International Continence Society Research Articles

The Prevalence of Lower Urinary Tract Symptoms and Overactive Bladder in South Korea: A Cross-Sectional, Population-Based Study.

PurposeLower urinary tract symptoms (LUTS) affect over half of the adults’ population worldwide, with an increasing prevalence among the older age groups. Therefore, with the increasing elderly population, LUTS is an important disease, highlighting the need for accurate data on its prevalence. This present study aimed to investigate the prevalence of LUTS in South Korea.MethodsThe study targeted individuals aged at least 19 years nationwide. We conducted computer-assisted telephone interviews, 80% mobile random digital dialing (RDD) sampling frame, and 20% landline RDD sampling frame between April and May 2020. Questionnaires included The International Prostate Symptom Score (IPSS), the overactive bladder symptom score (OABSS), and the characteristics of respondents. Current International Continence Society definitions were used for individual LUTS and OAB.ResultsThere were 2,000 respondents, 1,009 (50.4%) were women and 546 (27.3%) were aged ≥60 years. Based on our IPSS questionnaire survey results, 77.9% of the respondents had LUTS; 63.7% had mild symptoms (1–7), 11.7% had moderate symptoms (8–19), and 2.4% had severe symptoms (20–35). The prevalence and severity of LUTS increased with age with 22.1% of respondents aged 60 years and above complaining of moderate or severe LUTS. According to the survey through OABSS, the prevalence of OAB was 9.6%, males were 10.3% and females were 9.0%.ConclusionsBased on our survey results, 77.9% of the Korean adult population (over the age of 19) experienced at least one LUTS, and the severity increased with age. The prevalence and severity of OAB increased with age, especially after 40 years; the prevalence of OAB was 9.6%, and 13.4% of them were over 60 years old.

What is the real burden of the overactive bladder? Results from a national prevalence study.

To describe the prevalence of overactive bladder determining patient-reported outcome measures (PROMS) and potential risk factors. A cross-sectional population-based study to estimate lower urinary tract symptoms (LUTS) prevalence in the Colombian population was performed (COBaLT study). Overactive bladder (OAB) was assessed using 2002 International Continence Society definitions and the Report on the Terminology for Female Pelvic Floor Dysfunction. PROMS were included to evaluate participant's perceptions of health-related quality of life (QoL). Spanish validated questionnaires were used, including the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and Patient Perception of Bladder Condition (PPBC) scale. A total of 1060 individuals were assessed. The mean age of participants was 42.2 years, and most participants were Hispanic (93.15%). The overall prevalence of OAB syndrome was 31.70%, and it was more frequently reported in women than in men (39.25% vs. 24.15%). Most participants with OAB did not perceive their symptoms as bothersome. The most bothersome symptom, associated with moderate/severe impact in QoL was urinary urgency. According to the PPBC questionnaire 75.6% of the participants reported that their bladder condition does not cause any problem, while 11.% reported moderate to severe bother. The multivariable model showed high blood pressure and anxiety were associated with OAB in men. In females, depression, obstructive sleep apnea, IBS, and pelvic organ prolapse were associated with OAB syndrome. Using the symptomatic definition of OAB can overestimate the real impact and burden of the condition, and treatment should be targeted to those symptomatic patients with QoL impairment as they would benefit from further management. The questionnaires seem to overestimate the condition, since we assessed it from a PROMS perspective there is not such a marked QoL impact.

An anatomical pathogenesis of lower urinary tract definitions from the 2002 ICS report symptoms, conditions, syndromes, urodynamics.

