Urinary Incontinence Research Articles

Long-Term Outcomes of Tension-Free Vaginal Tape Procedures in Argentine Women: Our First Report After 20 Years.

Transvaginal tape is currently a stress urinary incontinence (SUI) treatment with recommendation grade A in accordance with the 7th International Consultation on Incontinence. The main aim of the present study was to evaluate objective and subjective outcomes of tension-free vaginal tape (TVT) 20 years after our medical group started to use it. A second aim was to describe the voiding phase and the immediate, medium-term, and late complications of TVT procedures. This is a retrospective cohort study that included patients diagnosed with SUI who received TVT treatment in a tertiary care hospital in Argentina from 1999 to 2003. Objective outcomes were recorded in a medical visit by means of urogynecological examination, which included a cough stress test with a comfortably full bladder and uroflowmetry. Subjective outcomes were assessed using quality-of-life questionnaires and questions addressed to the patient, regarding whether the patient felt cured and would recommend surgery. A total of 74 patients with an average follow-up of 18years were evaluated. Most of the patients evaluated (96.8%) were objectively continent in the long term, 95.3% reported feeling cured, and 97.6% would recommend surgery. The complications were similar to those reported in the literature. No cases of voiding disorder were found in the long-term follow-up. Tension-free vaginal tape is a minimally invasive, safe, and effective surgical technique, with a high objective and subjective cure rate, a low rate of complications related to the mesh or aging, and good results in long-term follow-up.

093. A Rare Case of Giant Urethral Stone Removal by Uretrolithotomy in A Patient with Urethral Diverticles

Background: A rare case involving a 54-year-old male who complained of persistent micturition pain for 10 years. The patient experienced urinary incontinence and reported a palpable mass under his testicle. Methods: Clinically, a mass was found in the perineum, and imaging studies using bipolar voiding urethrocystography showed a urethral stricture with urethral stones measuring 4 cm in diameter. Results: The patient underwent urethrolithotomy surgery for urolithiasis. After surgery, the patient was admitted to the general ward for 3 days and then discharged. Panendoscopic and urethrography evaluations revealed no residual stones, and urethral dilation was noted. Conclusion: Urethral stones are rare and may result from calculus migration from the upper urinary tract or structural abnormalities of the urethra. The occurrence of stones within the diverticulum is reported to range from 1% to 10% and often presents with nonspecific symptoms. It is important to evaluate the size and location of the urethral calculus, as well as the underlying urethral pathology.

095. A Rare Case Report: A 10-Years-Old Girl with Ectopic Ureter and Ectopic Hypoplasia Kidney

Background: The urinary tract system develops from an embryological structure in the dorsal part of the embryo, the intermediate mesoderm, which develops between the 4th and 10th week of gestation. During the embryogenesis process, disturbed metanephric mesenchyme can cause congenital abnormalities of the kidneys and urinary tract (CAKUT), one of which is ectopic abnormalities. Ectopic ureter and ectopic kidney had an incidence of 1:2000 and 1:3000 worldwide, respectively. Additionally, this rare case will be even more uncommon with the presence of a hypoplasia kidney. These anomalies contribute to impaired urinary drainage. Case: A 10-year-old girl was referred to the surgical department at Dr. Kariadi Hospital due to continuous urinary incontinence. She can urinate regularly via the urethra, but constantly has vaginal leaks. Previously, she had physiotherapy at the regional hospital but there was no improvement. Contrast-enhanced computed tomography revealed an ectopic kidney image accompanied by right kidney hypoplasia and a cyst on the upper pole of the right kidney measuring ± 0.89 x 0.86 cm. Then, urethrocystoscopy and colposcopy also showed the right ureteral orifice on the superior wall of the vagina, ± 2 cm from the vaginal introitus with the left ureteral orifice in a normal position. The patient underwent ureteral reimplantation, and her symptoms successfully resolved, leading to a favourable prognosis. Conclusion: Complete ectopic ureter and ectopic hypoplasia kidney are rare congenital anomalies that require early recognition and careful management in pediatric patients.

Knowledge of pelvic floor muscles in community-dwelling women aged over 60: its relationship with urinary incontinence.

