Urinary Incontinence Episodes Research Articles

Efficacy and Safety of Vibegron for Persistent Symptoms of Overactive Bladder in Men Being Pharmacologically Treated for Benign Prostatic Hyperplasia: Results From the Phase 3 Randomized Controlled COURAGE Trial.

Efficacy and safety of vibegron, a β3-adrenergic receptor agonist, was assessed among men with symptoms of overactive bladder (OAB) receiving pharmacologic treatment for benign prostatic hyperplasia (BPH) in a phase 3 randomized controlled trial. Men ≥ 45 years with OAB symptoms and BPH, treated with α-blocker with/without 5α-reductase inhibitors, were randomized 1:1 to vibegron or placebo for 24 weeks. Coprimary end points were change from baseline at week 12 in mean daily micturitions and urgency episodes. Secondary end points were change from baseline at week 12 in mean nightly nocturia and daily urge urinary incontinence episodes, International Prostate Symptom Score‒storage score, and volume voided per micturition. Safety was evaluated via adverse events (AEs). Of 1105 participants randomized, 965 (87.3%) completed the trial. At week 12, vibegron was associated with significant reductions vs placebo in daily micturitions (least squares mean difference [95% CI], -0.74 [-1.02, -0.46]; P < .0001) and urgency episodes (-0.95 [-1.37, -0.54]; P < .0001). Vibegron was also associated with significant improvements vs placebo at week 12 in nocturia episodes (least squares mean difference, -0.22 [-0.36, -0.09]; P = .002), urge urinary incontinence episodes (-0.80 [-1.33, -0.27]; P = .003), International Prostate Symptom Score‒storage scores (-0.9 [-1.2, -0.6]; P < .0001), and volume voided (15.07 mL [9.13-21.02]; P < .0001). AE rates were similar in vibegron (45.0%) and placebo (39.0%) arms; AEs occurring in ≥ 2% of participants were hypertension (9.0% vs 8.3%), COVID-19 (4.0% vs 3.1%), UTI (2.5% vs 2.2%), and hematuria (2.0% vs 2.5%). In this trial, vibegron met all primary and secondary end points, and was safe and well tolerated in men with OAB symptoms and pharmacologically treated BPH.

The effect of duloxetine on stress urinary incontinence.

This study aims to evaluate the effect of duloxetine on stress urinary incontinence (SUI) episode frequency (IEF) per week IEF. In this clinical trial, 100 women aged 20-80 years with urinary incontinence were assessed based on the standard questionnaire of urinary tract disorders. All the patients received a placebo for 2 weeks. Patients were then randomly divided into two groups of 50 patients each, receiving duloxetine (40 mg twice a day for 12 weeks) and placebo. The two groups were compared in terms of IEF and the mean score of quality of life and side effects. The two groups of duloxetine and placebo recipients were matched at the beginning of the study in terms of age, BMI, IEF, parity, and type of delivery. IEF significantly decreased in the duloxetine recipient group compared to the placebo group. The mean score of quality of life in the duloxetine recipient group increased significantly. The rate of study abandonment in the duloxetine recipient group was significantly higher than in the placebo group. Vertigo was the most common complication that caused patients to discontinue the use of the drug. Duloxetine is therapeutically effective for SUIin women. Patients should be provided information regarding potential side effects and their management.

Normalization of urination parameters in a boy with cerebral palsy after rehabilitation using an “ExoAtlet” exoskeleton

Lower urinary tract dysfunction occurs in 30%–55.5% of patients with cerebral palsy. The article presents a clinical example of medical rehabilitation of a child with cerebral palsy and dysfunctional urination using the verticalization method and ExoAtlet exoskeleton. Description of observation. A 15-year-old boy had urinary disorders in the form of urine leakage after urination, incomplete emptying of the bladder, episodes of enuresis, and frequent urination while sitting. The gait was unsteady and aided with crutches supported by the elbow. Examinations included uroflowmetry and electromyography. The results indicated a decrease in contractility and impaired evacuation function of the detrusor. In total, 15 rehabilitation sessions were performed using the ExoAtlet exoskeleton, after which the patient gained an independent gait supported by a cane, and the child was taught to urinate in a standing position. A repeat urological examination revealed a positive change in urination parameters with partial relief of pollakiuria and complete relief of the residual bladder volume. Verticalization and activation of striated muscles, obtained following the use of an exoskeleton in a child with cerebral palsy and dysfunctional urination, in combination with restored posture, helped normalize lower urinary tract function.

