: </strong>Accreditation Council for Graduate Medical Education case logs for URPS GFCs in both GYN- and URO-based programs were analyzed for the 2019-2023 academic years (AY). Unpaired t-tests with Welch's correction were used to compare annual mean logged cases between URO- versus GYN-based GFCs for select surgical categories and the top 11 most logged index cases.</p><p><strong>Results: </strong>GYN-based GFCs logged more cases for all pelvic organ prolapse (POP) categories including surgery on apical POP, anterior wall POP, and posterior wall POP (all p < 0.01), while URO-based GFCs logged more cases for surgery on the urinary system (p = 0.03). For the top 11 logged procedures, URO-based GFCs logged more sacral neuromodulation cases (p = 0.02), whereas GYN-based GFCs logged more slings, vaginal hysterectomies, minimally-invasive hysterectomies, vaginal apical POP, vaginal posterior POP, vaginal anterior POP, and minimally-invasive apical POP cases (all p < 0.01). There was no difference between URO- and GYN-based GFCs for complex urodynamics, cystoscopy with botox injection, or periurethral injection cases.</p><p><strong>Conclusions: </strong>URO-based URPS fellows tend to graduate with more surgery on the urinary system and sacral neuromodulation cases, while GYN-based fellows perform more slings, hysterectomies, and POP surgery. These findings may help fellowships better understand potential differences in training among graduates from URO- and GYN-based programs and encourage collaboration to lessen these discrepancies.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"1970-1976"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141458397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Early bladder dysfunction after vesicovaginal fistula repair: A prospective comparative analysis of transvaginal, open, and laparoscopic abdominal approaches. 膀胱阴道瘘修补术后早期膀胱功能障碍:经阴道、开腹和腹腔镜腹部方法的前瞻性比较分析。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-09 DOI: 10.1002/nau.25548
Madhur Anand, Manoj Kumar, Mayank Jain, Amber Gupta, Abhijeet Kumar, Bhupendra Pal Singh, Vishwajeet Singh, Apul Goel

Introduction: We aim to compare the clinical and urodynamic profile of lower urinary tract symptoms (LUTS) in patients undergoing laparoscopic, open transabdominal, and laparoscopic transabdominal vesicovaginal fistulae (VVF) repair at 3 months of repair, that is, in early postoperative period.

Materials and methods: Fifty-one consecutive patients with endoscopically confirmed VVF were enrolled in our study over 2 years. Malignant fistulae, radiation-induced, and complex fistulae were excluded after cross-sectional imaging. All patients underwent a postoperative assessment for the success of the repair. Then at 3 months, they completed the American Urological Association Symptom Score questionnaire and underwent a dual channel pressure-flow urodynamic study. The results of transvaginal, laparoscopic, and open transabdominal repairs were compared.

Results: All patients belonged to the Indian Caucasian race. The mean age was 35.43 ± 6.63 years. Thirty-two patients had supratrigonal and 19 had trigonal fistulae. Laparoscopic transabdominal repair was done in 15 patients, open transabdominal repair in 22 patients, and transvaginal repair in 14 patients. Forty-six patients reported some LUTS at a median follow-up of 5.83 ± 2.37 months postoperatively. Only 18 (35.2%) of these patients had moderate to severe symptoms The postoperative bladder dysfunction rates in open transabdominal, transvaginal and laparoscopic transabdominal groups were 36.4%, 28.6%, and 20%, respectively. Twenty-seven patients (52.9%) had some urodynamic abnormality, that is, small capacity (5), high voiding pressures (14), genuine stress incontinence (3), and poor compliance (3). Bladder capacity was a significant predictor of bladder dysfunction in our patients.

Conclusions: In our study, all three surgical approaches were associated with bladder dysfunction, however, it was the least in the laparoscopic transabdominal approach. Postoperative bladder capacity is a significant predictor of bladder dysfunction.