AimTo present an anatomical pathogenesis parallel with the 2002 International Continence Society Lower Urinary Tract (LUTS) definitions standardization Report 2002.MethodsEach LUTS section is discussed using the same numbers as the Report.Results Normal function Bladder control is binary, with two reflexes alternating, either closure (dominant) or open (micturition), with the same cortical and peripheral components: three directional muscle forces contracting against pubourethral (PUL) and uterosacral (USL) ligaments for closure, two against uterosacral ligaments for micturition. Dysfunction OAB symptoms reflect a prematurely activated micturition; PUL/USL weakness prevents muscle forces from controlling afferent urothelial emptying signals. Stress urinary incontinence is a consequence of weak PULs allowing posterior muscle forces to open the urethra during effort. Lax USLs weaken contractile force of the posterior urethral opening vectors, so detrusor has to contract against an unopened urethra. This is experienced as “obstructive micturition.”ConclusionsAnatomical analysis indicates the ICS definitions are fundamentally sound, except for “OAB” which implies detrusor causation. Minor changes, OAB to “overactivated” bladder allow causation outside of bladder. This construct supports OAB and its component symptoms as a syndrome, as intuited by the Committee, (albeit as a prematurely activated micturition), retains the acronym, explains OAB cure by ligament repair, and incontinence pathogenesis from two post‐2002 syndromes which need an addition to the definitions, Posterior Fornix Syndrome (of which OAB is a component) and Tethered Vagina Syndrome, which is the basis for skin‐grafting cure of the 30%–50% of women who continue leaking urine massively after successful obstetric fistula closure.

Overactive bladder: A multicenter study in Pakistan.

To determine the overall prevalence of overactive bladder in Pakistan, and to determine the difference in prevalence in relation to gender. The multicenter study was conducted from February 2017 to October 2018 at 11 institutions across the country, and comprised randomly selected healthy subjects of either gender who were assessed on the basis of symptoms defined by the International Continence Society for overactive bladder. Data was collected using a questionnaire based on the symptoms which was filled for the respondent by designated health workers. Data was analysed using SPSS 23. Of the 1291 respondents, 632(49%) were males with a mean age of 37.8±14.4 years, and 659(51%) were females with a mean age of 38.3±13.7 years. The overall prevalence of overactive bladder was 82(6.4%). Among the males, it was 15(2.4%) and among the females 67(10.2%) (p=0.001). Urgency, frequency and nocturia were reported by 82(6.4%) respondents; 15(1.2%) males and 67(5.2%) females (p=0.001). The prevalence of overactive bladder was found to be low when assessed with strict application.

2D ultrasound diagnosis of middle compartment prolapse: a multicenter study.

Recently, a specific methodology has been defined, using transperineal ultrasound, for the differential diagnosis of middle compartment prolapse [uterine prolapse (UP) or cervical elongation (CE) without UP] based on the difference in the pubis-uterine fundus distance at rest and with the Valsalva maneuver, with a cutoff point of 15 mm. The objective of this study was to validate the diagnostic utility of a ≥15 mm difference between the pubis-uterine fundus distance at rest and during the Valsalva maneuver to define UP in a multicenter study. This prospective multicenter observational study included 94 patients (UP =51; CE without UP =43). The clinical examination was based on the International Continence Society Pelvic Organ Prolapse Quantification (ICS POP-Q) system for assessing pelvic organ prolapse (POP) and patients were candidates for corrective surgery of the middle compartment of the pelvic floor (correction of UP or CE without UP). The ultrasound study was performed by transperineal ultrasound (B-mode) with the patient undergoing dorsal lithotomy. The distance evaluation was performed in relation to the posteroinferior pubic margin in the midsagittal plane, with reference to the uterine fundus (established as the most distal hyperechogenic) line from the pubis to the uterine fundus at rest and with the Valsalva maneuver. We defined UP detected using UP as a difference of ≥15 mm between the pubis-uterine fundus distance at rest and with the Valsalva maneuver. Agreement between the clinical and ultrasound diagnosis of UP was assessed using the Cohen kappa coefficient of agreement and its 95% CIs. The ultrasound diagnosis of global UP at the three centers showed very good agreement, with a kappa index of 0.826 (0.71, 0.94). The agreement of ultrasound with the clinical diagnosis of UP using the ICS POP-Q system was very good for each of the hospitals [Hospital 1: 0.814 (0.64, 0.98), Hospital 2: 0.847 (0.64, 1) and Hospital 3: 0.824 (0.59, 1)]. A difference of ≥15 mm between the pubis-uterine fundus distance at rest and during the Valsalva maneuver for the diagnosis of UP presents very good agreement with the results of clinical evaluation with the ICS POP-Q system.

