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How Should the BCI and BOOI Index be Correctly Applied in Patients With Low-Compliance Bladder? 低顺应性膀胱患者如何正确应用BCI和BOOI指数?
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2025-01-08 DOI: 10.1002/nau.25663
Xiao Zeng, Ting Kang, WenJiao Huang, Tao Jin
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引用次数: 0
Unilateral and Bilateral Transcutaneous Tibial Nerve Stimulation in Women With Overactive Bladder Syndrome: A Randomized Controlled Study (UBTTNS-OAB Study). 单侧和双侧经皮胫神经刺激治疗女性膀胱过度活动综合征:随机对照研究(UBTTNS-OAB 研究)。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2025-01-01 Epub Date: 2024-10-25 DOI: 10.1002/nau.25608
Letícia Martinelli Galhardo, Geovanna Volta Giorgenon, Marina Rótoli, Camila Carvalho de Araújo, Luiz G O Brito, Cássia R T Juliato

Introduction: The efficacy of unilateral versus bilateral Transcutaneous Tibial Nerve Stimulation (TTNS) for women with Overactive Bladder Syndrome (OAB) remains uncertain.

Objective: To compare the efficacy of unilateral and bilateral TTNS in the tibial region in women with OAB.

Methods: This randomized, controlled, triple-blind clinical trial included women with OAB or urgency-predominant urinary incontinence (UUI). Participants were randomized (1:1) into the Unilateral Tibial Group or Bilateral Tibial Group. Before treatment, they underwent a pre-assessment including peripheral sensitivity examination and completion of sociodemographic data and seven validated questionnaires on urinary symptoms, quality of life, sleep, and psycho-emotional aspects. TTNS interventions were administered twice weekly (12 sessions, 30 min each). Posttreatment, participants underwent another physical examination and completed the same questionnaires, with a 30-day follow-up. Categorical variables were analyzed using Chi-square or Fisher's Exact Test, while numerical variables were assessed with the Mann-Whitney test. Group comparisons over time utilized intention-to-treat ANOVA (p < 0.05).

Results: Thirty-five women participated: 17 in the unilateral group and 18 in the bilateral group. Mean ages were 55.1 (±14.7) years and 52.7 (±12.6) years, respectively (p = 0.680). Initial OAB severity (ICIQ-OAB) did not differ significantly between groups (p = 0.561). Both groups showed significant improvement in ICIQ-OAB scores: unilateral group from 10.1 (±3.4) to 5.8 (±3.4) (p < 0.001), bilateral group from 9.3 (±3.3) to 5.1 (±4) (p < 0.001), with no intergroup difference (p = 0.395). Improvement in UUI symptoms was observed: unilateral group from 2.2 (±1.4) to 0.7 (±1.5), bilateral group from 1.5 (±1.9) to 0.2 (±0.5), without significant intergroup difference (p = 0.645). Quality of life scores improved similarly between groups (p = 0.055).

Conclusion: TTNS appears to be effective in improving bladder storage and UUI symptoms in women with OAB, with no difference between unilateral and bilateral applications.

Clinical trial registration: Brazilian Registry of Clinical Trials (REBEC) (RBR: 96f2fgkn).

