Long-term Urinary Incontinence Research Articles

Editorial Comment on “Natural History of Artificial Urinary Sphincter Erosion: Long-Term Lower Urinary Tract Outcomes and Incontinence Management”

Editorial Comment on “Natural History of Artificial Urinary Sphincter Erosion: Long-Term Lower Urinary Tract Outcomes and Incontinence Management”

Clinical characteristics and predictors of long-term postoperative urinary incontinence in patients treated with robot-assisted radical prostatectomy: A propensity-matched analysis.

This study aimed to elucidate the clinical characteristics and predictors of long-term postoperative urinary incontinence (PUI) after robot-assisted radical prostatectomy (RARP). This study included patients who underwent RARP at our institution and were stratified into PUI (≥1 pad/day) and continence (0 pad/day) groups at 60 months after RARP. A propensity score-matched analysis with multiple preoperative urinary status (Expanded Prostate Cancer Index Composite urinary subdomains, total International Prostate Symptom Score (IPSS), and IPSS-quality of life scores) was performed to match preoperative urinary status in these groups. Serial changes in urinary status and treatment satisfaction preoperatively and until 60 months after RARP were compared, and predictors of long-term PUI were assessed using multivariate logistic regression analysis. A total of 228 patients were included in the PUI and continence groups (114 patients each). Although no significant difference in preoperative urinary status was observed between the two groups, the postoperative urinary status significantly worsened overall in the PUI group than in the continence group. Treatment satisfaction was also significantly lower in the PUI group than in the continence group from 12 to 60 months postoperatively. Multivariate logistic regression analysis revealed that age (≥70 years) and biochemical recurrence (BCR) were significant predictors of the long-term PUI group (p < 0.05). Patients with long-term PUI had poor overall postoperative urinary status and lower treatment satisfaction than the continence group. Considering the age and risk of BCR is important for predicting long-term PUI when performing RARP.

Natural History of Artificial Urinary Sphincter Erosion: Long-term Lower Urinary Tract Outcomes and Incontinence Management

ObjectivesTo describe long-term lower urinary tract outcomes and incontinence management after AUS erosion, including risk factors associated with each outcome. MethodsWe retrospectively reviewed our prospectively maintained AUS database for men undergoing device explantation for urethral erosion from 1/1/1986-10/31/2023. Outcomes included development of urethral stricture and management of post explant incontinence (e.g. pads/clamp, catheter, salvage AUS, supravesical diversion). Risk factors were tested for association with stricture formation and repeat AUS erosion using logistic regression. Results1943 unique patients underwent AUS implantation during the study period, and 217 (11%) had a device explantation for urethral erosion. Of these, 194 had complete records available and were included for analysis. Median follow-up from implantation was 7.5 yrs (IQR 2.7-13.7) and median time to erosion was 2 yrs (IQR 0-6). 96 patients (49%) underwent salvage AUS placement. Of those, 38/96 (40%) were explanted for subsequent erosion. On multivariable analysis, no factors were significantly associated with risk of salvage AUS erosion. On multivariable model, pelvic radiation (OR 2.7; 95% CI 1.0-7.4) and urethral reapproximation during explant for erosion (OR 4.2; 95% CI 1.5-11.2) were significantly associated with increased risk of urethral stricture (p<0.05). At the time of last follow-up, 69/194 (36%) patients had a functioning salvage AUS, including both initial and subsequent salvage implants. ConclusionsFollowing AUS erosion, radiation history and urethral reapproximation at explantation were risk factors for development of urethral stricture. Salvage AUS replacement can be performed, but has a higher rate of repeat urethral erosion.

Reproductive history of parous women and urinary incontinence in midlife: A National Birth Cohort follow-up study.

To investigate how reproductive history was associated with urinary incontinence in midlife. A follow-up study. Denmark. A total of 39 977 mothers who participated in the Maternal Follow up (2013-2014) in the Danish National Birth Cohort. National registries provided their reproductive history. How parity, mode of birth and obstetric tears associated with urinary incontinence were estimated with adjusted odds ratios (OR) and 95% CI using logistic regression. Self-reported urinary incontinence including subtypes stress, urge and mixed urinary incontinence. At an average age of 44 years, the prevalence of any urinary incontinence was 32% (21% stress, 2% urge, and 8% mixed urinary incontinence). Women with two births more often had urinary incontinence than women with one birth (OR 1.20, 95% CI 1.10-1.31). Compared with women with only spontaneous births, a history of only caesarean sections was associated with much lower odds of urinary incontinence (OR 0.39, 95% CI 0.35-0.42) and a history of instrumental births with slightly lower odds (OR 0.92, 95% CI 0.86-0.98). Compared with no tear/first-degree tear as the largest tear, episiotomy was associated with less urinary incontinence (OR 0.91, 95% CI 0.86-0.97) whereas third/fourth-degree tears were associated with more (OR 1.14, 95% CI 1.04-1.25). Findings were mainly explained by similar associations with stress and mixed urinary incontinence. Vaginal birth was associated with a higher risk of long-term urinary incontinence, but our results indicate that this risk may be reduced by shortening the second stage of birth.

