Incontinence Episodes Research Articles

Effectiveness of Fluid and Caffeine Modifications on Symptoms in Adults With Overactive Bladder: A Systematic Review.

Overactive bladder (OAB) is prevalent in men and women and negatively impacts physical and psychological health. Fluid and caffeine intake modifications, which are lifestyle modification interventions, are simple methods to manage OAB. However, studies that synthesized both interventions and found scientific evidence are scarce. This review aimed to synthesize scientific evidence on whether fluid and caffeine intake modifications are effective for OAB symptoms. PubMed, CINAHL (Cumulative Index for Nursing and Allied Health Literature), Embase, Scopus, the Cochrane Library, KoreaMed, and RISS (Research Information Sharing Service) were used to search for studies and 8 studies were included. The Cochrane risk of bias tool (RoB 2.0) and ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) were used to assess the quality of selected studies. Due to the heterogeneous outcome variables, a meta-analysis was not conducted. Among the 8 included, 7 studies were randomized controlled trials and one was a quasi-experimental study. Four studies assessed urgency. Caffeine reduction was statistically effective for urgency symptoms, but increasing fluid intake was not. Frequency was assessed in 5 studies, which showed decreasing caffeine and fluid intake was effective in treating the symptoms. Urinary incontinence episodes were assessed in 6 studies, and nocturia in 2. Restricting caffeine intake was effective in treating these 2 symptoms, but restricting both caffeine and fluid intake was not. Quality of life (QoL) was examined in 5 studies, and modifying fluid and caffeine intake significantly improved QoL in 2. Although there were limited studies, our review provides scientific evidence that fluid and caffeine intake modification effectively manages OAB symptoms. Further research should examine acceptability and sustainability of interventions in the long-term and enable meta-analysis.

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

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

Comparison of micro-radiofrequency therapy and tolterodine for the treatment of newly diagnosed overactive bladder: A retrospective cohort study.

This study aimed to retrospectively compare the efficacy and safety of micro-radiofrequency (RF) therapy through the urethra vs. oral tolterodine tartrate in the treatment of newly diagnosed overactive bladder (OAB). In this study, 46 patients who were newly diagnosed with moderate-to-severe OAB were included; 23 of them underwent the micro-RF treatment procedure, and the other 23 patients took tolterodine. Bladder diaries were recorded 3 days before treatment and during the follow-up period on 1, 3, and 7 weeks after micro-RF therapy or oral tolterodine. Micturition parameters including daily voiding times, daily urge urinary incontinence (UI) episodes, daily urgency episodes, mean volume per micturition, post-void residual volume (PVR), maximum urine flow rate (Qmax), overactive bladder symptom score (OABSS), and quality of life (QoL) score were analyzed. All 46 patients underwent either micro-RF or oral tolterodine treatment, as well as a complete follow-up. The incidence of adverse events in the micro-RF group was 8.7% (2/23), and that in the tolterodine group was 43.5% (10/23). The following two adverse events happened in the micro-RF group: an injury to the urethra during catheterization in a man and a urinary tract infection in a woman, both of which were relieved or disappeared after day 3. The adverse effects in the tolterodine group were mainly dry mouth (4/23), dysuria (5/23), and constipation (8/23), but none of the patients withdrew from the drug therapy. Compared to pre-therapy, all parameters of both groups, including daily voiding times, daily urgency episodes, mean volume per micturition, OABSS, and QoL score, demonstrated significant improvements during follow-up in 7 weeks after therapy, except for daily UI episodes in the tolterodine group, while the above parameters showed bigger improvements in the micro-RF group than in the tolterodine group. Besides, the general treatment efficacy of micro-RF was 73.9% (17/23), which was significantly better than tolterodine (10/23, 43.5%), and the difference was 30.4% [95% CI: 3.4-57.5%, p = 0.036]. In this retrospective study, we found that micro-RF therapy is safe and more effective than oral tolterodine for newly diagnosed moderate-to-severe OAB in a short-term follow-up. Stronger evidence would be provided through a well-designed, prospective, randomized controlled trial.

