Continence (Amsterdam, Netherlands)最新文献_第3页

Feasibility of replacing a tibial nerve neuromodulation implant. A case series 胫骨神经调节植入物置换的可行性。案例系列

IF 1.2

Continence (Amsterdam, Netherlands)

Pub Date : 2025-10-11 DOI: 10.1016/j.cont.2025.102293

Harry J. Kendall , Martijn A.C. Smits , Frank M.J. Martens , John P.F.A. Heesakkers

Introduction

Implantable tibial neuromodulation (iTNM) is a minimally invasive treatment for lower urinary tract dysfunction. In a previously reported study, patients received the first-generation Renova iStim System™, which consists of an implantable electrode powered by an external wearable unit. Following study completion, a second-generation wearable, non-compatible with the original implant, was developed, necessitating surgical revision to maintain therapy. This is the first report detailing the surgical, technical, and clinical aspects of such a revision.

Methods

Five patients with overactive bladder (OAB) who had completed a three-year follow-up in the original study opted for implant revision due to device incompatibility. The new implant was activated four weeks post-surgery, with efficacy assessed three months post-revision using a three-day voiding diary and compared to original baseline and 36-month data. Patient satisfaction was evaluated after six months using the Patient Global Impression of Improvement (PGI-I). Complications were monitored throughout routine follow-up.

Results

All patients originally received the implant in 2015; revisions were performed in 2022 without difficulties or complications. Mean operating time was 48 min. Leak episodes per day were 7.67 (SD 4.43) at baseline, 1.27 (SD 2.27) at 36 months, and 3.13 (SD 4.82) post-revision. Mean PGI-I score was 3 (SD 1.79). One patient required and responded well to device reprogramming.

Conclusion

Revision surgery for iTNM proved safe, easily performable, and restores clinical effectiveness and patient satisfaction, making it a promising long-term therapeutic option for OAB.

植入式胫神经调节（iTNM）是一种治疗下尿路功能障碍的微创治疗方法。在先前报道的一项研究中，患者接受了第一代Renova iStim System™，该系统由一个由外部可穿戴设备供电的植入式电极组成。研究完成后，开发了与原始植入物不兼容的第二代可穿戴式植入物，需要手术翻修以维持治疗。这是第一份详细介绍手术、技术和临床方面的报告。方法5例膀胱过动症（OAB）患者在最初的研究中完成了3年的随访，由于器械不兼容而选择了假体翻修。新植入物在手术后四周激活，在修复后三个月使用三天排尿日记评估疗效，并与原始基线和36个月的数据进行比较。六个月后使用患者整体改善印象（PGI-I）评估患者满意度。在常规随访中监测并发症。结果所有患者均于2015年首次种植；在2022年进行了修订，没有困难或并发症。平均手术时间48 min。基线时每天泄漏次数为7.67次（SD 4.43）， 36个月时为1.27次（SD 2.27），修订后为3.13次（SD 4.82）。PGI-I平均评分为3分（SD 1.79）。一名患者需要设备重新编程并反应良好。结论iTNM翻修手术安全、易操作，恢复了临床疗效和患者满意度，是一种有前景的OAB长期治疗选择。

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引用次数: 0

Sensation kinetics identifies novel bladder sensation-capacity curve shapes during urodynamics in patients with urinary urgency 感觉动力学识别新的膀胱感觉-容量曲线形状在尿急患者尿动力学

IF 1.2

Continence (Amsterdam, Netherlands)

Pub Date : 2025-10-03 DOI: 10.1016/j.cont.2025.102291

John E. Speich , Annapoorani Narayanan , Mrudula Bandaru , Nyasia Jones , Devina Thapa , Rui Li , Zachary E. Cullingsworth , Anna S. Nagle , Andrew F. Colhoun , Adam P. Klausner

Objective

Overactive bladder (OAB) is characterized by urinary urgency. To better characterize the relationship between bladder sensation and urgency, a tablet-based “Sensation Meter” was developed to enable construction of bladder sensation-capacity curves. The objective of this study was to correlate sensation-capacity curve shapes during urodynamics (UDS) with urgency severity and bother.

Methods

Individuals with moderate-to-severe urgency presenting for clinically indicated UDS were prospectively enrolled after urgency characterization using the International Consultation on Incontinence OAB questionnaire (ICIq-OAB). Throughout UDS filling, participants recorded sensation of bladder fullness (0–100 %) using the Sensation Meter. Sensation-capacity curves were constructed and area-under-the-curve (AUC) analysis was implemented to differentiate between three curve-shape patterns defined as r, l, and j-shape. Curve shapes were correlated categorically to urgency severity and bother, UDS capacity, and the presence/absence of DO.