To investigate the awareness of the pelvic floor muscles (PFMs) and PFM exercises (PFME) knowledge, training and experience in community-dwelling women aged 60 and over and its relationship with urinary incontinence (UI). This is a questionnaire based study which was carried out in 9 Physical Medicine and Rehabilitation Centers, including a total of 500 women aged 60 and over and living in the community. The questionnaire included questions about awareness of PFMs, UI complaints and PFME knowledge, training and experience. Knowledge and awareness of PFMs and PFME knowledge, training and experience were compared in subgroups with or without urinary incontinence. The mean age of the women included in the study was 67.8 ± 6.1 (60-88). Knowledge and awareness of PFMs and PFME knowledge, training and experience were low in the study population. Knowledge and awareness of PFMs were significantly low in the subgroup with urinary incontinence (p < 0.05). Kegel exercise training and experience were significantly low in the subgroup without urinary incontinence (p = 0.01, p < 0.01). Knowledge and awareness of PFMs and PFME knowledge, training and experience are low in community-dwelling women aged 60 and over and training programs should be organized to teach the function of the PFMs and to perform PFME correctly in this population.

Outcomes after robot-assisted radical cystectomy with orthotopic neobladder in women

PurposeTo investigate functional, oncological and complication outcomes in women undergoing robot-assisted cystectomy (RARC) with intracorporeal orthotopic neobladder.MethodsFrom a multi-institutional database, we identified females with bladder cancer treated with RARC and intracorporeal orthotopic neobladder. We evaluated the continence rate, short-term oncological outcomes, and complication rates. Analyses were repeated and stratified by the status of preserving gynecological organs.ResultsThe study involved 146 patients with the median age 60 years (IQR, 51–66 years). Pelvic organ-preserving procedure (POP) was performed in 77 patients (53%). Overall daytime and nighttime continence rates were 54% and 53%, respectively. For POP, the continence rate was 58% for both daytime and nighttime continence. In the non-POP cohort, the continence rate was 50% for daytime and 49% for nighttime continence. Both groups had balanced positive surgical margin rates (5,3% for POP and 4,7% for non-POP). In the whole cohort, high-grade (Clavien-Dindo ≥3) early and late complication rate was 7,5% and 7,5%, respectively.ConclusionsRobot-assisted radical cystectomy with intracorporeal orthotopic neobladder in females demonstrate excellent functional and complication outcomes. Pelvic organ-preserving cystectomy enhances urinary continence rates without adversely affecting surgical margins. Orthotopic neobladder in selected women with bladder cancer, along with pelvic organ-preserving cystectomy may be used for improved functional outcomes without compromising oncological results.

Day-to-day variations and effects of urinary and fecal incontinence among adults with spina bifida: an ecological momentary assessment diary pilot study

BackgroundNo studies have evaluated the day-to-day variations in urinary incontinence (UI) and fecal incontinence (FI) among adults with spina bifida (SB). We aimed to 1) describe variations in UI/FI over 30 days, 2) assess factors associated with the negativity effects of incontinence, and 3) correlate anxiety about incontinence and health-related quality of life (HRQOL) among adults with SB (exploratory). MethodsAdults with SB participated in a larger 30-day smartphone-based ecological momentary assessment (EMA) study of well-being and incontinence. We analyzed baseline demographics, temporal variables (baseline UI/FI, incontinence, and negativity on days prior), and incontinence episode-specific variables (number of daily episodes, incontinence interval, quantity). Urinary and fecal incontinence-related anxiety (UIA/FIA) was measured on a 5-point Likert scale (“How anxious were you because of urine/stool leaks today?”), HRQOL with QUALAS-A (scores range 0-100, 0=lowest HRQOL). Mixed-effects, random intercept ordinal and linear regression was used. ResultsEighty-nine adults participated at a median age of 33 years old (71% female, 53% shunted, 49% community ambulators). Participants contributed 2578 total diary days: 61% were associated with any incontinence (41% UI only, 6% FI only, 13% both). Eighty-two (92%) adults reported UI on a median of 16 days, but experiences varied: 6% had a single episode, while 33% had UI on 28-30 days (Summary Figure). Seventy adults (79%) reported FI on a median of 5 days, less frequently than UI (p<0.001), but experiences varied: 11% had a single FI episode, while 31% had FI on 10 or more days. Fewer participants reported any UIA than FIA (50% vs. 72%, respectively, p<0.001). On multivariate regression, (1) higher UIA was reported by individuals with higher baseline UIA, higher UIA on days prior, multiple daily episodes and higher UI quantity (p<=0.02), while (2) higher FIA was reported by those with lower baseline HRQOL, fewer FI episodes on days prior, higher FIA on days prior, and higher UI quantity (p<=0.02). FIA was correlated with lower end-of-study HRQOL (p=0.03). DiscussionInstances of incontinence are not uniform experiences. Their effects vary with factors beyond the actual episode. This suggests novel potential points of intervention to improving long-term HRQOL among people with incontinence. ConclusionDay-to-day experiences of UI and FI vary among adults with SB across multiple dimensions. Anxiety about incontinence when it occurs varies not only based on individual- and episode-specific characteristics, but also on incontinence in the preceding days. Operationalizing these insights into potential clinical interventions warrants further investigation.