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.

Minimally invasive correction of stress urinary incontinence in women with pelvic floor dysfunction

BACKGROUND: Pelvic floor dysfunction is widespread among young women. Stress urinary incontinence is a common manifestation of the dysfunction and, even in mild forms, affects the quality of life of patients. Much attention is focused on finding and improving minimally invasive methods for treating stress urinary incontinence in women of reproductive and perimenopausal age to prevent disease progression and improve quality of life.&#x0D; AIM: The aim of this study was to evaluate the immediate and long-term results of paraurethral injections of a high-density hyaluronic biopolymer for the correction of stress urinary incontinence in women of reproductive and perimenopausal age.&#x0D; MATERIALS AND METHODS: We examined 37 patients aged 44.6 ± 4.7 years with mild to moderate stress urinary incontinence combined with grade I to II genital prolapse. After general clinical and special studies (urination diaries, King’s and Pelvic Organ Prolapse / Urinary Incontinence Sexual Questionnaire, cough test, complex urodynamic study, ultrasound examination of the urethrovesical junction and pelvic floor ultrasound with compression elastography), paraurethral injection of 4.0 ml of the high-density hyaluronic biopolymer crosslinked with 1,4-butanediol diglycidyl ether was performed. The effectiveness of therapy was evaluated 1, 6 and 12 months after the procedure.&#x0D; RESULTS: A negative cough test was detected after one, six and 12 months of follow-up in 96.9, 73.1 and 43.8 % of women, respectively; the absence of stress urinary incontinence episodes according to urination diaries was in 85.7, 61.3 and 35.0 % of patients, respectively. Gradual resorption of the drug was monitored over 12 months of observation. An ultrasound examination showed a decrease in urethral mobility one month after the procedure. According to the results of elastography before treatment, the average value of the strain ratio of paraurethral tissues was 0.50 (0.30–0.69) (p 0.001), after one and six months — 0.88 (0.76–1.03) and 0.79 (0.66–1.07) (p 0.001 and p = 0.005 respectively). Thus, the stiffness of the paraurethral tissues of the proximal posterior wall of the urethra increased within six months after the procedure. When observing women after 12 months, the stiffness values of the studied tissues decreased and approached the values before treatment. During the entire observation period, the patients noted a decrease in the degree of discomfort due to problems with urination according to the questionnaires.&#x0D; CONCLUSIONS: The introduction of the high-density hyaluronic biopolymer helps to increase the stiffness of paraurethral tissues and improve the structural support of the urethra in patients with stress urinary incontinence. After the procedure, a 12-month follow-up revealed a decrease or absence of stress urinary incontinence episodes according to urination diaries and the preservation of the positive effect of treatment according to the results of the cough test. A gradual decrease in the effect of therapy is associated with biodegradation of the drug. This method of treating mild forms of stress urinary incontinence is effective for women of reproductive and perimenopausal age who do not plan surgical treatment, are interested in achieving a quick result of therapy and are informed that the effect decreases over time after the procedure.

The effect of electroacupuncture applied to women with stress urinary incontinence on urinary incontinence severity and symptoms: Systematic review and meta-analysis of randomized controlled trials

IntroductionStress Urinary Incontinence is a condition that impairs the quality of life in women and randomized controlled trials of electroacupuncture for stress urinary incontinence have been conducted. ObjectiveThe aim of this systematic review and meta-analysis was to examine the effect of electroacupuncture on the severity and symptoms of urinary incontinence in women with stress urinary incontinence. MethodsLiterature searches were conducted in PubMed, CINAHL, Scopus and Science Citation Index until November 2023. This study was based on the recommendations of the Cochrane guidelines. Data were analyzed using the Review Manager computer program (Version 5.4). The methodological quality of the studies was assessed using the RoB-2 tool. ResultsThe analysis included 888 women with stress urinary incontinence and three studies. In women with stress urinary incontinence, electroacupuncture intervention improved urinary incontinence severity and quality of life (MD: −2.37, 95% CI: −3.29 to 1.45, Z = 5.07, p < 0.001), urinary leakage (SMD: −0.79, 95% CI: −1.02 to −0.55, Z = 6.60, p = 0.001) and incontinence episode frequency (SMD: −2.24, 95% CI: −4.17 to −0.32, Z = 2.29, p < 0.02). ConclusionIn women with stress urinary incontinence, electroacupuncture intervention decreased the severity of urinary incontinence and improved the quality of life. Symptoms related to urinary incontinence were found to decrease urinary leakage and incontinence episode frequency. The studies included in the analysis were determined to be low-risk studies in quality assessment.

