Pub Date : 2025-08-11DOI: 10.1016/j.cont.2025.102277
Andry Perrin , Lysanne Campeau , Jas Singh , Jacques Corcos
Introduction
To gather expert opinion and describe trends in the management of early and prolonged bladder outlet obstruction following stress urinary incontinence surgery.
Methods
Expert physicians and members of the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU), were queried by means of an online survey regarding the management of bladder outlet obstruction following stress urinary incontinence surgery.
Results
Sixty surgeons answered the questionnaire (9 %). Most responders performed >20 sling procedures per year, and 15 % of them were autologous fascial pubovaginal slings. The estimated prevalence of complete postoperative urinary retention was 3 %. The prevalence of post-void residual volume ≥200 ml, was estimated around 8 %. Of those presenting with post-void residual ≥200 ml, 35 % were symptomatic. For a inability to void 48 h after synthetic mid-urethral sling insertion, most responders would observe for a week before planning an incision of the sling. In the case of post-void residual ≥200 ml, the trend of the majority would be observation. In patient in inability to void 48 h following autologous fascial pubovaginal sling procedure, most participants would offer observation, as well as if the patient presented with post-void residual ≥200 ml.
Conclusions
According to expert opinion, although we could highlight some trends in the management of bladder outlet obstruction associated with urinary retention following the surgical management of female stress urinary incontinence, particularly with regards to observation, there was no consensus on the management in terms of method or timing of surgical revision.
{"title":"Management of bladder outlet obstruction after stress urinary incontinence surgery in women: Results of a North American Survey among surgeons","authors":"Andry Perrin , Lysanne Campeau , Jas Singh , Jacques Corcos","doi":"10.1016/j.cont.2025.102277","DOIUrl":"10.1016/j.cont.2025.102277","url":null,"abstract":"<div><h3>Introduction</h3><div>To gather expert opinion and describe trends in the management of early and prolonged bladder outlet obstruction following stress urinary incontinence surgery.</div></div><div><h3>Methods</h3><div>Expert physicians and members of the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU), were queried by means of an online survey regarding the management of bladder outlet obstruction following stress urinary incontinence surgery.</div></div><div><h3>Results</h3><div>Sixty surgeons answered the questionnaire (9 %). Most responders performed >20 sling procedures per year, and 15 % of them were autologous fascial pubovaginal slings. The estimated prevalence of complete postoperative urinary retention was 3 %. The prevalence of post-void residual volume ≥200 ml, was estimated around 8 %. Of those presenting with post-void residual ≥200 ml, 35 % were symptomatic. For a inability to void 48 h after synthetic mid-urethral sling insertion, most responders would observe for a week before planning an incision of the sling. In the case of post-void residual ≥200 ml, the trend of the majority would be observation. In patient in inability to void 48 h following autologous fascial pubovaginal sling procedure, most participants would offer observation, as well as if the patient presented with post-void residual ≥200 ml.</div></div><div><h3>Conclusions</h3><div>According to expert opinion, although we could highlight some trends in the management of bladder outlet obstruction associated with urinary retention following the surgical management of female stress urinary incontinence, particularly with regards to observation, there was no consensus on the management in terms of method or timing of surgical revision.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"15 ","pages":"Article 102277"},"PeriodicalIF":1.2,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144860688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-08-11DOI: 10.1016/j.cont.2025.102275
Carlos Arturo Levi D'Ancona , Tufan Tarcan , Stefania Musco , Arthur Degani Ottaiano , Peter F.W.M. Rosier
Aim
To present the body of evidence on the practice of assessment and diagnosis of lower urinary tract dysfunction (LUTD) in post radical prostatectomy urinary incontinence (PRP-UI). This serves as a scientific background overview for a presentation made available on the International Continence Society (ICS) website.
Methods
ICS-Teaching module prepared by an ad-hoc working group instituted by the ICS Urodynamics Committee using an expert literature review focusing on guidelines and clinical practice and consensus formation by the members of the working group. Finally, the content was reviewed by the core members of the ICS Urodynamics and Standardisation Steering Committees.
Results
In addition to non-invasive initial assessment of PRP-UI, clinical practice guidelines state that a specialist (urologist-) assessment includes performing or considering invasive urodynamics to evaluate LUT functions before surgical treatment. We explain the practical elements and consequences of this.
