Introduction: Making a treatment decision for female stress urinary incontinence (SUI) can be challenging for patients and healthcare providers. Dutch guidelines advise to counsel both pelvic floor muscle therapy and midurethral sling surgery as primary treatment options in uncomplicated moderate to severe cases. The use of a patient decision aid (PDA) can support decision-making, reduce decisional conflict and decisional regret, and increase knowledge. The aim of this study was to develop and evaluate an online PDA for females (SUI).
Methods: This mixed-methods study was performed in consecutive stages by a multidisciplinary working group. PDA design was based on the International Patient Decision Aids Standards (IPDAS) and on outcomes of needs assessments amongst patients and healthcare providers. Content was based on Dutch guidelines, targeted literature searches and patient information from the Dutch scientific society for gynecology. The concept version was evaluated by patients, patients' advocates, and healthcare providers.
Results: Using the nominal group technique, the working group established the design and format of the PDA. Fifty-six out of 58 applicable items of the IPDAS were met. The PDA contains information on the condition, advice on lifestyle adaptations, and describes surgical and nonsurgical treatment options. The option grid contains comparisons of the primary treatment options. Furthermore, value clarification exercises and narratives were included. Acceptability and usability evaluation of the concept version was performed by 15 healthcare providers, three patients, and two patients' advocates. Comments were processed in the working group, resulting in the final version of the PDA, which was supported by all assessors.
Conclusion: Our multidisciplinary working group developed an online PDA for women with moderate to severe SUI including conservative and surgical treatment options, based on IPDAS criteria, guidelines, scientific evidence, and needs assessments from patients and healthcare providers. This PDA is supported by patients, healthcare providers, scientific societies, and the Dutch patients' association. The next step is to evaluate and implement this PDA in daily practice.
Trial registration: ID 2014-308.
Aim: Sacral neuromodulation (SNM) is widely recognized as the essential treatment modality for patients suffering from various lower urinary tract disorders, particularly overactive bladder (OAB). This prospective study recruited patients who underwent variable frequency SNM treatment at six Chinese medical centers, aiming to evaluate the gender-specific effects of this intervention and provide precise guidance on its application for clinical management.
Methods: This prospective study was managed by Beijing Hospital, and six Chinese medical centers participated in this prospective research. Inclusion and exclusion criteria were established to screen patients based on the indication for SNM. During the research, all patients were required to record 72-h voiding diaries, urgency scores, and visual analogue scale (VAS) scores to reflect their disease symptoms. Additionally, subjective questionnaire surveys such as OAB symptom score (OABSS) and quality-of-life (Qol) score were recorded to reflect the patients' quality of life and treatment satisfaction.
Results: In this study, 52 patients (male patients: 25; female patients: 27) with OAB symptoms agreed to undergo variable frequency stimulation SNM therapy and finally convert to Stage II. Regarding the baseline outcomes, no significant differences were observed between the male and female groups. In terms of postoperative indicators, male patients showed a greater improvement in Qol scores compared to their female counterparts (20.06 ± 13.12 vs. 40.83 ± 26.06, p = 0.005). The results from VAS scores indicated that pain remission was more pronounced in male patients than in female patients (0.31 ± 0.87 vs. 1.67 ± 2.16, p = 0.02). Importantly, there was a statistically significant disparity in urinary urgency between males and females (male patients: 1.19 ± 1.56; female patients: 2.17 ± 1.52, p = 0.04).
Conclusions: In our study, we found that variable frequency SNM treatment yielded sex-specific differences in therapeutic effects, with male patients having a better outcome in some metrics. This suggests that a patient's sex may influence when variable frequency SNM is used, and in the patient's follow-up.
Trial registration: ClinicalTrials.gov identifier: ChiCTR2000036677.
Background: Video-urodynamic studies (VUDS) are the recommended standard of diagnostic care to objectively assess neurogenic lower urinary tract dysfunction (NLUTD) in individuals with spinal cord injury/disease (SCI/D). This examination requires the insertion of a catheter into the bladder, which increases the risk of a urinary tract infection (UTI). Data on symptomatic UTIs after VUDS are limited.
