1-hour Pad Test Research Articles

Urinary Continence Restoration Through an Endourethral Device: A 3-Month Pilot Study on 10 Patients.

Background: Stress urinary incontinence (SUI) is a widespread and frustrating condition that affects millions of people worldwide, with severe consequences on patients' quality of life and health care systems' costs. Currently, the most severe cases of SUI are treated using implanted (and rather invasive) extraurethral artificial sphincters. The authors propose an innovative, minimally invasive endourethral device for the treatment of SUI. Methods: Ten patients with SUI were enrolled in three Italian centers and underwent device implantation. After 10, 30, 60, and 90 days, correct device position was confirmed by ultrasonography. Improvements in continence and quality of life were evaluated through a 24-hour pad-test, an International Consultation on Incontinence Questionnarie-Short Form (ICI-Q) and a custom checklist. The device was explanted after 90 days. Results: The proposed device was successfully implanted and explanted in 8 out of 10 patients. The results of the pad-test, ICI-Q, and custom checklist demonstrated remarkable improvements in continence (median improvement: 82% with respect to the initial condition) and quality of life (mean reduction of the impact of urine losses on the quality of life: 61%). No major pain or discomfort was reported. Conclusions: The results demonstrate the efficacy of the proposed endourethral artificial sphincter in addressing SUI. The proposed device was successfully implanted and explanted in a short time (∼10 minutes) without intrinsic side effects and without triggering pain or discomfort.

The International Consultation on Incontinence Questionnaire Short Form as a Substitute for 1-Hour Pad Weight Testing in the Evaluation of Urinary Incontinence in Patients With Pelvic Organ Prolapse Undergoing Surgery.

Stress urinary incontinence is a postoperative complication occurring in patients with pelvic organ prolapse (POP). Although the 1-hour pad test measures the degree of urinary incontinence qualitatively and quantitatively, some elderly women undergoing POP surgery do not have the daily activities of living to perform the pad test. Therefore, we examined whether the International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) could be used as an alternative tool for pad tests. We retrospectively evaluated 132 patients with POP. In our hospital, 57 patients were treated by laparoscopic sacrocolpopexy (LSC), whereas 75 were treated by transvaginal mesh surgery (TVM). We measured the changes in symptoms preand postoperatively using the ICIQ-SF and 1-hour pad weight testing, and investigated the correlation between the total plus component question scores of the ICIQ-SF and 1-hour pad weight. The preoperative ICIQ total scores in all patients decreased significantly as the amount of leakage on the 1-hour pad weight decreased. The component question scores also decreased significantly with decreasing levels of 1-hour pad weight. The LSC and TVM groups had decreased ICIQ-SF total and component question scores as pad weight decreased. At 12 months postoperatively, the ICIQ total scores in all patients significantly declined as the amount of leakage on the 1-hour pad weight decreased. In the LSC group, the ICIQ-SF total and component question scores also decreased with decreased pad weight, but the differences were not always significant between ICIQ scores and pad weight. In the TVM group, the ICIQ-SF total and component question scores also significantly decreased as the pad weight decreased. The ICIQ-SF could be an appropriate substitute for the 1-hour pad weight testing in predicting the severity of urinary incontinence. In the future, we hope to predict the level of urine leakage based on the ICIQ-SF score.

Kegel exercises with a guidebook for stress urinary incontinence treatment

BACKGROUND Stress urinary incontinence (SUI) is uncontrollable urine leakage when intra-abdominal pressure increases. Behavioral therapy with Kegel exercise is currently the best conservative management recommendation for treating SUI patients. This study aimed to investigate the success of supervised Kegel exercises using the Kegel exercises guidebook in women with SUI. METHODS This quasi-experimental study involved both groups being taught the same regiment of Kegel exercises, but the intervention group was given the Kegel exercises guidebook. After 12 weeks, the compliance, subjective, and objective success rates were evaluated through the patient’s notes, Urinary Distress Inventory-6, Incontinence Impact Questionnaire-7, perineometer, and pad test. RESULTS Patients with a higher level of education had lower compliance to Kegel exercises (p = 0.01; odds ratio [OR] 0.38; 0.18–0.79). No significant difference was observed in the subjective symptom improvement between the two groups. The intervention group had a significantly higher success rate based on objective success by analyzing the 1-hour pad test results. The intervention group was also more adherent (p<0.001; OR 4.78; 2.51–9.0). CONCLUSIONS Patients who received the Kegel exercises guidebook were more compliant and more objectively successful than those who did not receive the manuals.