Conclusions
This module provides expert guidance on the diagnosis of dysfunction in patients with signs and symptoms of PRP-UI. The coexistence of (other) LUTD with UI is plausibly relevant to management selection, although prospective evidence for this is understudied. Standard urodynamic techniques can be used but should in certain cases be adapted and supplemented for the testing of patients with PRP-UI.
{"title":"ICS teaching module: Urodynamic testing for patients with post radical prostatectomy urinary incontinence","authors":"Carlos Arturo Levi D'Ancona , Tufan Tarcan , Stefania Musco , Arthur Degani Ottaiano , Peter F.W.M. Rosier","doi":"10.1016/j.cont.2025.102275","DOIUrl":"10.1016/j.cont.2025.102275","url":null,"abstract":"<div><h3>Aim</h3><div>To present the body of evidence on the practice of assessment and diagnosis of lower urinary tract dysfunction (LUTD) in post radical prostatectomy urinary incontinence (PRP-UI). This serves as a scientific background overview for a presentation made available on the International Continence Society (ICS) website.</div></div><div><h3>Methods</h3><div>ICS-Teaching module prepared by an ad-hoc working group instituted by the ICS Urodynamics Committee using an expert literature review focusing on guidelines and clinical practice and consensus formation by the members of the working group. Finally, the content was reviewed by the core members of the ICS Urodynamics and Standardisation Steering Committees.</div></div><div><h3>Results</h3><div>In addition to non-invasive initial assessment of PRP-UI, clinical practice guidelines state that a specialist (urologist-) assessment includes performing or considering invasive urodynamics to evaluate LUT functions before surgical treatment. We explain the practical elements and consequences of this.</div></div><div><h3>Conclusions</h3><div>This module provides expert guidance on the diagnosis of dysfunction in patients with signs and symptoms of PRP-UI. The coexistence of (other) LUTD with UI is plausibly relevant to management selection, although prospective evidence for this is understudied. Standard urodynamic techniques can be used but should in certain cases be adapted and supplemented for the testing of patients with PRP-UI.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"15 ","pages":"Article 102275"},"PeriodicalIF":1.2,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144878605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-25DOI: 10.1016/j.cont.2025.102274
Charalampos Konstantinidis , Ryuji Sakakibara , Desiree Vrijens , Glenn T. Werneburg , Blayne Welk , Stephanie Kotes , Marcus J. Drake , Christina – Anastasia Rapidi , Cristiano M. Gomes , Luis Abranches-Monteiro , Kadir Onem , Stefan de Wachter , Sanjay Sinha
The manuscript examines the impact of various rare neurological disorders on lower urinary tract dysfunction (LUTD), building upon previous parts of this series. It discusses several infections and their sequelae, such as Neuroborreliosis (Lyme Disease), Herpes Zoster (HZ), and Neurosyphilis. Lyme Disease is a vector-borne infection leading to storage and voiding symptoms. Herpes Zoster (HZ) is associated with various types of LUTD due to its effect on spinal nerves. Neurosyphilis, historically, is a common cause of LUTD due to the degeneration of the spinal cord. In the manuscript, other miscellaneous conditions, such as Radiation Myelopathy, Decompression Sickness and Charcot Spine, are also discussed. Radiation Myelopathy is a chronic condition affecting bladder function post-radiation therapy. Decompression Sickness occurs in scuba divers and can lead to LUTD as a neurological complication. Charcot Spine represents a destructive spinal condition that can lead to LUTD and may require intensive management. Some degenerative disorders such as Progressive Multifocal Leucoencephalopathy (PML), Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), RSF1 related disorder – CANVAS (Cerebellar Ataxia, Neuropathy, Vestibular Areflexia Syndrome), Acute Disseminated Encephalomyelitis (ADEM) and Spinal Cord Sarcoidosis which have varying impacts on LUT function are also included in this report. Additionally, the paper includes two metabolic and toxic myelopathies (severe B12 deficiency and Nitrous oxide myelopathy), which may cause LUTD.
The document emphasizes the necessity for urologists to recognize and manage LUTD in patients with these uncommon neurological conditions, promoting a comprehensive understanding of their overlaps in clinical symptoms. The overall goal is to better inform clinicians and aid in patient management by summarizing current knowledge and encouraging further research. This serves as the fourth installment in a series aiming to provide insights into rare neuro-urological diseases.
