Maximum Voided Volume Research Articles

Long term safety, continuation rates and subjective and objective success of Posterior Tibial Nerve Stimulation for Overactive Bladder

Introduction:Posterior tibial nerve stimulation (PTNS) is currently offered to patients with refractory overactive bladder (OAB). We aim to evaluate the efficacy, safety and long-term continuation of PTNS over 11 years. Methods:We conducted a retrospective cohort study on all patients who underwent PTNS from 2012 to 2023. The primary outcomes were change in urinary frequency over 24 hours, maximum voided volume (MVV), number of episodes of urgency urinary incontinence (UUI) and patient perception of intensity of urgency scale (PPIUS). Results:We identified 81 patients. 83% of patients completed 12 treatments of PTNS, and 54% of those that did not complete their full course of treatment stated that this was due to inefficacy. 33% of patients underwent PTNS ‘top ups’ as needed. Only 1 patient reported an adverse effect of musculoskeletal leg pain.28% of patients reported a subjective improvement of their symptoms by 50% or more. There was an average reduction in daytime frequency by 0.6 episodes (p = 0.033), an increase in MVV by 13mls (p = 0.927), a reduction in UUI episodes each day by 0.7 (p = 0.008) and a reduction in average PPIUS by 0.4 (p = 0.024). Conclusion:PTNS remains a safe treatment option for patients with refractory OAB with evidence of both subjective and objective improvement to most symptoms. The majority of our patients completed a 12-week cycle but only 1 in 3 chose to have further PTNS ‘top ups’ and only 1 in 5 are continuing with PTNS for long term management of their OAB.

Effects of external neuromuscular electrical stimulation in women with urgency urinary incontinence: a randomized sham-controlled study

Background and PurposeThe present study aims to investigate the effects of external neuromuscular electrical stimulation (NMES) on urinary symptoms, pelvic floor muscle strength (PFMS), quality of life (QoL), sexual function, perception of subjective improvement (PSI), and satisfaction in urgency urinary incontinence (UUI).Materials and MethodsThe randomized sham-controlled study design was employed in this study. Women aged 18–65 years, who were diagnosed with UUI, were randomly allocated into the NMES (external NMES + lifestyle advice, n = 15) and sham groups (sham NMES + lifestyle advice, n = 15). Both groups performed the application for 30 min, three days a week for eight weeks. Urinary symptoms were evaluated by using the International Incontinence Consultation Questionnaire-Short Form (ICIQ-SF) and a 3-day bladder diary. PFMS was assessed using the Modified Oxford Scale (MOS), QoL using the King’s Health Questionnaire (KHQ), and sexual function using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12). The PSI and satisfaction were questioned.ResultsThere was a higher level of decrease in the ICIQ-SF score, the mean number of voids/night and UI, all scores related to the KHQ (excluding interpersonal relationships), and a higher level of increase in maximum voiding volume, MOS scores, PISQ-12-emotional, PISQ-12-physical, and PISQ-12-total scores in the NMES group when compared to the sham group (p < 0.05). PSI and satisfaction were at higher levels in the NMES group than in the sham group (p < 0.05).ConclusionsExternal NMES was an effective and complementary method in reducing urinary symptoms and improving PFMS, QoL, sexual function, PSI, and satisfaction level in women with UUI.Clinical Trial RegistrationNCT04727983.

Development of a Novel Prediction Tool for Response to First-Line Treatments of Monosymptomatic Nocturnal Enuresis: A Randomized, Controlled, International, Multicenter Study (DRYCHILD).

Nocturnal urine volume and bladder reservoir function are key pathogenic factors behind monosymptomatic nocturnal enuresis (MNE). We investigated the predictive value of these together with other demographic and clinical variables for response to first-line treatments in children with MNE. A randomized, controlled, international, multicenter study was conducted in 324 treatment-naïve children (6-14 years old) with primary MNE. The children were randomized to treatment with or without prior consideration of voiding diaries. In the group where treatment choice was based on voiding diaries, children with nocturnal polyuria and normal maximum voided volume (MVV) received desmopressin (dDAVP) treatment, and children with reduced MVV and no nocturnal polyuria received an enuresis alarm. In the other group, treatment with dDAVP or alarm was randomly allocated. A total of 281 children (72% males) were qualified for statistical analysis. The change of responding to treatment was 21% higher in children where treatment was individualized compared to children where treatment was randomly selected (risk ratio = 1.21 [1.02-1.45], P = .032). In children with reduced MVV and no nocturnal polyuria (35% of all children), individualized treatment was associated with a 46% improvement in response compared to random treatment selection (risk ratio = 1.46 [1.14-1.87], P = .003). Furthermore, we developed a clinically relevant prediction model for response to dDAVP treatment (receiver operating characteristic curve 0.85). The present study demonstrates that treatment selection based on voiding diaries improves response to first-line treatment, particularly in specific subtypes. Information from voiding diaries together with clinical and demographic information provides the basis for predicting response. NCT03389412.

