Female Lower Urinary Tract Dysfunction Research Articles

Sacral Neuromodulation in the Treatment of Non-Neurogenic Female Lower Urinary Tract Dysfunction; First Case-series and Systematic Review of Literature

Objective: To demonstrate which types of non-neurogenic female lower urinary tract dysfunction (LUTD) respond to sacral neuromodulation (SNM) after the failure of all non-invasive treatments.Materials and Methods: Female LUTD performed SNM between 2017 and 2019 were retrospectively reviewed. A case with anatomical or neurological abnormalities were excluded by thorough physical examination and investigations. The specific type of LUTD, including midurethral obstruction (MUO), was diagnosed by videourodynamics (VUDS). Clinical diagnoses, including idiopathic urinary retention (IUR), voiding dysfunction (VD) and refractory overactive bladder (OAB), were used instead of VUDS diagnosis when the result was normal or inconclusive. The International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) in Thai version were used to compare between pre and post-treatment. Responder was defined as an IPSS and/or OABSS decreased more than 50% from baseline.Results: Total 21 cases were performed SNM. The average age was 49.6 (24–80) years. The average pre-treatment IPSS and OABSS were 23.4 and 6.4 as well as average post-treatment IPSS and OABSS were 13.7 and 3.8. Only 9 out of 21 cases (42.9%) showed improvement after SNM. The responders included 7 out of 11 MUO (63.6%), 1 out of 4 IUR (25.0%), and 1 out of 3 OAB (33.3%). None of the VD cases responded to SNM.Conclusion: SNM is another option for female patients with LUTD who have failed to respond to conservative treatments. After completely excluding anatomical and neurological abnormalities, the types of LUTD having a chance to respond to SNM are MUO, IUR, and OAB.

Is there enough evidence to justify the use of laser and other thermal therapies in female lower urinary tract dysfunction? Report from the ICI-RS 2019.

There is increasing evidence to suggest that thermomodulation may have a role in the management of women with lower urinary tract dysfunction (LUTD) and there has been widespread adoption of laser and radiofrequency (RF) therapies within clinical practice. However, in many areas of LUTD, the data are still limited and there remains a need for further evaluation of the safety and efficacy of thermal therapy. The aim of this study proposal is to report the findings of the International Consultation on Incontinence Research Society to clarify our current knowledge regarding the evidence for thermal therapy in LUTD and to set research priorities for the future. Literature review based on the search terms: "laser," "radiofrequency," "genitourinary syndrome of the menopause" or "urogenital atrophy," "stress urinary incontinence (SUI)," "pelvic organ prolapse," "OAB" or "overactive bladder," and "urinary tract infection." The current available evidence, though of low or very low quality, appears promising for the use of laser therapy in the management of genitourinary syndrome of the menopause, there are some data to suggest a possible role in SUI although very little evidence for urogenital prolapse. At present, the evidence supporting the use of laser in OAB and recurrent urinary tract infection is limited or lacking, while the available evidence for RF in the management of all forms of LUTD is much less robust. Laser and RF are being introduced clinically as a minimally invasive, low-risk interventions for women with LUTD although at present, the evidence supporting usage is limited. Consequently, there is an urgent need to demonstrate the safety and efficacy with prospective long-term studies including sham studies and comparative studies with current standard therapy.

Clinical and urodynamic evaluation of women referred with diabetes mellitus

We investigated the impact of diabetes mellitus (DM) on female lower urinary tract dysfunction. We prospectively collected data of 1,640 consecutive diabetic women from the inpatient departments and outpatient clinics of urology, endocrinology, geriatrics, and nephrology in primary, secondary, and tertiary referral hospitals, rural healthcare stations, and nursing homes in Dujiangyan, China. Clinical histories were taken on an individualized basis depending on patient presentation. Urodynamics were performed in the enrolled female diabetic patients after excluding other causes of lower urinary tract dysfunction. Data on lower urinary tract symptoms and urodynamic parameters were analyzed. Ninety-three percent of diabetic women complained of lower urinary tract symptoms, and 88% had positive urodynamic findings. Sixty-three percent presented with storage symptoms, 918 cases of which had detrusor overactivity, 787 impaired detrusor contractility, and 131 detrusor areflexia. Among the 918 patients with impaired detrusor contractility or detrusor areflexia, the mean first sensation of filling was 238.1ml, with a mean maximum cystometric capacity of 624ml, mean maximum flow rate of 9.6ml/s, mean detrusor pressure at maximum flow rate of 32.4cmH2O, and mean postvoid residual of 323ml. Thirty-eight of 131 patients with detrusor areflexia had impaired renal function on blood chemistry test, and massive bilateral ureterohydronephrosis and "Christmas-tree-shaped" bladder in videourodynamic studies. On the whole, 95% diabetic women had diabetic cystopathy. DM alters voiding patterns significantly, causing various lower urinary tract symptoms in a significant proportion of diabetic women. Diabetic cystopathy is a progressive condition with a spectrum of clinical symptoms and urodynamic findings. The prevalence of diabetic cystopathy is very high in Dujiangyan, China.