{"title":"Lower Urinary Tract Dysfunction in Uncommon Neurological Diseases – Part IV: Infections, Inflammatory, Toxic, and Structural Disorders – A NUPC Report","authors":"Charalampos Konstantinidis , Ryuji Sakakibara , Desiree Vrijens , Glenn T. Werneburg , Blayne Welk , Stephanie Kotes , Marcus J. Drake , Christina – Anastasia Rapidi , Cristiano M. Gomes , Luis Abranches-Monteiro , Kadir Onem , Stefan de Wachter , Sanjay Sinha","doi":"10.1016/j.cont.2025.102274","DOIUrl":"10.1016/j.cont.2025.102274","url":null,"abstract":"<div><div>The manuscript examines the impact of various rare neurological disorders on lower urinary tract dysfunction (LUTD), building upon previous parts of this series. It discusses several infections and their sequelae, such as Neuroborreliosis (Lyme Disease), Herpes Zoster (HZ), and Neurosyphilis. Lyme Disease is a vector-borne infection leading to storage and voiding symptoms. Herpes Zoster (HZ) is associated with various types of LUTD due to its effect on spinal nerves. Neurosyphilis, historically, is a common cause of LUTD due to the degeneration of the spinal cord. In the manuscript, other miscellaneous conditions, such as Radiation Myelopathy, Decompression Sickness and Charcot Spine, are also discussed. Radiation Myelopathy is a chronic condition affecting bladder function post-radiation therapy. Decompression Sickness occurs in scuba divers and can lead to LUTD as a neurological complication. Charcot Spine represents a destructive spinal condition that can lead to LUTD and may require intensive management. Some degenerative disorders such as Progressive Multifocal Leucoencephalopathy (PML), Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), RSF1 related disorder – CANVAS (Cerebellar Ataxia, Neuropathy, Vestibular Areflexia Syndrome), Acute Disseminated Encephalomyelitis (ADEM) and Spinal Cord Sarcoidosis which have varying impacts on LUT function are also included in this report. Additionally, the paper includes two metabolic and toxic myelopathies (severe B12 deficiency and Nitrous oxide myelopathy), which may cause LUTD.</div><div>The document emphasizes the necessity for urologists to recognize and manage LUTD in patients with these uncommon neurological conditions, promoting a comprehensive understanding of their overlaps in clinical symptoms. The overall goal is to better inform clinicians and aid in patient management by summarizing current knowledge and encouraging further research. This serves as the fourth installment in a series aiming to provide insights into rare neuro-urological diseases.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"15 ","pages":"Article 102274"},"PeriodicalIF":1.2,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-17DOI: 10.1016/j.cont.2025.102273
Donna Z. Bliss , Marshall K. Muehlbauer , Dominique Jamison , Alexandra Weinberger , Molly Conway , Casey Kirchschlager , Olga V. Gurvich , Jeannine McCormick , Ryanne Johnson , Mary Benbenek , Emma Jennings , Joseph A. Konstan , Holly E. Richter
Aims
To describe patients’ experience self-managing conservative interventions for fecal incontinence (FI) during usual FI care.
Methods
Community-living adults with FI recruited from urogynecology and continence clinics participated in a pilot study developing a mobile application for FI self-management support. Data were collected using a demographics questionnaire, FI severity index tool, and semi-structured interviews about participants’ experience self-managing conservative interventions for FI which were part of their usual care treatment plan. Interviews were recorded and transcribed verbatim using online video software. Transcripts were analyzed using content analysis.
Results
Data from 17 women, aged 30 to ≥60 years, 9 White, 8 Black/African American, who had FI ranging from less than one year to more than 10 years were analyzed in this study. Themes of responses described starting interventions soon after receiving them, mixed opinions about ease of performing some interventions (e.g., pelvic floor muscle exercises, completing diaries), barriers to performing interventions (e.g., forgetfulness, no time), practical strategies facilitating self-management (e.g., setting alarms, keeping a schedule), emotional strategies that were supportive and motivating (e.g., maintaining hope, seeing positive results), and advice about self-management to others with FI (seek help, give it time).
Conclusion
Patient experiences provided clinicians with specific topics to target for patient education and ways to support themselves in self-managing FI.
