Urgency Frequency Research Articles

Discriminating Different Bladder and Bladder Outlet Dysfunctions by Urinary Biomarkers in Women with Frequency–Urgency Syndrome

To investigate the role of urinary biomarkers in discriminating different bladder and bladder outlet dysfunctions in women with frequency-urgency syndrome. Urine samples collected from 146 women with frequency-urgency syndrome and 34 controls were investigated. All patients were included in previous clinical trials of functional urology studies and underwent a videourodynamic study. Patients with frequency-urgency syndrome were subdivided into idiopathic detrusor overactivity (IDO), neurogenic detrusor overactivity (NDO), dysfunctional voiding (DV), and hypersensitive bladder (HSB) subgroups. Urine samples were collected before any treatment, and urinary inflammatory proteins (interleukin- (IL-) 1β, IL-2, IL-6, IL-8, tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF)), neurogenic proteins (nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), and prostaglandin E2 (PGE2)), and oxidative stress biomarkers (8-isoprostane, total antioxidant capacity (TAC), and 8-hydroxydeoxyguanosine (8-OHdG)) were measured and compared between the different OAB subgroups and controls. Of the 146 patients, 31 had IDO, 41 had NDO, 45 had DV, and 29 had HSB. The control group included 34 women. The patients with HSB had lower urinary TAC and IL-2 levels than the controls. The patients with IDO, NDO, and DV had significantly higher urinary TNF-α levels than those with HSB. The patients with IDO and NDO showed an increase in the urinary 8-isoprostane levels, whereas the patients with IDO had higher urinary IL-2, NGF, and BDNF levels than those with NDO. The other urinary inflammatory biomarkers did not show enough significant differences to discriminate between the different bladder and bladder outlet dysfunctions. The urinary levels of inflammatory, neurogenic, and oxidative stress biomarkers varied widely among the patients with bladder and bladder outlet dysfunction. This study's results provide evidence that women with frequency-urgency syndrome and different urodynamic subtypes have varying bladder inflammation and oxidative stress conditions, which might have an impact on treatment outcomes.

Urethral Pain Syndrome: Treatment with Oxygen and Hyaluronic Acid

AIM: The aim of our clinical study has been to evaluate the efficacy of the association between high concentration oxygen and hyaluronic acid (HA) for the treatment of urethral pain syndrome (UPS). MATERIALS AND METHODS: Twenty women (45–65 years old) with suspected UPS diagnosis appealing to our Second Opinion Medical Consultation Network signed an informed consent form and were treated with oxygen/HA therapy treatment, 7 times a week, for a total of 5 weeks at the outpatient clinic (Clinic Ester Veronesi, Modena, Italy).The physicians of the Second Opinion Network followed up weekly from remote (WhatsApp, Skype) each treated patient as to state the effectiveness, tolerability, and side effects of the treatment. RESULTS: We observed significant reductions in number of urgency urinary incontinence (−25.37 vs. −12.01 mean value), nocturia episodes (−24.01 vs. −11.23 mean value), volume voided in each micturition (−127.79 vs. −98.20 mean value), and micturitions per 24 h (−44.01 vs. −20.12 mean value). Analyses of the pre- and post-treatment scores showed a statistically significant improvement in Vaginal assessment scale, pain urgency frequency, and patient perception of bladder condition scale scores (p < 0.0305, p < 0.0001, and p < 0.0001, respectively). No side effects associated with the treatment were reported by the patients. CONCLUSIONS: We can highlight that Caressflow® is effective and very well tolerated in UPS syndrome: The oxygen flow mixed with HA gives immediately a sense of freshness and urethro-bladder relaxation that lasts several hours. Further studies including larger sample sizes, placebo, and or challenge with other local and systemic treatments and different administration schedules versus longer follow-up are recommended.

