Pub Date : 2024-11-16DOI: 10.1016/j.cont.2024.101728
A. Gammie , L. Thomas , A. Bacon , H. Yasmin , R. Axell , T. Greenwell , H. Hashim
A database of reliable, screened, good quality data is a vital tool for research. We present the structure of a database for urodynamic data that has been developed and proven in use by two major UK urology centres. We share with this paper a spreadsheet of the data structure for others to copy and use in their own departments, in the hope that clinical services can be streamlined, research encouraged and data easily combined for large studies. We also describe screening criteria to facilitate the removal of anomalous or erroneous data entries.
{"title":"A database structure for urodynamic records","authors":"A. Gammie , L. Thomas , A. Bacon , H. Yasmin , R. Axell , T. Greenwell , H. Hashim","doi":"10.1016/j.cont.2024.101728","DOIUrl":"10.1016/j.cont.2024.101728","url":null,"abstract":"<div><div>A database of reliable, screened, good quality data is a vital tool for research. We present the structure of a database for urodynamic data that has been developed and proven in use by two major UK urology centres. We share with this paper a spreadsheet of the data structure for others to copy and use in their own departments, in the hope that clinical services can be streamlined, research encouraged and data easily combined for large studies. We also describe screening criteria to facilitate the removal of anomalous or erroneous data entries.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"13 ","pages":"Article 101728"},"PeriodicalIF":0.0,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-07DOI: 10.1016/j.cont.2024.101724
Aytaj Jafarzade , Aydan Biri , Osman Ufuk Ekiz , Tamer Mungan
Aim:
This study aims to compare the efficacy of CO2 fractionated laser therapy and topical estrogen treatment in managing Genitourinary Syndrome of Menopause (GSM).
Materials and Methods:
A total of 88 patients diagnosed with GSM were included in this retrospective study. Of these, 39 received CO2 fractionated laser treatment, while 49 were treated with topical estrogen. Patients whose treatment was completed 1 to 1.5 months prior and had pre-treatment Vaginal Health Index (VHI) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scored recorded were included in the study. These patients were invited for a follow-up visit, during which post-treatment VHI and ICIQ-SF scores were assessed by a physician.
Results:
Both the laser and estrogen groups showed significant improvements in VHI and ICIQ-SF scores after treatment (p < 0.00001 for both groups). No statistically significant difference was found between the post-treatment VHI and ICIQ-SF scores of the two groups (p < 0.923 and p < 0.579, respectively).
Conclusion:
Although there was no significant difference in the treatment efficacy between estrogen and CO2 fractionated laser therapy, there was a considerable difference in cost, with CO2 fractionated, with laser treatment being 23–24 times more expensive. Therefore, CO2 fractionated laser therapy, which shows similar short-term efficacy to topical estrogen, may be more suitable for patients where hormone therapy is contraindicated.
{"title":"Vaginal LASER and estrogen comparison in Genitourinary Syndrome of Menopause","authors":"Aytaj Jafarzade , Aydan Biri , Osman Ufuk Ekiz , Tamer Mungan","doi":"10.1016/j.cont.2024.101724","DOIUrl":"10.1016/j.cont.2024.101724","url":null,"abstract":"<div><h3>Aim:</h3><div>This study aims to compare the efficacy of CO2 fractionated laser therapy and topical estrogen treatment in managing Genitourinary Syndrome of Menopause (GSM).</div></div><div><h3>Materials and Methods:</h3><div>A total of 88 patients diagnosed with GSM were included in this retrospective study. Of these, 39 received CO2 fractionated laser treatment, while 49 were treated with topical estrogen. Patients whose treatment was completed 1 to 1.5 months prior and had pre-treatment Vaginal Health Index (VHI) and International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) scored recorded were included in the study. These patients were invited for a follow-up visit, during which post-treatment VHI and ICIQ-SF scores were assessed by a physician.</div></div><div><h3>Results:</h3><div>Both the laser and estrogen groups showed significant improvements in VHI and ICIQ-SF scores after treatment (p < 0.00001 for both groups). No statistically significant difference was found between the post-treatment VHI and ICIQ-SF scores of the two groups (p < 0.923 and p < 0.579, respectively).</div></div><div><h3>Conclusion:</h3><div>Although there was no significant difference in the treatment efficacy between estrogen and CO2 fractionated laser therapy, there was a considerable difference in cost, with CO2 fractionated, with laser treatment being 23–24 times more expensive. Therefore, CO2 fractionated laser therapy, which shows similar short-term efficacy to topical estrogen, may be more suitable for patients where hormone therapy is contraindicated.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"13 ","pages":"Article 101724"},"PeriodicalIF":0.0,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142701136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-06DOI: 10.1016/j.cont.2024.101723
Ria Pothoven , Judith A.M. Derks , Erik Arendsen , Dick A.W. Janssen
Introduction:
Intravesical treatment is currently dependent on catheterization which can cause urethral discomfort and risk of urinary tract infections in selected patient groups such as interstitial cystitis/bladder pain syndrome (IC/BPS), overactive bladder syndrome (OAB) and recurrent urinary tract infections (rUTI). This study describes real-life clinical experience of a minimally invasive syringe adapter (Ialuadapter®) for catheter-free instillation of intravesical treatment.