{"title":"Patients’ experiences with self-management of conservative interventions for fecal incontinence","authors":"Donna Z. Bliss , Marshall K. Muehlbauer , Dominique Jamison , Alexandra Weinberger , Molly Conway , Casey Kirchschlager , Olga V. Gurvich , Jeannine McCormick , Ryanne Johnson , Mary Benbenek , Emma Jennings , Joseph A. Konstan , Holly E. Richter","doi":"10.1016/j.cont.2025.102273","DOIUrl":"10.1016/j.cont.2025.102273","url":null,"abstract":"<div><h3>Aims</h3><div>To describe patients’ experience self-managing conservative interventions for fecal incontinence (FI) during usual FI care.</div></div><div><h3>Methods</h3><div>Community-living adults with FI recruited from urogynecology and continence clinics participated in a pilot study developing a mobile application for FI self-management support. Data were collected using a demographics questionnaire, FI severity index tool, and semi-structured interviews about participants’ experience self-managing conservative interventions for FI which were part of their usual care treatment plan. Interviews were recorded and transcribed verbatim using online video software. Transcripts were analyzed using content analysis.</div></div><div><h3>Results</h3><div>Data from 17 women, aged 30 to ≥60 years, 9 White, 8 Black/African American, who had FI ranging from less than one year to more than 10 years were analyzed in this study. Themes of responses described starting interventions soon after receiving them, mixed opinions about ease of performing some interventions (e.g., pelvic floor muscle exercises, completing diaries), barriers to performing interventions (e.g., forgetfulness, no time), practical strategies facilitating self-management (e.g., setting alarms, keeping a schedule), emotional strategies that were supportive and motivating (e.g., maintaining hope, seeing positive results), and advice about self-management to others with FI (seek help, give it time).</div></div><div><h3>Conclusion</h3><div>Patient experiences provided clinicians with specific topics to target for patient education and ways to support themselves in self-managing FI.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"15 ","pages":"Article 102273"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-10DOI: 10.1016/j.cont.2025.101918
Cathy Murphy , Lucie Pannell , Ritu Ghosh , Sureshkumar Kamalakannan , Vennila Palanivelu , Almah Kuambu , Ben Zuvani , George Stefan , Iuliana Mesesan
Background
Effectively managing urine and faecal leakage is essential to maintain quality of life for people living with incontinence. Most people affected by long-term incontinence use continence management products (purchased or homemade). These products can have both positive and negative consequences. Globally, people living in lower and middle income settings often do not have access to products or only very limited options, but availability is increasing. Understanding the challenges of product use is important to support product decision making. The aim of this study was to identify and describe challenges associated with using continence management products for adults and young people living with incontinence in India, Papua New Guinea and Romania.
Methods
We used a qualitative exploratory design and participatory action research approach in this study. Data were collected using semi-structured interviews with 63 people (continence product user n = 42, parent/carer n = 21) who took part in a total of 54 interviews in India, Papua New Guinea and Romania. Secondary analysis of the data was undertaken using a framework approach to address the study aim.
Results
Participants used products namely, indwelling urinary catheters, disposable absorbent products and homemade products (e.g. bottles or blankets). Experiences varied widely and depended on individual characteristics and circumstances. Four themes were used to categorise the key challenges associated with continence product use (i. Physical side-effects, ii. Cost and impact on access, iii. Engagement in day-to-day activities and iv. Psychological and social effects). The large majority of participants reported one or more negative consequences of use, with skin damage, infection, embarrassment, smell, difficulties using or disposing of the products and cost dominating, varying by product type. Some challenges were relatively minor, but others (such as wounds or needing to move out of their home) were potentially life changing.
Conclusion
Most participants reported an overall benefit from using products, but many also experienced significant challenges. Some did not appear to be using an appropriate product to meet their needs or were using products incorrectly (e.g. not changing them frequently enough). Ensuring a range of products to meet individual needs will help mitigate against unintended harms. To optimise the benefits of product use, policy makers and service providers seeking to improve continence product provision should consider local and individual contexts, and ensure personnel are trained to support product selection and correct fit and usage.