Clinical approach and diagnosing bladder stone in a 74-year-old man patient: a case report

This article reports a 74-year-old man came to the emergency department with complaint blood in urine, urinary tract symptom such as nocturia, frequency urgency, and cloudy urine. Physical examination showed suprapubic area was hard on palpation. The abdominal X-ray of the patient showed an opaque stone in the bladder. An ultrasound scan showed a multiple bladder stone with the longest stone 1.59 cm in size. Bilateral kidney cyst and the prostate was enlarged with volume ±123.85 cc, IPP 2.29 cm. Entire stone elimination and eradication related BPH and urinary tract infections (UTIs) are the principal goal of the remedy. The patient was treated with Lithotripsy, antibiotics, alpha-blockers, antihypertension medications and showed clinical remission.

Combination of High Fecal Calprotectin and High Scores of The Frequency of Night Motion and Urgency Might Discriminate Ulcerative Colitis Patients with Bad Quality of Life and Fatigue in Ulcerative Colitis Patients

Combination of High Fecal Calprotectin and High Scores of The Frequency of Night Motion and Urgency Might Discriminate Ulcerative Colitis Patients with Bad Quality of Life and Fatigue in Ulcerative Colitis Patients

Combination therapy of solifenacin and mirabegron vs monotherapy in overactive bladder

Introduction and Objectives: Overactive bladder (OAB) with symptoms of frequency, urgency with or without urgency incontinence and nocturia is one of the most bothersome symptom affecting the quality of life of both men and women. Antimuscarinics and Beta 3 agonists both play an important role in reducing the bothersome symptoms. In this study we find the efficacy of low dose combination therapy of solifenacin 5 mg with mirabegron 25 mg vs the monotherapy solifenacin 10 mg or Mirabegron 50 mg.Materials and Methods: It is a prospective study conducted on 150 patients at Madras medical college and were divided into 3 groups. Group A received solifenacin 10 mg/day, Group B received solifenacin 5 mg/day + Mirabegron 25 mg/day and Group C received Mirabegron 50 mg/day. Patients were evaluated for improvement in frequency, urgency, leak episodes, voided volume and improvement in quality of life after a period of 4 weeks and 12 weeks. The three groups were compared using anova test and chi square test and p value was calculated.Results and Observations: Majority of patients of OAB belong to age group > 50 years and majority were females showing female predilection towards OAB. The mean duration of symptoms was 36.01± 7.91 months. Compared with monotherapy, the combination therapy resulted in a significant improvement in reducing the mean number of micturition/24hr from baseline to End of Treatment (EoT). The frequency of urgency episodes and mean number of nocturia episodes/24hr was significantly reduced in patients taking combination therapy as compared to monotherapy. In all the groups a decrease in mean number of incontinence episodes/24hr was observed from baseline to EoT but was not statistically significant. The frequency of antimuscarinic side effects (dry mouth, constipation, urinary retention) had lower incidence in combination therapy compared with solifenacin group. Conclusions: Combination therapy of solifenacin and mirabegron demonstrated significant improvement over monotherapy (solifenacin 10 mg & mirabegron 50 mg) in frequency of micturition, urgency and nocturia episodes without increasing bothersome adverse effects associated with antimuscarinic therapy.

A Multi-Center, Randomized, Blind, Controlled Clinical Trial of the Safety and Efficacy of Micro Radio Frequency Therapy System for the Treatment of Overactive Bladder.

PurposeThe purpose of this study was to evaluate the efficacy and safety of low power micro radiofrequency (RF) therapy (μRFthera®) through urethra in the treatment of overactive bladders (OAB) through a prospective, single-blind, placebo-controlled, multi-center clinical protocol.Materials and MethodsOne hundred and fourteen patients with refractory OAB were randomized at 2:1 ratio, treatment to control undergoing same procedures except only the micro-RF treatment group at turned “on” setting in energy. Bladder diaries recorded during the screening period (3 days before enrollment) and during follow-up period on week 1, 3, and 7, respectively. The patients in control could choose receiving an energized treatment during extension stage.ResultsThe treatment efficacy was 76.1%. There was 49.80% rate improvement compared to control (95%CL 32.48%, 67.13%). The crude rate ration (RR) was 2.89, 95% CI (1.67–5.01) with p < 0.001 in uni-variate analysis, while the RR became 2.94, 95% CI (1.67–5.16) with p < 0.001 after adjusted potential confounding factors in multi-variate analysis. Statistically significant improvements have been demonstrated in the frequency of urination, urgency, nocturia, and quality of life (QoL) scores.ConclusionsMicro RF therapy is safe and effective for the treatment of OAB. The main treatment-related complications were catheterization related complications.Clinical Trial RegistrationZhejiang Device Registration Certificate No. 202090909, www.chictr.org.cn, Clinical Trial Accession Number: ChiCTR2100050096.