Relation of Hysterectomy with Urinary Incontinence

Urinary incontinence is defined by international continence society as “a condition in which involuntary loss of urine is objectively demonstrable and is a social hygiene problem “It refers to the involuntary leakage of urine can be associated with a systemic complication. Its prevalence is higher in women than in men thought it can affect men and women equally. It has the high prevalence due to its impact on the quality of life. The presence of urinary incontinence can be associated with anger; embarrassment related to any clinical condition, with loss of self-esteem and decrease motivation and decrease social, physical quality of life. Moment plausibility is that the bladder is presently overactive because of the surgery or changes in the pelvic floor musculature related with hysterectomy. Urge incontinence causes spillage of urine all of a sudden, related with critical ness and the powerlessness to smother such inclinations. Objective: Aim of this study is to determine urinary incontinence in women with hysterectomy. To assess the impact of urinary incontinence on quality of life of women undergone hysterectomy. Background: Furthermore, this study highlighted the presence of pain, discomfort, alteration of Quality of life and functional limitation due to incontinence of urine associated after Hysterectomy. An observational survey from different hospitals of Rawalpindi and Islamabad was conducted to collect relevant information. Methods: Standard questionnaire tools (UDI-6) and (KHQ) was used to collect data from 100 women using convenient random sampling technique in different hospitals of Rawalpindi and Islamabad. Results: The result revealed that urinary incontinence in women with hysterectomies strongly associated with altered quality of life causing loss of self-esteem leading to an impairment. Conclusion: This study concluded urinary incontinence associated with hysterectomy had pronounced effects on quality of life of women causing physical, social and psychological role limitations and participation restriction.

An overactive bladder treatment: Mirabegron versus Tolterodine

Background: Overactive bladder (OAB), as described by the International Continence Society (ICS), is characterized by complex symptoms, which include urinary urgency (strong, sudden need to urinate that is difficult to delay) with or without urge incontinence that is usually associated with frequency (abnormally frequent urination) and nocturia (excessive urination at night).1 The objective of this study is to assess the efficacy of mirabegron and tolterodine, comparing both drugs by International Prostate Symptom Score (IPSS), micturition episodes per 24 hours, nocturia, urgency, urge incontinence after 12 weeks of intervention among patients who presented with predominantly storage lower urinary tract symptoms (LUTS).2,3METHODS: This is a prospective observational study conducted on 40 patients with overactive bladder over a period of 15 months, from January 2019 to March 2020. 20 patients received Mirabegron 50 mg (tablet) once daily (Group-M) and the other 20 patients received Tolterodine 4 mg (tablet) once daily (Group-T). RESULTS: The difference in urinary frequency episodes per 24 hours after 12 weeks in the Group-M was 2.75 ± 1.41, while that among Group-T was 1.15 ± 1.04 with significant p-value < 0.05. The difference of nocturia episodes after 12 weeks in the Group-M was 1.45 ± 0.88, while that in Group-T was 0.7 ± 0.65 with significant p-value < 0.05. The difference of urgency episodes after 12 weeks in Group-M was 1.65 ± 0.99, while that among Group-T was 1 ± 0.79 with significant p-value < 0.05. The difference of urge incontinence episodes after 12 weeks was not statically significant between the two groups (Table 1). The difference of IPSS after 12 weeks in the Group-M was 5.7 ± 3.65, while that among Group-T was 3.85 ± 1.27 with significant p-value < 0.05 (Table 2). CONCLUSION: Mirabegron improved urinary urgency, total number of micturition episodes/24 hours, nocturia, IPSS score more than Tolterodine in over active bladder patients. There was no statistical difference between Mirabegron and Tolterodine in terms of urinary incontinence episodes.

Bristol UTraQ: A proposed system for scoring the technical quality of urodynamic traces.

To develop and test a scoring system for the technical quality of a urodynamic trace METHODS: Rasch analysis was used to select the most discriminating questions relating to good urodynamic practices. The questions were taken from International Continence Society standard documents and tested on 60 traces of varying quality and from different sources. Twenty-five questions were selected by this process. These were tested with 10 traces by seven scorers, and with 60 traces by a single scorer. A pass quality score of 75% resulted in good discrimination between good and poor traces. Further editing and clarification resulted in a final score sheet of 23 Yes/No questions. A proposed scoring system, "Bristol UTraQ," for the technical quality of urodynamic traces has been developed and tested. We suggest a score above 75% indicates acceptable trace technical quality. High technical quality is the essential first step in ensuring that urodynamic studies can answer the urodynamic questions for every patient. Plans for further validation are outlined.