Precise Prediction of Long-Term Urinary Incontinence after Robot-Assisted Laparoscopic Radical Prostatectomy by Readily Accessible "Everyday" Diagnostics during Post-Surgical Hospitalization.

Aim and Objectives: We aimed to test the predictive value of readily accessible and easily performed post-surgical "bedside tests" on their validity of long-term urinary incontinence (UI) (≥12 months) in patients following robot-assisted laparoscopic radical prostatectomy (RALP). Material and Methods: Patients undergoing RALP between July 2020 and March 2021 were prospectively included and subdivided into two groups based on their pad usage after 12 months (0 vs. ≥1 pad). After catheter removal, patients performed a 1 h pad test, documented the need for pad change in a micturition protocol and received post-voiding residual urine volume ultrasound. Univariate and multivariable analyses were used to demonstrate the predictive value of easily accessible tests applied after catheter removal for UI following RALP. Results: Of 109 patients, 47 (43%) had to use at least one pad (vs. 62 (57%) zero pads) after 12 months. Univariate testing showed a significant difference in urine loss between both groups evaluated by the 1 h pad test performed within 24 h after catheter removal (70% < 10 mL, vs. 30% ≥ 10 mL, p = 0.004) and in the need for pad change within the first 24 h after catheter removal (14% dry pads vs. 86% wet pads, p = 0.003). In multivariable analyses, the combination of both tests (synoptical incontinence score) could be confirmed as an independent predictor for UI after 12 months (p = 0.011). Conclusions: Readily accessible "everyday" diagnostics (pad test/change of pads after catheter removal) following RALP seem to be associated with a higher rate of long-term UI. This finding is crucial since patients with a potentially higher need for patient education and counselling can be identified using these readily accessible tests. This could lead to a higher patient satisfaction and improved outcomes.

Pelvic Floor Muscle Exercises can Effectively Improve Urinary Incontinence after Radical Prostatectomy: Systematic Review and Meta-Analysis Based on Randomised Controlled Trials.

This study aims to assess the effect of pelvic floor muscle exercise (PFME) on urinary incontinence after radical prostatectomy. PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP and other domestic and foreign databases were searched for published literature until December 2023 on the effect of pelvic muscle exercise on urinary incontinence in patients after radical prostatectomy. The retrieved literatures were screened, and data were extracted. After evaluating the quality of the literatures, RevMan 5.4 software was used for meta-analysis. This work included nine articles consisting of 1208 sufferers with urinary incontinence after radical prostatectomy. The forest plot showed that patients in the experimental group had better postoperative outcomes at 1 month (Relative Risk (RR) = 3.38, 95% confidence interval (CI) (1.83; 6.25)), 3 months (RR = 1.99, 95% CI (1.67; 2.38)) and 6 months (RR = 1.34, 95% CI (1.20; 1.49)). The incidence of urinary incontinence was statistically significant compared with the control group (p < 0.05). Patients in the experimental group 12 months after surgery (RR = 1.13, 95% CI (0.99; 1.23)) showed no significant difference in the incidence of urinary incontinence compared with the control group (p > 0.05). PFME can significantly increase the recovery rate of urinary incontinence in sufferers with prostate cancer at 1, 3 and 6 months after radical surgery but have no significant improvement at 12 months. Urodynamic analysis may be needed for patients with long-term urinary incontinence.

A matched-analysis on short-term and long-term (up to 5 years of follow-up) urinary incontinence outcomes after robot-assisted radical prostatectomy with and without anterior and posterior reconstruction: data on 1358 patients