Genitourinary management and follow-up for patients with Stevens-Johnson syndrome/toxic epidermal necrolysis

ObjectiveTo review the cases of Stevens-Johnson syndrome and/or toxic epidermal necrolysis in adult male patients to determine the incidence of genitourinary manifestations, the indication for urethral catheters, and to provide recommendations for management. Materials and methodsThis is a retrospective observational study of adult male patients over a ten year period. The study group is divided into patients with and without genitourinary manifestations. ResultsWe identified 57 patients who met the study inclusion criteria, of whom 39 had genitourinary involvement. The most common location of lesions was the phallus although many patients had multiple sites of involvement. These lesions were treated similarly compared to other nongenitourinary cutaneous lesions. Four patients presented with dysuria, one with frequency, and one with hesitancy and intermittency. A urethral catheter was placed in 25 of the 39 patients. None of the patients who were not catheterized and did not have lower urinary tract symptoms at the time of presentation developed voiding symptoms during their hospital stay. Apart from a one-time episode of incontinence in one patient that resolved spontaneously, none of the patients who were catheterized developed voiding issues after their catheters were removed. No patients required follow-up with urology after discharge. ConclusionsNo patients developed a symptomatic urethral stricture. Many patients had multiple sites of involvement. Despite no standardized treatment being used, all cutaneous lesions were successfully treated in patients who survived their illness, with documented resolution of genitourinary lesions on physical examination. Routine urethral catheterization and urologic consultation are not necessary in these patients.

Bayesian Borrowing Methods for Count Data: Analysis of Incontinence Episodes in Patients with Overactive Bladder

We examine the performance of the power prior and the meta-analytic-predictive (MAP) prior for the analysis of (overdispersed) count data when multiple historical control data are incorporated into the analysis of the current data. To this end, we explore the Poisson and the negative binomial distribution. We propose a computational approach based on path sampling for the calculation of the scaling constant of the Modified Power Prior (MPP). We illustrate the methods through a motivating example of a clinical trial evaluating the effect of an experimental treatment to reduce the number of incontinence events for patients with an overactive bladder. Furthermore, we assess the performance of these methods via a simulation study in case of heterogeneity of the control arms. For similar current and historical control arms, the MPP approach offers greater statistical power than the MAP prior approach. When the means are different across the control arms, the MPP yields a slightly inflated Type I error rate, whereas the MAP prior does not. When the dispersion parameters are different across the control arms, the results are reversed. In conclusion, the MPP approach outperforms the MAP prior approach for count data.

Effects of ospemifene on overactive bladder in postmenopausal women with vulvovaginal atrophy

Objective Overactive bladder (OAB) is a complex and multifactorial syndrome associated with urinary frequency, urgency and incontinence. The menopause-associated hormonal changes play a role in the development of this condition. Vaginal estrogens are effective in improving OAB in postmenopausal women (PMW) with vulvovaginal atrophy (VVA). Ospemifene is a selective estrogen receptor modulator licensed for the treatment of VVA. This study aimed to evaluate the effects of ospemifene on OAB symptoms in PMW with VVA. Methods Forty PMW suffering from OAB and VVA received oral ospemifene (60 mg/day) for 12 weeks. All patients were assessed with a urodynamic study, a 3-day bladder diary and validated questionnaires (International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form [ICIQ-UI SF] and International Consultation on Incontinence Questionnaire – Overactive Bladder [ICIQ-OAB]) at enrollment and at the end of the study. Results Cytometric capacity, bladder compliance and verbal sensory threshold responses during bladder filling were improved after treatment. The voiding diary showed a significant reduction of daily voids, urge urinary incontinence episodes and nocturnal events. The median overall scores of the ICIQ-UI and ICIQ-OAB were also significantly improved. Conclusions Our study suggest that treatment with ospemifene in PMW suffering from OAB is associated with a reduction of OAB symptoms due to a decreased bladder sensitivity and with an improvement in quality of life.