Methods:
A retrospective study from a single center was performed. Quantitative and qualitative data was obtained on the use of the syringe adapter (Ialuadapter®) in 61 patients with IC/BPS (n=48), rUTI (n=6) and mixed /other diagnoses (including OAB; n= 7) who were receiving intravesical therapy. The evaluation period was 6 months during 2018–2019. Reasons for trying the syringe adapter, reasons for continuing with it and occurrence of UTIs before and during the evaluation period were recorded. In addition, 3 year follow-up data were obtained to assess long-term usage of the syringe adapter.
Results:
Mean follow-up was 4 months. The use of the syringe adapter was successful in 75% and a positive experience in 74% with the latter continuing to use the syringe adapter. Long-term (>3 yrs) adherence of 40% was observed. The patients reported less pain (41%) while 23% reported that it was easier to use compared to conventional catheters. Only 6 UTIs were observed in the follow-up period.
Discussion and conclusions:
This retrospective study shows that the Ialuadapter® is a good, safe alternative to conventional catheterization for intravesical treatment.
{"title":"Short and long-term clinical results of a minimally invasive syringe adapter for catheter free instillation of intravesical treatments","authors":"Ria Pothoven , Judith A.M. Derks , Erik Arendsen , Dick A.W. Janssen","doi":"10.1016/j.cont.2024.101723","DOIUrl":"10.1016/j.cont.2024.101723","url":null,"abstract":"<div><h3>Introduction:</h3><div>Intravesical treatment is currently dependent on catheterization which can cause urethral discomfort and risk of urinary tract infections in selected patient groups such as interstitial cystitis/bladder pain syndrome (IC/BPS), overactive bladder syndrome (OAB) and recurrent urinary tract infections (rUTI). This study describes real-life clinical experience of a minimally invasive syringe adapter (Ialuadapter®) for catheter-free instillation of intravesical treatment.</div></div><div><h3>Methods:</h3><div>A retrospective study from a single center was performed. Quantitative and qualitative data was obtained on the use of the syringe adapter (Ialuadapter®) in 61 patients with IC/BPS (n=48), rUTI (n=6) and mixed /other diagnoses (including OAB; n= 7) who were receiving intravesical therapy. The evaluation period was 6 months during 2018–2019. Reasons for trying the syringe adapter, reasons for continuing with it and occurrence of UTIs before and during the evaluation period were recorded. In addition, 3 year follow-up data were obtained to assess long-term usage of the syringe adapter.</div></div><div><h3>Results:</h3><div>Mean follow-up was 4 months. The use of the syringe adapter was successful in 75% and a positive experience in 74% with the latter continuing to use the syringe adapter. Long-term (>3 yrs) adherence of 40% was observed. The patients reported less pain (41%) while 23% reported that it was easier to use compared to conventional catheters. Only 6 UTIs were observed in the follow-up period.</div></div><div><h3>Discussion and conclusions:</h3><div>This retrospective study shows that the Ialuadapter® is a good, safe alternative to conventional catheterization for intravesical treatment.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"13 ","pages":"Article 101723"},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142660878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-05DOI: 10.1016/j.cont.2024.101726
Lisa Kane Low , Beverly Rosa Williams , Diane K. Newman , Jeni Hebert-Beirne , Sonya S. Brady , Deepa R. Camenga , Aimee S. James , Jean F. Wyman , D. Yvette Lacoursiere , Kathryn L. Burgio , The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium
Purpose:
Qualitative studies exploring bladder health are rare compared to research focusing on lower urinary tract symptoms (LUTS). Our aim was to explore adolescent and adult women’s perceptions about what constitutes a healthy bladder.
Methods:
We conducted a 7-site focus group study of bladder health with adolescent and adult women across six age categories (11–14 to 65+ years). Transcripts were analyzed using transdisciplinary, directed content analysis and an iterative interpretive consensus building approach to identify key constructs, focusing on “healthy bladder” and “unhealthy bladder” codes.