Findings

The study included 69 participants (52F, 17M). The distribution of sensation-capacity curve shapes was 7 (10 %) r-shape, 43 (62 %) l-shape, and 19 (28 %) j-shape. A j-shaped curve was significantly associated with severe urgency and with high urgency bother, but not with bladder capacity or DO.

Conclusions

The key finding was the association between a j-shaped sensation-capacity curve, demonstrating a rapid acceleration of sensation near the end of filling, with both urgency symptom severity and bother. Curve shapes were not associated with bladder capacity or DO, suggesting that a j-shaped curve may potentially identify a separate driver of urinary urgency. Additional studies are needed to determine whether sensation-capacity curves can be used to identify novel OAB/urgency phenotypes or guide therapy.

目的膀胱过动症（OAB）以尿急为特征。为了更好地描述膀胱感觉与尿急之间的关系，我们开发了一种基于药片的“感觉计”，用于构建膀胱感觉-容量曲线。本研究的目的是将尿动力学（UDS）期间的感觉-容量曲线形状与尿急严重程度和尿急相关。方法采用国际尿失禁咨询OAB问卷（ICIq-OAB）对尿失禁紧迫性进行描述后，前瞻性纳入临床指征UDS的中度至重度尿急患者。在UDS填充过程中，参与者使用感觉计记录膀胱充盈感（0 - 100%）。构建感觉能力曲线，并进行曲线下面积（AUC）分析，以区分定义为r形、l形和j形的三种曲线形状。曲线形状与急症严重程度和麻烦程度、UDS容量和DO的存在与否直接相关。该研究包括69名参与者（52岁，17岁）。感觉容量曲线形状分布为r形7个（10%），l形43个（62%），j形19个（28%）。j型曲线与严重急症和高度急症显著相关，但与膀胱容量或DO无关。结论关键的发现是j型感觉-容量曲线与急症症状严重程度和烦恼程度之间的关系，表明在充盈结束时感觉迅速加速。曲线形状与膀胱容量或DO无关，提示j形曲线可能潜在地识别尿急的单独驱动因素。需要进一步的研究来确定感觉能力曲线是否可以用于识别新的OAB/紧急表型或指导治疗。

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引用次数: 0

Urinary incontinence in Africa: Experiences of women and healthcare workers in Nigeria and Kenya and opportunities for expanding care 非洲尿失禁：尼日利亚和肯尼亚妇女和保健工作者的经验以及扩大护理的机会

IF 1.2

Continence (Amsterdam, Netherlands)

Pub Date : 2025-09-30 DOI: 10.1016/j.cont.2025.102290

Laura E. Keyser , Fatimat Akinlusi , Oliver Muchiri , Eliud Luutsa , Michael Ngigi , Michelle Angwenyi , Jessica L. McKinney

Rationale

Urinary incontinence (UI) is prevalent among women worldwide, however perspectives from African women with UI and healthcare workers (HCWs) involved in their care are lacking.

Objective

To understand UI in Africa through the perspectives of women with UI and HCWs to inform effective, accessible, and patient-centered treatment.

Findings

A total of 175 participants were interviewed August–September 2023 about the healthcare environment, digital health, and UI care, management, and treatment options in this qualitative study: 88 women with UI (37 Nigerian, 51 Kenyan) and 87 HCWs (29 Nigerian, 58 Kenyan). All participants provided written informed consent; the study was approved by institutional and national ethics’ committees in Nigeria and Kenya.

Amongst women:

• Health literacy, cultural and religious beliefs, and healthcare system interactions influence healthcare decision-making.

• UI symptoms are frustrating; education, treatment and dismantling of stigma are desired.

• Lack of awareness of UI as a medical condition is pervasive and care-seeking is extremely low.

Amongst HCWs:

• Recognition that UI is a burdensome and highly prevalent medical condition that is underdiagnosed and undertreated.

• Gaps identified, including training needs, prevalence studies and other research, and national guidelines for fistulous and non-fistulous incontinence.

Conclusions

This research highlights the pervasive and distressing nature of UI among women in two African countries. Despite high prevalence, low health-seeking behaviors persist. Sensitization efforts focused on pelvic health and UI could improve health literacy. Cultural values of community and collective responsibility could serve as enablers for raising awareness and encouraging treatment-seeking. Expanding research and training in UI management and access to treatment could strengthen healthcare systems in these settings.