PurposeWe report a comparative monocentric study with a short and long-term follow-up with the aim to assess differences about urinary continence outcomes in patients treated with Robot-Assisted Radical Prostatectomy (RARP) with two different techniques: with anterior and posterior reconstruction and without any kind of reconstruction.Materials and methodsFrom January 2016 to September 2021, at the Department of Urology of the “F. Miulli” Hospital of Acquaviva delle Fonti, in Italy, 850 eligible patients underwent extraperitoneal RARP with anterior and posterior reconstruction and 508 without reconstructions.ResultsIn patients undergoing RARP with reconstructions 1 month after surgery the urinary continence was preserved in 287/850 patients (33.8%), 3 months after surgery in 688/850 (81%), 6 months in 721/850 (84.8%), 12 months in 734/850 (86.3%), 18 months in 671/754 (89%), 24 months in 696/754 (92.3%), 36 months in 596/662 (90%), 48 months in 394/421 (93.6%), 60 months in 207/212 (97.6%). In patients undergoing RARP without reconstruction 1 month after surgery urinary continence was preserved in 99/508 (19.4%), after 3 months in 276/508 (54.3%), 6 months in 305/508 (60%), 12 months in 329/508 (64.7%), 18 months in 300/456 (65.7%), 24 months in 295/456 (64.7%), 36 months in 268/371 (72.3%), 48 months in 181/224 (81%), 60 months in 93/103 (90.3%).ConclusionIn our case study, the RARP with anterior and posterior reconstruction technique is associated with a statistically significant higher rate (up to 48 months of follow-up) and a faster recovery of urinary continence compared to the technique without reconstructions.

Predictors of Long-Term Urinary Incontinence After Robot-Assisted Laparoscopic Prostatectomy.

Urinary incontinence is a major complication after radical prostatectomy. We analyzed the predictors of urinary incontinence after robot-assisted radical prostatectomy. One hundred twenty-one patients, whose urinary continence status was evaluable at 3 months, 6 months, and 12 months after robot-assisted radical prostatectomy, were included from October 2016 to September 2021. Data were retrospectively collected from electronic medical records. The continence status was evaluated by interviewing the patients about the number of urinary pads used per day. We compared the patients' age, body mass index, prostate volume, membranous urethral length on preoperative magnetic resonance imaging, surgeon experience, and pathological findings between patients with and without regained continence at 12 months after robot-assisted radical prostatectomy. The urinary continence rates were 30%, 57.8% and 79.3% at 3 months, 6 months, and 12 months, respectively, after robot-assisted radical prostatectomy. Twelve months after robot-assisted radical prostatectomy, 96 patients had regained continence and did not require urinary pads, whereas 25 patients had persistent urinary incontinence and required urinary pads. Membranous urethral length and surgeon experience were significantly different between patients with and without regained continence at 12 months after robot-assisted radical prostatectomy (P=0.05). However, no significant differences existed in age, body mass index, prostate volume, and pathological findings between patients with and without regained continence at 12 months after robot-assisted radical prostatectomy. Membranous urethral length and surgeon experience are predictors of urinary incontinence after robot-assisted radical prostatectomy. Measuring the membranous urethral length is recommended before performing the operation.

Preoperative pelvic floor muscle exercise for continence after radical prostatectomy: a systematic review and meta-analysis.

We performed a systematic review and meta-analysis to evaluate the effect of preoperative pelvic floor muscle exercise on urinary incontinence after radical prostatectomy. We searched the literature for randomized controlled trials evaluating the diagnostic analysis of preoperative pelvic floor muscle exercise (PFME) and postprostatectomy incontinence in the MEDLINE, EMBASE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, China Biomedical Literature Database, China Journal Full-text Database, Wanfang Database and Weipu Database. The retrieval time limit is from the establishment of the database to January 2023. We used a risk ratio with accompanying 95% confidence interval (CI) to express estimates. Reviewer Manager (RevMan) 5.1.0 was used to complete all statistical analyses. Twelve studies were included based on the selection criteria. The total number of patients included in the final analysis was 1,365. At 1th month, there was no difference in continence rates between the groups [odds ratio (OR): 0.47; 95% confidence interval (CI), 0.22-1.02, p = 0.06]. At 3th month, there was statistically significant difference in PFME group before operation (OR: 0.61; 95% CI, 0.37-0.98, p = 0.04). At 6th and 12th months, there was no difference between groups (OR: 0.57; 95% CI, 0.28-1.17, p = 0.13), (OR: 0.56; 95% CI, 0.27-1.15, p = 0.12). Preoperative pelvic floor muscle exercise can improve postoperative urinary incontinence at 3rd months after radical prostatectomy, but it cannot improve urinary incontinence at 6th months or longer after surgery, which indicates that preoperative PFME can improve early continence rate, but cannot improve long-term urinary incontinence continence rate.

Prevalence and Features of Post-stroke Urinary Incontinence: A Retrospective Cohort Study.