Examining vaginal and vulvar health and sexual dysfunction in patients with interstitial cystitis (UNICORN-1 study).

The Vaginal Health Index Score (VHIS) and vulvodynia swab tests are used to assess vaginal health and vulvodynia. However, few studies have used these tests in patients with interstitial cystitis/bladder pain syndrome (IC/BPS). IC/BPS is a chronic, debilitating disorder, characterised by urinary frequency, urinary urgency and pelvic pain. It adversely affects organs adjacent to the urinary system, leading to complications of sexual dysfunction. This study was aimed at understanding sexual dysfunction in patients with IC/BPS, as well as deterioration of vaginal health and vulvodynia. This study compared the vaginal health of IC/BPS patients with that of asymptomatic control individuals. The Pain Urgency Frequency (PUF) score, Female Sexual Function Index (FSFI), VHIS, and vulvodynia swab tests, were used as tools. The PUF and FSFI are questionnaire-based surveys of bladder symptoms and sexual function respectively. VHIS evaluation and vulvodynia swab tests are performed by physicians. The PUF was used to assess baseline IC/BPS symptoms to validate the patient population, and FSFI, vulvodynia swab tests and VHIS were used to determine between-group differences. Thirty-seven patients were recruited in each group. The IC/BPS group had a higher PUF score (18.19±3.51 vs 3.56±2.35; p<0.05), worse total FSFI (15.72±4.46 vs 26.3±4.93; p<0.05), and worse vulvodynia swab test and total VHIS (11.59±2.87 vs 22.05±3.05; p<0.05) scores than those of the control group. Asian women with IC/BPS experienced greater sexual dysfunction, worsened vaginal health and increased vulvodynia compared with control individuals. Information on vaginal and vulva health is very useful in evaluating IC/BPS patients.

Hengli® Chinese Botulinum Toxin Type A for Treatment of Patients With Overactive Bladder: A Multicenter, Prospective, Randomized, Double-Blind, Placebo-Controlled Trial.

Objective: To evaluate the efficacy and safety of Hengli® Chinese botulinum toxin type A (BTX-A; 100 U) in Chinese patients with overactive bladder. Methods: This study was a multicenter, randomized, double-blind, placebo-controlled trial in Chinese patients who were inadequately managed with anticholinergic medications. Eligible patients were randomized 2:1 to receive intradetrusor injections of Hengli® BTX-A (n = 144) or placebo (n = 72). The primary endpoint was the change in the number of daily micturition episodes at week 6 from baseline. The secondary efficacy endpoints included the average frequency of urgency and urinary incontinence (UI) episodes per day, urgency score, average micturition volume per day, OABSS, and QoL score. Results: In the Hengli® BTX-A group, there was a significantly greater reduction in the average number of micturition episodes per 24 h compared with the placebo group (3.28 vs. 1.43; p = 0.003). Moreover, there was a significantly greater improvement in the daily number of urgency episodes, micturition volume and OABSS score. An increased post-void residual urine volume, dysuria, and urinary tract infection represented adverse events (AEs) in the Hengli® BTX-A group. Most AEs were mild or moderate in severity. One patient in the BTX-A group initiated clean intermittent catheterization (CIC) during treatment. Conclusion: Hengli® BTX-A treatment was well-tolerated and resulted in significant improvements in OAB symptoms among Chinese patients inadequately managed by anticholinergics. Clinical Trial Registration: http://www.chinadrugtrials.org.cn/clinicaltrials.prosearch.dhtml, Identifier: CTR20131190.