Clinical Observation of Acupuncture Combined with Biofeedback Electrical Stimulation in the Treatment of Female Stress Urinary Incontinence.

To investigate the clinical efficacy of acupuncture combined with biofeedback electrical stimulation on female stress urinary incontinence. Ninety patients diagnosed in a hospital between January 2020 and January 2021 were randomly divided into three groups (A, B and C). Group A was treated with biofeedback electrical stimulation, 3 times a week for 30min for 15 times. Group B used acupuncture treatment, including Guanyuan, Qihai, Zhongji, Zusanli, Sanyinjiao and Yinlingquan, once a day, Monday-Friday, 30min each, for a total of 10 times. Group C was treated with acupuncture combined with biofeedback electrical stimulation. All three groups were combined with pelvic floor muscle training. Following treatment, the changes in class I and II muscle fibre strength, ICI-Q-SF score and urine leakage in the 1-hour pad test were compared. Prior to treatment, there was no significant difference in the general data of the three patient groups, as well as class I and II muscle fibre strength, ICI-Q-SF score and 1-hour urinary pad test (P > 0.05). Following treatment, class I and II muscle fibre strength in groups A and C improved compared with before, with statistical significance (P < 0.05); there was no significant difference in group B (P > 0.05). In the three groups, ICI-Q-SF scores and 1-hour urinary pad test results were lower compared with before (P < 0.05), with those in group C better than those in groups A and B (P < 0.05). The treatment efficiency of the three patient groups was 86.7%, 83.3% and 96.7%, respectively. Combined acupuncture and biofeedback electrical stimulation can improve pelvic floor muscle strength, urine leakage and quality of life, and can be superior to biofeedback and acupuncture treatment alone.

Effect of a Modified Technique of Posterior Reconstruction by Iliopectineal Ligament Suspension During Robot-assisted Laparoscopic Radical Prostatectomy on Early Continence: A Randomised Controlled Trial

ObjectivesTo evaluate the effect of a modified technique of posterior reconstruction by iliopectineal ligament suspension during robot-assisted radical prostatectomy (RARP) on recovery of early continence. MethodsA prospective, single surgeon, single center, randomized controlled trial was performed from August 2018 to March 2020 with 171 patients (92 control vs. 79 experimental). The posterior reconstruction was done using a standard technique in the control group and was modified for the experimental group by incorporating not only the “Rocco” stitch between Denonvilliers’ fascia and the rhabdosphincter but also the iliopectineal ligaments bilaterally to further improve posterior support with this suspensory ‘hammock’. Both groups of patients were followed for a year with questionnaires and 24-hour pad tests. ResultsBoth groups were comparable in terms of baseline demographic, clinical and pathological characteristics. With regards to recovery of urinary continence, no statistically significant differences were found for socially continent (0-1 pads per day) or fully continent (0 pads per day) rates at all time points examined (1, 3, 6, 12 months). Moreover, there was no statistically significant differences between the groups for presence of urinary symptoms, bowel symptoms, sexual function, and hormonal symptoms. ConclusionsThe modified technique of posterior reconstruction by iliopectineal ligament suspension is not associated with improved early continence as compared to the standard posterior reconstruction technique during RARP. Future studies may want to explore other variations of suspensory sutures that could strengthen posterior urethral support to achieve earlier recovery of continence.

Navigating Treatment Choices for Stress and Urgency Urinary Incontinence Using Graph Theory in Discrete Mathematics.

In this study, we propose a method for navigating the choice of treatment for stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) using graph theory in discrete mathematics. Our previous study accumulated data from 150 patients who underwent tension-free vaginal tape (TVT), transobturator tape (TOT), and vaginal non-ablation Erbium YAG laser (VEL) surgeries between 2014 and 2016. Network diagrams were created using this data. The treatments TVT, TOT, and VEL, along with patient characteristics (1-hour pad test: 1-hrPadTest, Overactive Bladder Symptom Score: OABSS), were represented as nodes and edges in the network diagram. We then employed a heuristic function to select the optimal treatment method for the patients with SUI and UUI. This process enables medical professionals to easily navigate the data for patients with both SUI and UUI concerns by calculating the shortest path connecting the 1-hrPadTest and OABSS. These results, which are consistent with those of previous studies, suggest that VEL is the optimal treatment. Unlike previous studies that employed statistical knowledge that is challenging for patients to understand, our study aids patients in visually comprehending and developing a customized treatment plan. This approach introduces a novel perspective for clinical decision-making in the treatment of urinary incontinence. To the best of our knowledge, this is the first study to apply discrete mathematics to patient decision-making for urinary incontinence treatment.