The Importance of Terminology for Quantifying Nocturia in Practice

BackgroundAlthough nocturia, affecting mainly the elderly population, is a urinary tract symptom, it may also be a part of conditions not related to the urinary tract. In this scenario, nocturia terminology is crucial to avoid confusion and misunderstanding across different specialities. The International Continence Society (ICS) provides the updated nocturia terminology. ObjectiveTo review, describe, and explain the applicability of nocturia terminology based on the ICS standardisation documents. Design, setting, and participantsThe ICS report provides definitions on the terminology for nocturia and nocturnal lower urinary tract function, which were identified and summarised. Outcome measurements and statistical analysisTerminology was classified as symptoms and signs, and an explanation of how terms are applied in a bladder diary for use in clinical practice was given. Results and limitationsTerminology was classified into symptoms and signs. Nocturia is a symptom where the patient reports waking up to pass urine during their main sleep period, and every episode is followed by sleep or the intention to sleep. Nocturnal polyuria is a symptom when the patient perceives that they have passed large volumes of urine during the main sleep period. Enuresis is the complaint of incontinence that occurs while a patient is asleep and is usually unaware of it. All these terms can be a sign when quantified on the bladder diary. The remaining terminology is identified and quantified on the 3-d bladder diary (24-h voided volume, 24-h polyuria, nocturnal urine volume, night-time frequency, first morning void, night-time main sleep period). ConclusionsThe health care provider must understand the critical differences between the different terms. It will facilitate communication among all the professionals involved in the care of these patients. A 3-d bladder diary is a fundamental tool for assessing nocturia. Patient summaryThis paper has the objective of defining and explaining all the terms currently used for nocturia. For this purpose, we utilised the published standard terminology and summarised it with examples for better understanding and applicability.

International Continence Society (ICS) report on the terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction.

The terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction has not been defined and organized into a clinically based consensus terminology report. The aim of this terminology report is to provide a definitional document within this context that will assist clinical practice and research. This report combines the input of the members of sexual health in men with LUT and PF Dysfunction working group of the International Continence Society (ICS), assisted at intervals by external referees. Appropriate core clinical categories and a sub-classification were developed to give coding to definitions. An extensive process of 18 rounds of internal and external review was involved to exhaustively examine each definition, with decision-making by collective opinion (consensus). The Committee retained evidence-based definitions, identified gaps, and updated or discarded outdated definitions. Expert opinions were used when evidence was insufficient or absent. A terminology report for sexual health in men with LUT and PF dysfunction, encompassing 198 (178 NEW) separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different speciality groups involved. Conservative and surgical managements are major additions and appropriate figures have been included to supplement and clarify the text. Emerging concepts and measurements, in use in the literature and offering further research potential, but requiring further validation, have been included as an appendix. Interval (5-10 years) review is anticipated to keep the document updated. A consensus-based terminology report for sexual health in men with LUT and PF dysfunction has been produced to aid clinical practice and research. The definitions that have been adopted are those that are most strongly supported by the literature at this time or are considered clinical principles or consensus of experts' opinions.

Prevalência de incontinência urinária, impacto na qualidade de vida e fatores associados em usuárias de Unidades de Atenção Primária à Saúde

Abstract Introduction: Urinary incontinence (UI) has a considerable negative impact on quality of life, resulting in psychosocial, emotional and health impairment, high costs to the health system and limited activities of daily living. Objective: To describe the proportion of women with UI and its impact on quality of life (QOL), and investigate the factors associated with this condition among users of Primary Health Care Units (PHCUs) in the municipality of Governador Valadares, Minas Gerais state (MG), Brazil. Methods: Cross-sectional study with female users of the municipal PHCUs. A questionnaire compiled by the researchers was used for data collection. Participants who reported urine leakage in any situation completed the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Results: A total of 201 women took part in the study, 36.32% of whom had UI and obtained a score of 7, indicating a moderate impact on their QOL. Urinary incontinence was associated with age, income, body mass index and parity. Conclusion: The proportion of women with UI corroborates the prevalence described by the International Continence Society (ICS), moderately impacting quality of life and indicating normalization of the problem. Urinary incontinence was also correlated with age, income, BMI and number of pregnancies. This demonstrates the need for health education strategies at PHCUs to prevent and treat UI in this group, as well as intersectoral activities to improve the income of the population in order to control modifiable risk factors.