导言:单侧和双侧经皮胫神经刺激(TTNS)对膀胱过度活动综合征(OAB)女性患者的疗效仍不确定:比较单侧和双侧经皮胫神经刺激术对膀胱过度活动症女性患者的疗效:这项随机对照三盲临床试验的参与者包括患有尿失禁(OAB)或急迫性尿失禁(UUI)的女性。参与者被随机(1:1)分为单侧胫骨组或双侧胫骨组。在治疗前,他们接受了预评估,包括外周敏感度检查、社会人口学数据填写以及关于排尿症状、生活质量、睡眠和心理情感方面的七份有效问卷。TTNS 干预每周进行两次(12 次,每次 30 分钟)。治疗后,参与者再次接受身体检查,填写相同的问卷,并进行为期 30 天的随访。分类变量采用卡方检验(Chi-square)或费雪精确检验(Fisher's Exact Test)进行分析,数字变量采用曼惠尼检验(Mann-Whitney Test)进行评估。不同时间段的组间比较采用意向治疗方差分析(P 结果:35 名妇女参加了治疗:单侧组 17 人,双侧组 18 人。平均年龄分别为 55.1 (±14.7) 岁和 52.7 (±12.6) 岁(p = 0.680)。两组患者最初的 OAB 严重程度(ICIQ-OAB)无显著差异(p = 0.561)。两组患者的 ICIQ-OAB 评分均有明显改善:单侧组从 10.1(±3.4)分降至 5.8(±3.4)分(p 结论:TTNS 似乎能有效治疗 OAB:TTNS似乎能有效改善OAB女性患者的膀胱储尿和尿失禁症状,单侧和双侧应用之间没有差异:临床试验注册:巴西临床试验注册中心(REBEC)(RBR:96f2fgkn)。
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引用次数: 0
Prediction Value of Bladder Deformity Index for Upper Urinary Tract Damage in Patients With Neurogenic Bladder. 膀胱畸形指数对神经源性膀胱患者上尿路损伤的预测价值
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2025-01-01 Epub Date: 2024-11-11 DOI: 10.1002/nau.25610
Ran Chang, Limin Liao, Huafang Jing, Yi Gao, Siyu Zhang, Yue Wang, Juan Wu

Aim: This study aimed to assess the predictive value of the Bladder Deformity Index (BDI) in determining upper urinary tract (UUT) damage among patients with neurogenic bladder (NB).

Methods: Clinical data of 132 NB patients admitted to the China Rehabilitation Research Center between January 2018 and December 2023 were retrospectively analyzed. Patients were categorized into UUT damage and normal UUT function groups based on the MRU and ultrasound grading systems for hydronephrosis, patients with the grade greater than or equal to I degree were considered to have UUTD. Patient demographics, biochemical parameters, and video-urodynamics (VUDS) findings were collected, and BDI was calculated. Independent sample t tests were employed to compare general characteristics and VUDS parameters between groups. Receiver operating characteristic (ROC) curves were utilized to evaluate the predictive capability of UUT damage.

Results: The study comprised 132 patients (86 males and 46 females) with an average NB duration of 7.37 ± 9.37 years (range: 0.2-44 years). UUT damage was present in 40.91% (n = 54) of patients. Significant differences (p < 0.05) were observed between the UUT damage and normal groups in terms of the duration of LUTS (9.98 ± 10.52 vs. 4.83 ± 7.32 years), creatinine levels (135.58 ± 110.51 vs. 57.66 ± 12.26 μmol/L), and BDI (103.28 ± 71.6 vs. 19.23 ± 15.03%). No significant differences were noted in age, bladder volume, or residual urine between the groups (p > 0.05). The AUC for the duration of LUTS, creatinine, and BDI were 0.691, 0.786, and 0.908, respectively, with a BDI Yoden index of 77%.

Conclusion: Long-term LUTS, elevated creatinine levels, and high BDI are associated with UUT damage. BDI demonstrates high sensitivity and specificity in diagnosing UUT damage, outperforming creatinine levels and NB duration. Patients with BDI values exceeding 77% are at a heightened risk of UUT damage. BDI facilitates quantitative evaluation of cystography and preliminary evaluation upper and lower urinary tract function in NB patients. Further research is warranted to validate BDI's feasibility in quantifying cystography and diagnosing UUT damage.

Trial registration: This study is retrospective and does not require clinical trial registration.