Results:
Forty-four focus groups with 360 participants were completed. Three thematic categories were identified: (1) concept of a healthy bladder (conceptual abstraction); (2) experience of a healthy bladder (subjective experience); and (3) lifestyle and life course considerations (bladder health in context). Participants struggled to define the unfamiliar concept of healthy bladder and relied on contextualized experiences and behaviors for characterizing bladder health. They described the concept of a healthy bladder as something that you did not need to think about but did require attention to healthy habits to maintain. Other features of a healthy bladder discussed include having bladder control despite urgency and environmental constraints on voiding, normal voiding frequency, and qualities of urine and urination. Participants struggled with lack of information about healthy bladder habits and noted absence of routine bladder health screening.
Discussion:
Findings identify need to promote public education and information sharing in health care visits about bladder health. Further they can inform bladder health promotion and clinical research on LUTS prevention.
{"title":"The many facets of perceived bladder health in women: Absence of symptoms and presence of healthy behaviors across the life course","authors":"Lisa Kane Low , Beverly Rosa Williams , Diane K. Newman , Jeni Hebert-Beirne , Sonya S. Brady , Deepa R. Camenga , Aimee S. James , Jean F. Wyman , D. Yvette Lacoursiere , Kathryn L. Burgio , The Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium","doi":"10.1016/j.cont.2024.101726","DOIUrl":"10.1016/j.cont.2024.101726","url":null,"abstract":"<div><h3>Purpose:</h3><div>Qualitative studies exploring bladder health are rare compared to research focusing on lower urinary tract symptoms (LUTS). Our aim was to explore adolescent and adult women’s perceptions about what constitutes a healthy bladder.</div></div><div><h3>Methods:</h3><div>We conducted a 7-site focus group study of bladder health with adolescent and adult women across six age categories (11–14 to 65+ years). Transcripts were analyzed using transdisciplinary, directed content analysis and an iterative interpretive consensus building approach to identify key constructs, focusing on “healthy bladder” and “unhealthy bladder” codes.</div></div><div><h3>Results:</h3><div>Forty-four focus groups with 360 participants were completed. Three thematic categories were identified: (1) concept of a healthy bladder (conceptual abstraction); (2) experience of a healthy bladder (subjective experience); and (3) lifestyle and life course considerations (bladder health in context). Participants struggled to define the unfamiliar concept of healthy bladder and relied on contextualized experiences and behaviors for characterizing bladder health. They described the concept of a healthy bladder as something that you did not need to think about but did require attention to healthy habits to maintain. Other features of a healthy bladder discussed include having bladder control despite urgency and environmental constraints on voiding, normal voiding frequency, and qualities of urine and urination. Participants struggled with lack of information about healthy bladder habits and noted absence of routine bladder health screening.</div></div><div><h3>Discussion:</h3><div>Findings identify need to promote public education and information sharing in health care visits about bladder health. Further they can inform bladder health promotion and clinical research on LUTS prevention.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"13 ","pages":"Article 101726"},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142660877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-05DOI: 10.1016/j.cont.2024.101725
Rachel Stading , Natalia Hernandez , Julian Pacheco , Lia Miceli , Danielle D. Antosh , Julie N. Stewart , Ricardo Gonzalez , Yahir Santiago-Lastra , Rose Khavari
Introduction:
In older adults, pharmacological treatment of overactive bladder (OAB) with anticholinergics and beta-3 agonists could be associated with negative cognitive effects; highlighting the need for alternative treatment modalities. Currently, there is relatively little evidence assessing outcomes of onabotulinomtoxin-A injection as thirdline therapy in this population. This study sought to evaluate the outcomes of intradetrusor BTX-A injection in patients over 70 years of age between August 2014 March 2022.
Methods:
A retrospective chart review was performed on patients with a clinical diagnosis of OAB and who underwent an initial intradetrusor onabotulinomtoxinA injection at 70 years or older from three US centers. Patient characteristics and self-reported symptoms before and after injection were statistically analyzed.
Results:
Amongst the 210 patients, 94% reported urinary urgency, 92% reported urgency urinary incontinence, and 89% reported daytime frequency. The most common medications initially prescribed were beta-3 agonist at 66% and anticholinergics at 65%. Following treatment, 80% reported >50% improvement in incontinence, 81% in urgency, 79% in daytime frequency, and 78% in nocturia. Temporary de novo intermittent catheterization was initiated in 8/210 (3.8%) patients, and one (0.5%) required indwelling catheter placement; with 67% returning for repeat injections. Thirty-six (17%) had a symptomatic urinary tract infection at follow-up. Seventy-five percent of patients did not require drug therapy following injection. In a subgroup analysis of octogenerians (n = 50/210), 73% showed improvement in urgency and 68% had less incontinence post-injection.
Discussion:
OnabotulinomtoxinA was well tolerated in patients older than 70 with improvement in overactive bladder symptoms and reduction in requirement of drug therapy.