Comparison of Mirabegron and Vibegron in Women With Treatment-Naive Overactive Bladder: A Randomized Controlled Study

ObjectiveTo compare the efficacy and safety of mirabegron versus vibegron in postmenopausal women with treatment-naïve overactive bladder (OAB). MethodsWe conducted a prospective randomized controlled study of women with treatment-naïve OAB. The patients received mirabegron or vibegron at 50 mg daily for 12 weeks by a stratified randomized method. The OAB symptom score (OABSS) and quality of life (QOL) index were evaluated before and 4 and 12 weeks after the treatment. The patients’ 3-day voiding diary and postvoided residual urine volumes were evaluated before and 12 weeks after the treatment. ResultsOf 213 patients initially enrolled in this study, 199 patients were randomized to the mirabegron group (n = 97) or vibegron group (n = 102). Twelve weeks after the treatment, OABSS, QOL index, the numbers of micturition, urgency episodes, incontinence episodes, and voided volume per 24 hours were significantly improved compared with the baseline in both groups, and there was no significant difference in the rate of change in both groups. The postvoid residual urine volume was not significantly different in the 2 groups at 12 weeks. Discontinuation because of adverse effects was observed in 6.2% of patients in the mirabegron group and 6.8% in the vibegron group, with no significant difference between 2 groups. ConclusionBoth mirabegron at 50 mg and vibegron at 50 mg improved OAB symptoms and the parameters of voiding diary equally in postmenopausal women with treatment naïve OAB.

Adopting the Swenson-like technique for patients with Hirschsprung disease in Vietnam.

To evaluate outcomes of adopting the Swenson-like technique in transanal pull-through for Hirschsprung disease (HD) at a children's institution in Southeast Asia. A retrospective chart review was performed over 42months at a safety-net pediatric hospital in Vietnam. From January 2019 to June 2022, the Swenson-like technique was implemented and performed on 139 patients (115 male, 24 female, mean age 6.4 ± 11.96months). There were 123 transanal-only resections, 5 transanal plus laparoscopic, and 11 transanal plus laparotomy. The mean operative time was 70.9 ± 43.6min. The average length of the resected specimen was 18.8 ± 10.9cm. No urethral or vaginal injuries occurred. Postoperative complications included 1 anastomotic leak (0.7%), 4 anastomotic stenoses (2.8%), and 2 perianal abscesses in the setting of recurrent enterocolitis (1.4%). With a mean follow-up of 26 ± 11.9months (range 3-48months), there were 25 enterocolitis cases (17.9%), 45 patients with constipation (32.3%), 1 episode of fecal incontinence lasting longer than 6months (0.7%), and 1 rectal-vestibular fistula noted one year postoperatively (0.7%). There were no deaths. The Swenson-like technique in transanal pull-through for Hirschsprung's disease was safely adopted at our institution. The results show that applying this technique uniformly in a single institution led to excellent outcomes.

Correlations of mean voided volume with other parameters of overactive bladder syndrome

Mean voided volume (MVV) is a non-invasive indicator of urinary bladder capacity and frequently used as secondary or even primary endpoint in clinical studies of bladder function, particularly in the context of overactive bladder syndrome. We have analyzed previously reported results from two large, non-interventional studies (n = 1335 and 745 patients with overactive bladder syndrome treated with 30–45 mg propiverine ER) to address two questions: How does MVV relate to other typically used parameters of overactive bladder syndrome (primary aim)? Is MVV a normally distributed variable (secondary aim)? We found that distribution of MVV at baseline and after treatment exhibits a skewed distribution and deviates from a normal distribution, albeit not to a major extent. Basal MVV was weakly to moderately inversely correlated to numbers of urgency, incontinence and nocturia episodes (Spearman’s correlation coefficient 0.2224–0.2960) and somewhat stronger but still only moderately to micturition frequency (0.3296–0.3505). Associations of similar strength were found for absolute and % treatment-associated changes of MVV. MVV was not associated with age and only inconsistently with gender. We conclude that MVV should not be treated as a normally distributed variable and propose that at least partly different (patho)physiological factors may regulate MVV as compared to urgency, incontinence, frequency and nocturia. This should be considered in the choice of primary endpoint in clinical studies.

Transcutaneous Neuromodulation for Constipation and Fecal Incontinence in Children: A Systematic Review and Meta-Analysis.