Implications of Underactive Bladder Syndrome for Nocturia. Do We Need Urodynamic Assessment?

Nocturia is a common urological symptom defined by the International Continence Society (ICS) as “the number of times urine is passed during the main sleep period. Having woken to pass urine for the first time, each urination must be followed by sleep or the intention to sleep. This should be quantified using a bladder diary” [1]. The prevalence of nocturia is high in both genders and increases with age. Nocturia or nocturnal polyuria can be caused by wide-ranging nonurological factors, such as cardiovascular disease, obstructive sleep apnoea, polypharmacy, or learnt behaviour.

The Scientific Impact of Abstracts on Functional Urology – an Evaluation of the European Association of Urology (EAU) and International Continence Society (ICS) congresses of 2015 until 2019

The Scientific Impact of Abstracts on Functional Urology – an Evaluation of the European Association of Urology (EAU) and International Continence Society (ICS) congresses of 2015 until 2019

Effect of Pelvic Floor and Abdominal Muscle Exercise on Women with Stress Urinary Incontinence: A Quasi-experimental Study

Introduction: International continence society and the international urogynaecology association defined the Urinary Incontinence (UI) as “the complaint of any involuntary urine loss”. Pelvic Floor Muscles (PFM) weakness leads to Stress Urinary Incontinence (SUI). There exists an association between physical exertions along with urinary loss in UI. For decreasing urine leak episodes in women, PFM exercises are recommended. The PFM serves as the inner unit and the transverse abdominal muscle, multifidus along with diaphragm act as core muscles. Therefore, for treating SUI, abdominal muscle strengthening might be efficient. Aim: To analyse the effect of combined PFM exercises and abdominal muscle exercises on SUI symptoms. Materials and Methods: A quasi-experimental study was executed with 15 subjects in the Experimental Group (EG) and 11 subjects in the Control Group (CG) via purposive sampling technique at outpatient department. The EG was treated with abdominal muscle exercises along with Pelvic Floor Exercises (PFE) for eight weeks while the CG was treated with PFE. Via phone calls, the training’s follow-up was conducted. PFM strength and the Questionnaire for Urinary Incontinence Diagnosis (QUID) were the outcome measures. The between group perineometer scores analysed with paired t-test. For examining the pre and post-test score of PFM strength scores the independent t-test was employed. For analysing the QUID score Wilcoxon signedrank test, Mann-Whitney U test was applied. Results: The mean of PFM strength (mmHg) for the interventional group was 5.4 while in the CG the mean was 1.64 as exhibited by the within group analysis (p=0.001). An enhancement in every component of QUID in the interventional group was shown in the post-test QUID score between groups which depicted a statistically significant difference in all the components (cough p=0.001, bending p=0.002, walk p=0.001). Conclusion: Abdominals and PFM exercise lessens the SUI symptoms even though PF exercise is the regular treatment aimed at SUI. Better improvement in SUI symptoms and PFM strength is possible by the abdominals along with eight week PF exercise program.

Vaginal Laser Therapy for Stress Urinary Incontinence: A Systematic Review of Prospective Randomized Clinical Trials.

The most common type of urinary incontinence in women is stress urinary incontinence (SUI) which negatively impacts several aspects of life. The newly introduced vaginal laser therapy is being considered for treating SUI. This systematic review aimed to evaluate the efficacy of vaginal laser therapy for stress urinary incontinence in menopausal women. We searched the following databases: MEDLINE (via PubMed), EMBASE, Cochrane Library databases, Web of Science, clinical trial registry platforms, and Google Scholar, using the MeSH terms and keywords [Urinary Incontinence, Stress] and [(lasers) OR laser]. In our systematic review, prospective randomized clinical studies on women diagnosed with SUI as per the International Continence Society's diagnostic criteria were included. The Cochrane Risk-of-Bias assessment tool for randomized clinical trials was used to evaluate the quality of studies. A total of 256 relevant records in literature databases and registers and 25 in additional searches were found. Following a review of the titles, abstracts, and full texts, four studies involving 431 patients were included. Three studies used CO2-lasers, and one used Erbium: YAG-laser. The results of all four studies revealed the short-term improvement of SUI following both the Erbium: YAG-laser and CO2-laser therapy. SUI treatment with CO2-laser and Erbium: YAG-laser therapy is a quick, intuitive, well-tolerated procedure that successfully improves incontinence-related symptoms. The long-term impact of such interventions has not been well established as most trials focused on the short-term effects.