{"title":"Intradetrusor OnabotulinumtoxinA outcomes for overactive bladder in older adults","authors":"Rachel Stading , Natalia Hernandez , Julian Pacheco , Lia Miceli , Danielle D. Antosh , Julie N. Stewart , Ricardo Gonzalez , Yahir Santiago-Lastra , Rose Khavari","doi":"10.1016/j.cont.2024.101725","DOIUrl":"10.1016/j.cont.2024.101725","url":null,"abstract":"<div><h3>Introduction:</h3><div>In older adults, pharmacological treatment of overactive bladder (OAB) with anticholinergics and beta-3 agonists could be associated with negative cognitive effects; highlighting the need for alternative treatment modalities. Currently, there is relatively little evidence assessing outcomes of onabotulinomtoxin-A injection as thirdline therapy in this population. This study sought to evaluate the outcomes of intradetrusor BTX-A injection in patients over 70 years of age between August 2014 March 2022.</div></div><div><h3>Methods:</h3><div>A retrospective chart review was performed on patients with a clinical diagnosis of OAB and who underwent an initial intradetrusor onabotulinomtoxinA injection at 70 years or older from three US centers. Patient characteristics and self-reported symptoms before and after injection were statistically analyzed.</div></div><div><h3>Results:</h3><div>Amongst the 210 patients, 94% reported urinary urgency, 92% reported urgency urinary incontinence, and 89% reported daytime frequency. The most common medications initially prescribed were beta-3 agonist at 66% and anticholinergics at 65%. Following treatment, 80% reported >50% improvement in incontinence, 81% in urgency, 79% in daytime frequency, and 78% in nocturia. Temporary <em>de novo</em> intermittent catheterization was initiated in 8/210 (3.8%) patients, and one (0.5%) required indwelling catheter placement; with 67% returning for repeat injections. Thirty-six (17%) had a symptomatic urinary tract infection at follow-up. Seventy-five percent of patients did not require drug therapy following injection. In a subgroup analysis of octogenerians (n = 50/210), 73% showed improvement in urgency and 68% had less incontinence post-injection.</div></div><div><h3>Discussion:</h3><div>OnabotulinomtoxinA was well tolerated in patients older than 70 with improvement in overactive bladder symptoms and reduction in requirement of drug therapy.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"12 ","pages":"Article 101725"},"PeriodicalIF":0.0,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142659521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1016/j.cont.2024.101719
Andrey Tomilov , Evgeniy Veliev , George Kasyan , Elena Golubtsova , Bagrat Grigoryan , Zurab Bagatelia , Dmitry Pushkar
Objective:
The aim of this review is to evaluate existing classification systems for surgical complications in male stress urinary incontinence (SUI) management, specifically highlighting the limitations of the widely used Clavien–Dindo classification in addressing infection-related complications. Additionally, this review introduces a novel reporting system, the pragmatic Complication Reporting System for Male Stress Urinary Incontinence Surgeries (COMUS), designed to improve the classification of complications and enhance clinical outcomes.
Evidence Acquisition:
SUI is a frequent postoperative complication that significantly impairs the quality of life in patients following surgeries for both malignant and benign prostate diseases. Surgical interventions such as artificial urinary sphincter and sling implantation carry a risk of complications, necessitating a robust system for evaluating and comparing outcomes. The Clavien–Dindo classification, although widely used, fails to adequately address the specific challenges in managing male SUI, particularly in relation to infections.
Results:
The newly developed pragmatic COMUS system classifies complications based on the level of intervention required for resolution, distinguishing between invasive and non-invasive treatments. Furthermore, it accounts for infection-related complications, which are often not fully addressed in other classification systems.
Conclusion:
The pragmatic COMUS system improves upon existing frameworks by incorporating infection management and grading complications according to treatment needs. This more comprehensive classification enhances the accuracy of outcome evaluation, ultimately aiding clinicians in making better-informed decisions for managing male stress urinary incontinence.