Comparison of the efficiency of transcutaneous electrical nerve stimulation and manual therapy in children with cerebral palsy with lower urinary system dysfunction- a randomized prospective trial

Neurological defects in children with cerebral palsy (CP) not only affect their motor skills but also lead to bladder and bowel problems. Although most children with CP have achieved urinary control, more than 50% of cases experience lower urinary tract symptoms (LUTS). Common LUTS complaints observed in CP include delayed toilet training, urinary incontinence, increased frequency of urination, urgency, urinary hesitancy, and recurrent urinary tract infections. This study aimed to prospectively evaluate and compare the effectiveness of two different physiotherapy approaches, sacral Transcutaneous Electrical Nerve Stimulation (TENS) and massage, on lower urinary tract dysfunction in children with CP. A total of 54 children with CP who had the Dysfunctional Voiding Scoring System (DVISS) of 8.5 or higher were included in the study. Children were randomized to the TENS (TG; n=27) and Manual Therapy (MG; n=27) groups. TENS application was performed 2 sessions in a week for 20min for a total of 12 weeks. The electrodes used during the application were adhered bilaterally to the parasacral region (S2-S4). 4 electrodes of 5×5cm were used. Classical bowel massage was applied to the MG with the friction massage technique twice a week for 12 weeks. Manual therapy applications were performed in the form of abdominal, colon, and friction massage, twice a week for 20min by the physiotherapist. Massage was applied to the abdominal region between the lower subcostal border and the anterior superior iliac spine. Questionnaires were applied before and after treatment interventions: DVISS, functional bladder capacity (FBC), frequency of voiding, and urinary incontinence episodes evaluated by bladder diary, Bristol Gaita Scale, and Pediatric Incontinence Quality of Life Scale (PIN-Q) used. The decrease in the episodes of incontinence was higher in the TG (p=0.037; p<0.05). FBC increased after treatment in both groups, but there was no statistically significant difference between the groups (p=0.683; p>0.05). Manual therapy was more effective in improving constipation symptoms. In both groups, DVISS and PIN-Q values decreased after treatment, but the decrease in TG was statistically significant in the evaluation made between groups (p=0.001; p<0.01). Both parasacral TENS and massage provided a significant improvement in LUTS, constipation, and quality of life but TENS showed a bigger improvement. We suggest adding these interventions to the treatment of bladder and bowel problems in CP children.

The Impact of Extracorporeal Magnetic Stimulation as Addition to Mirabegron in Overactive Bladder Treatment in Women: A Single-Centre Randomized Sham-Controlled Study

(1) Background: The purpose of our prospective, single-blinded, randomized, sham-controlled study was to investigate the effect of the additional extracorporeal magnetic stimulation (ExMI) to pharmacological treatment in overactive bladder syndrome (OAB) in women. (2) Methods: We recruited 56 women with OAB, who were allocated into two study groups: the active group received mirabegron 50 mg daily and a total of 16 sessions of ExMI in 8 weeks, whereas the sham group received mirabegron 50 mg daily and sham stimulation following the same treatment protocol. Treatment success was evaluated after 4 and 8 weeks. (3) Results: Both groups experienced significant reduction in daytime urinary frequency, nocturia, and number of weekly incontinence episodes after 8 weeks. There were no statistically significant differences in end-point daytime urinary frequency and nocturia between groups. However, the overall average reduction rate in weekly number of incontinence episodes was 43.7% in treatment group and 24.2% in the control group. The number of urinary incontinence episodes in the treatment and control group was reduced for 3.8 ± 11.8 vs. 2.5 ± 4.3 episodes at week 4 and additional 3.3 ± 6 vs. 0.4 ± 3.2 episodes at week 8, respectively (p = 0.013). Moreover, IIQ-7 score showed a significantly greater score reduction and patients’ evaluated improvement of symptoms was higher in the active group. (4) Conclusions: The addition of ExMI to mirabegron in OAB treatment further improves the weekly incontinence episode reduction rate and also leads to grater improvement in symptoms.