Voiding camp: A successful and unique bladder rehabilitation program for children with urinary incontinence

Standard urotherapy is a well-established treatment for children with incontinence, although it is often challenging for both child and parents, and not always successful. As an alternative, several in- and outpatient bladder training programs have shown positive results on achieving continence. However, the disadvantage is the hospital environment, which can be more stressful for the child, and also quite expensive for society. The aim was to evaluate the outcome on achieving continence following a voiding camp, where standard urotherapy was applied during a one-week stay at a regular summer youth camp, outside the hospital. Retrospective analysis of 105 children with urinary incontinence, followed in an expert centre for urinary incontinence for at least one year. Data at 7 different time points, before, during and until 6 months after voiding camp were collected. Even though all children had regular follow-up in an expert centre for urinary incontinence for at least one year before participating voiding camp, only 15% of the children reached the recommended amount of daily fluid intake (1.5L/day). Once minimal daily fluid intake was re-established during the voiding camp, an immediate increase in the maximum voided volume (MVV), and a decrease in the number of wet days and wet nights per week was noted. This effect on a higher MVV remained even 3 months after voiding camp. Although sufficient daily fluid intake is a well-established part of standard urotherapy, up until now there was no data that proved the positive impact of sufficient daily fluid intake on bladder volume training and achieving continence in children. Voiding camp, as an unique bladder rehabilitation program for children with incontinence, is a successful alternative treatment option. Optimizing the daily fluid intake during voiding camp had a major positive impact on bladder volume training and achieving continence in children.

Four-hour voiding observation: Normative data from term Indian neonates

BackgroundThe four-hour voiding observation is an important non-invasive urodynamic test for infants and young children before toilet training. The study was performed to generate normative data for term Indian neonates. MethodsThe study was a descriptive study performed in the Department of Paediatrics of a secondary care hospital in South India with patients having nationwide representation from August 2018 to August 2020. Term neonates, appropriate for gestational age on days 4–14 of life were included. Neonates at risk of oliguria or abnormal bladder functions were excluded. Four-hour voiding observation was performed by direct observation of voids, pre- and post-void diaper weight and measurement of post-void residue (PVR) by ultrasonography using two formulae within five minutes of voiding. ResultsA total of 102 neonates (166 voids) were studied. Important results were (a) Eight neonates did not void; (b) median (fifth–95th percentile) of important test outcomes as follows: voided volume: 15 (7.5–33.5) ml, maximum voided volume (MVV) 16.5 (8.0–38.7) ml, PVR 3.2 (0.5–10.2) ml, PVR% 17.0 (2.9–46.4) % functional bladder capacity 19.7 (9.6–38.0) ml, and diuresis: 1.7 (0.0–5.1) ml/kg/hour; (c) four (4.3%) neonates had one interrupted void each; (d) linear regression yielded the following formulae: MVV (ml) = 8.1019 + 4.8702 ∗Diuresis (ml/kg/hr) and PVR % (max) = 14.2312 + 3.2682∗ Diuresis (ml/kg/hr). ConclusionNormative data on the four-hour voiding observation study for Indian term exclusively breast-fed neonates are reported.