目的:本研究旨在评估膀胱畸形指数(BDI)在判断神经源性膀胱(NB)患者上尿路(UUT)损伤方面的预测价值:回顾性分析2018年1月至2023年12月期间中国康复研究中心收治的132例NB患者的临床数据。根据MRU和超声肾积水分级系统将患者分为UUT损伤组和UUT功能正常组,分级大于或等于I度的患者被认为患有UUTD。收集患者的人口统计学资料、生化参数和视频尿动力学(VUDS)检查结果,并计算 BDI。采用独立样本 t 检验比较组间一般特征和 VUDS 参数。利用受体操作特征曲线(ROC)评估 UUT 损伤的预测能力:该研究包括 132 名患者(86 名男性和 46 名女性),平均 NB 病程为 7.37 ± 9.37 年(范围:0.2-44 年)。40.91%的患者(n = 54)存在 UUT 损伤。差异显著(P 0.05)。LUTS持续时间、肌酐和BDI的AUC分别为0.691、0.786和0.908,BDI约登指数为77%:结论:长期尿失禁、肌酐水平升高和 BDI 偏高与 UUT 损伤有关。BDI 在诊断 UUT 损伤方面具有较高的灵敏度和特异性,优于肌酐水平和 NB 持续时间。BDI 值超过 77% 的患者发生 UUT 损伤的风险较高。BDI 有助于对膀胱造影进行定量评估,并初步评估 NB 患者的上下尿路功能。需要进一步研究验证 BDI 在量化膀胱造影和诊断 UUT 损伤方面的可行性:本研究为回顾性研究,无需进行临床试验注册。
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引用次数: 0
Efficacy of Biofeedback Therapy for Giggle Incontinence in Children: How Many Sessions Are Required? 生物反馈疗法对儿童咯咯失禁的疗效:需要进行多少次治疗?
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2025-01-01 Epub Date: 2024-10-20 DOI: 10.1002/nau.25605
Furkan Adem Canbaz, Gonca Gerçel, Sefa Sağ

Introduction: Giggle incontinence (GI) is characterized by the sudden and involuntary expulsion of urine coinciding with episodes of laughter. The underlying pathophysiology of this condition remains unclear, and various treatment approaches are employed. The objective of this study is to assess the effectiveness of biofeedback (BF) therapy in treating GI and ascertain the requisite number of therapy sessions needed for efficacy.

Methods: Medical records of children treated with BF therapy for GI between November 2022 and November 2023 were retrospectively analyzed. The success of treatment was assessed after four and eight sessions, as well as following three maintenance sessions. Treatment outcomes were evaluated using the scoring system recommended by the International Children's Continence Society (ICCS), which categorizes responses into three levels: no response (Score 0), partial response (Score 1), and complete response (Score 2).

Results: Thirteen patients were initially diagnosed with GI. Of these, 10 patients were included in the study as three discontinued treatments. The cohort comprised an equal gender distribution with five females (50.0%) and five males (50.0%). The mean age of patients was 8.9 ± 3.3 (range 5-16) years. Two out of ten patients had a history of previous treatment for overactive bladder, while three had received treatment for primary monosymptomatic nocturnal enuresis. Following the completion of all BF sessions, the rate of complete response was observed at 80.0% (n = 8), while the partial response rate accounted for 10.0% (n = 1). Statistical analysis revealed significant differences in response scores after four and eight sessions (p < 0.01) as well as between the results after eight sessions and the completion of maintenance sessions (p < 0.01).

Conclusion: BF therapy demonstrates a high success rate in managing GI. Completion of at least eight BF therapy sessions enhances the probability of a successful outcome in the treatment of GI. Additionally, it has been observed that maintenance sessions contribute to the increased efficacy of the treatment.

简介傻笑性尿失禁(GI)的特点是在大笑时突然不自主地排出尿液。该病症的病理生理学尚不清楚,因此采用了多种治疗方法。本研究的目的是评估生物反馈疗法(BF)治疗遗尿症的效果,并确定疗效所需的治疗次数:方法: 对2022年11月至2023年11月期间接受生物反馈疗法治疗消化道疾病的儿童病历进行回顾性分析。在四次和八次治疗后,以及三次维持治疗后,对治疗的成功率进行了评估。治疗结果采用国际儿童尿失禁协会(ICCS)推荐的评分系统进行评估,该系统将反应分为三个等级:无反应(0 分)、部分反应(1 分)和完全反应(2 分):13名患者最初被诊断为消化道疾病。结果:13 名患者最初被诊断为消化道疾病,其中 10 名患者被纳入研究,因为有 3 名患者中断了治疗。患者性别分布均衡,其中女性 5 人(50.0%),男性 5 人(50.0%)。患者的平均年龄为 8.9 ± 3.3(5-16 岁)岁。十名患者中有两名曾接受过膀胱过度活动症治疗,三名曾接受过原发性单症状夜间遗尿症治疗。在完成所有膀胱过度活动治疗后,观察到完全应答率为 80.0%(8 人),部分应答率为 10.0%(1 人)。统计分析显示,四次治疗和八次治疗后的反应评分有明显差异(P 结论:BF 疗法对患者的成功率很高:BF 疗法在控制消化道疾病方面具有很高的成功率。完成至少八个 BF 治疗疗程可提高胃肠病治疗成功的概率。此外,据观察,维持疗程有助于提高疗效。
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引用次数: 0
The Association Between Urinary Incontinence With Pelvic Pain and Sensory-Motor Function in Older Women With Stroke. 中风老年妇女尿失禁与骨盆疼痛和感觉运动功能之间的关系
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2025-01-01 Epub Date: 2024-10-29 DOI: 10.1002/nau.25613
Fatih Özden, Yalcin Golcuk, Özgür Nadiye Karaman, Mehmet Özkeskin