{"title":"Pragmatic reporting system for complications of male stress urinary incontinence surgeries (COMUS)","authors":"Andrey Tomilov , Evgeniy Veliev , George Kasyan , Elena Golubtsova , Bagrat Grigoryan , Zurab Bagatelia , Dmitry Pushkar","doi":"10.1016/j.cont.2024.101719","DOIUrl":"10.1016/j.cont.2024.101719","url":null,"abstract":"<div><h3>Objective:</h3><div>The aim of this review is to evaluate existing classification systems for surgical complications in male stress urinary incontinence (SUI) management, specifically highlighting the limitations of the widely used Clavien–Dindo classification in addressing infection-related complications. Additionally, this review introduces a novel reporting system, the pragmatic Complication Reporting System for Male Stress Urinary Incontinence Surgeries (COMUS), designed to improve the classification of complications and enhance clinical outcomes.</div></div><div><h3>Evidence Acquisition:</h3><div>SUI is a frequent postoperative complication that significantly impairs the quality of life in patients following surgeries for both malignant and benign prostate diseases. Surgical interventions such as artificial urinary sphincter and sling implantation carry a risk of complications, necessitating a robust system for evaluating and comparing outcomes. The Clavien–Dindo classification, although widely used, fails to adequately address the specific challenges in managing male SUI, particularly in relation to infections.</div></div><div><h3>Results:</h3><div>The newly developed pragmatic COMUS system classifies complications based on the level of intervention required for resolution, distinguishing between invasive and non-invasive treatments. Furthermore, it accounts for infection-related complications, which are often not fully addressed in other classification systems.</div></div><div><h3>Conclusion:</h3><div>The pragmatic COMUS system improves upon existing frameworks by incorporating infection management and grading complications according to treatment needs. This more comprehensive classification enhances the accuracy of outcome evaluation, ultimately aiding clinicians in making better-informed decisions for managing male stress urinary incontinence.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"12 ","pages":"Article 101719"},"PeriodicalIF":0.0,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142534916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.1016/j.cont.2024.101721
Basu Chakrabarty , Anthony J. Kanai , Marcus J. Drake , Christopher H. Fry
Aim:
ATP signalling is involved in urinary bladder motor and sensory pathways, including stimulation-mediated release from parasympathetic varicosities to detrusor muscle and from urothelial cells when mechanically stressed. Both modalities are present in humans and other mammals but are especially prominent in overactive bladder syndromes. There is therefore an unmet need to understand how to regulate such release. This study tested the hypothesis that the nitric oxide (NO•)/ soluble guanylate cyclase (sGC)/ cyclic GMP/ protein kinase-G (PKG) pathway has a central role.
Methods:
In vitro nerve-mediated contractions and ATP/acetylcholine (ACh) release were measured from bladder wall strips, as was ATP release from urothelial cell suspensions subject to mechanical stresses. Enhanced spontaneous contractile activity was also measured in bladder wall preparations of spinal cord-injured mice. Interventions were designed to increase cellular cGMP levels (a cell-permeable cGMP analogue, a NO• donor, a phosphodiesterase inhibitor (PDEI), a sGC activator), or agents to reduce activity of pathway enzymes (sCG or PKG).
Results:
ATP-dependent contractions were reduced by the above interventions, as was ATP release; but ACh-dependent contractions and ACh release were unaffected. Spontaneous contractile activity was also reduced by the cGMP analogue and by a PDEI. ATP release from urothelial cell suspensions was also reduced by similar interventions.
Conclusions:
ATP release from efferent nerves and from urothelial cells were selectively reduced by upregulating the NO•/sGC/cGMP/PKG pathway. Translational aspects are discussed with respect to purinergic pathways and overactive bladder pathologies.
目的：ATP 信号参与膀胱运动和感觉通路，包括副交感神经曲张到逼尿肌的刺激介导释放，以及尿路上皮细胞在机械压力下的释放。这两种模式都存在于人类和其他哺乳动物中，但在膀胱过度活动综合征中尤为突出。因此，人们需要了解如何调节这种释放。本研究测试了一氧化氮（NO-）/可溶性鸟苷酸环化酶（sGC）/环GMP/蛋白激酶-G（PKG）途径在其中发挥核心作用的假设。方法：从膀胱壁带测量了体外神经介导的收缩和ATP/乙酰胆碱（ACh）释放，并测量了在机械压力下尿道细胞悬浮液中的ATP释放。脊髓损伤小鼠的膀胱壁制备物中也测得了增强的自发收缩活动。干预的目的是提高细胞中 cGMP 的水平（一种细胞渗透性 cGMP 类似物、一种 NO 供体、一种磷酸二酯酶抑制剂 (PDEI)、一种 sGC 激活剂），或降低通路酶（sCG 或 PKG）的活性。cGMP类似物和PDEI也会降低自发性收缩活动。结论：通过上调 NO-/sGC/cGMP/PKG 通路，可选择性地减少传出神经和尿路细胞的 ATP 释放。结论：通过调节NO-/sGC/cGMP/PKG途径，可有选择性地减少传出神经和尿道细胞的ATP释放。
{"title":"Control of nerve-mediated and urothelial ATP release by a protein kinase G-dependent pathway in the mouse bladder","authors":"Basu Chakrabarty , Anthony J. Kanai , Marcus J. Drake , Christopher H. Fry","doi":"10.1016/j.cont.2024.101721","DOIUrl":"10.1016/j.cont.2024.101721","url":null,"abstract":"<div><h3>Aim:</h3><div>ATP signalling is involved in urinary bladder motor and sensory pathways, including stimulation-mediated release from parasympathetic varicosities to detrusor muscle and from urothelial cells when mechanically stressed. Both modalities are present in humans and other mammals but are especially prominent in overactive bladder syndromes. There is therefore an unmet need to understand how to regulate such release. This study tested the hypothesis that the nitric oxide (NO•)/ soluble guanylate cyclase (sGC)/ cyclic GMP/ protein kinase-G (PKG) pathway has a central role.