A QUALITATIVE STUDY EXPLORING MEANINGFUL IMPROVEMENT IN BOWEL URGENCY AMONG ADULTS WITH MODERATE TO SEVERE ULCERATIVE COLITIS

Abstract BACKGROUND Ulcerative Colitis (UC) is a chronic disease with periods of relapse and remission. Bowel urgency, the sudden or immediate need for a bowel movement, is one of the most bothersome symptoms experienced by patients with UC. This study explored how patients define urgency severity and what would be a meaningful improvement based on a numeric rating scale (NRS). METHODS In-depth interviews were conducted in the United States with 19 adults with clinician-confirmed moderate to severe UC. Participants were asked to define levels of bowel urgency severity using an 11-point NRS (where 0 = no urgency and 10 = worst possible urgency) and to describe what would be a meaningful improvement based on how this change would impact their daily life. Interviews were audio-recorded, transcribed, and coded using thematic coding in NVivo. RESULTS Mild bowel urgency was described as ranging between 0 to 3 on the 11-point scale by most UC patients (n=16, 84%). Mild was described as “almost normal” or “normal urgency” (n=6, 32%) and being able to make it to the bathroom with ease (n=5, 25%). Most participants (n=15, 79%) rated moderate urgency between 4 to 6 on the 11-point scale. At this level, participants commented that they would need to ensure they are close to a bathroom (n=7, 37%). Finally, ratings for severe urgency clustered between 6 to 8 (n=7, 37%) and 8 to 10 (n=12, 63%). Severe bowel urgency was described as an immediate or uncontrollable need (n=8, 42%) which impacts their ability to leave the home (n=7, 37%). When asked about what change on the urgency NRS would be meaningful, n=10 (53%) participants reported that a 1-point change would be meaningful, with most stating that any change was an improvement. Participants commented that a 1-point change would reflect improved emotional well-being and greater confidence to leave the home. In contrast, 9 (47%) participants wanted improvements of more than 1-point change; 5 (26%) indicated that a 2-point improvement was required to consider the change meaningful and 4 (21%) felt a 3-point change or more was needed. With this greater level of change, participants described having a significant improvement in urgency, with less frequent urges and improved emotional well-being. CONCLUSION This qualitative study revealed that UC patients largely agreed regarding ratings of ‘mild’ and ‘moderate’ bowel urgency on an 11-point severity scale. ‘Severe’ bowel urgency was split between two ranges suggesting the existence of ‘very severe’ bowel urgency. In addition, the majority of UC patients perceived a 1 or 2-point reduction on the urgency NRS as a meaningful change in their lives.

Urinary Biomarkers in Interstitial Cystitis/Bladder Pain Syndrome and Its Impact on Therapeutic Outcome.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is defined as a chronic bladder disorder with suprapubic pain (pelvic pain) and pressure and/or discomfort related to bladder filling accompanied by lower urinary tract symptoms, such as urinary frequency and urgency without urinary tract infection (UTI) lasting for at least 6 weeks. IC/BPS presents significant bladder pain and frequency urgency symptoms with unknown etiology, and it is without a widely accepted standard in diagnosis. Patients’ pathological features through cystoscopy and histologic features of bladder biopsy determine the presence or absence of Hunner lesions. IC/PBS is categorized into Hunner (ulcerative) type IC/BPS (HIC/BPS) or non-Hunner (nonulcerative) type IC/BPS (NHIC/BPS). The pathophysiology of IC/BPS is composed of multiple possible factors, such as chronic inflammation, autoimmune disorders, neurogenic hyperactivity, urothelial defects, abnormal angiogenesis, oxidative stress, and exogenous urine substances, which play a crucial role in the pathophysiology of IC/BPS. Abnormal expressions of several urine and serum specimens, including growth factor, methylhistamine, glycoprotein, chemokine and cytokines, might be useful as biomarkers for IC/BPS diagnosis. Further studies to identify the key molecules in IC/BPS will help to improve the efficacy of treatment and identify biomarkers of the disease. In this review, we discuss the potential medical therapy and assessment of therapeutic outcome with urinary biomarkers for IC/BPS.