Purpose: The study aimed to investigate the association between urinary incontinence (UI) severity, pelvic pain, and sensory-motor function in older women with stroke.

Methods: A cross-sectional prospective study was carried out with 102 older women individuals with stroke. Barthel Index (BI), Incontinence Impact Questionnaire Short Form (IIQ-7), Urogenital Distress Inventory (UDI-6), Pelvic Pain Impact Questionnaire (PPIQ), Somatosensory Amplification Scale (SASS), and Somatic Sensitivity Scale (SeSS) were used for clinical measurements.

Results: Partial correlational analyses with age, stroke duration, and BMI as covariates revealed a moderate positive correlation between SASS and IIQ-7 (r = 0.315, p < 0.001) and UDI-6 (r = 0.376, p < 0.001). On the other hand, there was a strong positive correlation between SASS and PPIQ (r = 0.522, p < 0.001). SeSS had a low positive correlation with IIQ-7 (r = 0.198, p < 0.05) and UDI-6 (r = 0.203, p < 0.05). In addition, there was a positive and moderate correlation between SeSS and PPIQ (r = 0.384, p < 0.001). Multivariate linear regression analysis revealed causality of SASS (R2 = 0.381, p < 0.001) and SeSS (R2 = 0.167, p < 0.001) with PPIQ.

Conclusions: Increased abnormal sensory sensitivity is associated with increased pelvic pain levels in women with stroke. Clinicians should consider sensory abnormalities, especially pain, within the scope of UI in women with stroke. Our results provide preliminary essential data for sensory and pain awareness during pelvic rehabilitation in stroke patients.