</div></div><div><h3>Methods:</h3><div>In vitro nerve-mediated contractions and ATP/acetylcholine (ACh) release were measured from bladder wall strips, as was ATP release from urothelial cell suspensions subject to mechanical stresses. Enhanced spontaneous contractile activity was also measured in bladder wall preparations of spinal cord-injured mice. Interventions were designed to increase cellular cGMP levels (a cell-permeable cGMP analogue, a NO• donor, a phosphodiesterase inhibitor (PDEI), a sGC activator), or agents to reduce activity of pathway enzymes (sCG or PKG).</div></div><div><h3>Results:</h3><div>ATP-dependent contractions were reduced by the above interventions, as was ATP release; but ACh-dependent contractions and ACh release were unaffected. Spontaneous contractile activity was also reduced by the cGMP analogue and by a PDEI. ATP release from urothelial cell suspensions was also reduced by similar interventions.</div></div><div><h3>Conclusions:</h3><div>ATP release from efferent nerves and from urothelial cells were selectively reduced by upregulating the NO•/sGC/cGMP/PKG pathway. Translational aspects are discussed with respect to purinergic pathways and overactive bladder pathologies.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"12 ","pages":"Article 101721"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.cont.2024.101718
Karen Ward , Eric Bautrant , Gaurav Khatri , Sarah Love-Jones , Phyllis Glanc , Charlotte Korte , Nicolle Germano , Sherif Mourad , Hashim Hashim
Background:
Sacrohysteropexy and sacrocolpopexy are established treatments of uterine or vaginal vault prolapse respectively and involve insertion of mesh abdominally, often using permanent sutures and fixation devices. Complications following these procedures may be serious, and there is lack of evidence about long-term functional outcomes in terms of pain, dyspareunia and development of lower urinary tract and bowel symptoms.
Objective:
A non-systematic review of the available literature was performed and recommendations on assessment and management were developed by expert consensus.
Conclusion:
The current evidence is limited in quantity and quality, and recommendations on assessment management of mesh-related complications were made by experts in the field. Assessment and treatment of complications following abdominally placed mesh for pelvic organ prolapse will often require a multidisciplinary approach. Assessment may require EUA, and/or cystourethroscopy, sigmoidoscopy, and laparoscopy. MRI is the most useful imaging modality. Surgery to remove mesh carries a risk of urinary tract and bowel injury, as well as development of recurrent pelvic organ prolapse. A joint decision between the surgeon and the patient should be made before embarking on a partial removal of mesh; removal of all the mesh may be a better option albeit with higher risk of surgical complications. Complete removal of mesh and tacks or sutures from the sacral attachment may not be possible and is associated with risk of major haemorrhage.
{"title":"Diagnosis and treatment of abdominally inserted (sacrocolpopexy/sacrohysteropexy) mesh complications for vault/uterine prolapse","authors":"Karen Ward , Eric Bautrant , Gaurav Khatri , Sarah Love-Jones , Phyllis Glanc , Charlotte Korte , Nicolle Germano , Sherif Mourad , Hashim Hashim","doi":"10.1016/j.cont.2024.101718","DOIUrl":"10.1016/j.cont.2024.101718","url":null,"abstract":"<div><h3>Background:</h3><div>Sacrohysteropexy and sacrocolpopexy are established treatments of uterine or vaginal vault prolapse respectively and involve insertion of mesh abdominally, often using permanent sutures and fixation devices. Complications following these procedures may be serious, and there is lack of evidence about long-term functional outcomes in terms of pain, dyspareunia and development of lower urinary tract and bowel symptoms.</div></div><div><h3>Objective:</h3><div>A non-systematic review of the available literature was performed and recommendations on assessment and management were developed by expert consensus.</div></div><div><h3>Conclusion:</h3><div>The current evidence is limited in quantity and quality, and recommendations on assessment management of mesh-related complications were made by experts in the field. Assessment and treatment of complications following abdominally placed mesh for pelvic organ prolapse will often require a multidisciplinary approach. Assessment may require EUA, and/or cystourethroscopy, sigmoidoscopy, and laparoscopy. MRI is the most useful imaging modality. Surgery to remove mesh carries a risk of urinary tract and bowel injury, as well as development of recurrent pelvic organ prolapse. A joint decision between the surgeon and the patient should be made before embarking on a partial removal of mesh; removal of all the mesh may be a better option albeit with higher risk of surgical complications. Complete removal of mesh and tacks or sutures from the sacral attachment may not be possible and is associated with risk of major haemorrhage.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"12 ","pages":"Article 101718"},"PeriodicalIF":0.0,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142659438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-17DOI: 10.1016/j.cont.2024.101720
Dudley Robinson
The urogenital tract is sensitive to the effect of oestrogen and progesterone throughout adult life. Epidemiological studies have implicated oestrogen deficiency in the aetiology of lower urinary tract symptoms and Genitourinary Symptoms of the Menopause (GSM) occurring following the menopause. The role of systemic and local oestrogen replacement therapy in the management of postmenopausal lower urinary tract symptoms remains controversial although the use of vaginal oestrogens in the management of women complaining of lower urinary tract symptoms and GSM is now well established.