Long-term complications of stroke, persisting for more than 6 months after the initial event, substantially reduce the quality of life (QoL) in a significant percentage of stroke survivors. In this paper, we studied the prevalence of long-term urinary incontinence (UI) in post-stroke patients. In addition, we attempted to identify patient characteristics which were associated with higher UI prevalence, higher UI severity, and less UI-associated QoL. Medical records in a tertiary referral hospital were used to contact patients who had experienced a stroke between 6 to 32 months before the study date. The patients were given the International Consultation on Incontinence Questionnaire Short Form (ICIQ-UI-SF) questionnaire for determining the presence of UI and its severity. UI-positive patients were then given the I-QOL questionnaire to determine their QoL. The prevalence of UI in our study population (n=189) was 31%. Older age at the time of stroke was associated with higher UI severity (r=0.290) and lower QoL (r=-0.265). Furthermore, the presence of movement limitation was associated with higher UI prevalence (P<0.001, OR=3.89) and severity (P=0.002, d=1.05). Movement limitation also significantly impacted the psychological and social aspects of UI-associated QoL (P=0.035, d=-0.74). Conversely, higher body mass indices (BMIs) were associated with lower UI severity (r=-0.346) and higher QoL (r=0.281). In conclusion, UI continues to be prevalent in stroke survivors long after the cerebrovascular accident (CVA). As a result, these patients require continuous monitoring and UI prevention.

Barriers and enablers of pelvic floor rehabilitation behaviours in pregnant women with stress urinary incontinence: a qualitative analysis using the theoretical domains framework

BackgroundStress urinary incontinence during pregnancy is closely related to the occurrence of postpartum and long-term urinary incontinence. Early pelvic floor management is of great significance in promoting the recovery of pelvic floor tissues in pregnant women. However, effective management of urinary incontinence is far from achievable owing to the low adherence of pregnant women in partaking in pelvic floor rehabilitation. As a comprehensive framework for behavioural theory, the Theoretical Domain Framework allows for comprehensive identification of behavioural determinants. Using Theoretical Domain Framework, this study aimed to identify barriers and enablers of pelvic floor rehabilitation behaviours in pregnant women with stress urinary incontinence.MethodsA descriptive, qualitative design was used in this study. Face-to-face semi-structured interviews were conducted with pregnant women with stress urinary incontinence based on the Theoretical Domain Framework. The data were analysed using a combination of inductive and deductive methods.ResultsTwenty pregnant women with stress urinary incontinence were interviewed. Seven themes were summarised and used to explain the pelvic floor rehabilitation behaviours of pregnant women with stress urinary incontinence. The seven themes were (1) individual knowledge and experience of pelvic floor management, (2) judgments about expected outcomes, (3) interactions of interpersonal situations, (4) environment, resources, and decision-making processes, (5) personal goal-setting and efforts towards behaviour change, (6) emotional influences on decision-making, and (7) personal characteristics. Besides the "Optimism" domain, 13 of the 14 Theoretical Domains Framework domains were found to influence pregnant patients' pelvic floor rehabilitation behaviours after deductive mapping of themes to the Theoretical Domains Framework. In addition, the inductive analysis generated a theme of personal characteristics that did not map to any of the Theoretical Domains Framework domains.ConclusionsThe pelvic floor rehabilitation behaviours of pregnant women with stress urinary incontinence are complex and are affected by many factors. The findings confirm the need for multiple interventions to support pelvic floor management in pregnant women with stress urinary incontinence, focusing on enhancing knowledge and skills in pelvic floor care and using appropriate behaviour change techniques (such as prompts) to provide a supportive environment.

MP67-15 CROSS SECTIONAL AREA OF PSOAS MAJOR MUSCLE PREDICTS URINARY INCONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY

You have accessJournal of UrologyCME1 Apr 2023MP67-15 CROSS SECTIONAL AREA OF PSOAS MAJOR MUSCLE PREDICTS URINARY INCONTINENCE AFTER ROBOT-ASSISTED RADICAL PROSTATECTOMY Akihisa Hasegawa, Junya Hata, Shunsuke Yoshioka, Hiroki Natsuya, Yusuke Kirihana, Yusuke Hakozaki, Tomoyuki Kumekawa, Yuki Harigane, Yu Endo, Shunta Makabe, Kei Yaginuma, Yuta Matsuoka, Hitomi Imai, Yuki Yoshida, Akifumi Onagi, Seiji Hoshi, Tomoyuki Koguchi, Yuichi Sato, Hidenori Akaihata, Masao Kataoka, and Yoshiyuki Kojima Akihisa HasegawaAkihisa Hasegawa More articles by this author , Junya HataJunya Hata More articles by this author , Shunsuke YoshiokaShunsuke Yoshioka More articles by this author , Hiroki NatsuyaHiroki Natsuya More articles by this author , Yusuke KirihanaYusuke Kirihana More articles by this author , Yusuke HakozakiYusuke Hakozaki More articles by this author , Tomoyuki KumekawaTomoyuki Kumekawa More articles by this author , Yuki HariganeYuki Harigane More articles by this author , Yu EndoYu Endo More articles by this author , Shunta MakabeShunta Makabe More articles by this author , Kei YaginumaKei Yaginuma More articles by this author , Yuta MatsuokaYuta Matsuoka More articles by this author , Hitomi ImaiHitomi Imai More articles by this author , Yuki YoshidaYuki Yoshida More articles by this author , Akifumi OnagiAkifumi Onagi More articles by this author , Seiji HoshiSeiji Hoshi More articles by this author , Tomoyuki KoguchiTomoyuki Koguchi More articles by this author , Yuichi SatoYuichi Sato More articles by this author , Hidenori AkaihataHidenori Akaihata More articles by this author , Masao KataokaMasao Kataoka More articles by this author , and Yoshiyuki KojimaYoshiyuki Kojima More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are cases of persistent urinary incontinence after robot-assisted radical prostatectomy (RARP). Urinary incontinence is one of the factors that significantly reduce quality of life, and there is a need to elucidate predictive factors for urinary incontinence to assist in treatment selection. On the other hand, it has been reported that decreased skeletal muscle mass is a risk factor for perioperative complications and poor prognosis, and we considered that it could also be a predictor of urinary incontinence after RARP. Therefore, we measured cross sectional area of psoas major muscle (CSA-PMM), which has been one of the indicators of skeletal muscle volume, and analyzed the relationship between the systemic skeletal muscle and urinary incontinence after RARP. METHODS: Altogether, 539 (average 67.0±5.18 years old) who underwent RARP were enrolled in this study. CSA-PMM were measured by tracing the bilateral psoas major muscles at the upper border level of cross section L4 on preoperative CT. Urinary continence was defined as ≤2 g on a 1-hour pad test and was assessed at 1, 3, 6, 9, and 12 months after RARP. The correlation analysis between patient factors such as CSA-PMM, age, BMI, and eGFR and postoperative urinary continence was performed. The median of CSA-PMM was divided into two groups, high or low CSA-PMM groups, and used for analysis. RESULTS: The continence rates at 1, 3, 6, 9, and 12 months after RARP were 31.9%, 53.6%, 66.0%, 70.3%, and 70.8%, respectively. The median of CSA-PMM was 19.72 (10.39-33.16) ㎠. CSA-PMM was a significant predictor of urinary continence at 6, 9, and 12 months after RARP in univariate analysis (p<0.01, p<0.01, p=0.03). Furthermore, in multivariate analysis, it was a significant predictor of urinary continence at 3, 6, 9, and 12 months after surgery (p=0.02, p<0.01, p<0.01, p<0.01). CONCLUSIONS: CSA-PMM was a significant predictor of long-term urinary incontinence after RARP. Since the psoas major muscle is one indicator of total body skeletal muscle mass, patients with low CSA-PMM had lower pelvic floor muscle mass. This might be related to urinary incontinence. Source of Funding: Nothing © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e948 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Akihisa Hasegawa More articles by this author Junya Hata More articles by this author Shunsuke Yoshioka More articles by this author Hiroki Natsuya More articles by this author Yusuke Kirihana More articles by this author Yusuke Hakozaki More articles by this author Tomoyuki Kumekawa More articles by this author Yuki Harigane More articles by this author Yu Endo More articles by this author Shunta Makabe More articles by this author Kei Yaginuma More articles by this author Yuta Matsuoka More articles by this author Hitomi Imai More articles by this author Yuki Yoshida More articles by this author Akifumi Onagi More articles by this author Seiji Hoshi More articles by this author Tomoyuki Koguchi More articles by this author Yuichi Sato More articles by this author Hidenori Akaihata More articles by this author Masao Kataoka More articles by this author Yoshiyuki Kojima More articles by this author Expand All Advertisement PDF downloadLoading ...