Giggle incontinence: a scoping review.

Giggle incontinence (GI) is poorly described, defined, and understood. It is considered a bladder storage disorder in which laughter causes an uncontrollable episode of urinary incontinence that cannot be stopped until the bladder is completely emptied. It has been confused with stress urinary incontinence and overactive bladder. A thorough analysis of 26 articles on the subject of "giggle incontinence" and associated terms was performed, including all articles since the phrase first appeared. To date, 351 GI cases have been reported. It occurs mainly in women (69.5%) at 5 years of age, with a prevalence ranging from 8.4 to 16.2 years (average age of 12.4 years), and some cases have a family history of the disease (13-16.7%). This review discusses the historical background, current understanding, and challenges related to GI. It primarily affects females after the age of 5 years, causing complete bladder emptying during uncontrollable laughter. The exact cause is unknown, but hypotheses suggest involvement of the central nervous system. Diagnosis relies on clinical history, physical tests, and urine frequency evaluation. Management involves urotherapy techniques, biofeedback, and methylphenidate. Understanding GI will aid in developing more effective management techniques. IMPACT: Highlights limited awareness among healthcare professionals about giggle incontinence as a distinct condition, emphasizing the need for standardized diagnostic criteria and assessment tools. Addresses insufficient understanding of the underlying mechanisms and contributing factors, providing valuable insights for better diagnosis and treatment. Emphasizes the importance of patient education and support, calling for improved resources and counseling. Urges further research and evidence-based guidelines to enhance treatment strategies.

El efecto de la electroacupuntura en la gravedad y los síntomas de la incontinencia urinaria de esfuerzo en mujeres: revisión sistemática y metaanálisis de ensayos controlados aleatorizados

IntroductionStress Urinary Incontinence is a condition that impairs the quality of life in women and randomized controlled trials of electroacupuncture for stress urinary incontinence have been conducted. ObjectiveThe aim of this systematic review and meta-analysis was to examine the effect of electroacupuncture on the severity and symptoms of urinary incontinence in women with stress urinary incontinence. MethodsLiterature searches were conducted in PubMed, CINAHL, Scopus and Science Citation Index until November 2023. This study was based on the recommendations of the Cochrane guidelines. Data were analyzed using the Review Manager computer program (Version 5.4). The methodological quality of the studies was assessed using the RoB-2 tool. ResultsThe analysis included 888 women with stress urinary incontinence and three studies. In women with stress urinary incontinence, electroacupuncture intervention improved urinary incontinence severity and quality of life (MD:-2.37, 95% CI:-3.29 to 1.45, Z=5.07,p<0. 001), urinary leakage (SMD:-0.79, 95% CI:-1.02 to -0.55, Z=6.60,p=0.001) and incontinence episode frequency (SMD:-2.24, 95%CI:-4.17 to -0.32, Z=2.29,p<0.02). ConclusionIn women with stress urinary incontinence, electroacupuncture intervention decreased the severity of urinary incontinence and improved the quality of life. Symptoms related to urinary incontinence were found to decrease urinary leakage and incontinence episode frequency. The studies included in the analysis were determined to be low-risk studies in quality assessment.

Interventions for Enuresis in Children and Adolescents: An Overview of Systematic Reviews.