Paroxysmal cold hemoglobinuria

Paroxysmal cold hemoglobinuria, first described by Dresler in 1854, is characterized by the fact that after cooling a chill sets in and the temperature rises to 39-40 with all the sensations accompanying this state. Then there are pains in the lumbar region and in the abdomen, frequent urge to urinate with cramps, nausea, vomiting. At the height of the fever or soon after the temperature drops, dark urine (the color of black coffee or strong tea) begins to be secreted. The skin is pale, with an icteric tinge. The attack ends in 6-12 hours, sometimes after 1-3 days.

The role of the multi-disciplinary team and multi-disciplinary therapeutic protocol in the management of the chronic pelvic pain: There is strenght in numbers!

Introduction: The aim of the study is to evaluate the effectiveness of a Multi-disciplinary team (MDT) and multi-disciplinary approach in the treatment of Chronic Pelvic Pain (CPP). Methods: The data of all consecutive patients referred for a CPP from 11/2016 to 2/2019 has been prospectively collected. The sample was divided in two groups: Group A, made by patients managed after the institution of our MDT, and Group B, made of patients managed before this date. The MDT is composed by three urogynecologists, a psychologist and a physiotherapist. All Group A patients underwent a weekly bladder instillation with dimethyl sulfoxide (DMSO), kinesiotherapy for trigger points and Percutaneous Tibial Nerve Stimulation for 10 consecutive weeks. Patients were asked to perform a self-treatment following the Stanford Protocol and to adhere to a specific diet. All Group B patients were managed only with DMSO instillations and a strict diet. Results: The Group A was made of 41 females and 6 males while the Group B was made of 38 females and 5 males. The Group A patients showed a statistically significant improvement in the Pelvic Pain Urgency Frequency, in the frequency times reported at the 6 months voiding diary, and a better Patient Global Impression of Improvement. Conclusions: Our data support the efficacy of the MDT in the management of CPP. The multimodal approach might represent an effective and reproducible non-invasive option to manage successfully CPP.

P253 A qualitative study exploring meaningful improvement in bowel urgency among adults with moderate to severe Ulcerative Colitis

Abstract Background Ulcerative Colitis (UC) is a chronic disease with periods of relapse and remission. Bowel urgency, the sudden or immediate need for a bowel movement, is one of the most bothersome symptoms experienced by patients with UC. This study explored how patients define urgency severity and what would be a meaningful improvement based on a numeric rating scale (NRS). Methods In-depth interviews were conducted in the United States with 19 adults with clinician-confirmed moderate to severe UC. Participants were asked to define levels of bowel urgency severity using an 11-point NRS (where 0 = no urgency and 10 = worst possible urgency) and to describe what would be a meaningful improvement based on how this change would impact their daily life. Interviews were audio-recorded, transcribed, and coded using thematic coding in NVivo. Results Mild bowel urgency was described as ranging between 0 to 3 on the 11-point scale by most UC patients (n=16, 84%). Mild was described as “almost normal” or “normal urgency” (n=6, 32%) and being able to make it to the bathroom with ease (n=5, 25%). Most participants (n=15, 79%) rated moderate urgency between 4 to 6 on the 11-point scale. At this level, participants commented that they would need to ensure they are close to a bathroom (n=7, 37%). Finally, ratings for severe urgency clustered between 6 to 8 (n=7, 37%) and 8 to 10 (n=12, 63%). Severe bowel urgency was described as an immediate or uncontrollable need (n=8, 42%) which impacts their ability to leave the home (n=7, 37%). When asked about what change on the urgency NRS would be meaningful, n=10 (53%) participants reported that a 1-point change would be meaningful, with most stating that any change was an improvement. Participants commented that a 1-point change would reflect improved emotional well-being and greater confidence to leave the home. In contrast, 9 (47%) participants wanted improvements of more than 1-point change; 5 (26%) indicated that a 2-point improvement was required to consider the change meaningful and 4 (21%) felt a 3-point change or more was needed. With this greater level of change, participants described having a significant improvement in urgency, with less frequent urges and improved emotional well-being. Conclusion This qualitative study revealed that UC patients largely agreed regarding ratings of ‘mild’ and ‘moderate’ bowel urgency on an 11-point severity scale. ‘Severe’ bowel urgency was split between two ranges suggesting the existence of ‘very severe’ bowel urgency. In addition, the majority of UC patients perceived a 1 or 2-point reduction on the urgency NRS as a meaningful change in their lives.

