International Continence Society Research Articles

Managing female stress urinary incontinence in a post mesh era: What to do and when to refer.

Urinary incontinence is a common presentation in general practice and can significantly affect a patient's quality of life. Stress urinary incontinence (SUI) is defined by the International Continence Society as 'the complaint of any involuntary loss of urine on effort or physical exertion (egsporting activities), or on sneezing or coughing'. There is a key role for primary care providers in the assessment and management of female SUI. To highlight the key diagnostic and management principles of female SUIingeneral practice and discuss management options. SUI can usually be diagnosed based upon clinical history and targeted physical examination. Pelvic floor physiotherapy and lifestyle interventions, including weight modification and management of co-morbidities, are important first-line therapies. Surgical options for both persistent or complex SUI include urethral bulking agents, Burch colposuspension and pubovaginal fascial slings. Synthetic (mesh) mid-urethral slings remain a viable surgical option for women suffering SUI.

Opportunity for ICS urodynamic standardization: Sensation, rectal contractions, and involuntary detrusor contractions

Introduction and Objectives:The International Continence Society (ICS) has published essential documents standardizing urodynamic technique and reporting. Currently, no consensus exists regarding patient prompts for bladder sensation, particularly in the setting of impaired bladder sensation (e.g. spinal cord injury) (SCI). Similarly, no published standardization exists for the reporting of rectal contractions or duration and amplitude of involuntary detrusor contractions (IDCs). We evaluated current practice patterns among ICS urodynamicists regarding sensation prompts, mention of rectal contractions, and the extent to which involuntary detrusor contractions are described. Methods:A Qualtrics urodynamic testing survey was distributed via email to all ICS members twice over a 2 week period. The survey included 18 questions regarding provider and practice characteristics, urodynamic practice patterns, coaching prompts given to patients regarding sensation during urodynamic testing, and documentation of rectal and involuntary detrusor contractions (IDCs). Data were analyzed using descriptive statistics. Results:Of 2859 ICS members, 614 (21%) returned surveys. Of these, 35 did not perform urodynamic testing and 142 surveys were incomplete. Thus, 437/614 (71%) surveys were included in our analysis. Participants were most commonly fellowship-trained female functional urologists (40%) and practiced in a government service hospital (46.4%). Half of the providers (56%) are present for the study 100% of the time. Most participants instructed patients on how to report sensation during testing (57%). First Sensation (86%), First Desire (85%), Strong Desire (93%), and Urgency (86%) were the parameters most utilized. Various prompts for each of the UDS sensation parameters were reported including repeating ICS definitions and real-life analogies. 45% of respondents altered instructions for patients with impaired sensation (e.g. SCI), 59% commented on the presence or absence of rectal contraction, and 70% characterized the amplitude and duration of involuntary detrusor contractions in their reports. Conclusion:Although most survey participants report they standardize urodynamic instructions, there is no consensus for sensation prompts within ICS urodynamic practice publications. Urodynamic testing practice patterns vary widely among ICS urodynamicists with respect to sensation prompts, modified instructions for those with impaired sensation, and reporting of rectal contractions and involuntary detrusor contractions. Opportunity exists for further standardization of good urodynamic practice in published guidelines.

Chinese expert consensus on clinical diagnosis and treatment of non-neurogenic lower urinary tract dysfunction in children

Non-neurogenic lower urinary tract dysfunction (NNLUTD) is a common clinical problem in children, which is an important cause of lower urinary tract symptoms, urinary tract infection and vesicoureteral reflux in children, often accompanied by behavioral and psychological problems. At present, there is no consistent evaluation method and treatment for NNLUTD in children. Experts of Pediatric Urodynamics and Pelvic Floor Group of Pediatric Surgery Branch of Chinese Medical Association formulated this consensus according to the NNLUTD related diagnosis and treatment guidelines designated by International Children's Continence Society (ICCS) and International Continence Society (ICS), and combined with the latest relevant literatures at home and abroad, to provide reference for the clinical standard diagnosis and treatment of NNLUTD in children.

Validation of the Russian Version of the Prolapse Quality-of-life Questionnaire and its Application to Assess the Impact of Pelvic Organ Prolapse on Quality of Life and the Effect of Treatment in Women Undergoing Reconstructive Surgery.