Estrogen and Female Lower Urinary Tract Dysfunction

Estrogen and Female Lower Urinary Tract Dysfunction

The Relationship Between α1-Adrenergic Receptors and TRPM8 Channels in Detrusor Overactivity Induced by Cold Stress in Ovariectomized Rats

We studied whether cold stress induced detrusor overactivity in ovariectomized rats is associated with increased thermosensitive TRPM8 channel expression in the skin and whether the response could be inhibited by α1-adrenergic receptor blockade. A total of 24 Sprague-Dawley® rats at postnatal week 30 were randomly selected for ovariectomy (16) or sham ovariectomy (8). Five weeks later cystometric measurements of conscious, freely moving rats were made at room temperature (mean ± SEM 28C ± 2C) for 20 minutes. Eight ovariectomized rats were intravenously administered 1.0 mg/kg naftopidil. The other 8 ovariectomized and 8 sham operated rats were given naftopidil-free vehicle. Five minutes later they were transferred to a low temperature environment (mean 4C ± 2C) and micturition patterns were again recorded. TRPM8 channel expression in lumbar skin was estimated by real-time reverse-transcriptase polymerase chain reaction and immunohistochemistry. TRPM8 channel mRNA and protein in the skin of ovariectomized rats were significantly higher than in sham operated rats. At room temperature micturition parameters were similar in sham operated and ovariectomized rats. At low temperature sham operated and ovariectomized rats showed cold stress induced detrusor overactivity but increased micturition frequency and decreased bladder capacity were significantly greater in ovariectomized rats. Treatment of ovariectomized rats with naftopidil inhibited cold stress induced detrusor overactivity. Cold stress induced detrusor overactivity in rats with decreased estrogen is associated with TRPM8 channel up-regulation in the skin and mediated by nerve pathways using α1-adrenergic receptors.

Effect of Ovariectomy on External Urethral Sphincter Activity in Anesthetized Female Rats

The postmenopausal hypoestrogen condition is associated with various lower urinary tract dysfunctions, including frequency, urgency, stress urinary incontinence and recurrent urinary infection. We determined whether hypoestrogen induced lower urinary tract dysfunction after ovariectomy is also associated with an alteration in external urethral sphincter activity. Bilateral ovariectomy was performed in female Sprague-Dawley® rats and sham operated rats served as controls. Transvesical cystometry and external urethral sphincter electromyogram activity were monitored 4, 6 and 12 weeks after sham operation or bilateral ovariectomy and at 6 weeks in bilaterally ovariectomized rats treated with estrogen. The micturition reflex was elicited in sham operated and bilaterally ovariectomized, urethane anesthetized animals. Post-void residual urine increased and voiding efficiency decreased in rats with 4 to 12 weeks of bilateral ovariectomy. The silent period of external urethral sphincter electromyogram activity was shortened significantly and progressively at increased times after bilateral ovariectomy. These effects were prevented by estradiol treatment. As evidenced by shortening of the external urethral sphincter electromyogram silent period in ovariectomized rats, the disruption of coordination between the external urethral sphincter and the detrusor muscle could decrease urine outflow and in turn voiding efficiency. Estrogen replacement reverses these changes, suggesting that the central pathways responsible for detrusor-sphincter coordination are modulated by gonadal hormones.