MP71-19 ADDITION OF ACE INHIBITORS/ARBS TO HYDROCHLOROTHIAZIDE THERAPY ALLEVIATES NOCTURIA IN PATIENTS WITH HYPERTENSION

You have accessJournal of UrologyCME1 Apr 2023MP71-19 ADDITION OF ACE INHIBITORS/ARBS TO HYDROCHLOROTHIAZIDE THERAPY ALLEVIATES NOCTURIA IN PATIENTS WITH HYPERTENSION Claire Sunha Choi, Alexander Fang, Connelly Miller, Thomas Monaghan, Jude Appiah, Lauren Fink, and Jeffrey Weiss Claire Sunha ChoiClaire Sunha Choi More articles by this author , Alexander FangAlexander Fang More articles by this author , Connelly MillerConnelly Miller More articles by this author , Thomas MonaghanThomas Monaghan More articles by this author , Jude AppiahJude Appiah More articles by this author , Lauren FinkLauren Fink More articles by this author , and Jeffrey WeissJeffrey Weiss More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003339.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The association between nocturia and hypertension (HTN) is well-documented. Although recent studies suggest an increased risk of nocturia in patients with treated but uncontrolled hypertension, there is a lack of drug-specific data. With this in mind, we studied the effect of two common antihypertensive agents – hydrochlorothiazide (HCTZ) and angiotensin-converting enzyme inhibitors (Ace-I)/angiotensin II receptor blocker (ARB) – on nocturia in patients with hypertension. METHODS: We performed a retrospective analysis of voiding diaries from adult males who were diagnosed with HTN and treated for lower urinary tract symptoms at Brooklyn Veterans Affairs urology clinic. After excluding patients with comorbidities (obstructive sleep apnea, congestive heart failure, chronic kidney disease, diabetes insipidus and mellitus), subjects were divided into four groups: (1) untreated, (2) HCTZ only, (3) Ace-I/ARB only, and (4) HCTZ and Ace-I/ARB. One-way ANOVA with Tukey’s post-hoc test was performed to compare bladder diary parameters and nocturnal urge perception grade (UPG). RESULTS: A total of 234 diaries of adult males with hypertension (mean age±standard deviation=69.3±10.4, systolic BP=129.3±16.6, diastolic BP=76.1±11.0) were analyzed. Amongst 4 subgroups, hypertensive patients on HCTZ only had the most severe nocturia symptoms with highest actual number of voids (ANV) and nocturia index (Ni) with increased mean nocturnal UPG. This was associated with reduced maximum voided volume (MVV) and increased nocturnal bladder capacity index (NBCi), suggesting diminished bladder capacity in patients on HCTZ only. Interestingly, when Ace-I/ARBs were added to HCTZ, there was a reduction in ANV (p=0.014), NBCi (p=0.001) and UPG (p<0.001). CONCLUSIONS: The findings of this study imply that HCTZ worsens nocturia in hypertensive patients likely via diminished nocturnal functional bladder capacity, and addition of ACE Inhibitors/ARBs is associated with reduced nocturia severity. Given that thiazide diuretics and Ace-I/ARBs are frequently prescribed in combination, these results suggest a potential for personalized therapies on treatment of nocturia in patients with hypertension. Source of Funding: None. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1022 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claire Sunha Choi More articles by this author Alexander Fang More articles by this author Connelly Miller More articles by this author Thomas Monaghan More articles by this author Jude Appiah More articles by this author Lauren Fink More articles by this author Jeffrey Weiss More articles by this author Expand All Advertisement PDF downloadLoading ...

The role of the bladder diary in phenotyping men with LUTS.

The aim of this study was to compare the clinical characteristics of men with lower urinary tract symptoms(LUTS) grouped by 24-hurine output determined from a bladder voiding diary. An online database was queried to identify men who completed a 24-hour bladder diary (24HBD), and the Lower Urinary Tract Symptom Score (LUTSS) questionnaire from 2015 to 2019 using a mobile app. Data from the bladder diary and questionnaire were contemporaneously matched within a 2-week period. Additional data, including maximum uroflow (Qmax ) and postvoid residual urine (PVR), were obtained from the electronic medical record (EMR). The cohort was divided into three groups: normal, oliguria, and polyuria based on their 24-hour voided volume (24HVV). The LUTSS, 24HVV, maximum voided volume (MVV), maximum flow rate (Qmax ), and PVRwere compared between those with oliguria and polyuria. A total of 327 men (mean age 62, SD: 19) completed the LUTSS questionnaire and contemporaneous 24HBD. Of these, 61% had a normal 24HVV, 13% had oliguria, and 26% had polyuria. A total of 147 patients from the study cohort had contemporaneous Qmax and PVR abstracted from the EMR. There was no difference in symptom severity, bother, or PVR among the three patient groups. However, several objective metrics were significantly correlated with urine output. Men with oliguria, as compared to men with polyuria were older (65 vs. 55years) and had lower MVV (260vs.470 mL), fewer voids/24 h (8 vs. 13),and lower Qmax (8.5vs. 18.3 mL/s). These observations suggest that men with oliguria or polyuria and LUTS constitute easily distinguished phenotypes that might require different diagnostic and therapeutic algorithms. Those with oliguria were older, and had lower MVVs and much lower uroflows, suggesting that they are more likely to have underlying disorders such as bladder outlet obstruction and detrusor underactivity or may be patients with overactive bladder who reduced fluid intake to improve symptoms.

Maximum Voided Volume Is a Better Clinical Parameter for Bladder Capacity Than Maximum Cystometric Capacity in Patients With Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia: A Prospective Cohort Study.