The objective was to validate the translated Russian version of the prolapse quality-of-life (P-QoL) questionnaire and test its applicability to assess the impact of pelvic organ prolapse (POP) on QoL and the effect of treatment in women undergoing reconstructive surgery. Following a forward- and back-translation of the original English P-QOL questionnaire into Russian, the translated questionnaire was reviewed by a group of patients as well as an expert panel. Women with POP who were admitted to a university hospital for reconstructive surgery were recruited. All the women completed the P-QoL questionnaire, Pelvic Floor Distress Inventory (PFDI-20) and 36-Item Short Form Survey (SF-36) questionnaires before surgery. Clinical data and POP Quantification (POP-Q) Index according to the International Continence Society were obtained. Psychometric properties of the questionnaire were assessed. A total of 303 women with POP were included in the study. Most patients presented with POP-Q >2. The P-QoL questionnaire demonstrated good psychometric properties. High internal consistency was shown in all domains (Cronbach's alpha coefficient from 0.65 to 0.92). The test-retest reliability confirmed a highly significant stability between the total scores for each domain. Significant correlations of the P-QoL domains with the PFDI-20 and SF-36 scales (p < 0.05) were obtained, demonstrating satisfactory convergent validity. Discriminative construct validity was proved by the differences in the mean scores for P-QoL domains across POP-Q stages (p < 0.05): general health perceptions, role limitations, physical limitations, social limitations and severity measures were significantly higher for POP-Q stages 3 and 4 than for POP-Q stage 2 (p < 0.01); general health perceptions and severity measures were higher for POP-Q stage 4 than for POP-Q stage 3 (p < 0.05); sleep/energy was higher for POP-Q stage 3 than for POP-Q stage 2 (p < 0.05). Significant improvement of QoL in the 2months after surgery (p < 0.05) indicated that the P-QoL questionnaire is sensitive to change. The Russian version of the P-QoL questionnaire is characterized by appropriate psychometric properties. The P-QoL questionnaire is a useful tool for describing the QoL profile in women with POP before reconstructive surgery and evaluating treatment outcomes after the procedure.

Recurrent Pelvic Organ Prolapse after Sacrocolpopexy-A Surgical Challenge.

Background: Repeat sacrocolpopexy (reSCP) for recurrent pelvic organ prolapse (POP) is a rare and complex condition with little understanding of how to manage. Most authors recommend complete reSCP regardless of the underlying cause of the failure. This retrospective cohort study presents our management workflow and how to systematically approach this challenging situation. Methods: From 2017 to 2021, we analyzed all women undergoing surgery for recurrent POP after sacrocolpopexy at our tertiary referral hospital at the department of urogynecology. Preoperatively, all women underwent a structured work-up consisting of answering the validated German female pelvic floor questionnaires, a clinical examination utilizing the POP-Q staging system according to the International Continence Society (ICS), and a pelvic floor ultrasound. The surgical management was based on the preoperative findings and was adapted individually during surgery if indicated according to the estimated underlying problem for recurrence. Results: In total, 377 women underwent a primary laparoscopic sacrocolpopexy. However, ten women presented with a symptomatic recurrent prolapse requiring further surgical intervention. A reSCP was performed in eight women, including two with additional laparoscopic paravaginal repair to correct the displaced mesh placement at initial surgery. A vaginal correction was indicated in two women with an isolated posterior compartment prolapse. The analysis demonstrates that reSCP has a low intraoperative complication rate and high subjective and objective success rates. Conclusions: We could demonstrate that individualized reSCP after initial SCP is a challenging yet feasible and safe treatment option, but there may be suitable alternatives. If women undergo pre- and intraoperative standardized problem-oriented examinations, we can often identify the cause of the recurrent prolapse. Tailored surgery must be subsequently performed.