Safety and Efficacy of Erbium: Yttrium-Aluminum-Garnet Laser Treatment in Chinese Women with Mild-to-Moderate Stress Urinary Incontinence.

Background: This study aims to evaluate the safety and efficacy of erbium:yttrium-aluminum-garnet (Er:YAG) laser treatment in female patients with mild-to-moderate stress urinary incontinence (SUI). Methods: From July 2018 to June 2020, 72 female patients with mild-to-moderate SUI were enrolled in this study. A baseline assessment was conducted, which included a 1-hour pad test, the validated International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI-SF), postvoid residual (PVR) testing, pelvic organ prolapse quantification (POP-Q) testing, and a cough stress test. All patients underwent four sessions of Er:YAG laser treatment using a smooth mode. A reassessment was performed 6 months after treatment to evaluate the safety and efficacy of the Er:YAG laser. Results: All patients completed four clinic visits, with a 1-month interval, and were followed up for a minimum of 6 months. No severe adverse reactions were observed during the treatment process. The 1-hour pad test revealed a significant reduction in urinary leakage from baseline (6.30 ± 1.06 g) to the 6-month follow-up (2.70 ± 0.96 g, p < 0.001), with 34 of 72 (47.22%) patients achieving negative results. The ICIQ-UI-SF score significantly decreased from baseline to 6 months (10.82 ± 1.38 to 2.96 ± 0.52, p < 0.001). PVR experimental results showed a significant decrease in residual urine volume after treatment (103.72 ± 8.61 mL to 43.86 ± 4.92 mL, p < 0.001). At the 6-month follow-up, hematoxylin and eosin staining results demonstrated that Er:YAG laser treatment significantly facilitated an increase in the thickness of squamous epithelial cells. The efficacy of Er:YAG laser treatment for SUI was 77.78% (56/72). Conclusions: Several objective and subjective assessments confirmed the safety and efficacy of vaginal smooth mode Er:YAG laser treatment for mild-to-moderate SUI during the 6-month follow-up period. Nonablative Er:YAG laser in the smooth mode is a viable treatment option for SUI patients.

Effect of Pilates combined with pelvic floor muscle training on continence of post-prostatectomy incontinence in patients with different body mass index

BackgroundUrinary incontinence symptoms severely affect older people with different body mass index (BMI).To compare the efficacy of the pelvic floor muscle training (PFMT) in patients with post-prostatectomy incontinence with different BMI.MethodsThirty-seven patients with post-prostatectomy incontinence were included. They were divided into group A (BMI ≤ 25,12), group B (26 ≤ BMI ≤ 30,14), and group C (BMI ≥ 31,11) based on difference BMI. Three groups of patients underwent the same Pilates combined with kegel training. Participants were assessed with 1-hour pad test, the number of incontinence episodes, International Consultation on Incontinence Questionnaire and Oxford Grading Scale.ResultsIn the 1-hour pad test, the differences before and after training were statistically significant in all three groups of participants. Group A decreased from 81.83 ± 8.79 to 31.08 ± 5.64 g (P < 0.01). Group B decreased from 80.57 ± 8.87 to 35.85 ± 5.66 g (P < 0.01). Group C decreased from 83.55 ± 10.24 to 40.18 ± 7.01 g (P < 0.01). The number of incontinent episodes in group A decreased from 9.33 ± 1.07 to 3.25 ± 0.62 (P < 0.01). Group B decreased from 8.86 ± 1.09 to 3.79 ± 0.80 (P < 0.01). Group C decreased from 9.27 ± 1.10 to 4.09 ± 0.70 (P < 0.01). The correlation between the three groups of participants and the 1-hour pad test, with an R2 of 0.51. The correlation between the three groups of participants and the number of urinary incontinence episodes with a R2 of 0.43.ConclusionsPelvic floor muscle training can affect the recovery of urinary continence in patients with different BMI. Maintaining a lower BMI can be beneficial for improving urinary control.Trial registrationDate of trial registration: November 27, 2023.

Analyze, design, develop, implement, and evaluate approach to develop a pelvic floor muscle training guidebook to treat stress urinary incontinence in women.