Effects of using a mobile application on pelvic floor training in women with stress urinary incontinence: A randomized controlled clinical study.

Urinary incontinence (UI) is defined as any involuntary loss of urine that causes negative impacts on women's lives. Pelvic floor muscle training (PFMT) is considered to be "level A" of scientific evidence in the treatment of UI. Despite its efficacy, it is known that the effect of PFMT may depend on continuous adherence. Therefore, healthcare professionals are looking for alternatives to improve adherence in their patients. Healthcare has been innovating through mobile device apps. Thus, the objective of this study was to verify the effects of PFMT with the use of a mobile device app in incontinent women. This was a controlled, randomized clinical trial that occurred remotely. A total of 104 women with stress UI and/or mixed incontinence, over 18 years old, literate, with preserved cognitive capacity, with internet access and a mobile device with the Android system, participated in this study. They were randomly divided into two groups: The App group and the Booklet group, which underwent a PFMT protocol guided by a mobile app and a booklet, respectively. Both groups received daily reminders to perform the exercises. Before and after 12 weeks of intervention, it was evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the King's Health Questionnaire (KHQ). Both groups showed improvements in the final ICIQ-SF score. However, superior results were shown for the Booklet group (App: pre: 11.5 [±3.8], post: 9.8 [±4.5]; Booklet: pre: 12.6 [±4.5], post: 7.4 [±4.3]; p = 0.03). It was concluded that PFMT, with the use of a mobile app, is capable of reducing UI and the impact of UI, but it is not superior to training with the use of booklet instructions.

Analyzing Antibiotic Usage Trends in Genitourinary Infections and Procedures: Insights from the TriNetX Database

ObjectiveTo analyze antibiotic prescribing trends, particularly the decline in fluoroquinolone use for various GUI and procedures, and the growing preference for alternative treatments. MethodsThe TriNetX database was queried for antibiotic utilization rates from 2016 to 2022. We analyzed cases of cystitis, pyelonephritis, prostatitis, and other GUIs as well as periprocedure utilization for benign prostatic hyperplasia (BPH), urethral stricture disease, pelvic organ prolapse/stress urinary incontinence (POP/SUI), and overactive bladder/interstitial cystitis (OAB/IC). We determined the top four to six antibiotics prescribed within five days of diagnosis or procedure. Statistical analysis included linear regression modeling. ResultsFrom 2016-2022, fluoroquinolone use decreased in cystitis (p<0.001), pyelonephritis (p < 0.001), and prostatitis (p < 0.01). These infections were increasingly treated with beta-lactams (p<0.0001, p<0.01, p<0.01, respectively). Additionally, we found a decrease in fluoroquinolone utilization in procedures for BPH (p<0.001), urethral stricture (p<0.01), POP/SUI (p<0.001), and OAB/IC (p < 0.001). All cohorts except for OAB/IC showed a significant increase in beta-lactam use (p<0.001, p<0.01, p<0.01, respectively). ConclusionsWe noted a significant decline in fluoroquinolone use for GUI and procedures, accompanied by increased beta-lactam use, reflecting changes in prescribing practices. Judicious use is essential to promote antimicrobial stewardship and mitigate severe adverse effects.

A theoretical model for brisk walking- and running-induced lower urinary tract symptoms (BRUTS) and the development of the BRUTS-questionnaire (BRUTS-Q): A focus group and Delphi study.

Existing questionnaires provide limited information on the nature, severity and context surrounding lower urinary tract symptoms (LUTS) experienced during running, jogging and brisk walking. The aims of this study were to develop a theoretical model of the experience of LUTS by females participating in gait-based exercise activities and to use this model to generate a questionnaire to evaluate the presence, symptoms and bother associated with LUTS experienced by females during gait-based activities. A theoretical model was developed through a review of the literature and refined through a focus group consultation including pelvic health physiotherapists, females who experienced leakage during exercise and academic researchers who studied female LUTS. A draft questionnaire was developed using key constructs identified in the model by the focus group. A new expert panel was recruited, which included physiotherapists, women with self-reported gait-induced LUTS and urogynecologists. This panel followed a DELPHI process to evaluate the relevance and completeness of the constructs within the questionnaire. Two rounds of consultation were required to reach consensus on the completeness of included constructs as well as the inclusion and wording of questions. The resulting questionnaire contains questions related to five key constructs: physical activity characteristics, symptoms of urgency, urgency urinary incontinence, stress urinary incontinence experienced during exercise and management/mitigation strategies adopted by respondents. The content validity of the brisk walking- and running-induced lower urinary tracts symptoms questionnaire has been established. The next steps are to ensure that the questionnaire has adequate comprehensibility, followed by adequate measurement properties.