Treating symptomatic UTIs in older people

Practice NursingVol. 22, No. 1 Clinical Older PeopleTreating symptomatic UTIs in older peopleMargaret PerryMargaret PerrySearch for more papers by this authorMargaret PerryPublished Online:29 Sep 2013https://doi.org/10.12968/pnur.2011.22.1.21AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View articleReferencesClinical Knowledge Summaries (2010) Urinary Tract Infection (Lower) in Men. National Institute for Health and Clinical Excellence, London. http://www.cks.nhs.uk/urinary_tract_infection_lower_men/management/detailed_answers/view_all_detailed_answers (accessed 15 December 2010) Google ScholarGray RP, Malone Lee J (1995) Urinary tract infection in elderly people—time to review management? Age Ageing 24(4): 341–5. http://ageing.oxfordjournals.org/content/24/4/341.citation (accessed 15 December 2010) Google ScholarHicks D, Li CY (2007) Management of macroscopic haematuria in the emergency department. Emerg Med J 24: 385–90 Google ScholarHowes DA, Pillow MT (2010) Male Urinary Tract Infection. emedicine, Medscape. http://emedicine.medscape.com/article/778578-overview (accessed 15 December 2010) Google ScholarJuthani-Mehta MJ (2009) Urinary tract infections in elderly persons. In: American Society of Nephrology, ed. Geriatric Nephrology Curriculum. http://www.asn-online.org/education_and_meetings/geriatrics/Chapter32.pdf (accessed 15 December 2010) Google ScholarKamel HK (2004) Managing urinary tract infections in the nursing home: myths, mysteries and realities. Internet J Geriatr Gerontol 1(2): http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijgg/vol1n2/uri.xml (accessed 15 December 2010) Google ScholarMouton CP, Bazaldua OV (2001) Common infections in older adults. Am Fam Phys 63(2): 257–69 Google ScholarMundy AR (2006) Management of urethral strictures. Postgrad Med J 82(970): 489–93 Crossref, Google ScholarNicholle L (2009) Urinary tract infections in the elderly. Clin Geriatr Med 25(3): 423–36 Crossref, Google ScholarNicholle LE (2001) Urinary tract pathogens in complicated infection and in elderly individuals. J Infect Dis 183(Suppl 1): S5–8 Crossref, Google ScholarRajagopalan S, Yoshikawa T (2010) Urinary tract infections. In: Beers MH, Berkow R, eds. Merck Manual of Geriatrics. Chapter 100. http://www.merckmanu-als.com/mm_geriatrics/sec12/ch100.htm (accessed 20 December 2010) Google ScholarRaz R, Stamm WE (1993) A controlled trial of intravaginal oestriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med 329: 753–6 Crossref, Google ScholarRaz R, Gennesin Y, Wasser Jet al. (2000) Recurrent urinary tract infections in postmenopausal women. Clin Infect Dis 30: 152–6 Crossref, Google ScholarRobinson D, Cardozo L (2003) The role of oestrogens in female lower urinary tract dysfunction. Urology 62(4A Suppl): 45–51 Crossref, Google ScholarScottish Intercollegiate Guidelines Network (2006) Management of Suspected Bacterial Infection in Adults: A National Clinical Guideline. SIGN, Edinburgh. http://www.sign.ac.uk/pdf/sign88.pdf (accessed 15 December 2010) Google ScholarSmith AL, Ferlise VJ, Rovner ES (2006) Female urethral strictures: successful management with long-term, clean, intermittent catheterization after urethral dilatation. Br J Urol Int 98(1). http://onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2006.06206.x/full (accessed 15 December 2010) Google Scholar FiguresReferencesRelatedDetails 1 January 2011Volume 22Issue 1ISSN (print): 0964-9271ISSN (online): 2052-2940 Metrics History Accepted 30 November 2012 Published online 29 September 2013 Published in print 1 January 2011 Information© MA Healthcare LtdKeywordsUrinary tract infectionelderlyrisk factorsrecurrencealarm symptomstreatmentindications for referralPDF download

Receptor Isoforms That Mediate Estrogen and Progestagen Action in the Female Lower Urinary Tract