This aim of this paper is to review the history of post-menopausal hormonal therapy in the management of postmenopausal urinary incontinence, recurrent lower urinary tract infections and GSM with a special focus on the lifelong research in the field by Professor Linda Cardozo.
{"title":"Oestrogens and lower urinary tract dysfunction chronicling a lifetime of research","authors":"Dudley Robinson","doi":"10.1016/j.cont.2024.101720","DOIUrl":"10.1016/j.cont.2024.101720","url":null,"abstract":"<div><div>The urogenital tract is sensitive to the effect of oestrogen and progesterone throughout adult life. Epidemiological studies have implicated oestrogen deficiency in the aetiology of lower urinary tract symptoms and Genitourinary Symptoms of the Menopause (GSM) occurring following the menopause. The role of systemic and local oestrogen replacement therapy in the management of postmenopausal lower urinary tract symptoms remains controversial although the use of vaginal oestrogens in the management of women complaining of lower urinary tract symptoms and GSM is now well established.</div><div>This aim of this paper is to review the history of post-menopausal hormonal therapy in the management of postmenopausal urinary incontinence, recurrent lower urinary tract infections and GSM with a special focus on the lifelong research in the field by Professor Linda Cardozo.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"12 ","pages":"Article 101720"},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142659439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.cont.2024.101714
José Medina-Polo , Salvador Arlandis-Guzmán , Roberto Martínez-García , Bárbara Padilla-Fernández , David Manuel Castro-Díaz , Francisco Cruz , Carlos Errando-Smet , Montserrat Espuña-Pons , Carmen González-Enguita , Luis López-Fando , Alicia Martín-Martínez , Esther Martínez-Cuenca , Isabel Montes-Posada , Carlos Müller-Arteaga , Ana Belén Muñoz-Menéndez , Inés Ramírez-García , Cristina Ros , Pedro Blasco-Hernández
Introduction:
Most clinical practice guidelines currently recommend not to necessary perform routine urodynamic studies (UDS) before surgery for female stress urinary incontinence (SUI). However, there is no consensus in the literature. Our objective was to evaluate the available evidence and to establish a position as a scientific society.
Methods:
A search was conducted using PubMed, Web of Science and Scopus databases. Inclusion criteria were manuscripts in English with the terms “female urinary incontinence” and “urodynamics”. The analysis included 25 studies.
Results:
Regarding the usefulness of UDS in female undergoing SUI, two randomised, controlled trials have been published showing that preoperative UDS do not improve the results of SUI surgery. The review of data from different series on the surgical treatment of female SUI shows that up to 36% of patients undergoing surgery for SUI are complicated cases due to previous anti-incontinence surgery, pelvic prolapse that exceeds the hymen, radiotherapy or pelvic surgery. Moreover, the performance of UDS before treatment of SUI leads to a change in diagnostic orientation in 74% of patients with complicated SUI and 40% in the case of uncomplicated SUI. It should be noted that the UDS study modifies the proposed treatment in 23.8% and 11% of patients with complicated and uncomplicated SUI, respectively. A review by Serati et al. reported that the UDS results are congruent with the clinical diagnosis of SUI in 74.5% of cases. However, there is overactive detrusor in 10.6%, mixed urinary incontinence in 8% and the results of the UDS are inconclusive in 6.8% of cases. Therefore, it is estimated that UDS before surgery is more likely to change the management of SUI in 17% of patients.
Conclusions:
In women referring SUI, it is necessary to individualise the indication for UDS before surgical correction. UDS are complementary tests to be considered after non-invasive studies of the patient with a detailed clinical history, physical examination and other complementary tests such as a voiding diary, specific questionnaires and flowmetry with residual urine. We consider it necessary in cases of complicated or non-pure SUI.