Intermediate-term results of a prospective, multicenter study on remote programming sacral neuromodulation for refractory overactive bladder.

BackgroundTo evaluate the efficacy and safety of a novel remote programming sacral neuromodulation (SNM) system (BetterStim system) in the treatment of patients with refractory overactive bladder (OAB) for 3 years.MethodsA total of 8 centers in China enrolled 84 patients with OAB. Following test stimulation 70 patients underwent implantation using BetterStim. All patients returned for follow-up at 3 and 6 months postoperatively. After that, the visits were conducted by telephone. Outcomes of voiding diaries, the overactive bladder symptom score (OABSS), questionnaires regarding OAB-related quality of life (OAB-qol), and adverse events (AEs) were evaluated at each visit. The clinical therapeutic success was defined as ≥50% improvement from baseline in any of the voiding diary variables or average voids/day return to normal voiding (<8 voids/day). The analysis is a modified Completers analysis.ResultsAt the 36-month follow-up, the success rate was 79% for overall OAB symptoms, 69% for urge urinary incontinence (UUI) and 42% for urgency frequency (UF). The average number of voids/day decreased from 29.2±14.9 at baseline to 17.6±11.2 at 3 years, the average volume/void increased from 94.7±54.2 to 151.4±80.8 mL, the urgency reduced from 3.0±1.4 to 1.8±1.7 (all P<0.001). For patients with urge incontinence, mean leaking episodes/day decreased from 8.1±7.6 at baseline to 2.1±3.5 at three years (P<0.05). The devices were explanted in 8 (11.4%) patients. There were no remote programming-related AEs or device-related serious AEs that occurred.ConclusionsThe Intermediate-term results demonstrated that BetterStim SNM system with remote programming is safe and effective for patients with refractory OAB.

The Effect of Sacral Neuromodulation in Ambulatory Spina Bifida Patients with Neurogenic Bladder and Bowel Dysfunction

OBJECTIVETo assess the effect of sacral neuromodulation (SNM) in ambulatory spina bifida patients with neurogenic bladder and bowel dysfunction. MATERIALS AND METHODSWe retrospectively reviewed the records of 29 ambulatory spina bifida patients with neurogenic bladder and bowel dysfunction who underwent SNM testing from July 2012 to January 2020. Clinical data and video-urodynamic parameters were collected and compared using the t-test and the chi-square test. The potential risk factors were considered by logistic regression analysis. P < .05 was considered significant. RESULTSIn the test phase, 21 patients (72.4%) achieved successful improvement of at least 1 symptom. The success rate for chronic urinary retention (26.09%) was significantly lower (P <.05) than that for urgency–frequency syndrome (58.82%) and urinary incontinence (56.25%). The mean neurogenic bowel dysfunction score decreased from 13.3±6.29 to 6.9±5.09 (P <.0001). The urodynamic evaluation showed a significant improvement in the mean maximum cystometric capacity, compliance, and maximum detrusor pressure (P <.05). Implantation was performed in 16 cases (55.17%). The analysis of the risk factors showed that chronic urinary retention was a statistically significant variable (P <.05). No complications were reported in the test phase. The average follow-up time was 41.19±33.06 months. Two patients changed to intermittent catheterization, and 2 patients changed to augmentation cystoplasty. CONCLUSIONSNM is effective for neurogenic bladder and bowel dysfunction in patients with ambulatory spina bifida, especially in those without chronic urinary retention. And SNM can also significantly improve the urodynamic parameters of these patients during the storage period.

Patient quality of life and risk factors affecting the development of benign prostatic hyperplasia

The article considers the risk factors affecting the occurrence of benign prostatic hyperplasia (BPH) and the quality of life of patients with this type of pathology. World statistics indicate that BPH is a disease of mainly elderly and senile men. The main reason leading to the development of BPH is a change in the hormonal background of males. BPH is characterized by symptoms that negatively affect the quality of life of men, causing physical and psychological discomfort. This pathology is accompanied by squeezing of the bladder, which contributes to the appearance of frequent urge to empty it, erectile dysfunction, a decrease or complete absence of sexual desire, which often leads to a decrease in self-esteem and depression. Among the main risk factors that cause BPH controllable and uncontrollable ones are distinguished. Elimination of the influence of controllable risk factors that cause BPH leads to a decrease in the rate of progression of the disease, allows timely initiation of treatment, which has a positive effect on the quality of life of men with this diagnosis.