Bladder symptoms can be ameliorated by sex steroids but to our knowledge the mechanism of action is unknown. Previous studies of steroid receptor expression in the bladder did not indicate receptor subtype expression. We report the distribution of estrogen and progesterone receptor isoforms in the female lower urinary tract. Prospectively recruited women undergoing routine urogynecological or gynecological surgery provided cold cup biopsy samples from the bladder dome, trigone, and proximal and distal urethra. The samples were immediately frozen or fixed in formalin. After RNA extraction transcripts for estrogen receptor alpha and beta, and progesterone receptor A and B were noted on reverse transcriptase-polymerase chain reaction using isoform specific primers. The precise cellular localization of receptor proteins and their relative levels were assessed by immunochemistry in formalin fixed tissue sections with isoform specific antibodies. Nine premenopausal and 10 postmenopausal women were recruited into the study. Two postmenopausal women on hormone replacement therapy. Estrogen receptor alpha and beta, and progesterone receptor A and B transcripts were detected in whole bladder extracts. Nuclear estrogen receptor alpha immunoreactivity was present in squamous epithelium but absent from transitional epithelium. Estrogen receptor beta immunoreactivity was expressed in squamous and transitional cell epithelium. Nuclear progesterone receptor expression was present in urethral squamous epithelium only. Progesterone receptor expression was greater in premenopausal women and in postmenopausal women on estrogen. Estrogen receptor alpha and beta genes are transcribed in bladder tissue but only estrogen receptor beta is translated into protein, suggesting that the urothelium responds to endogenous estrogen via estrogen receptor beta. Progesterone receptor expression is confined to urethral squamous epithelium and the major isoform is progesterone receptor A.

The role of estrogens in female lower urinary tract dysfunction

The urogenital tract and lower urinary tract are sensitive to the effects of estrogen and progesterone throughout adult life. Epidemiologic studies have implicated estrogen deficiency in the etiology of lower urinary tract symptoms that occur after menopause. Although the role of estrogen replacement therapy in the management of postmenopausal urinary incontinence (UI) remains controversial, its use in the treatment of women with urogenital atrophy is now well established. This review summarizes recent evidence of the urogenital effects of hormone therapy, particularly emphasizing management of postmenopausal UI and recurrent lower urinary tract infections. Estrogen therapy alone has little effect in the management of urodynamic stress UI, although in combination with an α-adrenergic agonist, it may improve urinary leakage. Estrogen therapy may be of benefit for the irritative symptoms of urinary urgency, frequency, and urge UI, although this effect may result from reversal of urogenital atrophy rather than a direct action on the lower urinary tract. The role of estrogen replacement therapy in the treatment of women with recurrent lower urinary tract infections remains to be determined, although there is now some evidence that vaginal administration may be efficacious. Low-dose, vaginally administered estrogens have a role in the treatment of urogenital atrophy in postmenopausal women and appear to be as effective as systemic preparations.

An anatomical classification—a new paradigm for management of female lower urinary tract dysfunction

A new anatomical classification specifies anatomical defects in the anterior, middle and posterior zones of the vagina as the cause of female lower urinary tract dysfunction. An external musculoelastic mechanism stretches the vagina to open and close the outflow tract. The same pelvic floor muscles provide a peripheral control mechanism for micturition. The stretched vagina prevents the filling bladder from activating the stretch receptors in the bladder neck. Vaginal laxity may weaken transmission of muscle forces, interfering with urethral opening and closure, a mechanical process. Laxity may also destabilize the peripheral control mechanism, a neurological process, causing bladder control to swing between the open and closed modes urodynamically interpreted as bladder instability. Specific symptoms, signs, and urodynamic tests can be arranged into a pictorial algorithm. This acts as a practical guide for locating the three zones of anatomical defects. It has been possible to reinterpret almost all the definitions and descriptions of the International Continence Society (ICS) in terms of this classification, and to explain how vaginal laxity may cause premature activation of the micturition reflex (detrusor instability), stress incontinence and abnormal emptying (dribble, overflow). This convergence in anatomical and urodynamic (ICS) concepts explains many previously unexplained phenomena, and potentially opens up a new approach to management, nonsurgical strengthening of specific ligaments, or surgical reinforcement thereof with ambulatory “microinvasive” methods which do not require catheterization.

Use of routine videocystourethrography in the evaluation of female lower urinary tract dysfunction

AbstractControversy remains over which tests are necessary in the routine evaluation of women with lower urinary tract dysfunction. Is cystometry alone sufficient, or is a more detailed investigation such as videocystourethrography justified? Two hundred consecutive new patients attending for urodynamic assessment were reviewed. In fifteen (7.5%) patients the correct diagnosis was made only on videocystourethrography. We therefore suggest that videocystourethrography should continue to be used as the routine investigation of female lower urinary tract dysfunction.