Neurourology and Urodynamics最新文献

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).

Objectives: To automatically identify and diagnose bladder outflow obstruction (BOO) and detrusor underactivity (DUA) in male patients with lower urinary tract symptoms through urodynamics exam.

Patients and methods: We performed a retrospective review of 1949 male patients who underwent a urodynamic study at two institutions. Deep Convolutional Neural Networks scheme combined with a short-time Fourier transform algorithm was trained to perform an accurate diagnosis of BOO and DUA, utilizing five-channel urodynamic data (consisting of uroflowmetry, urine volume, intravesical pressure, abdominal pressure, and detrusor pressure). We used fivefold cross-validation, constructing training and internal test sets from 1725 patients from Renmin Hospital of Wuhan University (RHWU) at a 4:1 ratio, and used an independent external validation set consisting of 224 patients from The Central Hospital of Wuhan (TCHO) to build and evaluate the DI model. We further conducted subgroup analyses to provide a more detailed description of the AI model's interpretability regarding urodynamics.

Results: The AUC scores of BOO and DUA, which were measured through the STFT-based deep learning method, were 0.945 ± 0.020 and 0.929 ± 0.039 in RHWU and 0.881 and 0.850 in TCHO, respectively. The diagnostic efficiency of other subgroup analyses and indicators was also effective.

Conclusion: In this study, the proposed deep neural network combined with the short-time Fourier transform method is robust and feasible for interpreting the results of urodynamics in men and has the potential for application to assist clinicians in real clinical settings.

Background: Nocturia is among the most common and bothersome urinary tract symptoms in older adults. While sleep quality is key to nocturia management, there is little information on the impact of nocturia itself on sleep quality. We investigated the impacts of nocturia on sleep quality and quality of life and explored factors contributing to reduced sleep quality.

Methods: A total of 186 men, aged 42-88 years (patients with nocturia and a control group), were evaluated using the Pittsburgh Sleep Quality Index, the Nocturia Quality-of-Life questionnaire, a visual analog scale measurement of dry mouth, and the Overactive Bladder Symptom Score, among other tools. Patients were graded into four categories of nocturia severity based on 3-day frequency volume charts. Factors associated with reduced subjective and comprehensive sleep quality were investigated using multiple regression analysis.

Results: Initial undisturbed sleep duration was negatively associated with nocturia frequency. Subjective and comprehensive sleep quality, overactive bladder scores, sleep efficiency and oral dryness were significantly associated with nocturia-related quality of life, when controlled for both age and nocturia severity. Sleep efficiency was a major predictor of reduced subjective and comprehensive sleep quality; overactive bladder scores and oral dryness were also independently significantly associated with reduced subjective and comprehensive sleep quality on multiple regression analysis, although nocturia frequency and initial undisturbed sleep duration were not.

Conclusions: It may be beneficial to conduct a comprehensive assessment for overactive bladder and dry mouth when managing nocturia in older adults with poor sleep quality.

Aim: To investigate urinary incontinence prevalence and its association with neurodevelopmental disorders among children in Japan.

Methods: A web-based survey was conducted on children aged 5-15 years in Japan. Information on daytime and nocturnal incontinence and neurodevelopmental disorders, such as attention deficit hyperactivity disorder, autism spectrum disorder, and intellectual disability, was collected.

Results: Responses from 5186 questionnaires (2619 boys, 2517 girls) were evaluated. In total, 505 children had neurodevelopmental disorders. Furthermore, 148 children had daytime urinary incontinence. The incidence of daytime urinary incontinence did not differ significantly according to sex. Daytime urinary incontinence was associated with neurodevelopmental disorders in 33.1% of children. Moreover, 220 children had nocturnal enuresis. Boys had a significantly higher prevalence of nocturnal enuresis than girls in the overall cohort and early elementary school age group. Nocturnal enuresis was associated with neurodevelopmental disorders in 29.1% of children. Children with daytime urinary incontinence or nocturnal enuresis had a significantly higher incidence of neurodevelopmental disorders.

Conclusions: The prevalence of concomitant daytime and nocturnal urinary incontinence and neurodevelopmental disorders in children is significant.