Constipation is a disorder with a multifactorial origin. Constipation has a varied clinical presentation, including infrequent defecation of bulky stools and episodes of retentive fecal incontinence. Neuromodulation has been used to treat many health problems, with promising results. To conduct a systematic review of randomized clinical trials based on the effects of transcutaneous neuromodulation in treating constipation and retentive fecal incontinence in children and adolescents. A systematic review of randomized clinical trials was performed. Medline (PubMed), PEDro, SciELO, Cochrane (CENTRAL), Embase, and Scopus databases were searched from March 2000 to August 2022. We included clinical trials evaluating transcutaneous neuromodulation in children with constipation and fecal incontinence compared or associated with other types of treatment. Two reviewers independently selected relevant studies, assessed the methodological quality, and extracted the data. Three studies with 164 participants were included in this review. Two meta-analyses were generated based on these studies. These analyses revealed that transcutaneous neuromodulation is an effective adjuvant treatment modality that improves children's constipation and retentive fecal incontinence. The methodological quality of the included studies was classified as high based on the assessment of the quality of evidence, with a high degree of confidence based on the GRADE system. Transcutaneous neuromodulation is an effective adjuvant treatment modality for children with constipation and retentive fecal incontinence.

Web-Based Yoga-Pilates: A Prospective Cohort Study.

There are limited data to determine the change in severity, efficacy, and mechanism of action of yoga-Pilates in the treatment of stress urinary incontinence (SUI). The primary objective was to evaluate the effect of an 8-week web-based home yoga-Pilates exercise program on SUI severity and to evaluate the potential mechanism of action through ultrasound examination of the urethral rhabdosphincter cross-sectional area. This was a prospective cohort study of women with SUI. Participants underwent visits pre- and post-intervention, completed quality of life/severity surveys, and underwent pelvic examination and 3-dimensional transperineal ultrasonography to determine the urethral cross-sectional area. Pre- and post-intervention 24-hour voiding diaries were also collected. The intervention was an 8-week online yoga-Pilates video that tracked and prompted participation. Sixty women completed the study; they were predominantly premenopausal (67%) and vaginally parous (65%) and had done yoga (76%) and/or Pilates (44%). Seventy-three percent performed the exercises ≥3 times per week. For the primary outcome, the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form score improved from 9.5 (95% confidence interval [CI], 8.7-10.4) to 7.1 (95% CI, 6.3-7.9) (P < 0.001). The median (interquartile range) number of incontinence episodes per 24 hours decreased from 1 (1-3) to 1 (0-1) (P < 0.001). The Brink pelvic floor strength score improved from 7.1 (95% CI, 6.6-7.7) to 7.7 (95% CI, 7.2-8.2) (P = 0.01). Eighty-three percent reported that they were "better" on Patient Global impression of Improvement. There were no significant changes in urethral measurements. Although it did not meet the minimal clinically important difference, this 8-week web-based yoga-Pilates exercise program improved SUI symptoms and decreased the number of incontinence episodes in women with SUI.

Effectiveness and safety of sacral neuromodulation for neurogenic bladder

ABSTRACT Background The treatment of neurogenic bladder (NB) is a challenge because conventional therapy often fails. Sacral neuromodulation (SNM) is a minimally invasive technique and an unconventional treatment for neurogenic bladder. Its research is still in the exploratory stage. The research on its effectiveness and safety is not clear. Objective To assess the effectiveness and safety of sacral neuromodulation (SNM) for neurogenic bladder (NB). Methods By searching the PubMed databases and Cochrane Library databases, combined with the method of literature tracing, the clinical researches and works on neurogenic bladder and sacral neuromodulation therapy were collected. Two reviewers independently selected and extracted data, (1) determine whether the study meets the inclusion criteria and exclude the literature that meets the exclusion criteria. (2) Researchers’ screening results and data, if there are differences in the results, will be discussed to eliminate the differences. (3) Read the full text of the literature carefully to determine the final literature to be included. (4) The relevant data of 11 independent studies, a total of 291 patients, were systematically reviewed using review manager 5.3 software. Results This research included 11 independent studies with a total of 291 patients. The improvements of main outcomes before and after SNM therapy were significant: incontinence episodes /24 h (WMD −2.52; 95%CI-3.14-1.90; p <0.001), frequency/24 h (WMD-5.96; 95%CI −6.27，-5.66; p <0.001), voiding volume (WMD 116.09 mL; 95%CI 86.68，145.51; p <0.001), cystometric capacity (WMD 129.84 mL; 95%CI 100.53, 159.15; p <0.001), post-void residual volume (WMD-198.00 mL; 95%CI-264.60, −131.40; p <0.001), clean intermittent self-catheterization/24 h (WMD-2.48; 95%CI −2.96, −2.00; p <0.001). Conclusion This systematic review indicated that the sacral neuromodulation treatment for neurogenic bladder was effective and safe.