理性尿失禁（UI）在世界各地的妇女中普遍存在，然而，缺乏来自非洲妇女的UI和参与其护理的卫生保健工作者（HCWs）的观点。目的通过妇女尿失禁和卫生保健工作者的角度了解非洲的尿失禁，为有效、可及和以患者为中心的治疗提供信息。在这项定性研究中，共有175名参与者在2023年8月至9月接受了关于医疗保健环境、数字健康和UI护理、管理和治疗选择的访谈：88名UI女性（37名尼日利亚人，51名肯尼亚人）和87名HCWs（29名尼日利亚人，58名肯尼亚人）。所有参与者均提供书面知情同意书；这项研究得到了尼日利亚和肯尼亚的机构和国家伦理委员会的批准。•健康素养、文化和宗教信仰以及卫生保健系统的相互作用影响着卫生保健决策。•UI症状令人沮丧；需要教育、治疗和消除耻辱。•普遍缺乏对UI作为一种医疗状况的认识，求医人数极低。在卫生保健工作者中：•认识到泌尿系疾病是一种负担沉重且非常普遍的疾病，未得到充分诊断和治疗。•确定差距，包括培训需求，患病率研究和其他研究，以及瘘管性和非瘘管性尿失禁的国家指南。本研究突出了两个非洲国家妇女中普遍和令人痛苦的尿失禁本质。尽管发病率很高，但寻求健康的行为仍然很低。以盆腔健康和尿失禁为重点的敏化工作可以提高健康素养。社区和集体责任的文化价值可以成为提高认识和鼓励寻求治疗的推动因素。扩大在尿失禁管理和获得治疗方面的研究和培训可以加强这些环境中的卫生保健系统。

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引用次数: 0

The first report of vesicovaginal fistula repair experience in Afghanistan 阿富汗膀胱阴道瘘修复经验的首次报道

IF 1.2

Continence (Amsterdam, Netherlands)

Pub Date : 2025-09-30 DOI: 10.1016/j.cont.2025.102289

Zamari Noori , Ghulam Rabbani Habibi , Mohammad Arif Aslami , Sayed Manan Hashemi , Lina Naimi , Mohammad Jawid Nazari , Hadi Mostafaei , Helia Mostafaei , Hanieh Salehi-Pourmehr , Sakineh Hajebrahimi

Background

Vesicovaginal fistulas (VVF) are the most common type of acquired fistula, with various causes, etiologies, and management trends worldwide. We aimed to provide our first report on VVF repair experience in Afghanistan.

Methods

A retrospective analysis was conducted on 46 patients who underwent VVF repair between June 2019 and June 2024. Preoperative assessment included physical examination, imaging, and cystoscopy. In cases where the diagnosis was uncertain, a patient-reported pad count (number of pads used per day) was recorded as a supplementary measure of incontinence severity. The surgical procedure involved a transabdominal transvesical approach with circumferential excision of a bladder mucosal cuff around the fistula; the fistulous tract itself was not excised. Closure was performed in two layers, and an interposition flap (peritoneal or omental) was utilized in all cases. Success was defined as the absence of urine leakage one month post-surgery. Postoperative management involved suprapubic catheter drainage for 10–15 days, antibiotics for one week, and antimuscarinics. Complications were classified using the Clavien-Dindo system.

Results

All 46 VVFs were of iatrogenic origin: 35 followed total hysterectomy and 11 followed Cesarean section. Seven fistulas were larger than 2.5 cm, and 39 were 1 cm or smaller. The mean follow-up period was 38.43 months. The surgical success rate was 100 %. There were no major complications (Clavien-Dindo class ≥2); five patients had a surgical site infection, and one had a hematoma that required drainage.

Conclusion

Transabdominal VVF repair with an interposition flap, utilizing a technique that preserves the fistulous tract, achieved a 100 % success rate in this cohort. This approach is a highly effective management strategy for iatrogenic VVF in a challenging healthcare setting.