Enuresis is an involuntary and intermittent loss of urine during sleep, and its treatment can be done by pharmacological and non-pharmacological strategies. To conduct an overview to carry out a survey of the systematic reviews about treatment options for children/adolescents with enuresis. Databases used were Cochrane Library, PROSPERO, MEDLINE/PubMed, EMBASE, LILACS/BVS, PEDro, SciELO and Google Scholar. Any type of intervention for the treatment of enuresis in children/adolescents was selected by two independent researchers. Data extraction was done by two independent researchers. The risk of bias was assessed using Risk of Bias in Systematic Reviews (ROBIS) and A MeaSurement Tool to Assess Systematic Reviews (AMSTAR-2). Seven systematic reviews were included. According to ROBIS, three reviews had a low risk of bias, while the others had a high risk of bias. Based on AMSTAR-2, four systematic reviews were of moderate quality, two were low quality, and one was critically low quality. There is moderate confidence that the use of desmopressin plus an anticholinergic agent increases the chance of complete response compared to desmopressin alone. Neurostimulation may increase the risk of responses ≥50% and ≥90% compared to the control group. Likewise, it appears that electrical stimulation is superior to placebo about the chance of response ≥50%. In addition, there is clinical relevance in reducing enuresis episodes per week when neurostimulation is used compared to control groups.

Non-Pharmacological Management of Urge Urinary Incontinence in Women between 40 and 65 Years Old: A Systematic Review.

Urinary incontinence (UI) has been identified as a World Health Organization health priority. In particular, urge UI (UUI) refers to urine leakage associated with a sudden and compelling desire to void urine. It affects quality of life more than other kinds of UI, but it is not always treated adequately. For these reasons, this study aimed to evaluate the effectiveness of conservative treatment practices to counteract UUI in women aged 40-65 years old. This systematic review was conducted following the Joanna Briggs Institute (JBI) methodology. According to the protocol registered in PROSPERO, a systematic search was carried out in the CINAHL, Embase, PubMed, PsycInfo, Scopus and Web of Science databases up to October 2022, to find primary studies meeting the inclusion criteria. Fourteen studies were included. The scientific literature reported different strategies dealing with the problem of UUI, some purely physical, others physical and psycho-educational and others exclusively psychological. Conservative treatments are useful to aid the reduction in UUI episodes in middle-aged women. However, none of them can be considered more effective than others due to the impossibility of conducting meta-analytical analyses. Further studies comparing the effectiveness of conservative treatments for UUI are needed.

A Multicenter Study Evaluating the FREquency of Use and Efficacy of a Novel Closed-Loop Wearable Tibial Neuromodulation System for Overactive Bladder and Urgency Urinary Incontinence (FREEOAB)

ObjectiveTo evaluate the effectiveness and safety of a novel wearable neuromodulation system incorporating embedded electromyographic (EMG) evaluation, representing the first closed-loop wearable therapy for bladder control. MethodsThis 12-week, multicenter, open-label, single-arm study of subjects with Overactive Bladder assessed response of bladder diary parameters and Quality of Life (QOL) metrics. Subjects used the transcutaneous tibial neuromodulation system, either once or three times weekly, with evaluations at weeks 1, 4, 8, and 12. Enrolled subjects (N=96) were assessed for changes in urinary frequency, urgency, and urgency urinary incontinence episodes, and QOL changes using various questionnaires. ResultsIn the intent-to-treat population (N=96, mean age 60.8 ± 13.0 years, 88.5% female), significant reductions in 3-day diary parameters were observed for daily voids, incontinence and urgency episodes at 12 weeks. Quality of life improvements exceeded the minimal clinically important difference for all QOL questionnaires. Long-term results remained robust at 12 months. Device-related adverse events were mild and there were no device-related serious adverse events. Mean therapy compliance at 12 weeks was 88.5%. High satisfaction rates were reported for the device overall. ConclusionThe Avation device demonstrates promising efficacy in treating adults with OAB and UUI. At 12 weeks, both diary parameters and QOL indicators showed significant improvement and remained robust at 12 months. The device had a favorable safety profile with high compliance and patient satisfaction. This novel, closed-loop wearable tibial neuromodulation system represents a significant advancement in bladder control therapy, offering a non-invasive, patient-centered alternative with improved accessibility and ease of use.