Reliability and validity of the Brazilian version of the world health organization disability assessment schedule (WHODAS 2.0) questionnaire for women with urinary incontinence

Purpose To analyze the reliability and validity of the WHODAS 2.0 instrument for women with urinary incontinence (UI). Methods This is a methodological study with Brazilian women with complaints of urge, stress or mixed UI, over 18 years old, without cognitive disorders. The WHODAS 2.0 (36-item version) and the auxiliary instruments were applied through face-to-face and telephone interviews after 7–14 d. The psychometric properties evaluated were: Cronbach’s alpha for internal consistency, intraclass correlation coefficient (ICC) for intra-rater test-retest, Spearman’s correlation coefficient (rho) for construct validity of WHODAS 2.0 with auxiliary instruments; and ANOVA for discriminative validity with UI severity. Results 101 women with UI with a mean age of 50.71 ± 10.39 were included. WHODAS 2.0 showed good reliability in all domains and excellent reliability in the total score (>0.80). The intra-evaluator test-retest showed ICC values between 0.59 and 0.87 (p < 0.001). We observed a positive correlation between the WHODAS 2.0 domains and the instruments recommended by International Continence Society (ICS), with greater emphasis on moderate correlation with the Urinary Impact Questionnaire (IUQ-7) subscale (rho = 0.730 p < 0.001). Conclusion The WHODAS 2.0 instrument is a reliable and valid questionnaire for investigating the functioning and disability of women with UI.

Anorectal manometry — How to perform and interpret manometry

Anorectal manometry is the most widely used technique for detecting abnormalities of sphincter function and recto-anal coordination. It enables the investigation of defaecatory difficulties, including anal incontinence and evacuatory difficulties, the assessment of patients with anal fistula and obstetric anal sphincter injury. Anorectal manometry is routinely used in combination with other tests, such as endoanal ultrasound or defaecatory imaging to understand the pathophysiology and aid treatment planning.There are various techniques and reporting protocols available but adopting standardised methods is essential for meaningful results and for comparing results between different units. This paper follows the workshop on anorectal manometry at the International Continence Society conference in Vienna in 2022. It aims to outline the various techniques and equipment available, with examples of high-resolution manometry cases and their interpretation.

Étude CamiCon : évaluation d’un nouvel outil pour la réalisation d’un calendrier mictionnel automatisé et connecté

IntroductionA voiding diary (VD) is a key element in the evaluation of patients with overactive bladder (OAB) at initial presentation and during treatment to assess its effectiveness. In order to be clinically relevant, it must be performed over 3 days according to the International Continence Society (ICS). Unfortunately, some patients find it cumbersome. We aimed to evaluate the reliability and patient satisfaction when using a connected tank device. Material and methodWe conducted a single-center prospective study including 41 patients. Each patient completed a paper voiding diary and then a diary with Diary Pod® (DP) or inversely depending on the study arm. Data from 34 patients were collected. After completion of both diaries, patients completed a satisfaction questionnaire sent by email via GoogleForm. Study statistics were performed with Jamovi® and Excel® software. ResultData from 34 patients were analyzed. There was a statically significant difference (P=0.046) between the mean volume calculated from the paper VD and that calculated from the connected VD (DP). There was no statistically significant difference (P=0.112) between the mean number of daytime voids, mean number of nighttime voids (P=0.156), mean water intake (P=0.183) reported on the paper VD and the connected VD. Thirteen (42%) paper VD and 1 connected VD did not include documentation of the presence or absence of urine leakage or urgency. There was no statistically significant difference between the two calendars regarding the presence or absence of urine leakage (P=0.180) and urinary urgency (P=0.564). Eighty-four percent (26/31) preferred the connected tank to the usual method (paper/pen), while 55% (17/31) and 29% (9/31) of the participants respectively answered that the DP was “very definitely” or “definitely” an aid for performing VD. Nevertheless, 39% (12/31) and 55% (17/31) considered its price to be high or fair and only 22% (7/31) were inclined to buy it. ConclusionThis study showed that the Diary connected reservoir Pod® is a reliable and innovative tool for voiding schedules. It facilitates data collection for the majority of patients (83%) and could, through better patient compliance, provide better quality data and help their interpretation by the physician. These factors could encourage the implementation of the connected voiding diary as a diagnostic tool. It would also be used for the assessment of treatment effectiveness in daily clinical practice as well as in research. Its cost remains a major obstacle, judged by 39% of patients to be too high, and could therefore be proposed in specific situations requiring precise data.

Cross-Cultural Adaptation and Validation of the ICIQ-BD for Brazilian Women With Lower Urinary Tract Symptoms.