Bladder capacity is an important parameter in the diagnosis of lower urinary tract dysfunction. We aimed to determine whether the maximum bladder capacity (MCC) measured during a urodynamic study was affected by involuntary detrusor contraction (IDC) in patients with Lower Urinary Tract Symptoms (LUTS)/Benign Prostatic Hyperplasia (BPH). Between March 2020 and April 2021, we obtained maximum voided volume (MVV) from a 3-day frequency-volume chart, MCC during filling cystometry, and maximum anesthetic bladder capacity (MABC) during holmium laser enucleation of the prostate under spinal or general anesthesia in 139 men with LUTS/BPH aged >50 years. Patients were divided according to the presence of IDC during filling cystometry. We assumed that the MABC is close to the true value of the MCC, as it is measured under the condition of minimizing neural influence over the bladder. There was no difference in demographic and clinical characteristics between the non-IDC (n=20) and IDC groups (n=119) (mean age, 71.5±7.4) (P>0.05). The non-IDC group had greater bladder volume to feel the first sensation, first desire, and strong desire than the IDC group (P<0.001). In all patients, MABC and MVV were correlated (r=0.41, P<0.001); however, there was no correlation between MCC and MABC (r=0.19, P=0.02). There was no significant difference in MABC between the non-IDC and IDC groups (P=0.19), but MVV and MCC were significantly greater in the non-IDC group (P<0.001). There was no significant difference between MABC and MVV (MABC-MVV, P=0.54; MVV/MABC, P=0.07), but there was a significant difference between MABC and MCC between the non-IDC and IDC groups (MABC-MCC, P<0.001; MCC/MABC, P<0.001). Maximum bladder capacity from a urodynamic study does not represent true bladder capacity because of involuntary contractions.

Polyuria in patients with lower urinary tract symptoms: Prevalence and etiology.

Patients with lower urinary tract symptoms (LUTS) can be subcategorized into polyuria, normal or oliguria groups. Polyuria may be caused by pathologies including diabetes mellitus (DM), chronic kidney disease (CKD), diabetes insipidus (DI), or primary polydipsia (PPD). While fluid restriction is appropriate for some, doing so in all may result in serious complications. This study investigates the prevalence of these pathologies in LUTS patients with polyuria. Two databases were retrospectively queried for men and women who filled out a lower urinary tract symptom score (LUTSS) questionnaire, 24-hbladder diary (24HBD) and were polyuric (>2.5 L/day). Patients were divided into four groups: poorly controlled DM, DI, anCKD grade 3 and PPD. One-way analysis of variance compared 24HBD and LUTSS questionnaires. Pearson correlation examined LUTSS and bother with 24-h voided volume (24 HVV), maximum voided volume (MVV) and total voids. Among 814 patients who completed a 24HBD, 176 had polyuria (22%). Of the patients with complete data, 7.8% had poorly-controlled DM, 3.1% had DI, 4.7% had CKD grade 3% and 84.4% had PPD. Amongst the four different sub-groups, significant differences were seen in 24 HVV (p < 0.001), nocturnal urine volume (NUV) (p < 0.001), MVV (p = 0.003), daytime voids (p = 0.05), nocturnal polyuria index (NPi) (p < 0.001) and nocturia index (Ni) (p = 0.002). Significance was also seen between LUTSS and bother subscore (r = 0.68, p < 0.001), LUTSS and total voids (r = 0.29, p = 0.001) and bother sub-score and total voids (r = 0.21, p = 0.019). 22% of patients with LUTS were found to have polyuria based on a 24HBD. Within this cohort, four sub-populations were identified as being demonstrating statistically significant differences in 24 HVV, NUV, MVV, daytime voids, NPi and Ni. Identifying the underlying etiology of polyuria should be carried out to safely treat patients with LUTS.

MP18-05 EXTRA VOIDS IN PATIENTS WITH OVERACTIVE BLADDER

You have accessJournal of UrologyCME1 May 2022MP18-05 EXTRA VOIDS IN PATIENTS WITH OVERACTIVE BLADDER Kevin Rychik, Max Edeson, Edward Smith, Jeffrey Weiss, Wade Bushman, and Jerry Blaivas Kevin RychikKevin Rychik More articles by this author , Max EdesonMax Edeson More articles by this author , Edward SmithEdward Smith More articles by this author , Jeffrey WeissJeffrey Weiss More articles by this author , Wade BushmanWade Bushman More articles by this author , and Jerry BlaivasJerry Blaivas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002551.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We previously defined two new bladder diary metrics: the voiding frequency index (VFI) calculated by dividing the 24-hour urine voided volume (24HVV) by the maximum voided volume (MVV), and extra voids index (EVI) calculated as the difference between the actual number of voids in 24 hours (ANV) and VFI rounded down1. The EVI is therefore a metric for “extra voids,” The purpose of this study was to compare the number of extra voids in patients with OAB to asymptomatic reference patients2,3, and to characterize and quantify their voids according to urgency based on the Urgency Perception Score (UPS)4. METHODS: This was a retrospective database study of patients diagnosed with OAB who completed a 24-hour bladder diary (24HBD) and lower urinary tract symptom score questionnaire (LUTSS) using a smartphone app from 2015-2021. Criteria for a diagnosis of OAB were an OAB sub-score of ≥ 8 or ≥ 3 on one or more of questions 3 – 6 of the LUTSS. The ANV, VFI, and EVI values were calculated and compared to the same bladder diary metrics obtained from a cohort of asymptomatic reference patients 2,3. Then, we analyzed 24HBDs from a sub-set of 100 patients with OAB to classify each void according to the UPS, (grade 0 = “convenience voids,” grades 1 & 2 = “non-urgency voids,” grades 3 & 4 = “urgency voids”) and compared the mean UPS in men and women with a two sample t-test. RESULTS: There were 511 patients in the database of whom 400 had a diagnosis of OAB; 19 were excluded because of erroneous data, leaving a cohort of 381 patients who met all entry criteria. ANV, VFI and EVI were greater in men and women with OAB compared to asymptomatic reference men and women 2,3 (Table 1). When quantified according to UPS, 21% of voids in men were due to urgency, compared to 36% in women (Figures 1, 2). The mean UPS was greater in women (2.1) than men (1.8) (p<.001). CONCLUSIONS: EVI is a quantitative metric for the extra voids in a 24-hour period. Patients with OAB void about 4 times more daily than patients without OAB, including 2 extra voids, quantified by an EVI of 5 in patients with OAB compared to an EVI of 3 in references. The majority of voids in both sexes are non-urgency voids, although less so in women, and perhaps, conscious or subconscious attempt to ameliorate OAB symptoms. These data may be useful in developing therapeutic strategies including behavioral techniques and new therapies directed at alleviating urinary symptoms as well as prompting greater research into why people void as often as they do. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e296 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Rychik More articles by this author Max Edeson More articles by this author Edward Smith More articles by this author Jeffrey Weiss More articles by this author Wade Bushman More articles by this author Jerry Blaivas More articles by this author Expand All Advertisement PDF DownloadLoading ...