Efficacy and Safety of Sacral Neuromodulation in Treatment of Refractory Overactive Bladder

Background: Overactive bladder syndrome is a urinary disorder that occurs more frequently in women andolder people and is characterized by feeling an urge to urinate (sudden urge to urinate, with the feeling thatyou cannot get to the bathroom in time), doing it many times throughout the day (more than six) or havingepisodes of urinary incontinence (involuntary loss of urine) and nocturia (waking up several times duringthe night to urinate). In addition, other secondary symptoms may also occur, such as headache, dry mouth orblurred vision, among others. It is a problem that has a clear impact on the quality of life of those who sufferit and that can lead them to significantly reduce their social activity and negatively condition their work.Overactive bladder (OAB) is defined as urinary urgency with or without urgency urinary incontinence,nocturia, and/or frequency in the absence of UTI or other obvious pathology. Sacral neuromodulation is anewer surgical therapy for refractory OAB.Aim of Study: Is to assess the sacral neuromodulation (SN) safety and efficacy in refractory overactivebladder patients.Patients and Methods: In the period from November 2015 to May 2017. the unit of neurogenic bladderand neuromodulation in (Gazi Al_Harriry) surgical specialty hospital, medical city complex 27 patient agedfrom (17—55) year old were complaining from refractory overactive bladder. All the 27 patients underwentstage1 &amp; stage2 SNS devices implantation.Results: Patients of urgency incontinence (group1) demonstrated that the number of leak was significantlyreduced (p=0.01) after implantation of SN, (11.6_2.7) leak/day pre&amp; post SN, numbers of pads (6.9 _ 0.8)pad/day pre&amp;post SN. Patients with urgency frequency (group 2), numbers of voids/day pre &amp; post SNimplantation decreased significantly (p=0.01) (14.7 _ 6) voids /day. The voided volume increased significantly(p=0.02) from (136.4 _ 371.8) ml/void. The urgency episodes were decreased significantly (p=0.01) from(6.4 _ 2.1) episode/day. The complications occurred in 5 patients (18.5%). Two patients (7.4%) developedpain after trauma to the back, lead migration, lack of efficacy of device, treated by reprogramming thedevice, one patient (3.7%) get infection at the site of device implantation, SN was removed , there was onefemale patient (3.7%) got pregnancy and devise was deactivated. One patient (3.7%) complaining from painand discomfort at the device site was treated conservatively.Conclusion: Sacral neuromodulation is FDA approved as option for treatment of refractory OAB. There isexpanding of utilizing of SN in the past two decades. According to multiple studies in addition to our studyresults. The sacral neuromodulation is safe and efficacious treatment option for refractory OAB.

Vibegron: a β3-adrenergic agonist for the treatment of overactive bladder.

Overactive bladder (OAB) is an extremely common condition in adults of both sexes. It is characterized by an urgent need to micturate often accompanied by incontinence. The condition may also increase the number of micturitions in a 24-hour period as well as nocturia. The syndrome is not due to a urinary infection or other obvious pathology. In terms of drug treatment of OAB, there are two main approaches. One is the use of anticholinergic drugs that reduce the effect of the parasympathetic nervous system on the bladder. The other involves the use of drugs that are agonists at β3-adrenergic receptors in the bladder. These drugs increase the capacity of the bladder and cause reductions in the number of daily micturitions and nocturia and also importantly reduce the frequency of urinary urgency and urinary urgency incontinence. Vibegron is the second β3-adrenergic agonist to be approved for the treatment of OAB.