Multiple Endoclip Retraction Technique (MERT) in Laparoscopic Burch.

Background and Objectives:The multiple endoclip retraction technique (MERT) was developed based on our experience with suturing renal parenchyma in laparoscopic partial nephrectomy. In this study we prospectively evaluated the one-year results of cases treated by transperitoneal laparoscopic Burch with the MERT.Methods:The patients were evaluated with stress test, one-hour pad test, and were requested to complete the International Continence Society Incontinence Questionnaire short form (ICIQ-SF) in the postoperative period. The follow-up periods were postoperative 3, 6, and 12 months.Results:The primary outcome of this study was surgical success, defined as being cured of stress urinary incontinence (SUI) (no symptoms), experiencing improved symptoms of SUI in ICIQ-SF and negative stress test, and less than 2g urine leakage in a one-hour pad test.No statistically significant difference was found in terms of age, number of children, and body mass index (BMI) in patients according to the results of the 12 month postoperative stress test. We found statistically significant improvements at all control months in terms of stress test and pad weight. ICIQ-SF results showed a significant decrease at three months in patients who recovered after the operation. This rate has not changed in following control months. However, there was no statistical change in ICIQ-SF values in patients who did not recover after the operation.Conclusion:MERT seems to be one of the safe and effective modifications in the management of SUI with good one year outcomes when performed by suitably trained experienced surgeons.

Value of Transperineal Ultrasound in Short-term Evaluation of Pelvic Organ Prolapse after Transvaginal Mesh Implantation

Objective To observe the patients after transvaginal mesh(TVM)implantation surgery by using transperineal ultrasound(TPUS),compare the diagnosis of pelvic organ prolapse(POP)by TPUS and clinical examination[according to the Pelvic Organ Prolapse Quantification(POP-Q)system published by the International Continence Society],and to explore the role of ultrasound in postoperative evaluation as well as the high-risk factors of post-surgery POP recurrence. Methods This is a retrospective study based on the POP-Q records and TPUS data sets of patients within 6 months after TVM surgery during September 2013 and November 2019.The diagnostic results of TPUS and POP-Q were compared.The incidences of hiatal ballooning and levator avulsion were separately compared between the TPUS group and the control group. Results A total of 147 patients were enrolled.The Kappa values between TPUS and POP-Q in the diagnosis of anterior and posterior compartment POP were 0.268(P=0.000)and 0.235(P=0.001),respectively.There were altogether 37 cases diagnosed inconsistently between TPUS and POP-Q,including 14(9.52%)cases of anterior compartment prolapse and 23(15.65%)cases of posterior compartment prolapse.TPUS diagnosed 32 more cases of prolapse than POP-Q,which included 13(8.84%)cases of anterior compartment prolapse and 19(12.93%)cases of posterior compartment prolapse.The incidence of hiatal ballooning in the TPUS prolapse group was significantly higher than control group(51.35% vs.33.94%,χ2=3.950,P=0.047).The incidence of levator avulsion showed no significant difference between the two groups(P=1.000). Conclusions TPUS diagnosis of POP after TVM surgery has consistency with the POP-Q diagnosis of International Continence Society.TPUS can detect more POP cases,and thus it may act as a supplement for clinical diagnosis.Hiatal ballooning is associated with POP recurrence after TVM surgery.

Compression or obstruction: Prospective analysis of the function of the Adjustable Transobturator Male System (ATOMS) based on preand postoperative urodynamic data.

