Neurourology and Urodynamics最新文献

Objective: To assess differences in clinical presentation and illness impact in men and women presenting with urologic chronic pelvic pain syndrome (UCPPS) and between men diagnosed with interstitial cystitis/bladder pain syndrome (IC/BPS) or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS).

Methods: 356 men and 605 women from six sites across the United States were assessed using a comprehensive set of demographic, symptom, and illness impact measures. Multivariable regression analyses examined differences between men and women and between men previously diagnosed with CP/CPPS or IC/BPS. In a stepwise manner, analyses tested group differences, controlling for demographic variables including symptom duration and presence of bladder pain that varied with filling and voiding.

Results: Men diagnosed with IC/BPS had the most severe UCPPS symptoms, followed by women with IC/BPS, and then men with CP/CPPS only. While men and women showed similar patterns of symptoms across most of the variables, women had increased widespread non-pelvic pain, greater pelvic floor tenderness on exam, and higher self-reported sensory sensitivity compared to men. About 60% of men diagnosed with CP/CPPS only reported bladder symptoms of painful filling or relief with voiding.

Conclusions: A generally shared symptom pattern was found across men and women irrespective of diagnostic labels suggesting the use of key marker symptoms, such as severity of bladder symptoms and widespread pain, to better identify subgroups of UCPPS rather than diagnostic category. Women may have an increased likelihood of increased sensitivity and central sensitization than men, including those men with IC/BPS.

Trial registration: ClinicalTrials.gov Identifier: NCT02514265 - MAPP Research Network: Trans-MAPP Study of Urologic Chronic Pelvic Pain: Symptom Patterns Study (SPS).

Introduction: With increased access to gender affirming care, the rate of vaginoplasties in the US has risen rapidly. Although some retrospective studies report high rates of lower urinary tract symptoms (LUTS) after gender affirming vaginoplasty, the type and severity of symptoms has not been well-described. The purpose of this study was to prospectively characterize postoperative changes in lower urinary tract function after robotic peritoneal flap vaginoplasty as measured by the American Urological Association Symptom Index questionnaire (AUASI), Urogenital Distress Inventory 6 (UDI6), and additional measures.

Methods: This was a prospective observational study of patients undergoing gender affirming robotic peritoneal flap vaginoplasty enrolled between August 2020 to September 2021. LUTS were evaluated pre- and postoperatively (1, 3, 6, and 12-month) via the AUASI, UDI6, uroflowmetry, and post void residual (PVR) measurements. Averages and 95% confidence intervals over time were estimated and compared through univariate mixed-effect linear regression models.

Results: A total of 43 patients were enrolled. The average patient age was 31.1 ± 9.1 years. Overall AUASI Score declined over time (p = 0.002; -0.42,-0.09), though the decrease was less than the clinically minimum importance difference (MID) of 3 points. Preoperative AUASI was 8.1 ± 5.2, 1 month: 8.1 (95% CI: -1.9,1.8); 3 months: 5.2 (-5.0,-1.2); 6 months: 5.7 (-4.6,-0.62); 12 months: 5.2 (-4.9,-0.81). Similarly, UDI6 score declined over time (p = 0.002; -1.12,-0.26), though the decrease was less than MID of 16.7 points. UDI6 score preoperatively was 16.3 ± 1.8; 1 month post op: 16.5 (-5.2,5.0); 3 months: 16.2 (-5.6,5.1); 6 months: 11.6 (-10,1.0), and at 12 months: 8.1 (-13,-2.3). Overall uroflowmetric outcomes measured at postoperative visits including post void residual volume, maximum flow velocity, and average flow velocity did not show any difference at any postoperative time point when compared with preoperative measurements.

Conclusions: In this study both the AUASI and UDI6 declined over time from initial preoperative evaluation to the 12 month follow up period, although the changes in AUASI and UDI6 score did not reach MID. Additionally, urodynamic measurements remained unchanged postoperatively. This data suggests that robotic peritoneal flap vaginoplasty has no effect on lower urinary tract function.

Objective: Vesicovaginal fistula (VVF) is a pathological communication between the urinary bladder and the vagina. The most common cause of VVF is hysterectomy, while less common causes include obstetric trauma and pelvic surgery. Most cases require surgical intervention. Although various techniques have been described for the management of VVF, none has been considered the gold standard of management. In this study, we describe our technique using buccal mucosal graft (BMG) as a second layer in the repair of VVF through a vaginal approach.