The International Continence Society recommends the International Consultation on Incontinence Questionnaire-Bladder Diary (ICIQ-BD) for the assessment, management, and monitoring of lower urinary tract symptoms (LUTS). Translation, cross-cultural adaptation and validation will establish a valid and reliable tool for Brazilian women with LUTS. A cross-sectional study involving 101 women was carried out at the Urogynecology Outpatient Clinic in Belo Horizonte, Brazil, between August 2020 and April 2022. The process of cross-cultural adaptation and validation was executed following the ICIQ Group's protocol. Reviewed by an expert committee, the first pre-test was followed by subsequent adaptations, resulting in a second adapted version that underwent expert revisions. A second pretest was conducted, followed by cross-cultural adaptation and construct validation. Finally, the International Consultation on Incontinence Questionnaire-Bladder Diary-Brazilian Portuguese Version (ICIQ-BD-Br) underwent a validation process. Construct validity (IVC >0.78) and internal consistency were satisfactory (α-Cronbach coefficient 0.87-0.94). The following adjustments were made: a specific field was created to document sleep and wake times, and a printed score ranging from 0 to 4 was included in the bladder sensation column. Test-retest reliability ranged from fair to excellent for all analyzed items (Spearman correlation: 0.64-0.95). Criterion validity analysis indicated slight agreement for one of the four symptoms analyzed (nocturia k=0.32). The final version was approved by the ICIQ Group. The ICIQ-BD-Br has been adapted for use in Brazilian Portuguese and has exhibited robust construct validity and reliability for Brazilian women with LUTS.

Management of mixed urinary incontinence: IUGA committee opinion

Introduction and hypothesisMixed urinary incontinence (MUI) is defined by the International Urogynecology Association (IUGA) and International Continence Society as the complaint of involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing. It therefore implies the coexistence of both stress urinary incontinence (SUI) and urgency urinary incontinence (UUI). MUI is a heterogeneous diagnosis that requires an assessment of its individual components of SUI and UUI. Management requires an individualised approach to the symptom components. The aim of this review is to identify the assessment/investigations and management options for MUI.MethodsA working subcommittee from the IUGA Research & Development (R&D) Committee was created and volunteers invited from the IUGA membership. A literature review was performed to provide guidance focused on the recommended assessment and management of MUI. The document was then evaluated by the entire IUGA R&D Committee and IUGA Board of Directors and revisions made. The final document represents the IUGA R&D Committee Opinion.ResultsThe R&D Committee MUI opinion paper provides guidance on the assessment and management of women with MUI and summarises the evidence-based recommendations.ConclusionsMixed urinary incontinence is a complex problem and successful management requires alleviation of both the stress and urge components. Care should be individualised based on patient preferences. Further research is needed to guide patients in setting goals and to determine which component of MUI to treat first. The evidence for many of the surgical/procedural treatment options for MUI are limited and needs to be explored in more detail.

Overactive bladder ‘symptoms’ or ‘complaints’ in young and elderly patients or healthy volunteers?

Objective:The overactive bladder symptom complex is multifactorial and heterogeneously influenced by genetic and environmental factors. The role of ageing is not exactly known. Our objective is to evaluate age-related differences in bladder sensations in healthy volunteers and overactive bladder patients. Methods:68 patients with an overactive bladder, diagnosed by their urologist using the International Continence Society criteria, and 66 healthy volunteers were included: 41 patients and 20 volunteers were ≥60 years old. Subjects filled out sensation-related bladder diaries, for 2 periods of 3 days. Results:To obtain the following results, 6160 voids were assessed. Both young and older healthy volunteers experienced storage symptoms. However, older volunteers experienced more symptoms than younger ones. The healthy aged experienced more nocturia and voided 34% more often over 6 days, compared to the young people. They experienced more urge at a lower mean voided volume too. Younger OAB patients perceived their bladder to be ∼25% fuller at 100 ml compared to younger volunteers, older patients experienced a similar mean bladder fullness sensation to their healthy peers. Fourteen healthy older volunteers experienced voids with urge 3 (need to void now), however at a higher mean voided volume compared to the older OAB patients. They both experienced the same amount of nocturia. Conclusions:Storage symptoms are widespread throughout the population in a continuum of frequency and severity of symptoms. Ageing healthy volunteers shift on this continuum, from never having any urinary complaints towards experiencing (a severity of) symptoms that fit within the ICS definition of OAB. Hence, there is an important distinction between storage symptoms and storage complaints.