Patients' Preferences and Expectations in Overactive Bladder: A Systematic Review.

The aim of our study is to review the current available knowledge regarding preferences and expectations of patients with overactive bladder (OAB). The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines were followed for this manuscript's preparation. Three online databases were searched: PubMed/Medline, Embase, and Scopus, while a combination of the following keywords was used: detrusor overactivity, overactive bladder, urinary incontinence, perspectives, expectations, and preferences. Overall, 1349 studies were retrieved and screened while only 10 studies appeared to be relevant for the scope of this review. Most of the studies were related to preferences about OAB medications (i.e., antimuscarinics); four of them reported patients' inclinations to alternative treatments in the case of medication therapy failure (i.e., neuromodulation, Botox). No data were found about diagnosis or other aspects of disease management (i.e., surgery, follow-up). Based on these findings, from the patient's point of view, the ideal medication should be cheap, without risk of cognitive function impairment, and able to reduce daytime urinary frequency and incontinence episodes.

Efficacy of abobotulinumtoxinA versus onabotulinumtoxinA for the treatment of refractory neurogenic detrusor overactivity: a systematic review and indirect treatment comparison

AimsTo compare the efficacy and safety of abobotulinumtoxinA (aboBoNT-A) and onabotulinumtoxinA (onaBoNT-A) for the treatment of refractory neurogenic detrusor overactivity (NDO), using an indirect treatment comparison (ITC).Materials and methodsA systematic literature review was used to identify randomized controlled trials (RCTs) that evaluated botulinum toxin type A for the treatment of refractory NDO. Treatments were compared using a Bucher ITC approach. Efficacy outcomes were reduction in number of weekly urinary incontinence (UI) episodes at 6, 12, and 24 weeks of follow-up. The safety outcome was the proportion of patients with treatment-emergent urinary tract infections (TE-UTIs) during follow-up. Subgroup/sensitivity analyses were performed to investigate the impact of heterogeneity.ResultsFifteen studies of botulinum toxin type A were identified. Among these, onaBoNT-A 200 U was the only botulinum toxin type A considered an appropriate comparator for aboBoNT-A 600 U and 800 U. As such, six RCTs that evaluated onaBoNT-A or aboBoNT-A were included in the ITC. In base-case analyses, there were no statistically significant differences between aboBoNT-A and onaBoNT-A in terms of UI episodes or TE-UTIs. Numerically, the trend favored aboBoNT-A (either dose) for all endpoints and time points. At 12 and 24 weeks, the difference in reduction of UI episodes per week was considered clinically relevant when comparing aboBoNT-A 800 U with onaBoNT-A 200 U, but not when comparing the lower dose of aboBoNT-A (600 U) with onaBoNT-A 200 U. Results from subgroup/sensitivity analyses were consistent with the base case.LimitationsHeterogeneity across studies was observed; however, strong consistency of trends across analyses suggests the impact of heterogeneity is low.ConclusionsThere may be potential advantages of aboBoNT-A over onaBoNT-A, in terms of UI reduction, in patients with refractory NDO. More confirmatory studies are needed owing to the sparsity of current evidence.