Stress urinary incontinence (SUI) is a common problem that affects the quality of life of women worldwide. Pelvic floor muscle training (PFMT) is an effective conservative first-line treatment for SUI. However, low compliance with PFMT is one of the main reasons for therapeutic failure. Indirect supervision using a guidebook may improve PFMT outcomes. To develop a PFMT guidebook using the analyze, design, development, implementation, and evaluation (ADDIE) method. A guidebook was developed from July 2020 to April 2021 using the ADDIE method. This prospective study used mixed methods, namely qualitative analysis, focus group discussions, and in-depth interviews, and involved various experts from urogynecology, urology, medical rehabilitation, and physiotherapy departments. A pilot study was conducted on patients with SUI to evaluate the effectiveness of the guidebook. The ADDIE method was successfully implemented to develop the PFMT guidebook. The formative evaluation of the ADDIE steps mainly focused on the PFMT technique, content clarity, illustration, design, and color choice of the book. After the pilot study, the guidebook significantly improved Incontinence Impact Questionnaire, Short Form, 1-hour pad test, and perineometer scores. However, the pilot study showed no significant improvement in Urogenital Distress Inventory, Short Form scores. The PFMT guidebook developed using the ADDIE method improved outcomes in patients with SUI.

Comparative study of two techniques of laparoscopic burch colposuspension using sutures versus mesh in women with genuine stress urinary incontinence

ABSTRACT Background To compare the effectiveness and safety of laparoscopic colposuspension using sutures (LCS) versus mesh and staples (LCM) in the treatment of female stress urinary incontinence. Methods This randomized study was conducted over a total of 80 women with genuine stress urinary incontinence between January 2020 and April 2022. Women were randomly assigned to the LCS group (n = 40) or the LCM group (n = 40). They underwent objective evaluations, including a standardized stress test, a 24-hour pad test, and a frequency-volume chart. Subjective assessments were made using a quality-of-life questionnaire. Results The LCS group exhibited superior outcomes in PAD test improvement (from 147 [31–304] to 3 [0–300] at 1 year, p < 0.001), stress test scores (from 82 [11–153] to 1 [0–124] at 1 year, p < 0.001), and mean micturated volume (increase from 294 ± 65 to 321 ± 57 at 1 year, p = 0.037) compared to the LCM group. Urodynamic findings revealed a higher Maximum Urethral Closure Pressure in the LCS group (33.1 ± 6.9) versus the LCM group (28.3 ± 6.4, p = 0.002). Quality of life improvements were significantly better in the LCS group across various domains. However, the LCM group benefitted from shorter surgery duration, hospital stays, and bladder drainage duration. Conclusion LCS demonstrates significant advantages over LCM in treating female stress urinary incontinence, particularly in cure rates and quality of life improvements. Despite the operational benefits of LCM in terms of reduced surgery and recovery times, LCS offers superior therapeutic outcomes.

Effect of home-based core exercises on postpartum stress urinary incontinence during COVID-19 pandemic in Jeddah city: a randomised control trial

IntroductionIntroduction. Postpartum stress urinary incontinence affects many women worldwide; it may exist during pregnancy or postpartum with a risk of permanence increasing five years later. This study aimed to determine the effect of home-based core exercises on postpartum stress urinary incontinence during the COVID-19 pandemic, in Jeddah city.MethodsRandomised control trial was conducted on 26 postpartum women aged 25–40 years with mild or moderate grade stress urinary incontinence and a body mass index (BMI) less than 30 kg/m2. Participants were randomly divided into two equal groups (A &amp; B). Group A performed home-based core exercises and pelvic floor muscle training for twenty-four sessions three times weekly for eight weeks; each session lasted 30 minutes. Group B performed home-based PFMT only. The assessment of pelvic floor muscles (PFMs) was measured with the Modified Oxford Grading Scale, while the 1-hour pad test and International Consolation on Incontinence questionnaire-short form (ICIQ UI- SF) total score served to assess incontinence severity before and after treatment.ResultsThe results showed a significant improvement in PFMs strength and endurance in both groups and there was a highly significant difference between groups, favouring the study group (A). There was a highly significant difference between the groups in the 1-hour pad test and ICIQ-SF total score, favouring the study group (A).ConclusionsHome-based core exercises for postpartum SUI women were an effective method to improve PFMs strength and endurance and minimise SUI symptoms.