目的:该研究旨在调查中风老年妇女尿失禁(UI)严重程度、骨盆疼痛和感觉运动功能之间的关系:对 102 名中风老年妇女进行了横断面前瞻性研究。临床测量采用巴特尔指数(BI)、尿失禁影响问卷简表(IIQ-7)、尿道窘迫量表(UDI-6)、盆腔疼痛影响问卷(PPIQ)、躯体感觉放大量表(SASS)和躯体敏感性量表(SeSS):结果:以年龄、卒中持续时间和体重指数为协变量的部分相关性分析显示,SASS 与 IIQ-7 之间存在中度正相关(r = 0.315,p 2 = 0.381,p 2 = 0.167,p 结论:感觉异常敏感度增加会导致患者的躯体疼痛和肢体麻木:感觉灵敏度异常的增加与中风女性骨盆疼痛程度的增加有关。临床医生应将感觉异常,尤其是疼痛纳入中风妇女的 UI 检查范围。我们的研究结果为中风患者骨盆康复期间的感觉和疼痛意识提供了初步的重要数据。
{"title":"The Association Between Urinary Incontinence With Pelvic Pain and Sensory-Motor Function in Older Women With Stroke.","authors":"Fatih Özden, Yalcin Golcuk, Özgür Nadiye Karaman, Mehmet Özkeskin","doi":"10.1002/nau.25613","DOIUrl":"10.1002/nau.25613","url":null,"abstract":"<p><strong>Purpose: </strong>The study aimed to investigate the association between urinary incontinence (UI) severity, pelvic pain, and sensory-motor function in older women with stroke.</p><p><strong>Methods: </strong>A cross-sectional prospective study was carried out with 102 older women individuals with stroke. Barthel Index (BI), Incontinence Impact Questionnaire Short Form (IIQ-7), Urogenital Distress Inventory (UDI-6), Pelvic Pain Impact Questionnaire (PPIQ), Somatosensory Amplification Scale (SASS), and Somatic Sensitivity Scale (SeSS) were used for clinical measurements.</p><p><strong>Results: </strong>Partial correlational analyses with age, stroke duration, and BMI as covariates revealed a moderate positive correlation between SASS and IIQ-7 (r = 0.315, p < 0.001) and UDI-6 (r = 0.376, p < 0.001). On the other hand, there was a strong positive correlation between SASS and PPIQ (r = 0.522, p < 0.001). SeSS had a low positive correlation with IIQ-7 (r = 0.198, p < 0.05) and UDI-6 (r = 0.203, p < 0.05). In addition, there was a positive and moderate correlation between SeSS and PPIQ (r = 0.384, p < 0.001). Multivariate linear regression analysis revealed causality of SASS (R<sup>2</sup> = 0.381, p < 0.001) and SeSS (R<sup>2</sup> = 0.167, p < 0.001) with PPIQ.</p><p><strong>Conclusions: </strong>Increased abnormal sensory sensitivity is associated with increased pelvic pain levels in women with stroke. Clinicians should consider sensory abnormalities, especially pain, within the scope of UI in women with stroke. Our results provide preliminary essential data for sensory and pain awareness during pelvic rehabilitation in stroke patients.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":"165-170"},"PeriodicalIF":1.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142522515","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
Surgery for female urethral stricture. 女性尿道狭窄手术。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2025-01-01 Epub Date: 2024-01-10 DOI: 10.1002/nau.25358
Béatrice Bouchard, Lysanne Campeau

Background: Female urethral stricture (FUS) is a rare entity that causes great morbidity and suffering in those affected. As the available scientific data is sparce, there are no formal guidelines or standard of care for this disease.

Methods: This is a narrative review of the surgical management for female urethral stricture. The literature review was performed on PubMed. Articles were limited to English, but there was no limitation in terms of date.

Results: Management of FUS is divided between endoscopic and open surgical repair. Urethral dilation with or without urethrectomy can be offered as a first-line treatment. However, the rate of success of this procedure remains inferior to open surgical repair, and its efficacy decreases with the number of previous dilations. For distal urethral strictures, distal urethrectomy and advancement meatoplasty may be considered. Vaginal flaps are readily available, easy to harvest, well-vascularized, and allow for a dorsal or ventral orientation urethroplasty. The results of this procedure are promising, but most studies are small and retrospective. Labia flaps are easily accessible, wet, hairless, and elastic. The main limitations with the use of vaginal or labial tissues are co-existing conditions such as lichen sclerosis or vaginal atrophy, which may affect future results. Vaginal and labial graft urethroplasty can be used when it is not possible to mobilize an adequate flap. Stricture-free rates of this technique are variable. In cases of more severe stricture, an augmentation urethroplasty using buccal mucosa graft may be necessary. The techniques used in FUS replicate those for male urethral strictures, where both ventral and dorsal approaches can be utilized.

Conclusions: Although there is growing interest in the field, the optimal management of FUS remains to be determined.