Effect of Practicing Deep Breathing and Kegel Exercises on Menopausal Urinary Incontinence at Beni-Suef

Background: Urinary incontinence (UI) is one of the most common problems in menopausal women; it is defined by the International Continence Society (ICS) as the complaint of any involuntary loss of urine and its classification according to the presence of symptoms and pathophysiological mechanisms of occurrence. The Kegel Breathing technique combines breathing and pelvic floor contraction patterns to increase pelvic floor muscular strength while performing daily activities regularly. Normal breathing occurs when the pelvic floor muscles and the breathing muscle (diaphragm) move up and down in harmony manner. Aim of the study: The study aimed to evaluate menopausal women's urinary incontinence before and after practice of deep breathing and Kegel exercise. Design: A quasi-experimental study design was utilized in this study (one group pre and post-test). Sample: A purposive sample of 100 Menopausal women diagnosed with stress urinary incontinence. Setting: gynecological and urological outpatient clinics Beni-Suef university hospital. Tools: 1) a structure interviewing questionnaire schedule, 2) The International Consultation on Incontinence Modular Questionnaire 3) Pelvic floor muscles exercises checklist. Results: about 45% of the studied women reported that their frequency of urination is several times per day preprogram but it became only 19% post program implementation. Only 32% of the studied women can accurately detect the right muscle group at the 1st week of the 1st month. However, at the end of the 1st month; 82% of them can do. Moreover, at the end of the 2nd month; 90% can do. Additionally, at the end of the 3rd month; 93% of the studied women can accurately detect the right muscle group. Conclusion: Deep breathing and kegel exercise had positive effect on women's urinary incontinence. Recommendations: disseminate brochures and booklet about kegal and breathing exercise to enhance awareness program regarding stress urinary incontinence reliving measures for elderly women.

The Role of the Supine Empty Stress Test in the Evaluation of Women with Stress Urinary Incontinence: A Retrospective Cohort Study.

The International Continence Society recommends the supine empty stress test (SEST) as an accessory test in the evaluation of women with urinary incontinence, especially for the presence of intrinsic sphincter deficiency (ISD). The aim of this study was to investigate the relationship between the SEST and clinical findings in women diagnosed with stress urinary incontinence with single voiding cycle ambulatory urodynamics (AUM). AUM tracings of patients with lower urinary tract symptoms (LUTS = Lower urinary tract symptoms) (n = 513) were retrospectively reviewed, and 364 charts with urodynamic SUI were analyzed. Demographics, examination findings, scores of the Sandvik Incontinence Severity Index and validated questionnaires, and AUM findings were compared between SEST-positive and -negative groups. Additionally, the diagnostic accuracy of the SEST in the diagnosis of low abdominal leak point pressure (ALPP ≤ 60 cm H2O) in women with pure urodynamic SUI was calculated. The SEST was positive in 41.8% (n = 152) of the cohort. Women with a positive SEST had higher scores on the Sandvik severity index (9.2 ± 3.6 vs. 7.5 ± 3.8, p = 0.003) and lower ALPP (79.6 ± 29.3 vs. 98.4 ± 31.3, p < 0.001). The negative predictive value of the SEST for ISD was found to be 92.4%. Thus, the SEST seems to be an objective clinical test reflecting urinary incontinence severity while excluding the presence of ISD.

Investigating mortality and morbidity associated with UrINary incontinence during Older Womens Secondary Care Admissions and exploring nurses experiences of delivering related care (U-INconti): a mixed methods research protocol

IntroductionUrinary incontinence (UI) is associated with increasing age and is more frequently experienced by women. Despite 40% prevalence in the community, little is known about the prevalence/incidence of UI in...

Underactive Bladder and Detrusor Underactivity: New Advances and Prospectives.