Personalized Rehabilitation of Patients with Prostate Cancer after Radical Prostatectomy: a Comparative Analysis of Urodynamic Parameters

INTRODUCTION. Applying a personalized approach in the treatment of urinary incontinence in patients after RP can significantly improve the rates of correction of postoperative incontinence.&#x0D; AIM. To study the effect of personalized rehabilitation of patients with prostate cancer (PCa) after radical prostatectomy on the state of functional indicators of the lower urinary tract.&#x0D; MATERIALS AND METHODS. The study included 60 patients with verified primary resectable prostate cancer who underwent laparoscopic nerve-sparing prostatectomy. Patient ages ranged between 46 and 77 years (median 62.8 years). The patients were divided into main and control groups of 30 people each. The patients of the main group received rehabilitation using a personalized approach. The rehabilitation programs for the patients in the control group were formed on the basis of a syndromic-pathogenetic approach. Functional parameters of the lower urinary tract were assessed using a 24-hour pad test and a comprehensive urodynamic study before and after surgery, after a course of rehabilitation and 1 year after surgery.&#x0D; RESULTS. Assessment of the degree of urinary incontinence in patients with prostate cancer using a 24-hour pad test showed similar clinical pictures in both groups in the postoperative period in the form of mild or moderate disorders. After the rehabilitation course, a positive trend was observed, however, in the observation group, 66.7 % of patients completely retained urine, while in the comparison group only 40%. Similar trends were observed in a year after a surgical treatment. According to a comprehensive urodynamic study (CUDS), after rehabilitation in the observation group, 76.7 % of patients showed signs of restoration of detrusor activity to the preoperative level with retention of the effect a year after the intervention (p 0.05). A peak decrease in maximum detrusor pressure was observed in the postoperative period with a partial recovery of the indicator after rehabilitation and after 1 year in both groups. In the comparison group, a more pronounced decrease in detrusor pressure was observed, but the difference was statistically insignificant (p 0.05).&#x0D; DISCUSSION. This study tested a personalized approach in the rehabilitation of patients with urological oncology. This concept allows the use of physical and rehabilitation medicine technologies with maximum efficiency by identifying a specific patient model. The results of functional research methods (pad test, KUDI) are one of the potential determinants of the effectiveness of the use of rehabilitation technologies.&#x0D; CONCLUSION. The results of rehabilitation of patients in the group with a personalized approach can significantly improve the rates of correction of postoperative incontinence.

Modified Urethral Graciloplasty Cross-Innervated by the Pudendal Nerve for Postprostatectomy Urinary Incontinence: Cadaveric Simulation Surgery and a Clinical Case Report.

An artificial sphincter implanted in the bulbous urethra to treat severe postprostatectomy urinary incontinence is effective, but embedding-associated complications can occur. We assessed the feasibility, efficacy, and safety of urethral graciloplasty cross-innervated by the pudendal nerve. A simulation surgery on three male fresh cadavers was performed. Both ends of the gracilis muscle were isolated only on its vascular pedicle with proximal end of the obturator nerve severed and transferred to the perineum. We examined whether the gracilis muscle could be wrapped around the bulbous urethra and whether the obturator nerve was long enough to suture with the pudendal nerve. In addition, surgery was performed on a 71-year-old male patient with severe urinary incontinence. The postoperative 12-month outcomes were assessed using a 24-hour pad test and urodynamic study. In all cadaveric simulations, the gracilis muscles could be wrapped around the bulbous urethra in a γ-loop configuration. The length of the obturator nerve was sufficient for neurorrhaphy with the pudendal nerve. In the clinical case, the postoperative course was uneventful. The mean maximum urethral closure pressure and functional profile length increased from 40.7 to 70 cm H 2 O and from 40.1 to 45.3 mm, respectively. Although urinary incontinence was not completely cured, the patient was able to maintain urinary continence at night. Urethral graciloplasty cross-innervated by the pudendal nerve is effective in raising the urethral pressure and reducing urinary incontinence.

Adjustable Male Sling for The Treatment of Postprostatectomy Stress Urinary Incontinence: Intermediate-Term Follow-Up Results.

Objective To evaluate the outcomes of adjustable male sling (Argus®) implantation in the management of post-prostatectomy incontinence (PPI) with intermediate-term follow-up results. Materials and methods The data on adjustable male sling surgery between September 2015 and September 2020 were retrospectively analyzed. Patients were preoperatively evaluated with a voiding diary, 24-hour pad test, and validated questionnaire. Functional outcomes were also evaluated using 24-hour pad requirement and pad weight, and the International Consultation on Incontinence (ICIQ-SF) score. Results A total of 16 patients (eight having undergone the transurethral resection of the prostate [TUR-P] and eight radical prostatectomy [RP]) were enrolled in the study. Thirteen patients had moderate (81.25%) PPI, and three patients (18.75%) had severe PPI. With the mean follow-up of 36.9±14.3 months, nine patients (56.2%) were noted as cured and four (25%) as improved, with an overall success rate of 81.2%. At the last follow-up visit, the median number of pads used per day decreased from 3.5 to 1, and the 24-hour pad test result decreased from 300 to 50 gr (p < 0.001 and p < 0.001, respectively). The ICIQ-SF score decreased from the initial mean of 15.8 ± 2.3 to 7.1 ± 6.6 (p < 0.001). When the outcomes were compared according to the etiology, there was no statistically significant difference (p = 0.522). Conclusions Male sling surgery can be performed safely in patients with moderate and severe stress urinary incontinence with low complication and high success rates. The results of TUR-P-related PPI are similar to those of surgery performed due to the etiology of RP.