Prospective Long-term Health-related Quality of Life Outcomes After Surgery, Radiotherapy, or Active Surveillance for Localized Prostate Cancer

BackgroundLocalized prostate cancer (PCa) treatment is associated with reduced health-related quality of life (HRQoL). Current literature is limited by short-term follow-up. ObjectiveTo prospectively evaluate the 5-yr HRQoL outcomes in men undergoing radical prostatectomy (RP), external beam radiotherapy (EBRT), or active surveillance (AS). Design, setting, and participantsWe prospectively evaluated HRQoL in patients with low-risk/favorable intermediate-risk PCa enrolled in the Center for Prostate Disease Research multicenter database between 2007 and 2017. InterventionOf 1012 patients included in the study, 252 (24.9%) underwent AS, 557 (55.0%) RP, and 203 (20.0%) EBRT. Patients complete the Expanded Prostate Cancer Index Composite and the 36-item Medical Outcomes Study Short Form at baseline and thereafter each year up to 5 yr after treatment. Outcome measurements and statistical analysisTemporal changes in HRQoL were compared between treatments and were modeled using linear regression models adjusted for baseline HRQoL, demographic, and clinical characteristics. Results and limitationsRP showed the least irritative symptoms and worse incontinence in comparison with AS (p < 0.001 for both subdomains) or EBRT (p < 0.001 for both subdomains) at all time points. RP sexual domain score was worse than the scores of AS (mean difference 22.3 points, 95% confidence interval [CI] 10.5–27.8, p < 0.001) and EBRT (mean difference 16.9 points, 95% CI 12.5–20.3, p < 0.001) during years 1–3 and not different from that of EBRT (mean difference 2.9 points, 95% CI –4.8 to 8.3, p = 0.3) at years 4 and 5. Bowel function and bother were worse for EBRT than for AS (p < 0.001 for both subdomains) and RP (p < 0.001 for both subdomains) at all time points. During the 3–5-yr period, AS demonstrated the worst decline in all mental health domains (p < 0.001 in comparison with both EBRT and RP). ConclusionsRP results in worse long-term urinary function and incontinence, but in less irritative and obstructive symptoms than EBRT and AS. Sexual domain scores were least affected by AS, while RP shows similar scores to EBRT at long term. Long-term HRQoL changes are critical for advising patients. Patient summaryWe evaluated long-term health-related quality of life (HRQoL) in a large US population treated for localized prostate cancer. HRQoL outcomes varied according to treatment modality and time. These changes should inform patients about their expected outcomes following treatment.

Reversal of diabetic-induced myopathy by swimming exercise in pregnant rats: a translational intervention study.

Gestational diabetes mellitus (GDM) plus rectus abdominis muscle (RAM) myopathy predicts long-term urinary incontinence (UI). Atrophic and stiff RAM are characteristics of diabetes-induced myopathy (DiM) in pregnant rats. This study aimed to determine whether swimming exercise (SE) has a therapeutic effect in mild hyperglycemic pregnant rats model. We hypothesized that SE training might help to reverse RAM DiM. Mild hyperglycemic pregnant rats model was obtained by a unique subcutaneous injection of 100 mg/kg streptozotocin (diabetic group) or citrate buffer (non-diabetic group) on the first day of life in Wistar female newborns. At 90 days of life, the rats are mated and randomly allocated to remain sedentary or subjected to a SE protocol. The SE protocol started at gestational day 0 and consisted of 60 min/day for 6 days/week in a period of 20 days in a swim tunnel. On day 21, rats were sacrificed, and RAM was collected and studied by picrosirius red, immunohistochemistry, and transmission electron microscopy. The SE protocol increased the fiber area and diameter, and the slow-twitch and fast-twitch fiber area and diameter in the diabetic exercised group, a finding was also seen in control sedentary animals. There was a decreased type I collagen but not type III collagen area and showed a similar type I/type III ratio compared with the control sedentary group. In conclusion, SE during pregnancy reversed the RAM DiM in pregnant rats. These findings may be a potential protocol to consider in patients with RAM damage caused by GDM.

The effectiveness of concomitant intravaginal laser treatment in patients undergoing mesh excision due to vaginal exposure or extrusion

Objective: To investigate the efficacy of intravaginal laser therapy applied concurrently with mesh excision for the treatment of vaginal polypropylene mesh exposure or extrusion, which is the most common complication after transobturator tape (TOT), on the recurrence of incontinence.&#x0D; Material and Method: The data of 49 patients who underwent mesh excision due to vaginal mesh exposure or extrusion in our clinic between January 2009 and January 2020 were retrospectively analyzed. The patients were divided into two groups as simultaneous intravaginal laser therapy during the mesh excision (EL, n=23) and only mesh excision (EO, n=26). Data of the patients and long-term stress urinary incontinence (SUI) recurrence rates were determined and the groups were compared.&#x0D; Results: The mean age of the patients was 50.4±9.9 years and the mean follow-up period was 33.3±22.1 months. SUI recurrence in 1-h pad test was significantly lower in the EL group than the EO group at the 12 th month evaluation (8.7% vs 34.6% p=0.030 respectively). According to multivariate regression analysis operation type was an independent risk factor for SUI recurrence (p=0.021). However, there was no significant difference between the groups in terms of postoperative incontinence quality of life questionnaire (I-QOL) scores (p=0.082).&#x0D; Conclusion: Concomitant laser treatment applied with the mesh excision for the treatment of vaginal meshexposure or extrusion secondary to TOT surgery provides a significant advantage in preventing the recurrence of SUI.