Effectiveness of hydrodistention procedure under local anesthesia in the treatment of bladder pain syndrome/interstitial cystitis

Objective: We aimed to indicate the effectiveness of local anesthesia in the treatment of hydrodistention in women with Bladder Pain Syndrome/interstitial Cystitis (BPS/IC) in our study.&#x0D; Material and Method: The data of a total of 77 female patients who underwent hydrodistention treatment for BPS/IC in our clinic between January 2015 and July 2021 were analyzed retrospectively. The patients were divided into two groups as local anesthesia (LA, n=41) and spinal anesthesia (SA, n=36) groups according to the type of anesthesia applied. The groups were compared by determining the preoperative and postoperative O'Leary symptom index (SI) and problem index (PI), minimum voiding volume (MinVV), maximum voiding volume (MaxVV), average voiding volume (AvgVV) and daily frequency. &#x0D; Results: The mean age of the patients was 48.97±11.09 years in the LA group and 45.19±14.35 years in the SA group (p=0.197). There was no significant difference between the groups in terms of the preoperative European Society for the Study of Interstitial Cystitis (ESSIC) group (p=0.999). During the postoperative period, a median (IQR) improvement of 11.0 (2.0) points was observed in the SI of the LA group, while a median improvement of 11.0 (2.0) points were observed in the SA group (p=0.437). The median improvement in PI score was 8.4 (4.0) points in the SA group, while it was 7.0 (3.0) points in the LA group (p=0.415). There was no significant difference between the groups in terms of improvements in minVV, maxVV, avgVV and daily frequency (p=0.480, p=0.460, p=0.614 and p=0.910, respectively).&#x0D; Conclusion: Hydrodistention treatment in women with BPS/IC can be performed safely and with high success rate under local anesthesia and it is well tolerated by the patients. Local anesthesia offers a minimally invasive treatment option as well as the advantage of avoiding possible complications of spinal, epidural or general anesthesia.

Relationship between maximum voided volume obtained by bladder diary compared to contemporaneous uroflowmetry in men and women.

ABSTRACTIntroduction:The 24-hour bladder diary is considered to be the gold standard for evaluating maximum voided volume (MVV). However, we observed that patients often have a greater MVV during office uroflowmetry than that seen in the bladder diary. The purpose of this study is to compare these two non-invasive methods by which MVV can be determined - at the time of uroflowmetry (Q-MVV), or by 24hour bladder diary (BD-MVV).Materials and Methods:This was an Institutional Review Board approved retrospective study of patients evaluated for LUTS who completed a 24hour bladder diary and contemporaneous uroflowmetry. For Q-MVV, the patient was instructed to wait to void until their bladder felt full. Sample means were compared, and Pearson's correlations were calculated between the Q-MVV and BD-MVV data across the total sample, women, and men.Results:Seven hundred seventy one patients with LUTS completed bladder diaries. Of these, 400 patients, 205 women and 195 men, had contemporaneous Q-MVV. Mean BD-MVV was greater than mean Q-MVV. However, Q-MVV was larger in a sizable minority of patients. There was a weak correlation between BD-MVV and Q-MVV. Furthermore, there was a difference ≥50% between Q-MVV and BD-MVV in 165 patients (41%).Conclusions:The data suggest that there is a difference between the two measurement tools, and that the BD-MVV was greater than Q-MVV. For a more reliable assessment of MVV, this study suggests that both Q-MVV and BD-MVV should be assessed and that the larger of the two values is a more reliable assessment of MVV.