Clinical and Urodynamic results of the Argus T® sling in moderate and severe male stress urinary incontinence after radical prostatectomy - a 5 year prospective study.

Sling as a therapeutic option for male stress urinary incontinence (SUI) has been reviewed in the last two decades, as it is a relatively simpliest surgery compared to artificial urinary sphincter and has the ability to modulate urethral compression. This study aims to evaluate the efficacy, rate of complications, quality of life and the effects on bladder emptying of the Argus T® compressive and ajustable sling in moderate and severe male SUI treatment. Men eligible for stress urinary incontinence treatment after radical prostatectomy were recruited and prospectively evaluated, from March 2010 to November 2016. It was selected outpatient men with moderate and severe SUI, after 12 months of radical prostatectomy, who have failed conservative treatment. All patients had a complete clinical and urodynamic pre and post treatment evaluation, by means of clinical history, physical examination, urine culture, 1-hour pad test and ICIq-SF questionnaire. The UDS was performed after 12, 18 and 24 months postoperatively. Thirty-seven men underwent sling surgery, 19 patients (51.4%) with moderate and 18 (48.6%) with severe SUI. The minimum follow-up time was 5 years. Overall, we had a success rate of 56.7% at 60 months follow-up. After surgery, we did not observe significant changes in the urodynamic parameters evaluated during the follow-up. No patient had urodynamic bladder outlet obstruction (BOO) after sling implantation. Readjustment of the Argus T® sling was performed in 16 (41%) of the patients and 51% of the patients reported some adverse event. We demonstrate a long-term efficacy and safety of Sling Argus T® as an alternative to moderate and severe male SUI treatment. Furthermore, in our study bulbar urethra compression does not lead to bladder outlet obstruction.