背景:女性尿道狭窄(FUS)是一种罕见的疾病,会给患者带来极大的发病率和痛苦。由于现有的科学数据稀少,目前还没有针对这种疾病的正式指南或标准护理方法:本文是一篇关于女性尿道狭窄手术治疗的叙述性综述。文献综述在 PubMed 上进行。文章限于英文,但没有日期限制:FUS的治疗分为内窥镜手术和开放手术修复。尿道扩张术加或不加尿道切除术可作为一线治疗方法。然而,这种手术的成功率仍然低于开放式手术修复,而且其疗效会随着先前扩张次数的增加而降低。对于远端尿道狭窄,可以考虑进行远端尿道切除术和前移肉膜成形术。阴道瓣随时可用,易于采集,血管丰富,可用于背侧或腹侧方向的尿道成形术。这种手术的效果很好,但大多数研究都是小规模和回顾性的。阴唇瓣容易获取、湿润、无毛且富有弹性。使用阴道或阴唇组织的主要限制是同时存在苔藓硬化症或阴道萎缩等疾病,这可能会影响未来的效果。阴道和阴唇移植尿道成形术可用于无法移动足够皮瓣的情况。这种技术的无狭窄率不尽相同。在尿道狭窄比较严重的情况下,可能需要使用颊粘膜移植尿道成形术。FUS 所使用的技术与男性尿道狭窄的技术相同,都可以采用腹侧和背侧入路:尽管人们对该领域的兴趣与日俱增,但 FUS 的最佳治疗方法仍有待确定。
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引用次数: 0
Bladder outlet obstruction in women: Advanced evaluation. 女性膀胱出口梗阻:高级评估。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2025-01-01 Epub Date: 2024-01-30 DOI: 10.1002/nau.25298
Patrick M Lec, Victor W Nitti

Introduction: Herein, we provide a review of the indications, practical considerations, and interpretation of urodynamics (UDS) with or without fluoroscopy, as well as cystourethroscopy, for women with suspected bladder outlet obstruction (BOO).

Methods and results: A narrative review was performed focusing on the current primary literature and society guidelines around advanced diagnostic modalities for female BOO patients. UDS studies help diagnose BOO by identifying high-pressure low-flow voiding patterns and/or the characteristic radiographic appearance of the bladder neck and urethra during micturition. Cystourethroscopy aids in evaluating structural aberrations of the bladder outlet, and in surgical planning.

Conclusions: UDS studies and cystourethroscopy are useful adjuncts in carefully-selected female patients with suspected BOO.

导言:在此,我们将对疑似膀胱出口梗阻(BOO)女性患者进行带或不带透视的尿动力学检查(UDS)以及膀胱尿道镜检查的适应症、实际注意事项和解释进行综述:我们进行了一项叙述性综述,重点是当前的主要文献以及有关女性膀胱出口梗阻患者先进诊断方法的协会指南。膀胱尿道造影(UDS)研究通过识别高压低流量排尿模式和/或排尿时膀胱颈和尿道的特征性影像学外观来帮助诊断膀胱出口梗阻。膀胱尿道镜检查有助于评估膀胱出口结构畸变和手术规划:结论:尿道分泌物检查和膀胱尿道镜检查对于精心挑选的疑似 BOO 女性患者来说是非常有用的辅助检查手段。
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引用次数: 0
Occult Urinary Incontinence, Diabetes, Obesity, Prolapse Severity, and Type of Surgical Repair as Risk Factors for De Novo Stress Urinary Incontinence in Women Undergoing Surgical Repair of Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis. 隐匿性尿失禁、糖尿病、肥胖、脱垂严重程度和手术修复类型是接受盆腔器官脱垂手术修复的女性出现新的压力性尿失禁的风险因素:系统回顾与元分析》。
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2025-01-01 Epub Date: 2024-11-13 DOI: 10.1002/nau.25619
Ianne Kaline Bezerra Oliveira, Sergio Luis da Silva Calisto, Caroline Wanderley Souto Ferreira, Geraldo de Aguiar Cavalcanti

Purpose: The International Continence Society and the International Urogynecological Association have not yet standardized the definition of de novo stress urinary incontinence. Recent studies define the development of stress urinary incontinence as occurring after surgical repair of pelvic organ prolapse in previously continent women. The mechanisms that cause de novo stress urinary incontinence are not yet clear. Knowledge of the predictive factors for this outcome after surgical correction of pelvic organ prolapse would be useful for assessing whether a concomitant anti-incontinence procedure should be performed.

Materials and methods: The aim of this systematic review and meta-analysis was to identify some of the risk factors for de novo stress urinary incontinence: high body mass index, pelvic organ prolapse stage before surgery, presence of occult urinary incontinence, type of surgery, and the presence of diabetes mellitus. The present study was registered in the PROSPERO database under number CRD42021293764, and the systematic review was carried out according to the MOOSE recommendations and with the PRISMA 2020 guidelines.