This analysis, based on pre- and postoperative urodynamic data, is the first to elucidate the influence of the Adjustable Transobturator Male System (ATOMS, A.M.I. GmbH, Feldkirch, Austria) on the lower urinary tract and disclose possible obstructive properties. A prospective study was performed in patients who had stress urinary incontinence and were scheduled for ATOMS implantation after radical prostatectomy. Apart from continence assessment (24-hour pad test, International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form [ICIQ-SF]), urodynamic testing was done with International Continence Society (ICS)-standardized pressure-flow analysis before and after ATOMS implantation/adjustment. The Wilcoxon signed-rank test was used for statistical analysis. The analysis included 12 consecutive patients from two centers (mean age 69 years) with a mean followup of 246 days. Median urine leakage dropped from 240 (72-1250) to 70 (0-700) g/24 hours postoperatively, with a pad reduction of 4 to 0.9 pads/ day. Pressure-flow analysis revealed a significant change only in the bladder outlet obstruction index (BOOI). The bladder contractility index, intravesical pressure conditions, and uroflowmetry were not significantly affected. None of the patients showed de novo obstruction postoperatively in the ICS analysis. The ATOMS significantly increases the BOOI in conjunction with good continence results. However, no case reached pathological level according to the BOOI and thus there is no potential danger to the lower urinary tract or urethral integrity.

Randomised controlled trial to investigate the effectiveness of the symptom management after radiotherapy (SMaRT) group intervention to ameliorate lower urinary tract symptoms in men treated for prostate cancer

PurposeTo evaluate the effectiveness of the symptom management after radiotherapy (SMaRT) group intervention to improve urinary symptoms in men with prostate cancer.MethodsThe randomised controlled trial (RCT) recruited men from one radiotherapy centre in the UK after curative radiotherapy or brachytherapy and with moderate to severe urinary symptoms defined as scores ≥ 8 on the International Prostate Symptom Score (IPSS) questionnaire. Sixty-three men were randomised either; to SMaRT, a 10-week symptom-management intervention including group support, education, pelvic floor muscle exercises, or a care-as-usual group. The primary outcome was the IPSS at 6 months from baseline assessment. Secondary outcomes were IPSS at 3 months, and International Continence Society Male Short Form (ICS), European Organisation for Research and Treatment of Cancer Quality of Life prostate scale (EORTC QLQ-PR25), EORTC QLQ-30 and Self-Efficacy for Symptom Control Inventory (SESCI) at 3 and 6 months from baseline. Analysis of covariance (ANCOVA) was used to analyse the effect of the intervention.ResultsSMaRT group intervention did not improve urinary symptoms as measured by IPSS at 6-months. The adjusted difference was − 2.5 [95%CI − 5.0 to 0.0], p = 0.054. Significant differences were detected at 3 months in ICS voiding symptoms (− 1.1 [− 2.0 to − 0.2], p = 0.017), ICS urinary incontinence (− 1.0 [− 1.8 to − 0.1], p = 0.029) and SESCI managing symptoms domain (13.5 [2.5 to 24.4], p = 0.017). No differences were observed at 6 months.ConclusionsSMaRT group intervention provided short-term benefit in urinary voiding and continence and helped men manage symptoms but was not effective long term.

A Novel Capacitive Method for Urodynamic Measurements That is Suitable for Home Use

Purpose: Urinary incontinence is highly prevalent in both women and men. Urodynamic testing is essential for diagnosis, but a gap exists in the usefulness of simple assessments that do not provide sufficient data, and devices that provide the necessary data, but are used primarily in clinics and clinical trials. This study considered the existing methods of urodynamics testing and developed a device that was both effective and suitable for home use.
 Methods: A review of existing urodynamic methods led to development of a capacitive device. We created a device with sensor electrodes placed on the outside of a specimen container. The functionality of the electrodes and performance of the novel capacitive device were compared with that of a gravimetric device (Dorado KT, Laborie Medical Technologies, Mississauga, ON, Canada) used at the University Clinical Center, Maribor.
 Results: Measurements of fluid volume (p = 0.936), maximum (p = 0.327), and mean (p = 0.136) flow observed with the two devices were not significantly different. Graphical analysis of collected volumes and flow variation over time show a high degree of overlap.
 Conclusion: Compared with previously developed urodynamics testing devices, the capacitance method and the performance of this device represent an advance. The precision of the measurements needs improvement and did not fully address the recommendations of the International Continence Society, but he use of additional sensor electrodes is expected to improve performance. Extending the functionality as a standalone capacitive device for home use and upgrading with wireless access by mobile systems would allow for additional benefits beyond current voiding diaries.