Effect of Posterior Tibial Nerve Stimulation on Fecal Incontinence among Geriatrics

Background and aim:Incontinenceis one of the most common causes for admission to a residential facility. Fecal incontinence becomes more prevalent at the age of 70. In both men and women, fecal incontinence is a common condition, particularly among the elderly. Although a few research suggests that posterior tibial nerve stimulation can aid with fecal incontinence, more research is needed. Preoperative and postoperative measures are compared to determine treatment outcomes. Thus, the goal of this research is to see how posterior tibial nerve stimulation affects fecal incontinence in geriatrics.Methods:The research was conducted as a pilot study at SIMATS, using samples taken from Saveetha hospital's neuro IPD and physiotherapy OPD. A total of 15 patients were chosen at random based on the inclusion and exclusion criteria. The research included both geriatric men and women with fecal incontinence who were examined using the Wexner score prior and after intervention. The posterior tibial nerve was stimulated with electrical stimulation twice a day for 4 weeks.Result: The occurrence of incontinent episodes in geriatric individuals was drastically decreased, with a significant value of p&lt;0.001.Conclusion: The use of posterior tibial nerve stimulation in the elderly has been proven to be asuccessful therapy technique for reducing fecal incontinence episodes. In terms of treatment, the findings of this study seem promising.

Transcutaneous medial plantar nerve stimulation in women with idiopathic overactive bladder.

To define transcutaneous medial plantar nerve stimulation (T-MPNS) as a new neuromodulation method and assess the efficacy of T-MPNS on quality of life (QoL) and clinical parameters associated with incontinence in women with idiopathic overactive bladder (OAB). Twenty-one women were included in this study. All women received T-MPNS. Two self-adhesive surface electrodes were positioned with the negative electrode near the metatarsal-phalangeal joint of the great toe on the medial aspect of the foot and the positive electrode 2 cm inferior-posterior of the medial malleolus (in front of the medio-malleolar-calcaneal axis). T-MPNS was performed 2 days a week, 30 minutes a day, for a total of 12 sessions for 6 weeks. Women were evaluated for incontinence severity (24-h pad test), 3-day voiding diary, symptom severity (Overactive Bladder Questionnaire [OAB-V8]), QoL (Quality of Life-Incontinence Impact Questionnaire [IIQ-7]), positive response and cure-improvement rates, and treatment satisfaction at baseline and at the 6th week. Statistically significant improvement was found in the severity of incontinence, frequency of voiding, incontinence episodes, nocturia, number of pads, symptom severity, and QoL parameters at the 6th week compared with baseline. Treatment satisfaction, treatment success, and cure or improvement rates were found to be high at the 6th week. T-MPNS was first described in the literature as a new neuromodulation method. We conclude that T-MPNS is effective on both clinical parameters and QoL associated with incontinence in women with idiopathic OAB. Randomized controlled multicenter studies are needed to validate the effectiveness of T-MPNS.

Treating overactive bladder symptoms after transurethral prostatic surgery for benign prostatic hyperplasia - Which medication to choose?

Overactive bladder (OAB) symptoms are often encountered in patients after transurethral resection of the prostate (TUR-P) or transurethral incision of the prostate (TUI-P) for benign prostatic obstruction (BPO). Either antimuscarinics or β-3 agonist has been found effective in relieving OAB symptoms. However, urologists usually do not prescribe such medication immediately after TUR-P or TUI-P to avoid an increase in postvoid residual and risk of urinary tract infection. If OAB medication can be used and adverse events (AEs) can be reduced to minimum, patients' quality of life after bladder outlet obstruction surgery could be improved. This study compared the safety and efficacy between solifenacin and mirabegron in men undergoing TUR-P or TUI-P. This prospective, randomized trial compared the safety and efficacy of OAB medication on the reduction in Urgency Severity Score (USS), OAB Symptoms Score (OABSS), International Prostate Symptom Score, and urgency urinary incontinence episodes in men with BPO undergoing surgical intervention. All patients could void smoothly after catheter removal and were randomly received daily solifenacin 5 mg, mirabegron 50 mg, or no interventions for 4 weeks. At 2 and 4 weeks postoperatively, participants' OAB symptoms and AEs were evaluated. A total of 57 men were enrolled in this study with a mean age of 70.8 ± 6.1 years. At 2 weeks postoperatively, USS (1.56 ± 1.72 vs. 2.39 ± 1.72 vs. 2.26 ± 1.73, P < 0.011) and OABSS (5.33 ± 3.65 vs. 7.67 ± 4.19 vs. 8.58 ± 4.31, P < 0.000) were significantly reduced in patients taking solifenacin, mirabegron, or control, respectively. Two patients in the solifenacin group developed urinary retention. However, the changes of variables at 4 weeks postoperatively were insignificant among the three groups. Solifenacin and mirabegron are two different drug classes both equally effective in treating immediate OAB symptoms after TUR-P or TUI-P. However, OAB symptoms could be relieved at 4 weeks without any medication. Considering AEs, β-3 agonist has a more favorable safety profile than antimuscarinics.