膀胱阴道瘘（VVF）是最常见的获得性瘘类型，在世界范围内有各种原因、病因和治疗趋势。我们的目的是提供我们在阿富汗的VVF修复经验的第一份报告。方法对2019年6月至2024年6月间行VVF修复术的46例患者进行回顾性分析。术前评估包括体格检查、影像学检查和膀胱镜检查。在诊断不确定的情况下，记录患者报告的尿垫计数（每天使用的尿垫数量）作为尿失禁严重程度的补充措施。手术过程包括经腹经膀胱入路，瘘周围的膀胱粘膜袖环切除；瘘道本身没有切除。闭合分两层进行，所有病例均采用间置皮瓣（腹膜或网膜）。成功的定义是术后一个月没有尿漏。术后处理包括耻骨上导尿管引流10-15天，抗生素1周，抗毒蕈素。采用Clavien-Dindo系统对并发症进行分类。结果46例房颤均为医源性房颤，其中全子宫切除35例，剖宫产11例。7个瘘口大于2.5 cm， 39个瘘口小于或等于1 cm。平均随访时间为38.43个月。手术成功率为100%。无重大并发症（Clavien-Dindo分级≥2级）；5名患者有手术部位感染，1名患者有血肿需要引流。结论采用间置皮瓣修复经腹VVF，采用保留瘘道的技术，在本队列中获得了100%的成功率。这种方法是在具有挑战性的医疗环境中治疗医源性VVF的一种非常有效的管理策略。

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引用次数: 0

Depressive symptoms as mediator between adverse childhood events and fecal incontinence and constipation in community-dwelling men and women 抑郁症状在儿童不良事件与社区男女大便失禁和便秘之间的中介作用

IF 1.2

Continence (Amsterdam, Netherlands)

Pub Date : 2025-09-17 DOI: 10.1016/j.cont.2025.102287

Dina M. Mahjoob , Gommert A. van Koeveringe , Marco H. Blanker , Grietje E. Knol‐de Vries

Background

Fecal incontinence (FI) and constipation affect quality of life and are influenced by intricate interactions between psychological and physiological factors. This study explores the association between adverse childhood events (ACEs) and adult bowel dysfunction (FI and constipation) in community-dwelling men and women, examining depressive symptoms as a potential mediator.

Method

A secondary analysis was conducted using baseline data from a population-based cohort (n = 1,691, age ≥16 years). Participants completed validated questionnaires on FI, constipation, history of emotional neglect, psychological, physical, sexual abuse, and depressive symptoms. Regression models were used, for men and women separately, to examine the associations between ACEs, FI, and constipation, and to test for mediation via depressive symptoms. Analyses were adjusted for age, body mass index, and smoking status.

Result

Complete data were available for 553 men and 787 women. Depressive symptoms significantly mediated the relationship between ACEs and both FI and constipation. For FI, ACEs had a small direct effect (β = 0.104, p < 0.001) and a small, mediated effect (β = 0.057, p < 0.001, Sobel test: z = 6.47). For constipation, ACEs showed a moderate direct effect (β = 0.171, p < 0.001) and a moderate mediated effect (β = 0.130, p < 0.001, Sobel test: z = 10.84).

Conclusion

Depression mediates the relationship between ACEs and bowel dysfunction, with a stronger role in constipation (moderate effect) compared to FI (small effect). These findings underscore the importance of addressing psychological factors and childhood adversity in understanding bowel dysfunction and informing clinical approaches.

背景：大便失禁（FI）和便秘影响生活质量，并受到心理和生理因素复杂的相互作用的影响。本研究探讨了社区男性和女性儿童不良事件（ace）与成人肠功能障碍（FI和便秘）之间的关系，并研究了抑郁症状作为潜在的中介。方法采用基于人群的队列（n = 1,691，年龄≥16岁）的基线数据进行二次分析。参与者完成了关于FI、便秘、情感忽视史、心理、身体、性虐待和抑郁症状的有效问卷。分别对男性和女性使用回归模型来检验ace、FI和便秘之间的关系，并通过抑郁症状来检验其中介作用。对年龄、体重指数和吸烟状况进行了调整。结果男性553例，女性787例。抑郁症状显著介导ace与FI和便秘的关系。对于FI， ace具有较小的直接效应（β = 0.104, p < 0.001）和较小的中介效应（β = 0.057, p < 0.001， Sobel检验：z = 6.47）。对于便秘，ace表现出中度直接作用（β = 0.171, p < 0.001）和中度介导作用（β = 0.130, p < 0.001， Sobel检验：z = 10.84）。结论抑郁在ace与肠功能障碍之间起中介作用，在便秘方面的作用（中等作用）强于FI（小作用）。这些发现强调了心理因素和童年逆境在理解肠功能障碍和告知临床方法中的重要性。

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引用次数: 0

Autonomic dysreflexia during urodynamics: A systematic review of incidence and predictors 尿动力学中的自主神经反射障碍：发病率和预测因素的系统回顾

IF 1.2

Continence (Amsterdam, Netherlands)

Pub Date : 2025-09-16 DOI: 10.1016/j.cont.2025.102288

Yash Khanna , Tran Ngoc An Huynh , Paul Manohar

Objectives

Urodynamic investigation is a mainstay in assessment of lower urinary tract dysfunction in spinal cord injury (SCI). However, like with many forms of urological intervention in the SCI cohort – it carries a risk of autonomic dysreflexia (AD). This systematic review aims to ascertain the incidence and predictors of autonomic dysreflexia during urodynamic investigation, in those with SCI.