Methods: A single-center, observational study was conducted to evaluate the incidence of patient-reported UTI signs and symptoms 7 days after VUDS. No peri-interventional antibiotics were administered. The effect of sex, age, SCI/D duration, bladder evacuation method, bacteriuria, UTI prophylaxis, UTI history, or unfavorable VUDS results on the occurrence of patient-reported UTI signs or symptoms after VUDS was examined using binary logistic regression analysis.
Results: A total of 140 individuals with a mean age of 59.1 ± 14.0 years and a median SCI/D duration of 15.0 years (6/29 years) were evaluated. Seven days (mean 7 ± 1 days) after VUDS, 42 (30%) individuals reported at least one UTI sign or symptom. In the majority, signs and symptoms resolved without the need for antibiotic treatment, which was required in seven participants (5%). Male sex significantly (p = 0.04) increased the odds (odds ratio 3.74) of experiencing UTI signs and symptoms after VUDS.
Conclusions: In individuals with NLUTD, 30% experienced UTI signs and symptoms 1 week after VUDS. However, these signs and symptoms were transient and only 5% required antibiotic treatment. Thus, antibiotic prophylaxis does not seem necessary in all individuals with SCI/D undergoing VUDS.
Background: Machine learning algorithms as a research tool, including traditional machine learning and deep learning, are increasingly applied to the field of urodynamics. However, no studies have evaluated how to select appropriate algorithm models for different urodynamic research tasks.
Methods: We undertook a narrative review evaluating how the published literature reports the applications of machine learning in urodynamics. We searched PubMed up to December 2023, limited to the English language. We selected the following search terms: artificial intelligence, machine learning, deep learning, urodynamics, and lower urinary tract symptoms. We identified three domains for assessment in advance of commencing the review. These were the applications of urodynamic studies examination, applications of diagnoses of dysfunction related to urodynamics, and applications of prognosis prediction.
Results: The machine learning algorithm applied in the field of urodynamics can be mainly divided into three aspects, which are urodynamic examination, diagnosis of urinary tract dysfunction and prediction of the efficacy of various treatment methods. Most of these studies were single-center retrospective studies, lacking external validation, requiring further validation of model generalization ability, and insufficient sample size. The relevant research in this field is still in the preliminary exploration stage; there are few high-quality multi-center clinical studies, and the performance of various models still needs to be further optimized, and there is still a distance from clinical application.
Conclusions: At present, there is no research to summarize and analyze the machine learning algorithms applied in the field of urodynamics. The purpose of this review is to summarize and classify the machine learning algorithms applied in this field and to guide researchers to select the appropriate algorithm model for different task requirements to achieve the best results.
Background: Fecal incontinence, constipation, and pelvic pain are common pelvic floor symptoms (PFS), and frequently coexist with lower urinary tract symptoms (LUTS). However, their association with the longitudinal trajectory of LUTS have not been well described. Our objective was to investigate the association between PFS and the course of LUTS in community-dwelling men and women.
Methods: Men and women aged ≥16 years were invited to participate in a prospective observational cohort study. At baseline, and after 12 and 24 months, participants filled in the International Consultation on Incontinence Modular Questionnaire (ICIQ-MLUTS and ICIQ-FLUTS) for men and women respectively, the Wexner incontinence and constipation scale, and a questionnaire on pelvic pain. Generalized estimating equations were used to examine the association between change scores in defecation problems and pelvic pain, and LUTS change scores.
Results: A total of 694 men and 997 women gave informed consent, with 417 men and 566 women included in the analysis. The mean age was 63.2 ± 12.7 years for men and 58.6 ± 14.8 years for women. The study showed minor changes in LUTS scores over the 0-12 and 12-24-month periods. Generalized estimating equations revealed positive associations between changes in constipation and fecal incontinence and LUTS changes in both sexes. For instance, a one-point increase in Wexner constipation score was associated with 0.376 (0.165, 0.587) points higher LUTS change in men and 0.223 (0.109, 0.336) points in women during the 0-12-month follow-up. However, associations between changes in pain and LUTS scores varied across sexes and time periods.