MP67-15 CROSS SECTIONAL AREA OF PSOAS MAJOR MUSCLE PREDICTS URINARY INCONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP67-15 CROSS SECTIONAL AREA OF PSOAS MAJOR MUSCLE PREDICTS URINARY INCONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY Akihisa Hasegawa, Junya Hata, Shunsuke Yoshioka, Hiroki Natsuya, Yusuke Kirihana, Yusuke Hakozaki, Tomoyuki Kumekawa, Yuki Harigane, Yu Endo, Shunta Makabe, Kei Yaginuma, Yuta Matsuoka, Hitomi Imai, Yuki Yoshida, Akifumi Onagi, Seiji Hoshi, Tomoyuki Koguchi, Yuichi Sato, Hidenori Akaihata, Masao Kataoka, and Yoshiyuki Kojima Akihisa HasegawaAkihisa Hasegawa More articles by this author , Junya HataJunya Hata More articles by this author , Shunsuke YoshiokaShunsuke Yoshioka More articles by this author , Hiroki NatsuyaHiroki Natsuya More articles by this author , Yusuke KirihanaYusuke Kirihana More articles by this author , Yusuke HakozakiYusuke Hakozaki More articles by this author , Tomoyuki KumekawaTomoyuki Kumekawa More articles by this author , Yuki HariganeYuki Harigane More articles by this author , Yu EndoYu Endo More articles by this author , Shunta MakabeShunta Makabe More articles by this author , Kei YaginumaKei Yaginuma More articles by this author , Yuta MatsuokaYuta Matsuoka More articles by this author , Hitomi ImaiHitomi Imai More articles by this author , Yuki YoshidaYuki Yoshida More articles by this author , Akifumi OnagiAkifumi Onagi More articles by this author , Seiji HoshiSeiji Hoshi More articles by this author , Tomoyuki KoguchiTomoyuki Koguchi More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Hidenori AkaihataHidenori Akaihata More articles by this author , Masao KataokaMasao Kataoka More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are cases of persistent urinary incontinence after robot-assisted radical prostatectomy (RARP). Urinary incontinence is one of the factors that significantly reduce quality of life, and there is a need to elucidate predictive factors for urinary incontinence to assist in treatment selection. On the other hand, it has been reported that decreased skeletal muscle mass is a risk factor for perioperative complications and poor prognosis, and we considered that it could also be a predictor of urinary incontinence after RARP. Therefore, we measured cross sectional area of psoas major muscle (CSA-PMM), which has been one of the indicators of skeletal muscle volume, and analyzed the relationship between the systemic skeletal muscle and urinary incontinence after RARP. METHODS: Altogether, 539 (average 67.0±5.18 years old) who underwent RARP were enrolled in this study. CSA-PMM were measured by tracing the bilateral psoas major muscles at the upper border level of cross section L4 on preoperative CT. Urinary continence was defined as ≤2 g on a 1-hour pad test and was assessed at 1, 3, 6, 9, and 12 months after RARP. The correlation analysis between patient factors such as CSA-PMM, age, BMI, and eGFR and postoperative urinary continence was performed. The median of CSA-PMM was divided into two groups, high or low CSA-PMM groups, and used for analysis. RESULTS: The continence rates at 1, 3, 6, 9, and 12 months after RARP were 31.9%, 53.6%, 66.0%, 70.3%, and 70.8%, respectively. The median of CSA-PMM was 19.72 (10.39-33.16) ㎠. CSA-PMM was a significant predictor of urinary continence at 6, 9, and 12 months after RARP in univariate analysis (p<0.01, p<0.01, p=0.03). Furthermore, in multivariate analysis, it was a significant predictor of urinary continence at 3, 6, 9, and 12 months after surgery (p=0.02, p<0.01, p<0.01, p<0.01). CONCLUSIONS: CSA-PMM was a significant predictor of long-term urinary incontinence after RARP. Since the psoas major muscle is one indicator of total body skeletal muscle mass, patients with low CSA-PMM had lower pelvic floor muscle mass. This might be related to urinary incontinence. Source of Funding: Nothing © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e948 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akihisa Hasegawa More articles by this author Junya Hata More articles by this author Shunsuke Yoshioka More articles by this author Hiroki Natsuya More articles by this author Yusuke Kirihana More articles by this author Yusuke Hakozaki More articles by this author Tomoyuki Kumekawa More articles by this author Yuki Harigane More articles by this author Yu Endo More articles by this author Shunta Makabe More articles by this author Kei Yaginuma More articles by this author Yuta Matsuoka More articles by this author Hitomi Imai More articles by this author Yuki Yoshida More articles by this author Akifumi Onagi More articles by this author Seiji Hoshi More articles by this author Tomoyuki Koguchi More articles by this author Yuichi Sato More articles by this author Hidenori Akaihata More articles by this author Masao Kataoka More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement PDF downloadLoading ...

Comparison of the efficacy of intravaginal electrical stimulation in women with idiopathic overactive bladder naive and refractory to pharmacological agents.

This study aims to compare the effectiveness of intravaginal electrical stimulation (IVES) with regard to quality of life (QoL) and clinical parameters related to incontinence in women with idiopathic overactive bladder (iOAB) naive or refractory to treatment with pharmacological agents (PhA). In this prospective trial, PhA-naive women were included in Group 1 (n = 24) and women with PhA-resistant iOAB were included in Group 2 (n = 24). IVES was performed 3 days a week, with a total of 24 sessions for 8 weeks. Every session lasted 20 minutes. Women were evaluated for the severity of incontinence (24-hour pad test), pelvic floor muscle (PFM) strength (perineometer), 3-day voiding diary (frequency of voiding, nocturia, incontinence episodes, and the number of pads), symptom severity (OAB-V8), quality of life (IIQ-7), treatment success (positive response rate), cure/improvement rate, and treatment satisfaction. A statistically significant improvement was found in all parameters for each group at the 8th week compared to the baseline values (p < 0.05). At the 8th week, there were no statistically significant differences in the severity of incontinence, PFM strength, incontinence episodes, nocturia, number of pads, QoL, treatment satisfaction, cure-improvement, or positive response rates between the two groups (p > 0.05). It was found that the frequency of voiding and symptom severity parameters were significantly more improved in Group 1 than in Group 2 (p < 0.05). Although IVES was more effective in PhA-naive women with iOAB, it also appears to be an effective treatment in the management of women with PhA-resistant iOAB. This study was registered with ClinicalTrials.gov under no. NCT05416450.

Применение метода биологической обратной связи в лечении больных с недержанием мочи после радикальной простатэктомии.