Results: A total of 2429 articles were identified. Nine cohort studies were included in the systematic review and seven in the meta-analysis. The risk of bias was assessed via the Newcastle-Ottawa scale and the certainty of evidence was assessed using the GRADE approach for each outcome. In the meta-analysis, associations were identified between de novo stress urinary incontinence and occult urinary incontinence (n: 422; OR: 2.01; 95% CI: 1.26-3.22; p = 0.004), diabetes (n: 1213; OR: 2.35; 95% CI: 1.30-4.26; p = 0.005), and advanced pelvic organ prolapse (n: 1003; OR: 1.94; 95% CI: 1.14-3.30; p = 0.01). Consulting a meta-analysis for the type of surgery was deemed impossible. A previous study comparing abdominal sacrocolpopexy with minimally invasive sacrocolpopexy revealed that women who underwent abdominal sacrocolpopexy were more likely to develop de novo stress urinary incontinence (n: 77; OR: 4.73; 95% CI: 1.56-14.34; p = 0.005). Another study found that pelvic organ prolapse repair using a transvaginal mesh was associated with higher levels of de novo stress urinary incontinence compared to robot-assisted sacrocolpopexy (n: 76; OR: 6.74; 95% CI: 1.35-33.75; p = 0.02). A meta-analysis of overweight or obesity was not possible due to the different assessment methods used in the studies.

Conclusions: This meta-analysis revealed that occult incontinence, diabetes, and advanced pelvic organ prolapse before repair were associated with de novo stress urinary incontinence and these groups may therefore benefit from for anti-incontinence procedures concomitant with pelvic organ prolapse repair.

目的:国际尿失禁协会(International Continence Society)和国际泌尿妇科协会(International Urogynecological Association)尚未统一新发压力性尿失禁的定义。最近的研究将压力性尿失禁定义为以前有尿失禁症状的妇女在进行盆腔器官脱垂手术修复后发生的尿失禁。导致新发压力性尿失禁的机制尚不清楚。了解手术矫正盆腔器官脱垂后出现这种结果的预测因素有助于评估是否应同时进行抗尿失禁手术:本系统综述和荟萃分析的目的是确定新发压力性尿失禁的一些风险因素:高体重指数、手术前的盆腔器官脱垂阶段、存在隐性尿失禁、手术类型以及存在糖尿病。本研究已在 PROSPERO 数据库中注册,编号为 CRD42021293764,并根据 MOOSE 建议和 PRISMA 2020 指南进行了系统综述:结果:共发现了 2429 篇文章。系统综述纳入了 9 项队列研究,荟萃分析纳入了 7 项队列研究。采用纽卡斯尔-渥太华量表对偏倚风险进行了评估,并采用 GRADE 方法对每项结果的证据确定性进行了评估。在荟萃分析中,发现新发压力性尿失禁与隐匿性尿失禁(n:422;OR:2.01;95% CI:1.26-3.22;p = 0.004)、糖尿病(n:1213;OR:2.35;95% CI:1.30-4.26;p = 0.005)和晚期盆腔器官脱垂(n:1003;OR:1.94;95% CI:1.14-3.30;p = 0.01)之间存在关联。针对手术类型进行荟萃分析被认为是不可能的。之前一项比较腹部骶骨结扎术和微创骶骨结扎术的研究显示,接受腹部骶骨结扎术的女性更有可能出现新的压力性尿失禁(n:77;OR:4.73;95% CI:1.56-14.34;p = 0.005)。另一项研究发现,与机器人辅助骶骨结扎术相比,使用经阴道网片进行盆腔器官脱垂修复术与较高的新发压力性尿失禁相关(n:76;OR:6.74;95% CI:1.35-33.75;p = 0.02)。由于各研究采用的评估方法不同,因此无法对超重或肥胖进行荟萃分析:这项荟萃分析表明,隐匿性尿失禁、糖尿病和修复前的晚期盆腔器官脱垂与新发压力性尿失禁有关,因此这些人群可能会受益于在进行盆腔器官脱垂修复术的同时进行抗尿失禁治疗。
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引用次数: 0
Urethrolysis. 尿道溶解
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2025-01-01 Epub Date: 2024-01-30 DOI: 10.1002/nau.25387
Lauren D Gleich, Howard B Goldman
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引用次数: 0
Can We Differentiate Between Organic and Functional Bladder Outlet Obstruction in Males With Parkinson's Disease? 我们能否区分帕金森病男性患者的器质性和功能性膀胱出口梗阻?
IF 1.8 3区 医学 Q3 UROLOGY & NEPHROLOGY Pub Date : 2025-01-01 Epub Date: 2024-10-14 DOI: 10.1002/nau.25599
Miguel Vírseda-Chamorro, Jesús Salinas-Casado, José-María Adot-Zurbano, Santiago Méndez-Rubio, Jesús Moreno-Sierra