Methods

Systematic review was conducted according to PRISMA guidelines, and prospectively registered on PROSPERO (ID CRD420251000507). Ovid MEDLINE, Embase, Web of Science Core Collection and CINAHL databases were searched.

Results

Of total 2098 articles screened, 21 were ultimately included for systematic review. Of the 21 included studies, 13 reported incidence of AD during urodynamics, with reported incidence varyingly broadly from 7.9 to 90.9 %. In studies reporting SCI above T6 specifically, incidence of AD during urodynamics varied from 42.5 to 83.7 %, while in studies reporting incidence in SCI below T6, incidence varied from 5.9 to 82.3 %. There was heterogeneity in results regarding predictors of AD during urodynamics: level of injury was generally predictive of AD incidence, completeness of injury and patient age did not predict AD incidence but did potentially predict severity, and data regarding urodynamic predictors (detrusor overactivity, detrusor-sphincter dyssynergia, compliance, detrusor pressures) was conflicting. Several studies had high proportion of silent/asymptomatic AD (38–63 %), hence some authors suggested continuous/beat-to-beat cardiac monitoring during urodynamics in SCI patients to allow early identification and intervention for AD.

Conclusion

This systematic review identified the incidence of AD during urodynamics in SCI to be high, although results regarding predictors of AD were variable. Clinicians should consider continuous cardiac monitoring during urodynamics in at-risk SCI patients, and remain vigilant to risk of AD in SCI below T6. Future studies should aim to adopt a universal definition of AD and be prospective, to permit statistical synthesis and meta-analysis to conclusively define predictors of AD during urodynamics.

目的尿动力学研究是评估脊髓损伤（SCI）患者下尿路功能障碍的主要方法。然而，就像在脊髓损伤队列中许多形式的泌尿系统干预一样，它有自主神经反射障碍（AD）的风险。本系统综述旨在确定脊髓损伤患者尿动力学调查中自主神经反射障碍的发生率和预测因素。方法根据PRISMA指南进行系统评价，并在PROSPERO （ID CRD420251000507）进行前瞻性注册。检索MEDLINE、Embase、Web of Science Core Collection和CINAHL数据库。结果在共筛选的2098篇文章中，21篇最终纳入系统评价。在21项纳入的研究中，13项报告了尿动力学期间AD的发病率，报道的发病率从7.9%到90.9%不等。在专门报道T6以上SCI的研究中，尿动力学期间AD的发病率从42.5%到83.7%不等，而在T6以下SCI的研究中，发病率从5.9%到82.3%不等。尿动力学中AD的预测结果存在异质性：损伤程度通常可以预测AD的发病率，损伤的完全性和患者年龄不能预测AD的发病率，但可以预测严重程度，尿动力学预测数据（逼尿肌过度活动、逼尿肌-括约肌协同障碍、依从性、逼尿肌压力）存在矛盾。几项研究显示，无症状/无症状AD的比例很高（38 - 63%），因此一些作者建议在脊髓损伤患者的尿动力学过程中进行连续/搏动心脏监测，以便早期识别和干预AD。结论本系统综述发现脊髓损伤患者尿动力学过程中AD的发生率较高，尽管有关AD预测因素的结果存在差异。临床医生应考虑在高危SCI患者尿动力学期间持续进行心脏监测，并对T6以下SCI患者发生AD的风险保持警惕。未来的研究应旨在采用AD的通用定义，并具有前瞻性，允许统计综合和荟萃分析，以最终确定尿动力学中AD的预测因素。

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引用次数: 0

Promotion of continence care in low resource settings: a needs assessment from 17 countries 在资源匮乏环境中促进自制护理：来自17个国家的需求评估

IF 1.2

Continence (Amsterdam, Netherlands)

Pub Date : 2025-09-12 DOI: 10.1016/j.cont.2025.102282

Helia Mostafaei , Andrew Gammie , Sherif Mourad , Hanieh Salehi-Pourmehr , Sakineh Hajebrahimi

Background and Objective

Continence care remains a neglected area of health services in low-resource settings. This needs assessment aimed at exploring the organizational landscape, available support, and priority areas for strengthening continence care across 17 countries, with particular attention to awareness of and engagement with the International Continence Society (ICS).