导言：目前，大多数临床实践指南都建议在女性压力性尿失禁（SUI）手术前不必进行常规尿动力学检查（UDS）。然而，文献中并未达成共识。我们的目标是评估现有证据，并确立科学协会的立场。方法：我们使用 PubMed、Web of Science 和 Scopus 数据库进行了检索。纳入标准是以 "女性尿失禁 "和 "尿动力学 "为关键词的英文手稿。结果：关于尿动力学检查在女性 SUI 手术中的作用，已发表的两项随机对照试验表明，术前尿动力学检查并不能改善 SUI 手术的效果。对不同系列的女性 SUI 手术治疗数据进行的回顾表明，接受 SUI 手术治疗的患者中，有高达 36% 的患者属于复杂病例，原因包括之前接受过防失禁手术、盆腔脱垂超过处女膜、放疗或盆腔手术。此外，在治疗 SUI 之前进行尿液分析可改变 74% 的复杂 SUI 患者和 40% 的非复杂 SUI 患者的诊断方向。值得注意的是，UDS 研究分别对 23.8% 和 11% 的复杂性和非复杂性 SUI 患者的治疗方案进行了修改。Serati 等人的一篇综述报告称，在 74.5% 的病例中，UDS 结果与 SUI 的临床诊断一致。然而，10.6%的病例存在逼尿肌过度活动，8%的病例存在混合性尿失禁，6.8%的病例 UDS 结果不确定。结论：对于转诊的 SUI 女性，有必要在手术矫正前对 UDS 的适应症进行个体化。结论：对于转诊的 SUI 女性，在进行手术矫正前，有必要对 UDS 的适应症进行个体化处理。UDS 是在对患者进行详细的临床病史、体格检查和其他辅助检查（如排尿日记、特定问卷调查和残余尿流量计）后，在对患者进行非侵入性研究后考虑进行的辅助检查。我们认为，对于复杂或非单纯性 SUI 病例，有必要进行该检查。
{"title":"Position of the Ibero-American Society of Neurourology and Urogynecology (SINUG) on the urodynamics (UDS) in women undergoing surgical treatment for stress urinary incontinence (SUI)","authors":"José Medina-Polo , Salvador Arlandis-Guzmán , Roberto Martínez-García , Bárbara Padilla-Fernández , David Manuel Castro-Díaz , Francisco Cruz , Carlos Errando-Smet , Montserrat Espuña-Pons , Carmen González-Enguita , Luis López-Fando , Alicia Martín-Martínez , Esther Martínez-Cuenca , Isabel Montes-Posada , Carlos Müller-Arteaga , Ana Belén Muñoz-Menéndez , Inés Ramírez-García , Cristina Ros , Pedro Blasco-Hernández","doi":"10.1016/j.cont.2024.101714","DOIUrl":"10.1016/j.cont.2024.101714","url":null,"abstract":"<div><h3>Introduction:</h3><div>Most clinical practice guidelines currently recommend not to necessary perform routine urodynamic studies (UDS) before surgery for female stress urinary incontinence (SUI). However, there is no consensus in the literature. Our objective was to evaluate the available evidence and to establish a position as a scientific society.</div></div><div><h3>Methods:</h3><div>A search was conducted using PubMed, Web of Science and Scopus databases. Inclusion criteria were manuscripts in English with the terms “female urinary incontinence” and “urodynamics”. The analysis included 25 studies.</div></div><div><h3>Results:</h3><div>Regarding the usefulness of UDS in female undergoing SUI, two randomised, controlled trials have been published showing that preoperative UDS do not improve the results of SUI surgery. The review of data from different series on the surgical treatment of female SUI shows that up to 36% of patients undergoing surgery for SUI are complicated cases due to previous anti-incontinence surgery, pelvic prolapse that exceeds the hymen, radiotherapy or pelvic surgery. Moreover, the performance of UDS before treatment of SUI leads to a change in diagnostic orientation in 74% of patients with complicated SUI and 40% in the case of uncomplicated SUI. It should be noted that the UDS study modifies the proposed treatment in 23.8% and 11% of patients with complicated and uncomplicated SUI, respectively. A review by Serati et al. reported that the UDS results are congruent with the clinical diagnosis of SUI in 74.5% of cases. However, there is overactive detrusor in 10.6%, mixed urinary incontinence in 8% and the results of the UDS are inconclusive in 6.8% of cases. Therefore, it is estimated that UDS before surgery is more likely to change the management of SUI in 17% of patients.</div></div><div><h3>Conclusions:</h3><div>In women referring SUI, it is necessary to individualise the indication for UDS before surgical correction. UDS are complementary tests to be considered after non-invasive studies of the patient with a detailed clinical history, physical examination and other complementary tests such as a voiding diary, specific questionnaires and flowmetry with residual urine. We consider it necessary in cases of complicated or non-pure SUI.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"12 ","pages":"Article 101714"},"PeriodicalIF":0.0,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142534917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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