Underactive bladder (UAB) is a prevalent but under-researched lower urinary tract symptom that typically occurs alongside detrusor underactivity (DU). Unlike UAB, DU is a urodynamic diagnosis which the International Continence Society (ICS) defines as "a contraction of reduced strength and/or duration, resulting in prolonged bladder emptying and/or a failure to achieve complete bladder emptying within a normal time span". Despite the widespread prevalence of UAB/DU, there are significant gaps in our understanding of its pathophysiological mechanisms, diagnosis, and treatment compared with overactive bladder (OAB) and detrusor overactivity (DO). These gaps are such that clinicians regard UAB/DU as an incurable condition. In recent years, the understanding of UAB has increased. The definition of UAB has been clarified, and the diagnostic criteria for DU have been considered more comprehensively. Meanwhile, a number of non-invasive diagnostic methods have also been reported. Clinical trials involving novel drugs, electrical stimulation, and stem cell therapy have shown promising results. Therefore, this review summarizes recent reports on UAB and DU and highlights the latest advances in their diagnosis and treatment.

ICS-SUFU standard: Theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting, Part 2: Analysis of PFS, reporting, and diagnosis

Aims:The Working Group (WG), initiated by the International Continence Society (ICS) Standardisation Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, has revised the ICS Standard for pressure-flow studies of 1997. Methods:Based on the ICS standard for developing evidence-based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in December 2022 to facilitate public discussion and the comments received have been incorporated into this final release. Results:The WG has recommended analysis principles for the diagnosis of voiding dysfunction for adult men and women without relevant neurological abnormalities. New standard terms and parameters for objective and continuous grading of urethral resistance (UR), bladder outflow obstruction (BOO) and detrusor voiding contraction (DVC) are introduced in this part 2 of the standard. The WG has summarized the theory and recommendations for the practice of pressure-flow study (PFS) for patients in part 1. A pressure-flow plot is recommended for the diagnosis of every patient, in addition to time-based graphs. Voided percentage and post void residual volume should always be included in PFS analysis and diagnosis. Only parameters that represent the ratio or subtraction of pressure and synchronous flow are recommended to quantify UR and only parameters that combine pressure and flow in a product or sum are recommended to quantify DVC. The ICS BOO index and the ICS detrusor contraction index are introduced in this part 2 as the standard. The WG has suggested clinical PFS dysfunction classes for male and female patients. A pressure-flow scatter graph including every patient’s pdet at maximum flow (pdetQmax) with maximum flow rate (Qmax) point should be included in all scientific reports considering voiding dysfunction. Conclusion:PFS is the gold standard used to objectively assess voiding function. Quantifying the dysfunction and grading of abnormalities are standardized for adult males and females.

ICS-SUFU standard: Theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting, Part 1: Background theory and practice

Aims:The working group (WG) initiated by the International Continence Society Standardization Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction has revised the (1997) ICS Standard for pressure flow studies. Methods:Based on the ICS standard for developing evidence-based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in January 2023 to facilitate public discussion and the comments received have been incorporated into this final release. Results:The WG summarizes the theory and recommends the practice and the terms used for the diagnosis of voiding dysfunction for adult female and male patients without relevant neurological abnormalities, in part 1 of this standard. The WG has also recommended standard principles and parameters for objective and continuous grading of urethral resistance and detrusor voiding contraction on the basis of pressure flow studies in part 2. The recommendations for practice in this part have also the aim to increase the understanding of the physiology as well as the psychology of voiding. The potential effects of the laboratory situation of the test on the voiding as well as the role of the urodynamicist in this regard are discussed. The WG has recommended to use for diagnosis only the voidings that are considered representative by the patient. Conclusion:A pressure flow study is the gold standard to assess voiding function and to quantify dysfunction. This part of the standard explains the clinical background, gives recommendations for the execution of a pressure flow study and lists relevant terms, parameters, and units of measurements.

First in Human Subjects Testing of the UroMonitor: A Catheter-free Wireless Ambulatory Bladder Pressure Monitor.