{"title":"Challenges associated with using continence management products: Qualitative study set in India, Papua New Guinea and Romania","authors":"Cathy Murphy , Lucie Pannell , Ritu Ghosh , Sureshkumar Kamalakannan , Vennila Palanivelu , Almah Kuambu , Ben Zuvani , George Stefan , Iuliana Mesesan","doi":"10.1016/j.cont.2025.101918","DOIUrl":"10.1016/j.cont.2025.101918","url":null,"abstract":"<div><h3>Background</h3><div>Effectively managing urine and faecal leakage is essential to maintain quality of life for people living with incontinence. Most people affected by long-term incontinence use continence management products (purchased or homemade). These products can have both positive and negative consequences. Globally, people living in lower and middle income settings often do not have access to products or only very limited options, but availability is increasing. Understanding the challenges of product use is important to support product decision making. The aim of this study was to identify and describe challenges associated with using continence management products for adults and young people living with incontinence in India, Papua New Guinea and Romania.</div></div><div><h3>Methods</h3><div>We used a qualitative exploratory design and participatory action research approach in this study. Data were collected using semi-structured interviews with 63 people (continence product user n = 42, parent/carer n = 21) who took part in a total of 54 interviews in India, Papua New Guinea and Romania. Secondary analysis of the data was undertaken using a framework approach to address the study aim.</div></div><div><h3>Results</h3><div>Participants used products namely, indwelling urinary catheters, disposable absorbent products and homemade products (e.g. bottles or blankets). Experiences varied widely and depended on individual characteristics and circumstances. Four themes were used to categorise the key challenges associated with continence product use (i. Physical side-effects, ii. Cost and impact on access, iii. Engagement in day-to-day activities and iv. Psychological and social effects). The large majority of participants reported one or more negative consequences of use, with skin damage, infection, embarrassment, smell, difficulties using or disposing of the products and cost dominating, varying by product type. Some challenges were relatively minor, but others (such as wounds or needing to move out of their home) were potentially life changing.</div></div><div><h3>Conclusion</h3><div>Most participants reported an overall benefit from using products, but many also experienced significant challenges. Some did not appear to be using an appropriate product to meet their needs or were using products incorrectly (e.g. not changing them frequently enough). Ensuring a range of products to meet individual needs will help mitigate against unintended harms. To optimise the benefits of product use, policy makers and service providers seeking to improve continence product provision should consider local and individual contexts, and ensure personnel are trained to support product selection and correct fit and usage.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"15 ","pages":"Article 101918"},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144631985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-05DOI: 10.1016/j.cont.2025.101919
Mohammed Bassil Ismail , Wameedh Qays Abdullhussein
{"title":"Does the presence of Fowler's syndrome predicts successful long-term outcome of sacral nerve stimulation in women with non-obstructive urinary retention?","authors":"Mohammed Bassil Ismail , Wameedh Qays Abdullhussein","doi":"10.1016/j.cont.2025.101919","DOIUrl":"10.1016/j.cont.2025.101919","url":null,"abstract":"","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"15 ","pages":"Article 101919"},"PeriodicalIF":0.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144632065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-18DOI: 10.1016/j.cont.2025.101917
C. Fernandes , V. Viegas , A. Artiles Medina , J. Morale Herrea , J. Casado , L. Vega , C. Luque , L. San José , L. López-Fando Lavalle
Introductions and aims:
Pudendal nerve entrapment is a rare cause of pelvic pain that can be associated with lower urinary tract symptoms (LUTS). The LUTS incidence among PNE patients and the urodynamic study (UDS) role are underexplored. This study aims to explore the role of the UDS in PNE diagnosis and describe the prevalence of LUTS in this population.
Material and methods:
This retrospective, multicentric, cross-sectional study analyzed 144 patients with suspected PNE syndrome between 2016 and 2024. Electronic medical urology records of chronic pelvic pain patients were evaluated. The diagnosis of PNE was established based on neurophysiological tests (NFS) and response to pudendal nerve block. Complaints of LUTS were recorded, and UDS was systematically performed as part of the diagnostic course. PNE patients with LUTS who underwent surgery were evaluated considering LUTS and pain improvement at 12 months postoperatively.
Results:
A total of 87 patients (60.4%) were diagnosed with PNE. Among them, 51% reported LUTS, with a similar prevalence in women (56%) and men (55%). A statistically significant difference was found between gender and UDS dysfunction (), with underactive detrusor predominance in women (44%) and bladder outlet obstruction in men (40%). LUTS were more prevalent in patients with CPP from other causes, in both females () and males (). UDS dysfunctions showed a statistically significant difference between PNE and other CPP causes only in females (). Female PNE patients have more UDS anomalies in comparison to CPP from other causes. Of the PNE patients with LUTS, only 24 (60%) underwent surgery, and 11 (45.8%) experienced symptom improvement. In the univariate analysis, UDS results did not predict LUTS improvement after surgery ().