Methods: A total of 10 patients underwent surgery between May 2023 and December 2023. Patients were scheduled for follow-up 3 weeks after surgery or earlier for any new symptoms of urinary incontinence, overactive bladder, or dysuria. Before catheter removal, a CT cystogram was performed to confirm fistula closure. Additional follow-up visits were scheduled at 3-6 months after repair to assess outcome.

Results: Ten patients with a mean age of 35.7 ± 7.18 years were operated with the described technique. All patients had no recurrence of the fistula at the 6-month follow-up. None of them had additional morbidity due to the procedure. There were no post-operative complications.

Conclusions: Although the success rates of simple VVF are very high, the interposition of a tissue graft between the bladder and the vagina is required in the treatment of VVF, especially in those recurrent, large complex and radiation-induced fistulas. The buccal mucosa has a thick epithelium that provides strength to the graft and a thin submucosa that is important for revascularization, so its use as a second layer in VVF repair may be beneficial. Its harvesting is a relatively simple procedure. It is not time-consuming and is associated with low morbidity compared to Martius flap harvesting.

Objective: To test the Intra- and inter-rater reliability, measurement error and criteria and convergent validities of the Dualpex Plus (DP) for vaginal manometry in women with urinary incontinence (UI).

Design: This is a clinimetric properties study.

Setting: University Hospital in Brazil.

Population: One hundred and two women with UI.

Methods: Vaginal manometry was performed with DP and Peritron (Pr), in a random order. Intra-rater reliability was tested within a 1-week interval; inter-rater reliability was tested on the same day by two different evaluators. Perception of contraction and comfort with each device were assessed and compared with Chi-square or paired t tests. Reliability was evaluated by intraclass correlation coefficient (ICC) with a 95% confidence interval (CI). Criteria (with Pr) and convergent (with Oxford score) validities were evaluated by Pearson's correlation. The standard error of measurement (SEM) and the minimum detectable change were also calculated.

Main outcome measures: Intra- and inter-rater reliability, measurement error and criteria and convergent validities of the Dualpex Plus.

Results: DP showed substantial inter-rater and excellent intra-rater reliability (ICC = 0.85; 95% CI 0.76-0.91 and 0.90; 95% CI 0.86-0.93, respectively); strong and positive criteria validity (r = 0.83; p < 0.001) and convergent validity (r = 0.45; p < 0.001). Pressure values for pelvic floor muscle contraction were different between DP and Pr [17.61 ± 12.22 vs. 34.91 ± 21.22 cmH₂O; p < 0.001]. SEM was doubtful (19%) and the minimum detectable change was 0.152 cmH₂O. DP was more comfortable than Pr and perception of contraction was higher for Pr.

Conclusion: Dualpex Plus showed adequate clinimetric properties. Measurement error was considered doubtful. DP was more comfortable than Pr and perception of contraction was higher for Pr.

Background: Applicability of the virtual games has been increasingly added to rehabilitation treatments, including women's health interventions.

Objective: To develop a virtual interface designed to increase consciousness and relax the pelvic floor muscles, validate its content and appearance, and check the level of usability and satisfaction.

Methods: Physiotherapy specialists with experience in pelvic floor rehabilitation and database research were consulted to define the content. Thus, 13 physiotherapists specialized in the area participated in the content and appearance validation of the virtual game with a minimum agreement level of 80%. An evaluation of the usability level was conducted through MATCH (Checklist for Evaluation of the Usability of Applications for Touchscreen Phones) and the satisfaction level through a visual analog scale.

Results: The game is presented in two-dimensional (2D) configuration and is based on parachuting. The main activity required is muscle relaxation to open the parachute and descend to the target. The goal is to reach the target by traveling as long as possible with the parachute open. A physical exercise protocol from the American College of Sports Medicine was used to define the contraction/relaxation time. A total of 4 of the 15 items which represented the content and appearance for validation needed a second round to reach the desired level of agreement. The game showed a high level of usability M: 63.04 (±5.28) and the level of satisfaction of the virtual game showed an average of 9.7 (±0.55).

Conclusion: The virtual game developed for the pelvic floor muscle relaxation training showed content validity and adequate appearance and a high level of usability and satisfaction.

Introduction: Neurogenic bladder dysfunction is a prevalent condition characterized by impaired bladder control resulting from neurological conditions, for example, spinal cord injury or traumatic brain injury (TBI). Detrusor overactivity is a typical symptom of central nervous system damage. A lesion affecting the pontine neural network typically results in loss of tonic inhibition exerted by the pontine micturition center and causes involuntary detrusor contractions. Intrathecal baclofen (ITB), primarily indicated for spasticity management, holds potential in addressing the underlying mechanisms of neurogenic bladder dysfunction.