Urinary microbiome community types associated with urinary incontinence severity in women

BackgroundUrinary microbiome (urobiome) studies have previously reported on specific taxa and community differences in women with mixed urinary incontinence compared to controls. Therefore, we hypothesized that higher urinary and vaginal microbiome diversity would be associated with increased urinary incontinence severity. ObjectivesTo test if specific urinary or vaginal microbiome community-types are associated with urinary incontinence severity in a population of women with mixed urinary incontinence. Study DesignThis planned secondary, cross-sectional analysis evaluated associations between the urinary/vaginal microbiomes and urinary incontinence severity in a subset of ESTEEM trial participants with urinary incontinence. Incontinence severity was measured using bladder diaries and Urinary Distress Inventory (UDI) questionnaires collected at baseline. Catheterized urine samples and vaginal swabs were concurrently collected prior to treatment at baseline to assess the urinary and vaginal microbiomes.16S rRNA V4-V6 variable regions were sequenced, characterizing bacterial taxa to the genus level using the DADA2 pipeline and SILVA database. Using Dirichlet multinomial mixture methods, samples were clustered into community-types based on core taxa. Associations between community-types and severity measures (UDI total, UDI subscale scores, and the number of urinary incontinence episodes (total, urgency, and stress) from bladder diary) were evaluated using linear regression models adjusted for age and body mass index. Alpha diversity measures for richness (total taxa numbers) and evenness (proportional distribution of taxa abundance) were also analyzed for associations with urinary incontinence episodes and community-type. ResultsSix urinary microbiome community-types were identified, characterized by varying levels of common genera (Lactobacillus, Gardnerella, Prevotella, Tepidomonas, Acidovorax, Escherichia, and others). Analysis of urinary incontinence severity in 126 participants with MUI identified a Lactobacillus-dominated reference group with the highest abundance of Lactobacillus (76% mean relative abundance). A community characterized by fewer Lactobacilli (19% mean relative abundance) and greater alpha diversity, was associated with higher total urinary incontinence episodes (2.67 daily leaks, 95% CI: 0.76 - 4.59, p=0.007) and urgency urinary incontinence episodes (1.75 daily leaks, 95% CI: 0.24 - 3.27, p=0.02) compared to the reference group. No significant association was observed between community-type and stress urinary incontinence episodes or UDI total or subscores. The composition of vaginal community-types and urinary community-types were similar but comprised of slightly different bacterial taxa. Vaginal community-types were not associated with urinary incontinence severity, as measured by bladder diary or UDI total and subscale scores. Alpha diversity indicated that greater sample richness was associated with more incontinence episodes (observed genera p=0.01) in urine. Measures of evenness (Shannon/Pielou) were not associated with incontinence severity in the urinary or vaginal microbiomes. ConclusionsIn the urobiome of women with mixed urinary incontinence, a community-type with fewer Lactobacilli and more diverse bacteria was associated with more severe urinary incontinence episodes (total and urgency) compared to a community-type with high predominance of a single genus, Lactobacillus. Whether mixed urinary incontinence severity is due to lesser predominance of Lactobacillus, greater presence of other non-Lactobacillus genera, or the complement of bacteria comprising urobiome community-types, remains to be determined.

Quality of life after prophylactic surgery for colorectal adenomatous polyposis.

Colorectal adenomatous polyposis is characterized by the onset of tens to thousands of adenomas in the colorectal epithelium and, if not treated, leads to a lifetime increased risk of developing colorectal cancer compared to the general population. Thus, prophylactic surgery is recommended. This study aims to investigate the quality of life of colorectal adenomatous polyposis patients following prophylactic surgery and indirectly compares these findings with those of healthy adults of the normative sample. All patients who underwent prophylactic surgery for polyposis and were in follow-up at the hereditary digestive tract tumors outpatient department of our institute were eligible for the study. The Short Form-36 questionnaire and 21 ad hoc items were used at the time of clinical evaluation. A total of 102 patients were enrolled. For the SF-36 domains, mean values ranged from 64.18 for vitality to 88.49 for physical functioning, with the highest variability for role-physical limitations; the minimum value of functioning was reached for role-physical limitations, role-emotional limitations, and social functioning. The maximum value of functioning was reached for role-emotional limitations (73.96%) and role-physical limitations (60.42%). In total, 48.96% and 90.63% of patients reported no fecal or urinary incontinence episodes, respectively; 69.79% of patients did not have problems in work/school resumption or the personal sexual sphere. Quality of life following prophylactic surgery for these patients seems to be good when indirectly compared to HP-normative samples'. Young adult patients appear to quickly manage and adapt to changes in bowel functioning. A minority of patients may experience social and sexual issues.