Urodynamic evaluation of bladder function in patients with urinary incontinence secondary to congenital tethered cord syndrome after homogeneous spinal-shortening axial decompression procedure.

To evaluate the effect of homogeneous spinal-shortening axial decompression procedure (HSAD) on bladder function in patients with spina bifida tethered syndrome. Patients with tethered spinal cord syndrome were collected prospectively, and all patients were treated with lumbar HSAD. Patients' urodynamic evaluation mainly included detrusor function, sphincter function, sphincter coordination (Ig TLR, ratio of tension and loose of urethral sphincter), and bladder compliance. Meanwhile, all patients were followed up with ICI-Q-SF, SF-12, and Rantala scores. Twenty-four patients were included, with the average age of 27 ± 16years. At the final follow-up, patients' detrusor function, sphincter function, sphincter coordination, and bladder compliance, were all improved dramatically (all P < 0.01). The preoperative SF-12 score, ICQ, and Rantala score were [52.16 ± 5.64, 14.11 ± 5.25, 7.84 ± 4.87], whereas the postoperative mean was [33.53 ± 3.53, 9.05 ± 4.89, 15 ± 3.77] (P < 0.01, respectively). According to objective evaluation, 16.7% of them recovered to normal. According to the subjective evaluation, 25% of the patients returned to normal. Only one patient (4.2%) deteriorated. Limitations include none-randomized controlled design and limited patient samples. The HSAD can significantly restore the bladder function in patients with long-term urinary incontinence.

Biopolymer and Biomaterial Conjugated Iron Oxide Nanomaterials as Prostate Cancer Theranostic Agents: A Comprehensive Review

Prostate cancer (PCa) is the most common malignancy in men and the leading cause of death for men all over the world. Early diagnosis is the key to start treatment at an early stage of PCa and to reduce the death toll. Generally, PCa expresses characteristic morphologic features and serum biomarkers; however, early diagnosis is challenging due to its heterogeneity and long-term indolent phase in the early stage. Following positive diagnosis, PCa patients receive conventional treatments including surgery, radiation therapy, androgen deprivation therapy, focal therapy, and chemotherapy to enhance survival time and alleviate PCa-related complications. However, these treatment strategies have both short and long-term side effects, notably impotence, urinary incontinence, erectile dysfunctions, and recurrence of cancer. These limitations warrant the quest for novel PCa theranostic agents with robust diagnostic and therapeutic potentials to lessen the burden of PCa-related suffering. Iron oxide nanoparticles (IONPs) have recently drawn attention for their symmetrical usage in the diagnosis and treatment of several cancer types. Here, we performed a systematic search in four popular online databases (PubMed, Google Scholar, Scopus, and Web of Science) for the articles regarding PCa and IONPs. Published literature confirmed that the surface modification of IONPs with biopolymers and diagnostic biomarkers improved the early diagnosis of PCa, even in the metastatic stage with reliable accuracy and sensitivity. Furthermore, fine-tuning of IONPs with biopolymers, nucleic acids, anticancer drugs, and bioactive compounds can improve the therapeutic efficacy of these anticancer agents against PCa. This review covers the symmetrical use of IONPs in the diagnosis and treatment of PCa, investigates their biocompatibility, and examines their potential as PCa theranostic agents.

Daily urine loss immediately after urethral catheter removal may be an effective predictor of long-term urinary incontinence following robot-assisted laparoscopic radical prostatectomy.