Conclusion:
LUTS are highly prevalent in PNE and detectable in UDS. Assessing urinary symptoms is crucial in PNE evaluation. Urodynamic tests help clarify if LUTS stems from PNE or other CP causes. However, UDS findings do not predict LUTS improvement after surgery.
{"title":"The role of urodynamic study in pudendal nerve entrapment syndrome","authors":"C. Fernandes , V. Viegas , A. Artiles Medina , J. Morale Herrea , J. Casado , L. Vega , C. Luque , L. San José , L. López-Fando Lavalle","doi":"10.1016/j.cont.2025.101917","DOIUrl":"10.1016/j.cont.2025.101917","url":null,"abstract":"<div><h3>Introductions and aims:</h3><div>Pudendal nerve entrapment is a rare cause of pelvic pain that can be associated with lower urinary tract symptoms (LUTS). The LUTS incidence among PNE patients and the urodynamic study (UDS) role are underexplored. This study aims to explore the role of the UDS in PNE diagnosis and describe the prevalence of LUTS in this population.</div></div><div><h3>Material and methods:</h3><div>This retrospective, multicentric, cross-sectional study analyzed 144 patients with suspected PNE syndrome between 2016 and 2024. Electronic medical urology records of chronic pelvic pain patients were evaluated. The diagnosis of PNE was established based on neurophysiological tests (NFS) and response to pudendal nerve block. Complaints of LUTS were recorded, and UDS was systematically performed as part of the diagnostic course. PNE patients with LUTS who underwent surgery were evaluated considering LUTS and pain improvement at 12 months postoperatively.</div></div><div><h3>Results:</h3><div>A total of 87 patients (60.4%) were diagnosed with PNE. Among them, 51% reported LUTS, with a similar prevalence in women (56%) and men (55%). A statistically significant difference was found between gender and UDS dysfunction (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0</mn><mo>.</mo><mn>013</mn></mrow></math></span>), with underactive detrusor predominance in women (44%) and bladder outlet obstruction in men (40%). LUTS were more prevalent in patients with CPP from other causes, in both females (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0</mn><mo>.</mo><mn>027</mn></mrow></math></span>) and males (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0</mn><mo>.</mo><mn>030</mn></mrow></math></span>). UDS dysfunctions showed a statistically significant difference between PNE and other CPP causes only in females (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0</mn><mo>.</mo><mn>023</mn></mrow></math></span>). Female PNE patients have more UDS anomalies in comparison to CPP from other causes. Of the PNE patients with LUTS, only 24 (60%) underwent surgery, and 11 (45.8%) experienced symptom improvement. In the univariate analysis, UDS results did not predict LUTS improvement after surgery (<span><math><mrow><mi>p</mi><mo>=</mo><mn>0</mn><mo>.</mo><mn>680</mn></mrow></math></span>).</div></div><div><h3>Conclusion:</h3><div><em>LUTS are highly prevalent in PNE and detectable in UDS. Assessing u</em>rinary symptoms is crucial in <em>PNE evaluation.</em> Urodynamic tests help clarify if LUTS stems from PNE or other CP causes. However, UDS findings do not predict LUTS improvement after surgery.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"15 ","pages":"Article 101917"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-16DOI: 10.1016/j.cont.2025.101913
Omer Anis , Mikolaj Przydacz , Tyler Trump , Saar Anis , Howard B. Goldman
Introduction
Overactive bladder syndrome (OAB) is a prevalent condition characterized by urinary urgency, frequency, and nocturia, significantly affecting quality of life. Despite advancements in treatment options, physician practices and preferences for managing OAB vary widely, especially between different specialties. This study aims to evaluate the current global trends, preferences, and barriers regarding the selection and use of available third-line therapies for OAB, with a focus on which treatments are most commonly available and preferred in clinical practice.
Methods:
This cross-sectional survey aimed to gather insights into physicians’ practices and opinions regarding OAB management. A 17-item questionnaire was developed and distributed electronically to members of the International Continence Society (ICS). The survey, conducted from April to July 2024, collected anonymous responses from 201 physicians. Data analysis included descriptive statistics, chi-square tests, and ANOVA using R software.