Bladder contractility index changes with short-term antimuscarinic therapy in patients with detrusor overactivity: A placebo controlled randomised study

Aims:Bladder contractility is altered by high doses of anticholinergics. It is unknown if anticholinergics at doses used for treating overactive bladder alter bladder contractility. This is a randomised, double-blind, placebo controlled cross-over multicentre study with two 2-week treatment periods. Patients with a previous diagnosis of detrusor overactivity and reporting urinary frequency of at least seven times a day, one or more episodes of urge urinary incontinence per week and at least seven episodes of urgency per week were included. Methods:After a two-week washout period, subjects were randomised to receive propiverine 20 mg od, propiverine 15 mg tds, oxybutynin 5 mg tds or placebo for 2 weeks. After a second washout period, they were randomised to receive 2 weeks of another treatment not previously used. Ambulatory urodynamic monitoring was performed according to ICS standards for 4 h, using a standardised protocol before and after treatment. The bladder contractility index (BCI) was given by the formula: BCI = PdetQmax+ 5Qmax. The main outcome measure was the average BCI for the first 2 voids for each of the treatment. Results:77 participants were recruited. The average BCI for the first two voids was 143 (range 24–314). The BCI was not statistically different before and after antimuscarinic therapy or placebo although there were reductions in urinary frequency and urgency over placebo indicating efficacy over placebo in the treatment of detrusor overactivity. Conclusions:The bladder contractility index did not change significantly in response to antimuscarinic therapy despite a therapeutic effect. This suggests efficacy is mediated by an effect on another system such as sensory rather than motor function.

Comparison between Levels of Vitamin D in Primary Mono-Symptomatic Nocturnal Enuresis and Non-Enuretic Children

Background Enuresis (synonymous with intermittent nocturnal incontinence) refers to discrete episodes of urinary incontinence during sleep in children 25 years of age. Enuresis can be divided into primary enuresis (PE) and secondary enuresis (SE). A child who has never been dry is considered to have PE; a child who has been continent for at least 6 months before the onset of the bedwetting is considered to have SE. The pathogenesis of PE is similar to that of SE. Aim of the Study To compare between the levels of Vitamin D - as an important factor in growth and development - in primary monosymptomatic enuretic and non-enuretic children. Patients and Methods This is a case control study was performed in Ain Shams University Hospitals, Damanhour National Medical Institute. The study started on February 2020. The study included 60 children with primary mono-symptomatic nocturnal enuresis selected randomly and 60 healthy children age and sex matched children as a control group. Results We found that 61.7% of cases in the NE group had low Vit.D level (&amp;lt;20ng/ml) compared with 40% in the control group and this difference is statistically significant Conclusion Our study indicates that there • is a significant relationship between primary monosymptomatic nocturnal enuresis and serum vitamin D deficiency.

Pilot Study of a Novel At-Home Posterior Tibial Nerve System for Overactive Bladder Syndrome.

Urgency urinary incontinence and overactive bladder are common conditions. Third-line therapies are often underutilized because of either being too invasive or being burdensome for the patient. We aimed to determine the efficacy and acceptability of a noninvasive, home-based posterior tibial nerve treatment system for the treatment of overactive bladder syndrome. In this pilot study, 10 postmenopausal women with urgency urinary incontinence were given the SoleStim System for home-based posterior tibial nerve stimulation. Symptoms at baseline and completion of the 8-week study were determined by 3-day voiding diary and quality-of-life questionnaire (Overactive Bladder Questionnaire) to assess for reduction in incontinence episodes. All patients were 100% adherent to the SoleStim System application over the 8-week period and reported statistically significant reductions in the mean number of voids (-16.3%, P = 0.022), urgency episodes (-31.2%, P = 0.02), and urgency urinary incontinence episodes (-31.4%, P = 0.045). Forty percent of participants reported a decrease of ≥50% in their urgency urinary incontinence episodes. SoleStim was scored a value of 1.8 ± 2.0 (mean ± SD) on a 10-point usability scale, indicating that it was highly acceptable from an ease-of-use perspective. No adverse events were reported. The SoleStim System improved key overactive bladder (frequency, urgency, and urgency urinary incontinence episodes) and quality-of-life metrics. The results from this pilot study suggest that the SoleStim System may be a safe, effective, and highly acceptable at-home overactive bladder therapy.