Methods

A structured online survey was distributed to healthcare professionals involved in continence care. The questionnaire covered organizational affiliations, professional and patient support, educational needs, and preferred resources. Responses were analyzed descriptively.

Key Findings and Limitations

Twenty-two professionals, mainly urologists and urogynecologists from Afghanistan, Azerbaijan, Jordan, Egypt, UAE, The Gambia, Lebanon, Tanzania, Ghana, Pakistan, Armenia, Bangladesh, India, Turkey, and Iran, completed the survey. Many were affiliated with professional continence or urology/urogynecology organizations, indicating potential networks for collaboration. Support for healthcare providers and patients varied widely. Respondents emphasized the need for workshops, short courses, fellowships, and ICS lectures at regional conferences, along with translated patient information, online learning platforms, and affordable continence care materials. A strong interest in further engagement with the ICS was reported. Study limitations include the small sample size, potential self-selection bias, and a survey framed largely around ICS activities, which may have influenced responses.

Conclusions and Clinical Implications

This survey highlights unmet educational and resource needs in continence care across low-resource countries. Targeted interventions—such as professional training, accessible patient information, and low-cost materials—are required to strengthen services and improve quality of life for individuals with incontinence. Broader studies are needed to guide sustainable global initiatives.

背景与目的尿失禁护理仍然是低资源环境中被忽视的卫生服务领域。该需求评估旨在探索17个国家加强尿失禁护理的组织格局、现有支持和优先领域，特别关注对国际尿失禁协会（ICS）的认识和参与。方法对参与尿失禁护理的医护人员进行结构化在线调查。调查问卷涵盖组织隶属关系、专业和患者支持、教育需求和首选资源。对反应进行描述性分析。主要发现和局限性22名专业人员完成了调查，主要是来自阿富汗、阿塞拜疆、约旦、埃及、阿联酋、冈比亚、黎巴嫩、坦桑尼亚、加纳、巴基斯坦、亚美尼亚、孟加拉国、印度、土耳其和伊朗的泌尿科医生和妇科医生。许多人隶属于专业的尿失禁或泌尿科/泌尿妇科组织，表明潜在的合作网络。对医疗保健提供者和患者的支持差异很大。受访者强调需要在区域会议上举办讲习班、短期课程、奖学金和ICS讲座，以及翻译的患者信息、在线学习平台和负担得起的失禁护理材料。据报道，各方对进一步与国际商会接触有浓厚兴趣。研究的局限性包括样本量小，潜在的自我选择偏差，以及主要围绕ICS活动进行的调查，这可能会影响反应。结论和临床意义本调查强调了资源匮乏国家在失禁护理方面未满足的教育和资源需求。需要有针对性的干预措施，如专业培训、可获取的患者信息和低成本材料，以加强对失禁患者的服务并改善其生活质量。需要更广泛的研究来指导可持续的全球倡议。

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引用次数: 0

Development, usability, and randomized pilot feasibility study of a mobile application prototype supporting self-management of accidental bowel leakage. 支持意外肠漏自我管理的移动应用程序原型的开发、可用性和随机试点可行性研究。

IF 1.2

Continence (Amsterdam, Netherlands)

Pub Date : 2025-09-01 Epub Date: 2025-08-09 DOI: 10.1016/j.cont.2025.102276

Donna Z Bliss, Olga V Gurvich, Joseph A Konstan, Ryanne Johnson, Jeannine McCormick, Marshall Muehlbauer, Dominique Jamison, Emma Jennings, Mary Benbenek, Molly Conway, Alexandra Weinberger, Casey Kirchschlager, Holly E Richter

Aims: Patients need support in managing conservative interventions for fecal incontinence (FI). To address this need, a three-phased study aimed to develop and test the usability of a mobile application prototype (App-p) supporting patient self-management of FI and examine the feasibility of conducting a randomized controlled pilot study of App-p use.

Methods: Phase 1: The App-p was developed. Phase 2: App-p usability was tested. Phase 3: In a pilot feasibility study, patients with FI from an American continence/urogynecology practice were randomly assigned 1:1 to a usual care control group (UCC-Group) or usual care and App-p use group (APP-Group) and followed for five weeks. Study activities for both groups were completion of electronic data forms at baseline and five weeks and, at five weeks, a call with their clinician and an interview. Descriptive quantitative and qualitative analyses were conducted.