Urodynamics is the standard method of diagnosing bladder dysfunction, but involves catheters and retrograde bladder filling. With these artificial conditions, urodynamics cannot always reproduce patient complaints. We have developed a wireless, catheter-free intravesical pressure sensor, the UroMonitor, which enables catheter-free telemetric ambulatory bladder monitoring. The purpose of this study was twofold: to evaluate accuracy of UroMonitor pressure data, and assess safety and feasibility of use in humans. Eleven adult female patients undergoing urodynamics for overactive bladder symptoms were enrolled. After baseline urodynamics, the UroMonitor was transurethrally inserted into the bladder and position was confirmed cystoscopically. A second urodynamics was then performed with the UroMonitor simultaneously transmitting bladder pressure. Following removal of urodynamics catheters, the UroMonitor transmitted bladder pressure during ambulation and voiding in private. Visual analogue pain scales (0-5) were used to assess patient discomfort. The UroMonitor did not significantly alter capacity, sensation, or flow during urodynamics. The UroMonitor was also easily inserted and removed in all subjects. The UroMonitor reproduced bladder pressure, capturing 98% (85/87) of voiding and nonvoiding urodynamic events. All subjects voided with only the UroMonitor in place with low post-void residual volume. Median ambulatory pain score with the UroMonitor was rated 0 (0-2). There were no post-procedural infections or changes to voiding behavior. The UroMonitor is the first device to enable catheter-free telemetric ambulatory bladder pressure monitoring in humans. The UroMonitor appears safe and well tolerated, does not impede lower urinary tract function, and can reliably identify bladder events compared to urodynamics.

Intravesical Bladder Treatment and Deep Learning Applications to Improve Irritative Voiding Symptoms Caused by Interstitial Cystitis: A Literature Review.

Our comprehension of interstitial cystitis/painful bladder syndrome (IC/PBS) has evolved over time. The term painful bladder syndrome, preferred by the International Continence Society, is characterized as "a syndrome marked by suprapubic pain during bladder filling, alongside increased daytime and nighttime frequency, in the absence of any proven urinary infection or other pathology." The diagnosis of IC/PBS primarily relies on symptoms of urgency/frequency and bladder/pelvic pain. The exact pathogenesis of IC/PBS remains a mystery, but it is postulated to be multifactorial. Theories range from bladder urothelial abnormalities, mast cell degranulation in the bladder, bladder inflammation, to altered bladder innervation. Therapeutic strategies encompass patient education, dietary and lifestyle modifications, medication, intravesical therapy, and surgical intervention. This article delves into the diagnosis, treatment, and prognosis prediction of IC/PBS, presenting the latest research findings, artificial intelligence technology applications in diagnosing major diseases in IC/PBS, and emerging treatment alternatives.

To evaluate the predisposing factors of uterovaginal prolapse in women admitted in gynaecology ward

: Uterovaginal prolapse is an abnormal protrusion or herniation of pelvic organs from its normal position in the pelvis, due to failure of anatomical support. The prevalence of uterovaginal prolapse is difficult to be determined because many women are asymptomatic and many are hesitant to discuss with family. It can be considered a silent epidemic. The cause of uterovaginal prolapse is multifactorial. The parity, mode of delivery, postmenopausal status, obesity are some of the factors affecting the severity. The condition is preventive and by counseling and care during antenatal and postnatal period, the prevalence of this condition can be curtailed and quality of life can be improved.To evaluate the predisposing factors of uterovaginal prolapse in women admitted to the gynaecology ward.: A retrospective study was done for a period of 2 years from January 2019 to January 2021 at Integral Institute of Medical Sciences and Research, a tertiary care hospital and medical college, Kursi Road, Dasauli, Lucknow. The women admitted in gynaecology ward with symptoms of mass per vagina were included in the study. The data was retrieved from medical records of the department. The case file as per inclusion and exclusion criteria was identified and included in the study. The information of risk factors was collected using patient proforma. The pelvic organ prolapse quantification system (POPQ) approved by international continence society was used for categorizing uterovaginal prolapse. Data was analysed using SPSS version 20. Frequencies, percentage and mean computed to describe the variables of the study. The Chi-square test was used to compare variables. The statistical significance P&amp;#60;0.05 was considered significant.: The period of study was from January 2019 to January 2021. During this period 11256 patients were seen at the gynaecological clinic, out of which 206 patients had uterovaginal prolapse. The prevalence was 1.8%. The multiparity, prolonged and difficult deliveries, delivery by untrained personnel, mismanaged third stage of labour involving injury to sphincters and vaginal tears are determinants of prolapse uterus. Further postmenopausal condition causing hypoestrogenic state causes weaking of ligaments, collagen and aggravates the condition. Hence, preventive measures like institutional delivery, delivery by trained personnel, menopausal clinics may help the target population.