Antimicrobial resistance pattern of urinary tract pathogens from tertiary care hospitals in Bangladesh

Background: In Bangladesh, urinary tract infection (UTI) patients usually self-medicate or receive empirical treatment from physicians to start immediate treatment or to avoid expensive medical care. A study of 2016 in Bangladesh showed resistance to antibiotics like quinolones (52%), 3rd generation cephalosporin (51.1%), cotrimoxazole (47%) and imipenem (1%) in UTI. To understand the national situation of antimicrobial resistance (AMR), Institute of Epidemiology, Disease Control and Research (IEDCR), the national institute of epidemiology of Bangladesh, started a surveillance in ten tertiary care hospitals since 2017 from six types of specimens including urine of UTI patients. Objectives of this study were to determine the distribution and antibiotic resistance patterns of UTI pathogens. Methods and materials: We analyzed data of UTI patients enrolled in five initially started sites of AMR surveillance in 2018. UTI patient was defined as >5 years old patient attending outdoor, with abrupt onset of frequency of micturition & urgency with fever, chill or burning sensation of urine or loin pain. Epidemiological data and urine sample were collected. Sample were tested for routine microscopy examination and antimicrobial susceptibility test (AST). AST was performed by disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guideline. We included intermediate and resistant zone in calculation of resistance. Results: In 2018, a total of 1779 UTI patients reported, 439 (24%) had growth in culture. Culture positivity was more in UTI with >5 pus cells/high power field (HPF) (54/439, 80%) on microscopy than <5 pus cells/HPF (85/439, 19%). About 8% patient took antibiotics previously. Culture positive UTI was more in female 323 (73%) than male 116 (26%). Common pathogens were Escherichia coli (57.4%), Klebsiella (17.3%) and Staphylococcus aureus (10.93%). Escherichia coli was resistant 57% to quinolones, 55% to 3rd generation cephalosporin, 54% to cotrimoxazole and 5% to imipenem; Klebsiella was resistant 37% to third generation cephalosporin, 57% to quinolones, 54% to cotrimoxazole and 8.6% to imipenem. Gram negative bacteria also showed resistance to imipenem. Conclusion: Urinary pathogens showed higher resistance against commonly used antibiotics like quinolone, 3rd generation cephalosporin and cotrimoxazole. We recommend to conduct studies on prescription pattern and physicians should be aware about resistance pattern to treat accordingly.

Influence of patient sex on the effectiveness of sacral neuromodulation: A cohort study from China

BackgroundSacral neuromodulation (SNM) has been widely used to treat lower urinary tract dysfunction. Studies have shown a higher conversion rate among female patients than among male patients. However, the influence of gender on the clinical effectiveness of SNM remains unclear. We aimed to confirm whether patients of both genders show similar benefits after SNM treatment. Materials and methodsClinical data of patients with lower urinary tract symptoms associated with pelvic floor dysfunction (overactive bladder, neurogenic bladder, interstitial cystitis/painful bladder syndrome, idiopathic urinary retention) treated with SNM in 10 medical centres in China between January 2012 and December 2016 were retrospectively collected. The patients were classified by gender. Variations in objective (voiding diary) and subjective scores in the baseline, testing, and last follow-up periods were compared. Data were analysed using statistical measures. ResultsThe study included 203 patients (93 males, 110 females). There were no statistical differences in baseline information between the two groups, both groups showed improvement over time. Unsatisfactory improvement was observed in the quality of life and sexual life scores of both groups over the entire treatment period (all p＞0.05). Although there was a difference in the maximum voiding volume between the groups at baseline, no difference was observed at the last follow-up (p = 0.004, p = 0.044, p = 0.124), unlike in the average volume where a difference was noted at the last follow-up (p = 0.085, p = 0.964, p = 0.031). While there were no differences in quality of life, sexual life, or pelvic pain and urinary urgency frequency scores at baseline, a significant difference was observed at the last follow-up, and the degree of improvement was less among female patients (p = 0.836, p = 0.131, p = 0.015; p = 0.294, p = 0.265, p = 0.013; p = 0.299, p = 0.087, p = 0.015). ConclusionSNM treatment elicited a similar effect on patients of both gender; however, a significant difference was observed regarding patient satisfaction with the treatment. Further preoperative patient education, especially, for female patients with interstitial cystitis/painful bladder syndrome may improve patient satisfaction.