Results: The I'M ABLe App-p described 11 conservative interventions for FI, each with a journal for self-reporting intervention performance. App-p usability was very good (System Usability Score = 72 (12.5) (mean (SD)). Twenty eligible participants were randomized as planned. All study activities were completed by 60 % (6/10) of the UCC-Group and 80 % (8/10) of the APP-Group. All journals were completed by 80 % (8/10) of the APP-Group versus 30 % (3/10) of the UCC-Group. The APP-Group accessed the App-p 27 (5-45) days (median (range)), describing it as easy-to-use, convenient, and increasing self-management accountability. One UCC-Group participant and two APP-Group participants withdrew.

Conclusion: Results show feasibility of conducting a randomized controlled study using the App-p and support its further development.

目的：患者需要支持管理保守干预大便失禁（FI）。为了满足这一需求，一项分为三个阶段的研究旨在开发和测试支持FI患者自我管理的移动应用程序原型（App-p）的可用性，并检查进行App-p使用随机对照试点研究的可行性。方法：第一期：制备App-p。阶段2：测试App-p的可用性。第3阶段：在一项试点可行性研究中，来自美国尿失禁/泌尿妇科诊所的FI患者被随机按1:1分配到常规护理对照组（ucc组）或常规护理和App-p使用组（App-p组），随访5周。两组的研究活动都是在基线和五周完成电子数据表格，五周时与临床医生通话和面谈。进行了描述性、定量和定性分析。结果：I'M ABLe App-p描述了11种针对FI的保守干预措施，每种干预措施都有自我报告干预效果的日志。App-p可用性非常好(系统可用性得分= 72(12.5)（平均（SD））。20名符合条件的参与者按计划随机分组。ucc组的60%（6/10）和app组的80%（8/10）完成了所有的研究活动。app组的期刊完成率为80% (8/10)，ucc组为30%（3/10）。APP-Group使用App-p 27（5-45）天（中位数（范围）），将其描述为易于使用，方便，提高自我管理责任。1名UCC-Group与会者和2名APP-Group与会者退出。结论：应用App-p进行随机对照研究是可行的，支持其进一步开发。

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引用次数: 0

Long-term outcomes and complications of augmentation cystoplasty in pediatric neurogenic bladder patients: A systematic review and meta-analysis 儿童神经源性膀胱患者膀胱隆胸成形术的长期疗效和并发症：系统回顾和荟萃分析

IF 1.2

Continence (Amsterdam, Netherlands)

Pub Date : 2025-08-27 DOI: 10.1016/j.cont.2025.102280

Putu Angga Risky Raharja, Vidi Ibrahim Pratomo Affandi, Fina Widia, Gerhard Reinaldi Situmorang, Harrina Erlianti Rahardjo, Arry Rodjani, Irfan Wahyudi

Background

Augmentation cystoplasty (AC) is a surgical procedure used to manage pediatric neurogenic bladder (NB) when conservative treatments fail. While AC improves bladder function and continence, it carries significant long-term risks. This systematic review and meta-analysis evaluate the functional benefits and complications of AC in pediatric NB patients.

Methods

A comprehensive search of PubMed, Embase, Scopus, Web of Science, ClinicalTrials.gov, and the Cochrane Library was conducted from inception until February 14, 2025. Eligible studies included pediatric patients (≤18 years) with NB who underwent AC. Primary outcomes were continence improvement and bladder capacity increase, while secondary outcomes included complications such as bladder stones, perforation, and reoperation rates. A one-group meta-analysis was performed using logit transformation for categorical outcomes and weighted mean differences (WMD) for continuous outcomes. Heterogeneity was assessed using I² statistics.

Results

Nine retrospective cohort studies comprising 696 pediatric patients were included. The pooled continence improvement rate was 78.1 % (95 % CI: 62–89 %), and bladder capacity increased by 82.1 % (95 % CI: 64.3–99.9 %). The incidence of bladder stones was 19.3 %, bladder perforation was 6.0 %, and reoperation occurred in 24 % of cases. Significant heterogeneity was observed for reoperation rates (I² = 97 %).

Conclusion

AC effectively improves continence and bladder capacity in pediatric NB patients, but it carries a substantial risk of complications. The high reoperation and complication rates underscore the need for careful patient selection, standardized surgical techniques, and structured follow-up.