Methods: Urodynamic data were extracted from clinical charts of patients with severe supraspinal spasticity who received ITB treatment. Urodynamic studies were performed before pump implantation (PRE), after surgery (POST), and when achieving an effective steady state ITB dosage (ss-ITB), as reflected by a reduction in Modified Ashworth Scale (MAS) score. To determine potential risk factors for a poor response to ITB with respect to bladder function, patients were post hoc categorized into good and poor responders based on post void residual volume at ss-ITB.

Results: Apart from significantly reducing MAS scores, ITB caused significant increases in reflex volume, bladder capacity, and residual volume, and significant decreases in maximal detrusor and vesical pressures. Significant differences between good and poor responders (with respect to bladder function) were noted for reflex volume, bladder capacity, and residual volume at ss-ITB, whereas no urodynamic parameter served to differentiate the two groups at PRE.

Discussion: This study confirms a beneficial effect of ITB on bladder function in patients with severe supraspinal spasticity. However, concurring with the literature, a small subgroup of patients experienced serious deterioration in terms of increased reflex volume and residual volume, posing the risk of subsequent renal damage. Unfortunately, no urodynamic parameter predicted such a poor response to ITB before treatment initiation.

Objective: Adult patients with neurogenic lower urinary tract dysfunction (NLUTD) often have urinary symptoms that impact their quality of life (QOL). Our objective is to identify and summarize studies evaluating QOL changes across different NLUTD surgical interventions.

Methods: A systematic rapid evidence review was carried using EMBASE and MEDLINE. We included adult patients (> 18 years old) with NLUTD who underwent a relevant surgery and had a measurement of QOL. We included pre-post study designs (primary focus) and cross-sectional studies (secondary focus). Studies were reviewed and data extracted by multiple assessors. Standardized data extraction tables were used, and qualitative synthesis was performed.

Results: Of the 1074 screened articles 26 were included. There were 3/15 studies that evaluated reconstructive surgery (augmentation and/or catheterisable channel) pre-post intervention (n = 94 patients); there was a 7%-28% relative improvement in bladder related and overall QOL using validated questionnaires, and a large magnitude of improvement in studies using unvalidated questionnaires. There were 3/7 studies that looked at urinary diversion pre-post intervention (n = 153 patients) and showed an approximately 20%-60% improvement in validated questionnaires assessing bladder specific quality of life, and 0%-25% improvement in overall quality of life. Finally, 3/4 studies were pre-post stress incontinence surgeries (n = 67 patients) and they found an improvement in the ICIQ questionnaire scores and study-specific questionnaires.

Conclusion: The literature supporting a change in QOL in adult NLUTD patients undergoing surgical interventions is extremely limited due to a lack of pre-post studies, and the frequent use of unvalidated outcome measures.

Objectives: Failures and complications associated with treatments comprising laparoscopic sacrohysteropexy (SHP) for advanced pelvic organ prolapse (POP) are unclear. We compared failure rates associated with SHP and laparoscopic supracervical hysterectomy (SCH)/sacrocolpopexy (SCP) for advanced POP to determine whether they differed.

Methods: Clinical data of patients who underwent SHP (n = 52) and SCH/SCP (n = 209) were retrospectively examined. Only patients with advanced Pelvic Organ Prolapse Quantification stage III or IV were included. A single surgeon performed the procedures between October 2019 and October 2022. The primary objective was to compare the composite failure (CF) rates of both groups during the first year after surgery. CF was defined as the leading edge of any compartment beyond the hymen, the presence of subjective bulging, or the need for reoperation. The secondary objective was to analyze complications within 30 days and 1 year postoperatively.

Results: CF rates at 1 year were 13.5% and 5.7% with SHP and SCH/SCP, respectively (odds ratio [OR], 2.54; 95% confidence interval [CI], 0.80-7.48; p = 0.072). The 30-day perioperative complication rates were 3.8% and 3.3% with SHP and SCH/SCP, respectively (OR, 0.66; 95% CI, 0.069-3.1). The postoperative complication rates were 1.9% and 4.3% with SHP and SCH/SCP, respectively (OR, 0.44; 95% CI, 0.0097-3.3).

Conclusions: Complications associated with SHP for advanced POP did not differ from those associated with SCH/SCP. However, the occurrence of CF was higher with SHP, indicating a potentially clinically meaningful difference.

Clinical trial registration: This retrospective cohort study of human participants performed at Hokusuikai-Kinen Hospital was conducted in accordance with the principles embodied in the Declaration of Helsinki and approved by the Institutional Review Board (approval number 2022-080).