Introduction. Pelvic floor muscle training (PFMT) is the first line of treatment for urinary incontinence after radical prostatectomy. To improve the results of PFMT the biofeedback method is used, while there is no consensus in the scientific literature regarding its effectiveness. Objective: to evaluate the effectiveness of PFMT and biofeedback method for restoring urinary continence in patients after radical prostatectomy. Materials and methods. 47 men with urinary incontinence developed after radical prostatectomy were under observation. Patients of the 1st group (n=24) were recommended to perform PFMT at home 3 times a day for 15 minutes for 6 months. Patients of the 2nd group (n=23) also performed PFMT at home for 6 months, but during the first month they additionally performed exercises for the pelvic muscles on the stationary hardware-software biofeedback complex Uroproctocor" once a week for 40 min. The effectiveness of treatment was assessed using the ICIQ-SF questionnaire, 1- and 24-hour pad tests and urine interruption test. Results. 1 month after the start of treatment a significant decrease in the severity of urinary incontinence was reported by 58.3% of patients in the 1st group and 82.6% of patients in the 2nd group. At the same time, patients of the 2nd group used a significantly smaller number of pads and had a higher quality of life compared to patients of the 1st group. The skill of isolated contraction of the pelvic floor muscles was acquired by 73.9% of patients of the 2nd group, and it was in them that the effectiveness of treatment turned out to be the greatest. The rest of the patients of the 2nd group continued biofeedback therapy in the mode of 1 session every 2 weeks. By the 6th month of observation, improvement was noted in 70.8% of patients of the 1st group and 91.3% of patients of the 2nd group. Conclusions. The use of the biofeedback method increases the effectiveness of PFMT in patients with urinary incontinence after radical prostatectomy. The biofeedback method makes it possible to teach the patient how to properly perform PFMT, which increases their effectiveness, helps to reduce the duration of treatment and improves the quality of life of patients.

Optimal Duration for Supervised Pelvic Floor Muscle Training in Stress Urinary Incontinence Women: A Prospective Study

Objectives: We evaluated the optimal duration of pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) patients. Methods: This cross-sectional study was conducted at Cipto Mangunkusumo Hospital from November 2018 to June 2019. We recruited 55 subjects diagnosed with SUI based on the questionnaire for urinary incontinence diagnosis (QUID) score &gt;4 and more than 2 grams of 1-hour pad test. Considering the inclusion and exclusion criteria, we taught and supervised them for PFMT and evaluated them every four weeks to observe the urogenital distress inventory-6 (UDI-6), incontinence impact questionnaire-7 (IIQ-7), 1-hour pad test, and perineometer score. We used the Wilcoxon test to evaluate the improvement at a significance level of P&lt;0.05. Results: Our subjects were mostly obese (65%), 30-55 years old (60%), and had &gt;2 children (90%). There were improvements in UDI-6 and IIQ-7 for every four weeks up to 12 weeks of PFMT (P&lt;0.05, 95% CI). Pelvic floor muscle strength only improved significantly (P=0.001 and P=0.006, respectively) after eight weeks of PFMT. Also, the 1-hour pad test score decreased significantly after four weeks of training (P&lt;0.001). Discussion: SUI distress and symptoms decrease after four weeks of Kegel exercises and continue to improve until 12 weeks of therapy. However, the 1-hour pad test reaches clinical and statistical significance during the first month of exercise with no further improvement clinically. Pelvic floor muscle strength increased significantly after eight weeks of training.

The Risk Factor Associated with Stress Urinary Incontinence (SUI) Severity: a Cross-Sectional Multi-centered Study

Background: Stress urinary incontinence is defined as involuntary loss of urine on effort or exertion or with coughing or sneezing. SUI affects as many as 75% of older women, 44-57% of middle-aged, and 25% of young women. Risk factors include age, parity, vaginal birth, menopause, obesity, body mass index, diabetes, hysterectomy, chronically increased abdominal pressure, genetic factors, physical activity level, smoking, diet, and family history. Our purpose was to determine which risk factors are associated with the severity of stress urinary incontinence using a 1-hour pad test. Method: This cross-sectional multicentered study was performed on 178 women who complained of incontinence and had completed QUID for SUI. We collected data using a pad test, and we classified those women into two main groups, women with mild SUI with 1-hour pad test results 1-10 g and women with moderate and severe SUI with 1-hour pad test results more than 10 g. We use Phi and Cramer’s V to calculate the effect size of each risk factor. Results: There were 20 women with moderate and severe SUI, and 158 had mild SUI. We analyzed the risk factors associated with moderate-severe SUI women and found that age (p=0.03), perineometer result (p = 0.04), and level of education (p=0.02) are statistically significant. Conclusion: The severity of stress urinary incontinence is related to age, perineometer result, and level of education.