Conclusions: We observed minor changes in LUTS over time and weak associations between PFS and LUTS that sometimes differed between males and females, emphasizing the need for sex-specific considerations. These insights can provide valuable guidance for the development of targeted prevention trials, ultimately aiming to enhance overall pelvic health and patient well-being.
Introduction/purpose: Sacral neuromodulation (SNM) is effective therapy for overactive bladder refractory to oral therapies, and non-obstructive urinary retention. A subset of SNM devices is associated with infection requiring surgical removal. We sought to compare microbial compositions of explanted devices in the presence and absence of infection, by testing phase, and other clinical factors, and to investigate antibiotic resistance genes present in the biofilms. We analyzed resistance genes to antibiotics used in commercially-available anti-infective device coating/pouch formulations. We further sought to assess biofilm reconstitution by material type and microbial strain in vitro using a continuous-flow stir tank bioreactor, which mimics human tissue with an indwelling device. We hypothesized that SNM device biofilms would differ in composition by infection status, and genes encoding resistance to rifampin and minocycline would be frequently detected.
Materials/methods: Patients scheduled to undergo removal or revision of SNM devices were consented per IRB-approved protocol (IRB 20-415). Devices were swabbed intraoperatively upon exposure, with controls and precautions to reduce contamination of the surrounding field. Samples and controls were analyzed with next-generation sequencing and RT-PCR, metabolomics, and culture-based approaches. Associations between microbial diversity or microbial abundance, and clinical variables were then analyzed using t-tests and ANOVA. Reconstituted biofilm deposition in vitro using the bioreactor was compared by microbial strain and material type using plate-based assays and scanning electron microscopy.
Results: Thirty seven devices were analyzed, all of which harbored detectable microbiota. Proteobacteria, Firmicutes and Actinobacteriota were the most common phyla present overall. Beta-diversity differed in the presence versus absence of infection (p = 0.014). Total abundance, based on normalized microbial counts, differed by testing phase (p < 0.001), indication for placement (p = 0.02), diabetes mellitus (p < 0.001), cardiac disease (p = 0.008) and history of UTI (p = 0.008). Significant microbe-metabolite interaction networks were identified overall and in the absence of infection. 24% of biofilms harbored the tetA tetracycline/minocycline resistance gene and 53% harbored the rpoB rifampin resistance gene. Biofilm was reconstituted across tested strains and material types. Ceramic and titanium did not differ in biofilm deposition for any tested strain.
Conclusions: All analyzed SNM devices harbored microbiota. Device biofilm composition differed in the presence and absence of infection and by testing phase. Antibiotic resistance genes including to rifampin and tetracycline/minocycline, which are used in commercially-available anti-infective pouches, were frequently detected. Isolated organisms from SNM devices demons
Introduction: Vibegron is a selective β3-adrenergic receptor agonist that was approved by the US Food and Drug Administration in December 2020 for the treatment of overactive bladder in adults. This retrospective study assessed US pharmacy claims data to evaluate the real-world adherence and persistence of vibegron compared with mirabegron and with anticholinergics.
Materials and methods: This analysis used the Optum Research Database to identify adults with ≥1 pharmacy claim for vibegron, mirabegron, or an anticholinergic from April 1, 2021, to August 31, 2022. Patients had ≥ 90 days of continuous commercial or Medicare medical and pharmacy coverage preindex and ≥ 60 days of continuous pharmacy coverage postindex. Two independent propensity-score models matched patients treated with (1) vibegron versus mirabegron and (2) vibegron versus anticholinergics on key variables such as demographics and clinical characteristics, index copay, days' supply, and time of entry into analysis (index quarter). Adherence was measured by proportion of days covered (PDC) from index to the end of follow-up and was defined as PDC ≥ 80%. Persistence was defined as days to discontinuation of index medication (first 30-day gap) or end of follow-up.