β3-Adrenoceptor Agonist for the Treatment of Bladder Dysfunction in Children: A Systematic Review and Meta-Analysis.

ß3-adrenergic receptor agonists (ß3 agonists) have been used in treatment of overactive bladder (OAB) and neurogenic detrusor overactivity (NDO) in adults. However, their use in children has only recently been approved by the U.S. Food and Drug Administration for patients with NDO. As in adults, the role of ß3 agonists in children may include conditions such as OAB. This systematic review and meta-analysis aims to understand the intended use, efficacy and safety of ß3 agonists in the pediatric population. A literature search was performed in February 2021 across MEDLINE®, Embase®, Scopus®, the Cochrane Library and ClinicalTrials.gov. No language restrictions were placed. All records describing the clinical use of ß3 agonists in pediatric patients (<18 years of age) were included, regardless of the methodological design or outcomes assessed. The identified records were screened by 2 independent authors. The reporting was compliant with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Data extraction was performed by 2 independent reviewers, blinded to each other's extractions. The data were pooled using the fixed effects model. Of 367 records identified, 8 studies were included in the review (3 prospective and 5 retrospective). ß3 agonists led to improvements in both urodynamics parameters and self-reported outcomes such as incontinence. Commonly reported side effects were headaches (3%‒5.9%), constipation (3.5%‒5.7%), rhinitis/nasopharyngitis (1.7%‒5.8%) and blurred vision (1.7%‒2.9%). Clinically meaningful changes in safety outcomes (blood pressure, heart rate, electrocardiogram-related changes, liver function) were rare. Before and after ß3 agonist use, pooled effect estimates for maximum cystometric capacity for 171 patients were mean difference of +98.84 ml (95% CI 74.72, 122.96); for complete dryness, assessment of 235 patients showed a Peto odds ratio of 8.68 (95% CI 5.22, 14.45). ß3 agonists appear to be a promising, effective and safe alternative/adjunctive therapy in management of pediatric NDO or OAB, with improvements in both objective urodynamics parameters and subjective patient-reported outcomes following their use.

MP02-15 THE VOIDING FREQUENCY INDEX AND FUNCTIONAL BLADDER CAPACITY INDEX: TWO NEW INDICES DERIVED FROM BLADDER DIARIES

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Non-neurogenic Voiding Dysfunction I (MP02)1 Sep 2021MP02-15 THE VOIDING FREQUENCY INDEX AND FUNCTIONAL BLADDER CAPACITY INDEX: TWO NEW INDICES DERIVED FROM BLADDER DIARIES Kevin Rychik, Max Edeson, Jeffrey Weiss, Wade Bushman, and Jerry Blaivas Kevin RychikKevin Rychik More articles by this author , Max EdesonMax Edeson More articles by this author , Jeffrey WeissJeffrey Weiss More articles by this author , Wade BushmanWade Bushman More articles by this author , and Jerry BlaivasJerry Blaivas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001963.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The functional bladder capacity (FBC) is the largest voided volume recorded in a bladder diary. We define the minimum number of times a person must void based on their FBC and their 24-hour urine output as the voiding frequency index (VFI). We define the number of “extra voids”, the difference between the actual number of voids in 24 hours and the VFI, as the functional bladder capacity index (FBCI). The purpose of this study was to describe the normal and mean values for persons without LUTS and to evaluate how these values differ over the spectrum of lower urinary tract disorders. METHODS: This is a retrospective study of 511 patients with LUTS who completed a 24-hour bladder diary (BD) and lower urinary tract symptom score (LUTSS) questionnaire using a smartphone app* from 2015-2019. From the BD, we extracted the 24-hour voided volume (24HVV), FBC, as expressed by the maximum voided volume (MVV), and actual number of voids (ANV). Based on the LUTSS, patients were placed into 4 subgroups; overactive bladder (OAB), incontinence, nocturia and voiding dysfunction. Exclusion criteria included incomplete or inaccurate bladder diary or LUTSS entries. VFI was calculated as the ratio between the 24HVV and the FBC. FBCI was calculated by subtracting the VFI from the ANV. LUTS subgroup assignments were made based on the LUTSS questionnaire. These included OAB, urinary incontinence, nocturia and voiding dysfunction. Comparisons were made to calculate normative indices from previously published data sets. *weShare® URO from Symptelligence.com RESULTS: A total 487 patients provided adequate BD data for analysis (table 1). Larger FBCI as compared to normative values were found in patients with OAB, incontinence, and nocturia. CONCLUSIONS: FBCI is a quantitative metric for the “extra voids” in a 24-hour period. Our observations validate a commonly recognized pattern among patients with LUTS; voiding before feeling full in order to avoid being caught in a social or public situation where a bathroom is not available (anticipatory voids). Empirically, the larger the FBCI, the greater the likelihood a patient voids because of reasons unrelated related to functional bladder capacity. This metric may be useful in studies to quantitate the effect of behavior in evaluation and treatment of LUTS and prompting research into why people void as often as they do. Source of Funding: Institute for Bladder & Prostate Research © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e17-e17 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Rychik More articles by this author Max Edeson More articles by this author Jeffrey Weiss More articles by this author Wade Bushman More articles by this author Jerry Blaivas More articles by this author Expand All Advertisement Loading ...