Objectives: To determine the type of bladder outlet obstruction (BOO) in patients with Parkinson's disease (PD).

Material and method: A case-control study was carried out in 46 patients divided into two groups. Group 1 formed by 23 PD patients with BOO (a URA parameter ≥ 29 cm H2O). Group 2 formed by 23 patients with benign prostatic hyperplasia (BPH) and compressive obstruction (an opening pressure > 35 cm H2O) and URA parameter ≥ 29 cm H2O). Both groups underwent a pressure-flow study to calculate Dynamic Urethral Resistance Relationship (DURR) patterns. Based on previous research, we describe two types of DURR pattern. Pattern A typical of dynamic or functional obstruction and pattern B typical of static or organic obstruction.

Results: We found that PD patients had a significantly higher frequency of pattern A (70%) than BPH patients (4%). Other significant differences between groups were age (greater in PD group), bladder compliance (greater in PD group), maximum flow rate [Qmax (greater in BPH group)], maximum detrusor pressure [Pmax (greater in BPH group)], detrusor pressure at maximum flow rate [PQmax (greater in BPH group)], opening detrusor pressure (greater in BPH group), and the bladder contractility parameters BCI and Wmax (greater in BPH group). There were no significant differences in perineal voiding electromyography (EMG) activity between groups nor relationship between voiding EMG activity and the type of DURR pattern.

Conclusions: Our results are consistent with the usefulness of the DURR pattern to differentiate between functional and organic BOO in PD patients. Most PD patients have functional obstruction although a minority has organic obstruction consistent with BPH.

目的:确定帕金森病(PD)患者膀胱出口梗阻(BOO)的类型:确定帕金森病(PD)患者膀胱出口梗阻(BOO)的类型:对 46 名患者进行病例对照研究,分为两组。第一组由 23 名患有膀胱出口梗阻(URA 参数≥ 29 cm H2O)的帕金森病患者组成。第 2 组由 23 名患有良性前列腺增生症(BPH)和压迫性梗阻(开口压力大于 35 厘米水深)且尿道压力参数≥ 29 厘米水深)的患者组成。两组患者都接受了压力-流量研究,以计算动态尿道阻力关系(DURR)模式。根据以往的研究,我们描述了两种类型的 DURR 模式。A 型是典型的动态或功能性阻塞,B 型是典型的静态或器质性阻塞:我们发现,前列腺增生症患者出现 A 模式的频率(70%)明显高于良性前列腺增生症患者(4%)。各组之间的其他显着差异包括年龄(PD 组更大)、膀胱顺应性(PD 组更大)、最大流速[Qmax(BPH 组更大)]、最大逼尿肌压力[Pmax(BPH 组更大)]、最大流速下的逼尿肌压力[PQmax(BPH 组更大)]、开口逼尿肌压力(BPH 组更大)以及膀胱收缩力参数 BCI 和 Wmax(BPH 组更大)。各组间会阴部排尿肌电图(EMG)活动无明显差异,排尿肌电图活动与 DURR 模式类型之间也无关系:我们的研究结果表明,DURR模式有助于区分功能性和器质性BOO。大多数帕金森病患者有功能性梗阻,但也有少数患者有与良性前列腺增生症一致的器质性梗阻。
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Neurourology and Urodynamics
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