导言:我们旨在比较腹腔镜、开腹经腹和腹腔镜经腹膀胱阴道瘘(VVF)修补术患者在修补术后3个月,即术后早期的下尿路症状(LUTS)的临床和尿动力学特征:我们在两年内连续对51名经内镜确诊的膀胱阴道瘘患者进行了研究。经过横断面影像学检查,排除了恶性瘘管、辐射引起的瘘管和复杂瘘管。所有患者都在术后接受了修复成功与否的评估。3个月后,他们填写了美国泌尿协会症状评分问卷,并接受了双通道压力-流量尿动力学检查。比较了经阴道、腹腔镜和开腹经腹修补术的结果:所有患者均为印度高加索人种。平均年龄为 35.43±6.63 岁。32名患者为上三叉瘘,19名患者为三叉瘘。15名患者进行了腹腔镜经腹修补术,22名患者进行了开腹修补术,14名患者进行了经阴道修补术。术后中位随访时间为(5.83 ± 2.37)个月,有46名患者出现了尿失禁症状。开放式经腹、经阴道和腹腔镜经腹组的术后膀胱功能障碍发生率分别为 36.4%、28.6% 和 20%。27名患者(52.9%)有尿动力学异常,即容量小(5人)、排尿压力高(14人)、真正的压力性尿失禁(3人)和顺应性差(3人)。膀胱容量是预测患者膀胱功能障碍的重要因素:在我们的研究中,所有三种手术方式都与膀胱功能障碍有关,但腹腔镜经腹手术方式的膀胱功能障碍最少。术后膀胱容量是膀胱功能障碍的重要预测因素。
{"title":"Early bladder dysfunction after vesicovaginal fistula repair: A prospective comparative analysis of transvaginal, open, and laparoscopic abdominal approaches.","authors":"Madhur Anand, Manoj Kumar, Mayank Jain, Amber Gupta, Abhijeet Kumar, Bhupendra Pal Singh, Vishwajeet Singh, Apul Goel","doi":"10.1002/nau.25548","DOIUrl":"10.1002/nau.25548","url":null,"abstract":"<p><strong>Introduction: </strong>We aim to compare the clinical and urodynamic profile of lower urinary tract symptoms (LUTS) in patients undergoing laparoscopic, open transabdominal, and laparoscopic transabdominal vesicovaginal fistulae (VVF) repair at 3 months of repair, that is, in early postoperative period.</p><p><strong>Materials and methods: </strong>Fifty-one consecutive patients with endoscopically confirmed VVF were enrolled in our study over 2 years. Malignant fistulae, radiation-induced, and complex fistulae were excluded after cross-sectional imaging. All patients underwent a postoperative assessment for the success of the repair. Then at 3 months, they completed the American Urological Association Symptom Score questionnaire and underwent a dual channel pressure-flow urodynamic study. The results of transvaginal, laparoscopic, and open transabdominal repairs were compared.</p><p><strong>Results: </strong>All patients belonged to the Indian Caucasian race. The mean age was 35.43 ± 6.63 years. Thirty-two patients had supratrigonal and 19 had trigonal fistulae. Laparoscopic transabdominal repair was done in 15 patients, open transabdominal repair in 22 patients, and transvaginal repair in 14 patients. Forty-six patients reported some LUTS at a median follow-up of 5.83 ± 2.37 months postoperatively. Only 18 (35.2%) of these patients had moderate to severe symptoms The postoperative bladder dysfunction rates in open transabdominal, transvaginal and laparoscopic transabdominal groups were 36.4%, 28.6%, and 20%, respectively. Twenty-seven patients (52.9%) had some urodynamic abnormality, that is, small capacity (5), high voiding pressures (14), genuine stress incontinence (3), and poor compliance (3). Bladder capacity was a significant predictor of bladder dysfunction in our patients.</p><p><strong>Conclusions: </strong>In our study, all three surgical approaches were associated with bladder dysfunction, however, it was the least in the laparoscopic transabdominal approach. Postoperative bladder capacity is a significant predictor of bladder dysfunction.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"2101-2109"},"PeriodicalIF":1.8,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141559359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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
Response to letter to editor: Comparison of perioperative adverse events following suburethral sling placement using synthetic mesh, autologous rectus fascia, and autologous fascia lata in a National Surgical Registry. 回复致编辑的信:一个国家手术注册中心使用合成网片、自体直肌筋膜和自体腹股沟筋膜进行尿道下腔吊带置入术后围手术期不良事件的比较。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-16 DOI: 10.1002/nau.25531
Christopher X Hong, Young Son, Vaishnavi J Patel, Kimberly Lince, Priyanka Gupta
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引用次数: 0
Predicting success using response after lead implantation with sacral neuromodulation for urgency incontinence. 利用骶神经调控治疗急迫性尿失禁的导联植入后的反应预测成功率。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2024-11-01 Epub Date: 2024-07-29 DOI: 10.1002/nau.25562
Whitney K Hendrickson, Chong Zhang, James A Hokanson, Ingrid E Nygaard, Angela P Presson