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

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

Association between nocturia and frailty among elderly males in a veterans administration population.

The relationship between frailty and nocturnal voiding is poorly understood. To characterize the association between frailty, as defined by a frailty index (FI) based upon the Canadian Study of Health and Aging (CSHA) criteria, and nocturia, defined by measures of nocturnal urine production. Real-world retrospective analysis of voiding diaries from elderly males with lower urinary tract symptoms (LUTS) at an outpatient urology clinic. Males ≥ 65years with ≥ 2 nocturnal voids were included. A modified FI was calculated from the LUTS database, which captured 39 variables from the original CSHA FI. Patients were divided into 3 groups by modified FI: low (≤ 0.077) (n = 59), intermediate (> 0.077 and < 0.179) (n = 58), and high (≥ 0.179) (n = 41). Diary parameters were compared using the Kruskal-Wallis test and pairwise comparisons with the Wilcoxon rank-sum test and Bonferroni adjustment. The high frailty group was characterized by higher nocturnal urine volume (NUV), maximum voided volume (MVV), nocturnal maximum voided volume (NMVV), and nocturnal urine production (NUP). The presence of comorbid diabetes mellitus did not explain this effect. Elderly males seeking treatment for LUTS with a high frailty burden are disproportionately affected by excess nocturnal urine production. Future research on the mechanistic relationship between urine production and functional impairment is warranted.

The efficacy of electrical stimulation in treating children with nocturnal enuresis: A systematic review and meta-analysis.

We performed a systematic review and meta-analysis to evaluate the efficacy of electrical stimulation (ES) in treating children with nocturnal enuresis (NE). Randomized controlled trials (RCTs) of the use of ES for the treatment of NE in children were searched using EMBASE, MEDLINE, and the Cochrane Controlled Trials Register. The references of related articles were also searched. The systematic review was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Four RCTs involving 171 patients were studied. We found that there was statistically significant difference in the wet nights per week (mean difference [MD], -0.70; 95% confidence interval [CI], -0.89 to -0.51; P < .00001), the number of patients with clinical response (MD, 26.88; 95% CI, 11.16 to 64.74; P < .00001), and bladder capacity (MD, -0.70; 95% CI -0.89 to -0.51; P < .00001) in the ES group compared with the placebo group with the exception of maximum voided volume (MVV) (MD, 19.48; 95% CI, -9.18 to 48.14; P = .18). The study provides a significant improvement in statistics in the wet nights per week, the number of patients with clinical response and bladder capacity for children with NE compared with the placebo group with the exception of MVV.

Study on resting-state cerebral functional magnetic resonance imaging and ambulatory urodynamics monitoring in children with primary monosympt-omatic nocturnal enuresis

Objective To investigate the significance of blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI) and ambulatory urodynamics monitoring (AUM) to find the cause of primary monosymptomatic nocturnal enuresis (PMNE) in children. Methods Thirty-seven children with PMNE (20 males and 17 females) were selected, with a mean age of (11.3±4.1) years old.A clinical management tool, 3-day urination record, daytime BOLD-fMRI scan, conventional urodynamics (CUD) and AUM were performed respectively.Thirty-seven gender-age matched children(19 males, 18 females) who would receive surgery treatment because of upper urinary tract disease and were confirmed to have no lower urinary tract dysfunction by CUD were enrolled as controls, with a mean age of (11.1±2.9) years old, and 13 cases underwent BOLD-fMRI scanning. Results It was found that the ALFF value of the left middle frontal gyrus of PMNE was decreased and the ReHo value of the left superior occipital gyrus was increased compared with the control group by the resting BOLD-fMRI.The maximum voiding volume of PNME children was (303.11±87.48) mL, the total urine volume at night was (568.65±208.48) mL, and the nighttime bladder volume was (217.43±81.53) mL.The incidence of maximum voiding volume reduction, nocturnal polyuria and decreased nocturnal bladder volume were 24.32% and 56.76%, and 64.86%, respectively.However, AUM results showed that maximum detrusor pressure in the PMNE group was (39.22±7.78) cmH2O(1 cmH2O=0.098 kPa), which was statistically significantly higher than that in CUD (32.22±9.00) cmH2O, and the difference was statistically significant (P 0.05). Conclusions The abnormal functions of the left middle frontal gyrus and left superior occipital gyrus, nighttime DO and the decrease of bladder capacity at night are considered to be key causes of enuresis in children with PMNE.AUM and resting state BOLD-fMRI evaluations are helpful in differentiating the pathogenesis of PMNE. Key words: Enuresis; Ambulatory urodynamics monitoring; Functional magnetic resonance imaging; Resting state

Does repeated hydrodistension with transurethral fulguration for interstitial cystitis with Hunner’s lesion cause bladder contraction?