Results:
A total of 201 physicians responded, 60.7% of whom had completed fellowship training in relevant specialties. Among third line therapies, botulinum toxin injections and sacral neuromodulation (SNM) were the most favored treatments, with 46.2% and 29.9% of respondents rating them highly favorable, respectively. Urogynecologists from obstetrics and gynecology (OB-GYN) specialties were less likely to favor posterior tibial nerve stimulation (PTNS) compared to their urology-trained counterparts (p<0.001). Fellowship training significantly impacted the timing of follow-ups, with fellowship-trained physicians more likely to see patients at 4 weeks post-treatment. Key barriers to advanced therapies included patient resistance to implantable devices (65.8%) and limited neuromodulation training (27.9%).
Conclusions:
The management of OAB varies significantly across specialties, with notable differences in treatment preferences and barriers. While botulinum toxin and SNM remain popular choices, the availability of newer therapies such as implantable tibial nerve stimulation remains limited. Understanding these trends can inform future research and clinical guidelines aimed at improving OAB management and addressing barriers to advanced therapies.
{"title":"Global insights into overactive bladder management: A survey of physician preferences and practices","authors":"Omer Anis , Mikolaj Przydacz , Tyler Trump , Saar Anis , Howard B. Goldman","doi":"10.1016/j.cont.2025.101913","DOIUrl":"10.1016/j.cont.2025.101913","url":null,"abstract":"<div><h3>Introduction</h3><div>Overactive bladder syndrome (OAB) is a prevalent condition characterized by urinary urgency, frequency, and nocturia, significantly affecting quality of life. Despite advancements in treatment options, physician practices and preferences for managing OAB vary widely, especially between different specialties. This study aims to evaluate the current global trends, preferences, and barriers regarding the selection and use of available third-line therapies for OAB, with a focus on which treatments are most commonly available and preferred in clinical practice.</div></div><div><h3>Methods:</h3><div>This cross-sectional survey aimed to gather insights into physicians’ practices and opinions regarding OAB management. A 17-item questionnaire was developed and distributed electronically to members of the International Continence Society (ICS). The survey, conducted from April to July 2024, collected anonymous responses from 201 physicians. Data analysis included descriptive statistics, chi-square tests, and ANOVA using R software.</div></div><div><h3>Results:</h3><div>A total of 201 physicians responded, 60.7% of whom had completed fellowship training in relevant specialties. Among third line therapies, botulinum toxin injections and sacral neuromodulation (SNM) were the most favored treatments, with 46.2% and 29.9% of respondents rating them highly favorable, respectively. Urogynecologists from obstetrics and gynecology (OB-GYN) specialties were less likely to favor posterior tibial nerve stimulation (PTNS) compared to their urology-trained counterparts (p<0.001). Fellowship training significantly impacted the timing of follow-ups, with fellowship-trained physicians more likely to see patients at 4 weeks post-treatment. Key barriers to advanced therapies included patient resistance to implantable devices (65.8%) and limited neuromodulation training (27.9%).</div></div><div><h3>Conclusions:</h3><div>The management of OAB varies significantly across specialties, with notable differences in treatment preferences and barriers. While botulinum toxin and SNM remain popular choices, the availability of newer therapies such as implantable tibial nerve stimulation remains limited. Understanding these trends can inform future research and clinical guidelines aimed at improving OAB management and addressing barriers to advanced therapies.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"15 ","pages":"Article 101913"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144587459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-06DOI: 10.1016/j.cont.2025.101911
Benjamin E. Rubin , Jacob I. Bleau , Curtis A. Plante , Craig V. Comiter
Voiding dysfunction in primary bladder neck obstruction (PBNO) results from incomplete relaxation of the bladder neck, creating a functional obstruction. The efficacy of alpha-adrenergic antagonists supports the contention that adrenergic overactivity may contribute to increased bladder neck tone. This study examines the association between hyperadrenergic conditions and PBNO prevalence.
We conducted an observational study using the TriNetX database from 2004–2024. Males and females (18 years) were stratified into cohorts based on common disease states associated with hyperadrenergic signaling: anxiety, hypertension, obstructive sleep apnea, or heart failure. Each cohort was propensity score-matched to controls by age and BMI. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated for PBNO prevalence, with statistical significance set at p < 0.01.
PBNO prevalence was significantly higher in all hyperadrenergic cohorts than in control groups without the diseases. Hypertension showed the strongest association, with ORs of 3.86 (males) and 4.96 (females). Anxiety also demonstrated substantial associations (ORs: 2.68 males, 3.14 females). All comparisons were statistically significant (p < 0.0001).