Importance: Many women report inadequate symptom control after sacral neuromodulation (SNM), despite 50% reduction in urgency incontinence episodes (UUIE) after test stimulation.

Objective: To determine the ideal percent UUIE reduction after test stimulation that predicts 24-month success.

Study design: Using data from a multicenter SNM trial, we constructed receiver operating characteristic curves to identify an ideal threshold of percent UUIE reduction after test stimulation. We defined 24-month success as Patient Global Impression of Improvement of "very much better" to "better." We compared predictive accuracy of two models predicting success: (1) percent UUIE reduction alone and (2) with baseline characteristics.

Results: Of 149 women (median [IQR] baseline daily UUIE 4.7 [3.7, 6.0]), the ideal threshold for 24-month success was 72% (95% confidence interval 64,76%) UUIE reduction with accuracy 0.54 (0.42, 0.66), sensitivity 0.71 (0.56, 0.86) and specificity 0.27 (0.05, 0.55). The accuracy of the 50% reduction threshold was 0.60 (0.49, 0.71), sensitivity 0.95 (0.88, 1.0) and specificity 0.04 (0.0, 0.12). Percent reduction in UUIE was not better than chance in predicting 24-month success (concordance index [c-index] 0.47 [0.46, 0.62]); adding age, body mass index, diabetes mellitus and visual or hearing impairment the c-index was 0.68 (0.61, 0.78).

Conclusions: Among women who received an internal pulse generator (IPG) due to ≥50% UUIE reduction after test stimulation, we found no ideal threshold that better predicted 24-month success. Percent reduction in UUIE after test stimulation poorly predicts 24-month success with or without clinical factors. Given this, re-evaluating how we determine who should receive an IPG is needed.

重要性:许多女性在接受骶神经调节(SNM)治疗后,尽管尿急尿失禁发作次数(UUIE)减少了 50%,但症状控制仍不理想:研究设计:研究设计:利用一项多中心 SNM 试验的数据,我们构建了接收器操作特征曲线,以确定测试刺激后 UUIE 减少百分比的理想阈值。我们将 24 个月的成功定义为 "非常好 "到 "更好 "的 "患者总体改善印象"。我们比较了两种成功预测模型的预测准确性:(1) 单用 UUIE 降低百分比;(2) 基线特征:在 149 名女性(基线每日 UUIE 中位数 [IQR] 为 4.7 [3.7, 6.0])中,24 个月成功的理想阈值为 UUIE 减少 72%(95% 置信区间为 64%,76%),准确率为 0.54 (0.42, 0.66),灵敏度为 0.71 (0.56, 0.86),特异性为 0.27 (0.05, 0.55)。减少 50%阈值的准确度为 0.60 (0.49, 0.71),灵敏度为 0.95 (0.88, 1.0),特异度为 0.04 (0.0, 0.12)。在预测 24 个月的成功率方面,UUIE 的降低百分比并不优于偶然性(一致性指数 [c-index] 0.47 [0.46, 0.62]);加上年龄、体重指数、糖尿病和视力或听力损伤,c-index 为 0.68 (0.61, 0.78):结论:在因测试刺激后 UUIE 减少≥50% 而接受体内脉冲发生器 (IPG) 的妇女中,我们没有发现能更好地预测 24 个月成功率的理想阈值。无论是否存在临床因素,试验刺激后 UUIE 降低的百分比都不能很好地预测 24 个月的成功率。有鉴于此,我们需要重新评估如何确定哪些患者应该接受 IPG。
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Neurourology and Urodynamics
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