ABSTRACTObjective: To evaluate the effect of repeated bladder hydrodistension with transurethral resection or fulguration (TUF) of Hunner’s lesions on bladder capacity and interstitial cystitis (IC) symptoms. TUF for Hunner’s lesion is recommended in several IC/BPS guidelines, although recurrence is highly probable.Patients and methods: The study cohort comprised 44 IC patients with Hunner’s lesions who underwent multiple bladder hydrodistensions with TUF and electrocautery (EC) at our institution between July 2005 and June 2018. We analysed their frequency–volume chart, O’Leary Sant Interstitial Cystitis Symptom Index (ICSI), Interstitial Cystitis Problem Index (ICPI), and visual analogue scale (VAS) for pain, before and at 2, 6, and 12 months after surgery.Results: The 44 Hunner-type IC patients underwent a total of 117 surgeries. Patients were divided into three groups based upon the number of hydrodistensions with TUF they underwent. Group 1 (n = 44), Group 2 (n = 44) and Group 3 (n = 21) underwent one, two, and three surgeries, respectively. At 6 months after surgery, the mean average voided volume (AVV) and maximum voided volume (MVV) were 157 mL and 228 mL in Group 1; 203 mL, 283 mL in Group 2; and 193 mL, 264 mL in Group 3. The AVV in Group 2 (P < 0.01) and Group 3 (P < 0.03), and the MVV in Group 2 (P < 0.02) increased significantly compared to Group 1. ICSI, ICPI and VAS pain score in groups 2 (P < 0.003, P < 0.01, P < 0.05) and 3 (P < 0.001, P < 0.001, P < 0.001) decreased significantly compared to Group 1.Conclusion: Repeated hydrodistension and TUF with EC of Hunner’s lesions for recurrent Hunner-type IC patients improved their symptoms. There was a tendency toward an increase in bladder capacity and repeated hydrodistension with TUF did not appear to be a direct cause of bladder contraction.Abbreviations: AVV: average voided volume; BPS: bladder pain syndrome; EC: electrical cautery; IC: interstitial cystitis; ICPI: Interstitial Cystitis Problem Index; ICSI: Interstitial Cystitis Symptom Index; MVV: maximum voided volume; TUF: transurethral fulguration; TUR: transurethral resection; VAS: visual analogue scale

Efficacy and satisfaction with transcutaneous electrostimulation of the posterior tibial nerve in overactive bladder syndrome

Objective: Overactive bladder is a disease with a high prevalence. The management is difficult, because different demographic, social or economic aspects converge. Our objective was to evaluate the efficacy and satisfaction in patients with overactive bladder treated with transcutaneous electrostimulation of the posterior tibial nerve. Methods: This was a prospective and descriptive study of 45 patients with overactive bladder (with or without detrusor overactivity) resistant to pharmacological treatment. Patients received a weekly session for 12 weeks, with a duration of 30 minutes for each of the sessions. There was a screening after 12 sessions, after which if there had been no response, treatment was suspended and maintenance sessions were not continued (six twice-monthly sessions and three monthly sessions). It was considered that the treatment had been effective when it was possible to decrease the number of events, except the maximum voiding volume, the objective of which was to increase. The results were evaluated using a 3-day voiding diary, an overactive bladder short form questionnaire and a satisfaction level questionnaire. Statistical analysis was performed using IBM SPSS Statistics version 19.0. Independent variables with a normal distribution were examined using the t-test. The Wilcoxon signed-rank test was used to compare the averages of the quantitative variables without a normal distribution. Satisfaction was analysed by a binary and ordinal regression analysis, univariate and multivariate. A P value less than 0.05 was considered statistically significant. Results: All the parameters of the study improved to a statistically relevant degree: frequency, nocturia, urgency, maximum voided volume, urge urinary incontinence. The overactive bladder short form questionnaire score improved but was not statistically significant. Conclusions: The use of transcutaneous electrostimulation of the posterior tibial nerve is a safe, effective and minimally invasive alternative in the treatment of overactive bladder when pharmacological treatment has failed. Patients had a good objective and subjective response in our study. Level of evidence: 4.