Some patients who undergo robot-assisted laparoscopic radical prostatectomy (RARP) continue to experience long-term urinary incontinence (UI). This study aimed to evaluate easily obtainable factors that can predict long-term UI following RARP. A total of 315 patients who underwent RARP for localised prostatic cancer were analysed. We separated the patients into two groups, namely, the Continence group and the Incontinence group, according to the presence or absence of UI at 12months after surgery, and we compared the patients' characteristics and operative data to identify clinical signs associated with long-term UI. Additionally, correlations between these factors and postoperative urethral function were evaluated. Urinary continence was defined as both the use of 0 pads/per day and <2g of urine lost using the 24-hours pad weight test. Of 315 patients, 250 (79.4%) achieved urinary continence and 65 (20.6%) had long-term UI. Age, storage-related lower urinary tract symptoms before surgery, nerve-sparing surgery and the 24-hours urine loss immediately after urethral catheter removal significantly affected long-term UI after RARP. Multivariate logistic regression analyses revealed that the 24-hours urine loss after catheter removal was a significant predictor of long-term UI. Receiver operating characteristic curve analysis identified a urine loss of 330g/d as the optimal cut-off value, which yielded 92% sensitivity and 84% specificity, and it showed significant correlations with postoperative urethral function and the time to recover urinary continence. The 24-hours urine loss immediately after urethral catheter removal may be the most reliable and useful predictor of long-term UI following RARP.

Study protocol to investigate biomolecular muscle profile as predictors of long-term urinary incontinence in women with gestational diabetes mellitus

BackgroundPelvic floor muscles (PFM) and rectus abdominis muscles (RAM) of pregnant diabetic rats exhibit atrophy, co-localization of fast and slow fibers and an increased collagen type I/III ratio. However, the role of similar PFM or RAM hyperglycemic-related myopathy in women with gestational diabetes mellitus (GDM) remains poorly investigated. This study aims to assess the frequency of pelvic floor muscle disorders and pregnancy-specific urinary incontinence (PS-UI) 12 months after the Cesarean (C) section in women with GDM. Specifically, differences in PFM/RAM hyperglycemic myopathy will be evaluated.MethodsThe Diamater is an ongoing cohort study of four groups of 59 pregnant women each from the Perinatal Diabetes Research Centre (PDRC), Botucatu Medical School (FMB)-UNESP (São Paulo State University), Brazil. Diagnosis of GDM and PS-UI will be made at 24–26 weeks, with a follow-up at 34–38 weeks of gestation. Inclusion in the study will occur at the time of C-section, and patients will be followed at 24–48 h, 6 weeks and 6 and 12 months postpartum. Study groups will be classified as (1) GDM plus PS-UI; (2) GDM without PS-UI; (3) Non-GDM plus PS-UI; and (4) Non-GDM without PS-UI. We will analyze relationships between GDM, PS-UI and hyperglycemic myopathy at 12 months after C-section. The mediator variables to be evaluated include digital palpation, vaginal squeeze pressure, 3D pelvic floor ultrasound, and 3D RAM ultrasound. RAM samples obtained during C-section will be analyzed for ex-vivo contractility, morphological, molecular and OMICS profiles to further characterize the hyperglycemic myopathy. Additional variables to be evaluated include maternal age, socioeconomic status, educational level, ethnicity, body mass index, weight gain during pregnancy, quality of glycemic control and insulin therapy.DiscussionTo our knowledge, this will be the first study to provide data on the prevalence of PS-UI and RAM and PFM physical and biomolecular muscle profiles after C-section in mothers with GDM. The longitudinal design allows for the assessment of cause-effect relationships between GDM, PS-UI, and PFMs and RAMs myopathy. The findings may reveal previously undetermined consequences of GDM.

The comparison of transurethral versus suprapubic catheter after robot-assisted radical prostatectomy: a systematic review and meta-analysis.

The transurethral catheter (TUC) or supra-pubic catheter is commonly used after robot-assisted radical prostatectomy (RARP). However, the best way of urine drainage after the operation is still controversial. A comprehensive search of PubMed, Cochrane, Web of Science databases and the reference lists of relevant articles was performed up to July 2019. This systematic review and meta-analysis was performed based on all randomized controlled trials (RCTs) and retrospective studies assessing the two techniques. In total, nine studies (1,121 patients) were eligible, including three RCTs, one prospective and five retrospective studies. After RARP, postoperative pain was less in suprapubic catheter (SPC) group than TC group, both within 3 days [mean difference (MD): -0.70; 95% confidence interval (CI): -1.37 to -0.02; P=0.04] and 5 days after operation (MD: -0.96; 95% CI: -1.39 to -0.52; P<0.00001). There was no significant difference between SPC and TUC groups, in operation time (MD: 2.58; 95% CI: -5.82 to 10.97; P=0.55) and at rates of both catheterization-associated complication [odds ratio (OR): 1.05; 95% CI: 0.67 to 1.64; P=0.83] and long-term urinary incontinence (OR: 0.69; 95% CI: 0.42 to 1.12; P=0.13). Patients in SPC group suffer from less postoperative pain compared with the TUC group. SPC can be a better alternate of TUC.