Rehabilitation approach and results of using the biofeedback method (GIGER MD device) in children with neurogenic bladder.

GIGER MD device applies a biofeedback method through stimulated coordinated rhythmic and dynamic movements of the trunk and extremities in an anti-gravity position, thus helping to regain lost motor functions. In this article, the performance of the GIGER MD device was evaluated in 36 children with neurogenic bladder measuring gait speed, voiding bladder capacity, deviation from the age-adjusted bladder capacity (measured using the Koff scale), and urinary incontinence. Children using the GIGER MD device had an increase in voiding bladder capacity (33.79%, median volume increase of 50 ml) with a subsequent median decrease in median age-adjusted bladder capacity by 45.50% (median deviation before was 36% vs. 16% after treatment). The number of urinary incontinence episodes also reduced by 55.57% (7-3 episodes per day), and the 20-meter motor gait speed increased by 14.26% (from 23 to 19 s). Children who follow the GIGER MD therapy regularly for a period of 6 months show that CNS functional damage can be significantly improved.

The Efficacy and Safety of Acupuncture in Treating Stress Urinary Incontinence in Women from a Meta-Analysis of Four Randomized Controlled Trials.

To verify the efficacy and safety of acupuncture in treating stress urinary incontinence (SUI) in women in a single treatment cycle lasting at least 6 weeks. A preferred reporting items for systematic reviews and meta-analyses (PRISMA) summary was followed correctly. Through the use of EMBASE, Cochrane Library databases, and PubMed (until July 2021), we looked for randomized controlled trials. In addition, the included articles' original references were looked up as well. Totally, we analyzed four studies including 690 patients. Compared with the sham acupuncture group, this analysis verified that acupuncture was critically better result in decreasing mean urine leakage (p = 0.04), 1-hour pad test (p = 0.04), 72-hour incontinence episodes (p < 0.00001), International Consultation on Incontinence Questionnaire-Short Form scores (p = 0.0005) and improving patient self-evaluation (All p < 0.05). However, two groups had no statistical significance in improving pelvic floor muscle strength. In the matter of safety, mainly adverse events, especially with respect to pain, both groups showed no statistical difference. Acupuncture is more beneficial to patients with stress urinary incontinence in women with no critical difference in the incidence of advent events than sham acupuncture.

Ipidacrine therapy in a 1.5-month old child with Hirchprung’s disease at the postoperative period

Introduction. Motor colon dysfunction is seen in most patients after surgical intervention for Hirschsprung’s disease regardless of the pull-through technique and absence of technical errors during surgery. The main cause of motor colon dysfunction are developed dystrophic disorders in the wall of dilated colon which can be manifested as episodes of both fecal incontinence and constipation. Cholinesterase inhibitors are pathogenetic preparations which are prescribed for hypo- and atonic colon conditions. The authors present a clinical case of successful treatment of 1.5 month-old child with Hirschsprung’s disease who was prescribed postoperative cholinesterase inhibitor Ipidacrine.Clinical case. A boy, aged one month and one day, was operated on for Hirschsprung’s disease of the recto-sigmoid form. Agangliosis sized 13 cm. Colon hypotonic dysfunction persisted in the postoperative period. Rehabilitation for 19 days did not give any positive results. So, it was decided to prescribe Ipidacrine (after approval of the Expert Commission because of age restrictions for the given preparation). Ipidacrine effective dose was 2 mg per kg twice a day per os. Therapy lasted for 7 days after which the colon function was normalized. No adverse cholinergic effects were recorded.Conclusion. The authors consider that after sufficient accumulation of clinical data Ipidacrine can be prescribed as pathogenetic preparation in functional hypotonic colon disorders in children including those with Hirschsprung’s disease at their postoperative period.