Results: The matched vibegron and mirabegron cohorts included 4921 and 9842 patients, respectively, and the matched vibegron and anticholinergic cohorts included 4676 and 9352 patients, respectively. Patients receiving vibegron had greater mean PDC versus patients receiving mirabegron (0.67 vs. 0.64, respectively; p < 0.001) or anticholinergics (0.67 vs. 0.58; p < 0.001). A greater percentage of patients receiving vibegron were adherent versus those receiving mirabegron (49.0% vs. 45.1%, respectively; p < 0.001) or anticholinergics (49.1% vs. 38.5%; p < 0.001). Persistence was longer with vibegron compared with both mirabegron (median [95% CI], 171 [159-182] vs. 128 [122-137] days, respectively; p < 0.001) and anticholinergics (172 [159-183] vs. 91 [91] days; p < 0.001).
Conclusion: In this retrospective analysis of pharmacy claims data, patients receiving vibegron exhibited significantly higher adherence and demonstrated longer persistence in comparison to matched patient cohorts receiving either mirabegron or anticholinergics.
Introduction: There is no guideline or clinical consensus concerning the mid-urethral sling (MUS) operation for stress urinary incontinence (SUI) and future pregnancies. The aim of this systematic review and metanalysis is to evaluate the impact of pregnancy and of delivery on SUI in women who previously sustained a MUS surgery.
Methods: We performed a systematic review and meta-analysis, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, and selected seven publications for inclusion in the analysis.
Results: Recurrence of SUI after childbirth in women previously submitted to MUS was 22% (95% confidence interval [CI]: 18.0%-26.0%; I2 = 0%) while the reintervention rate for SUI the 5% (95% CI: 2.0%-8.0%; I2 = 47.34%) in the included studies. There was not statistically significant difference between women who delivered (both vaginally and by caesarian section) or not after MUS in SUI recurrence (RR 1.01, 95% CI 0.73-1.40; p = 0.96 and I2-test of 41% p = 0.18) and in SUI reintervention (RR 1.45, 95% CI 0.91-2.30; p = 0.12 and I2-test of 0% p = 0.38) with homogeneity among studies. There was no difference between women who delivered vaginally or by caesarian section both for recurrence of SUI (RR 1.24, 95%CI 0.77-2.01; p = 0.37 and I2-test of 0% p = 0.60) and reintervention (RR 1.61, 95% CI 0.76-3.42; p = 0.22 and I2-test of 0% p = 0.47). BMI ≥ 30 kg/m2, urinary incontinence (UI) before and during pregnancy emerged as risk factors for postpartum UI relapse.
Conclusion: Childbirth do not affect SUI relapse or reintervention in women previously submitted to MUS. In the same population of patients, no difference was highlighted concerning the mode of delivery for the outcome SUI relapse or reintervention. Previous MUS surgery may not be an appropriate indication for cesarean birth in subsequent pregnancy.
Introduction: Alpha-adrenergic antagonists are widely prescribed for lower urinary tract symptoms (LUTS), however there has been a report that their use is associated with dementia. Our objective was to investigate if new users of alpha-adrenergic antagonists with varying levels of cognitive impairment had an increased risk of cognitive decline compared to non-users.
Methods: This was a retrospective cohort study, utilizing data from the National Alzheimer's Coordinating Center (NACC) data set. After applying relevant exclusion criteria, 916 people who were newly using alpha-antagonist medications were matched with a propensity score to 916 who were not using these medications. The primary outcome was a clinically relevant cognitive decline measured by the Clinical Dementia Rating (CDR) Dementia Staging Instrument or the mini mental state examination (MMSE). Secondary outcomes included scores from other cognitive assessment tools.
Results: The matched cohorts did not differ significantly in baseline characteristics. There were no statistically significant differences in baseline or follow-up cognitive scores between those exposed and nonexposed to alpha-adrenergic antagonists. Clinically significant cognitive decline (as defined by the CDR) occurred in 9.72% of the exposed group and 8.19% of the nonexposed group. There was no observed effect of alpha-adrenergic antagonists on cognitive decline, as measured with the CDR (odds ratio [OR] 1.34, p = 0.14) or the MMSE (OR 0.98, p = 0.92). Stratified analyses by cognitive status and apolipoprotein E genotype interaction assessment also demonstrated no significant associations.
Conclusion: Alpha-adrenergic antagonists for LUTS do not appear to increase the risk of cognitive decline, offering reassurance to clinicians and patients.
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：