Remote pelvic floor muscle training in the treatment of stress urinary incontinence in women

BACKGROUND: Stress urinary incontinence in women is a common condition that can develop at a young age and, even with mild severity, disrupts the quality of life. The first line of treatment for stress urinary incontinence is pelvic floor muscle training, which is the most effective in biofeedback mode. The low effectiveness of self-study is often associated with irregular and incorrect exercise.&#x0D; AIM: The aim of this study was to evaluate the effectiveness of remote pelvic floor muscle training using the Tyulpan laser vaginal simulator under medical supervision in the treatment of mild and moderate stress urinary incontinence in women of reproductive and perimenopausal age, and to develop a predictive model for evaluating the effectiveness of treatment by this method.&#x0D; MATERIALS AND METHODS: We examined 48 patients aged 41.3 6.8 years (2655) with complaints of mild to moderate stress urinary incontinence. After general clinical and special studies (analysis of seven-day urination diaries, Kings questionnaire and Pelvic Organ Prolapse / Urinary Incontinence Sexual Questionnaire (PISQ-12), urethrovesical segment ultrasound examination), a remote course of treatment was started using the Tyulpan laser vaginal simulator under medical supervision via videoconference for 35 patients within three months. The participants were re-examined one, three and four to six months after the start of the pelvic floor muscle training course.&#x0D; RESULTS: The training course was fully completed by 25 participants. After one month of remote pelvic floor muscle training, according to urination diaries, a decrease in the number of stress urinary incontinence episodes was noted by 64.0% of patients and the absence of stress urinary incontinence episodes by 28.0% of patients (p 0.001); after three months of remote pelvic floor muscle training, by 32.0% and 68.0% of patients, respectively (p 0.001). A negative cough test after one month was detected in 62.5% of the participants (p = 0.002) and, after four to six months with the continuation of independent pelvic floor muscle training, in 81.9% of patients (p = 0.003). According to the ROC-analysis, the absence of stress urinary incontinence episodes was predicted when the amplitude of the simulator laser beam was greater than or equal to 90 cm (sensitivity 84.0%, specificity 96.0%; p 0.001). Distance learning under medical supervision had a positive impact on the quality of life and relationships with a partner and improved the womens psychological well-being (p 0.001).&#x0D; CONCLUSIONS: Remote pelvic floor muscle training is effective in women of reproductive and perimenopausal age with mild to moderate stress urinary incontinence who are able to contract their pelvic floor muscles and perform regular exercises. The effectiveness of the training course is 68.0% according to urination diaries and 81.9% according to the cough test. The absence of stress urinary incontinence episodes is predicted when the amplitude of the simulator laser beam is greater than or equal to 90 cm.

Efficacy and safety of vaginal electrical stimulation as an alternative or adjunct treatment for overactive bladder syndrome in women: a meta-analysis of randomized controlled trials.

The objective was to evaluate the efficacy and safety of vaginal electrical stimulation (VES) as an alternative or adjunct treatment for overactive bladder (OAB) syndrome in women. Five English-language databases and four Chinese-language databases were searched to identify relevant studies. Studies comparing VES (VES alone or VES plus other interventions) with other interventions (medicines, bladder training, or PFMT) were included. Voiding diary, quality of life (QoL), and adverse events were extracted from the included studies for comparison. Seven trials with 601 patients in total were reviewed. The results showed that when compared with other interventions, VES alone significantly improved urgency episodes (p = 0.0008) and voiding frequency (p = 0.01), but did not significantly reduce nocturia (p = 0.85), urinary incontinence episodes (p = 0.90) and number of pads (p = 0.87). When VES plus other interventions was compared with other interventions, the former significantly improved voiding frequency (p < 0.00001), nocturia (p < 0.00001), and number of pads (p = 0.03), but it did not significantly reduce urinary incontinence episodes (p = 0.24). Both VES alone (p < 0.00001) and VES plus other interventions (p = 0.003) showed significant benefit on QoL. This study demonstrated that VES alone decreased urgency episodes and QoL better than other therapies. Although VES alone reduced voiding frequency better and VES plus other therapies decreased nocturia, number of pads, urgency episodes, and QoL better than other therapies, the results should be interpreted with caution for clinical practice because some of the RCTs included were of low quality and because of the small number of studies included.