Our findings demonstrate a significant association between conditions characterized by increased adrenergic signaling and PBNO. The consistently higher ORs observed across all studied conditions, particularly hypertension and anxiety disorders, support the hypothesis that adrenergic overactivity may contribute to PBNO pathogenesis. These results suggest that patients with hyperadrenergic conditions may be at increased risk for PBNO and could benefit from targeted screening. Clinicians should consider the potential impact of these systemic conditions when evaluating and managing patients with lower urinary tract symptoms suggestive of PBNO.
原发性膀胱颈梗阻（PBNO）的排尿功能障碍是由于膀胱颈不完全松弛造成的功能性梗阻。α -肾上腺素能拮抗剂的疗效支持了肾上腺素能过度活动可能导致膀胱颈张力增加的论点。本研究探讨了肾上腺素能亢进与PBNO患病率之间的关系。我们利用TriNetX数据库从2004年到2024年进行了一项观测研究。男性和女性（≥18岁）根据与肾上腺素能亢进信号相关的常见疾病状态（焦虑、高血压、阻塞性睡眠呼吸暂停或心力衰竭）分层。每个队列根据年龄和体重指数与对照组进行倾向评分匹配。计算PBNO患病率的优势比（OR）和95%置信区间（ci）， p <为统计学显著性；0.01.所有肾上腺素能亢进组的PBNO患病率明显高于无疾病的对照组。高血压相关性最强，男性和女性的or分别为3.86和4.96。焦虑也表现出实质性的关联（or：男性2.68，女性3.14）。所有比较均有统计学意义(p <；0.0001)。我们的研究结果表明，以肾上腺素能信号增加为特征的条件与PBNO之间存在显著关联。在所有研究条件下观察到的持续较高的ORs，特别是高血压和焦虑症，支持肾上腺素能过度活动可能导致PBNO发病机制的假设。这些结果表明，肾上腺素能亢进的患者发生PBNO的风险可能会增加，可以从有针对性的筛查中获益。临床医生在评估和管理有提示PBNO的下尿路症状的患者时，应考虑这些全身性疾病的潜在影响。
{"title":"Increased prevalence of primary bladder neck obstruction in conditions associated with hyperadrenergic signaling","authors":"Benjamin E. Rubin , Jacob I. Bleau , Curtis A. Plante , Craig V. Comiter","doi":"10.1016/j.cont.2025.101911","DOIUrl":"10.1016/j.cont.2025.101911","url":null,"abstract":"<div><div>Voiding dysfunction in primary bladder neck obstruction (PBNO) results from incomplete relaxation of the bladder neck, creating a functional obstruction. The efficacy of alpha-adrenergic antagonists supports the contention that adrenergic overactivity may contribute to increased bladder neck tone. This study examines the association between hyperadrenergic conditions and PBNO prevalence.</div><div>We conducted an observational study using the TriNetX database from 2004–2024. Males and females (<span><math><mo>≥</mo></math></span>18 years) were stratified into cohorts based on common disease states associated with hyperadrenergic signaling: anxiety, hypertension, obstructive sleep apnea, or heart failure. Each cohort was propensity score-matched to controls by age and BMI. Odds ratios (OR) with 95% confidence intervals (CIs) were calculated for PBNO prevalence, with statistical significance set at p < 0.01.</div><div>PBNO prevalence was significantly higher in all hyperadrenergic cohorts than in control groups without the diseases. Hypertension showed the strongest association, with ORs of 3.86 (males) and 4.96 (females). Anxiety also demonstrated substantial associations (ORs: 2.68 males, 3.14 females). All comparisons were statistically significant (p < 0.0001).</div><div>Our findings demonstrate a significant association between conditions characterized by increased adrenergic signaling and PBNO. The consistently higher ORs observed across all studied conditions, particularly hypertension and anxiety disorders, support the hypothesis that adrenergic overactivity may contribute to PBNO pathogenesis. These results suggest that patients with hyperadrenergic conditions may be at increased risk for PBNO and could benefit from targeted screening. Clinicians should consider the potential impact of these systemic conditions when evaluating and managing patients with lower urinary tract symptoms suggestive of PBNO.</div></div>","PeriodicalId":72702,"journal":{"name":"Continence (Amsterdam, Netherlands)","volume":"15 ","pages":"Article 101911"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144230450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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