背景：膀胱增强成形术（AC）是一种在保守治疗失败时用于治疗小儿神经源性膀胱（NB）的外科手术。虽然交流电可以改善膀胱功能和尿失禁，但它也有很大的长期风险。本系统综述和荟萃分析评估了AC在儿科NB患者中的功能益处和并发症。方法综合检索PubMed、Embase、Scopus、Web of Science、ClinicalTrials.gov和Cochrane Library，检索时间为2025年2月14日。符合条件的研究包括接受AC治疗的NB儿科患者（≤18岁）。主要结局是尿失禁改善和膀胱容量增加，次要结局包括并发症，如膀胱结石、穿孔和再手术率。对分类结果使用logit变换，对连续结果使用加权平均差异（WMD）进行单组荟萃分析。采用I2统计量评估异质性。结果纳入9项回顾性队列研究，包括696例儿科患者。综合尿失禁改善率为78.1% (95% CI: 62 ~ 89%)，膀胱容量增加82.1% （95% CI: 64.3 ~ 99.9%）。膀胱结石发生率为19.3%，膀胱穿孔发生率为6.0%，再次手术发生率为24%。再手术率有显著的异质性（I2 = 97%）。结论ac可有效改善小儿NB患者的尿失禁和膀胱容量，但存在较大的并发症风险。高再手术率和并发症率强调了谨慎选择患者、标准化手术技术和有组织的随访的必要性。

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引用次数: 0

Increased prevalence of type 2 diabetes mellitus in urologic chronic pelvic pain syndrome 泌尿系统慢性盆腔疼痛综合征患者2型糖尿病患病率增高

IF 1.2

Continence (Amsterdam, Netherlands)

Pub Date : 2025-08-27 DOI: 10.1016/j.cont.2025.102281

Benjamin E. Rubin , Jacob I. Bleau , Curtis A. Plante , Craig V. Comiter

Background and objective

Urologic chronic pelvic pain syndrome (UCPPS) includes interstitial cystitis/bladder pain syndrome (IC/BPS) and chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). These conditions, hypothesized to be inflammatory in nature, are characterized by pelvic pain and urinary symptoms. Recent research has identified a higher prevalence of type 2 diabetes mellitus (T2DM) in females with IC/BPS; however, this association remains underexplored in males with CP/CPPS.

Methods

We conducted an observational study using the TriNetX database from 2004 to 2024. Males and females (≥18 years) were categorized into cohorts based on IC/BPS or CP/CPPS diagnoses. Each cohort was compared to a control group using propensity score matching based on age and BMI. Odds ratios (ORs) with 95 % confidence intervals were calculated for T2DM prevalence.

Key findings and limitations

T2DM was more prevalent in patients with UCPPS than in controls. Among IC/BPS patients, the OR for T2DM was 2.27 in males and 1.54 in females. In males with CP/CPPS, the OR was 1.75. All associations were statistically significant (p < 0.0001). The use of ICD-10 codes introduces the potential for misclassification and missing data. Additionally, the severity of UCPPS cannot be captured using only ICD-10 codes.

Conclusions

Our findings demonstrate a significant association between UCPPS and T2DM, particularly in males with IC/BPS and CP/CPPS. The increased T2DM prevalence in IC/BPS aligns with prior studies. These results suggest shared inflammatory or metabolic pathways and support consideration of T2DM screening in this population. Further research is warranted to elucidate underlying mechanisms linking chronic pelvic pain and T2DM.

背景与目的泌尿系慢性盆腔疼痛综合征（UCPPS）包括间质性膀胱炎/膀胱疼痛综合征（IC/BPS）和慢性前列腺炎/慢性盆腔疼痛综合征（CP/CPPS）。这些疾病，假设是炎症性的，以盆腔疼痛和泌尿系统症状为特征。最近的研究发现，IC/BPS女性中2型糖尿病（T2DM）的患病率较高；然而，这种关联在CP/CPPS男性患者中仍未得到充分研究。方法2004 - 2024年利用TriNetX数据库进行观测研究。根据IC/BPS或CP/CPPS诊断将男性和女性（≥18岁）分为队列。每个队列使用基于年龄和BMI的倾向评分匹配与对照组进行比较。计算T2DM患病率的优势比（ORs），置信区间为95%。主要发现和局限性：与对照组相比，st2dm在UCPPS患者中更为普遍。在IC/BPS患者中，男性T2DM OR为2.27，女性为1.54。男性CP/CPPS的OR为1.75。所有关联均具有统计学意义（p < 0.0001）。ICD-10代码的使用可能导致错误分类和数据丢失。此外，仅使用ICD-10代码无法捕获UCPPS的严重程度。我们的研究结果表明，UCPPS与T2DM之间存在显著相关性，特别是在患有IC/BPS和CP/CPPS的男性中。IC/BPS中T2DM患病率的增加与先前的研究一致。这些结果提示有共同的炎症或代谢途径，并支持在该人群中考虑进行2型糖尿病筛查。需要进一步的研究来阐明慢性盆腔疼痛和T2DM之间的潜在机制。

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引用次数: 0