Curvilinear relationship was found between visceral adiposity index and stress urinary incontinence among US adult women: A cross-sectional study.

The purpose of this study was to find out the relation between visceral adipose index (VAI) levels and stress urinary incontinence (SUI) in adult women. From the National Health and Nutrition Examination Survey (NHANES) 2007-2020, females aged 20 or above were identified for this study. Visceral adiposity was determined using the VAI score, and the assessment of urinary incontinence was carried out through a correlation questionnaire. Logistic regression models and restricted cubic spline (RCS) regression were employed to analyze the relationship between VAI levels and SUI. Among the 6522 participants, 2672 (41.0%) were reported SUI. Multivariate logistic regression revealed significantly higher odds of SUI with increasing VAI levels (Q4 vs. Q1), adjusted odds ratio (aOR) = 1.53 (CI: 1.29-1.81, p < 0.001). RCS regression indicated a curvilinear relationship between VAI and SUI (p = 0.003). In threshold analysis, aOR for developing SUI was 1.18 (CI: 1.11-1.26, p < 0.001) for participants with VAI < 4.73, suggesting an 18% increased risk of SUI with each unit increase in VAI. No association between VAI and SUI was observed when VAI was ≥4.73. Our study has revealed a significant curvilinear relationship between VAI and SUI within a large and representative sample of women. Future research is necessary to evaluate the relationship between the two and explicate the underlying mechanisms of this relationship.

The SDF-1/CXCR4 axis is involved in adipose-derived stem cell migration.

Intravenous injection of adipose-derived stem cells (ADSCs) can improve the urinary function of stress urinary incontinence (SUI) model rats and C-X-C chemokine receptor type 4 (CXCR4)-positive ADSCs are found in urethral tissues. The CXCR4 ligand stromal cell-derived factor-1 (SDF-1) is highly expressed in urinary incontinence model rats. In this study, we investigated the involvement of the SDF-1/CXCR4 axis in the homing of ADSCs. ADSCs were isolated from rats and purified. The levels of CXCR4 and CXCR7 were determined by western blot analysis and immunofluorescence assays following stimulation with SDF-1. Hypoxia conditioning was performed to treat the cells in vitro, following which the messenger RNA (mRNA) and protein level of SDF-1, CXCR4, and CXCR7 were estimated. We found that CXCR4 and CXCR7 were expressed in ADSCs at passage zero (P0), P1, and P3, and the expression of both increased after SDF-1 stimulation. The level of expression of the mRNAs and proteins of SDF-1, CXCR4, and CXCR7 in ADSCs was higher after hypoxic conditioning. We then knocked down CXCR4 or CXCR7 using small interfering RNAs and found that the mRNA levels of CXCR4 and CXCR7 were considerably downregulated in the si-CXCR4/7-transfected cells. We also found that the SDF-1/CXCR4 axis was required for the migration of ADSCs. The phosphorylation levels of Janus kinase (JAK), protein kinase B (AKT), andextracellular regulated protein kinase significantly increased in SDF-1-stimulated ADSCs. However, the migration of ADSCs was suppressed when the corresponding specific inhibitors were used to block JAK and AKT signaling or silence CXCR4, whereas no significant change was observed in the migratory ability of ADSCs when the ERK pathway was blocked or CXCR7 was silenced. The SDF-1/CXCR4 axis is involved in the migration of ADSCs and may play a role in the migrate of ADSCs in SUI.

Isolated laparoscopic extra-vesical ureteric reimplantation (I-LEVUR) for upper moiety ectopic ureter without lower moiety vesicoureteric reflux.

To evaluate the feasibility and outcomes of isolated laparoscopic extra-vesical ureteric reimplantation (I-LEVUR) for upper moiety ectopic ureter in patients with non-refluxing lower moiety ureter and avoid reimplanting normal lower moiety orifice. Between 2013 and 2024, 12 patients (8 females, 4 males) with ectopic ureter associated with a duplex system underwent I-LEVUR. Preoperative assessment included ultrasonography, voiding cystourethrography (VCUG), and magnetic resonance urography (MRU)/retrograde pyelogram (RGP). The procedure involved laparoscopic extravesical approach dissecting only the ectopic ureter in lower most part, preserving vascularity, and performing an isolated reimplantation without manipulating lower moiety ureter. Twelve patients, with a median age of 2.8years, underwent I-LEVUR. The mean operative time was 127.5min. No intraoperative complications occurred. Postoperative follow-up (median: 78.5months) showed no cases of ureteral obstruction or significant complications. Urinary continence improved in all patients. Two patients developed mild vesicoureteral reflux, managed conservatively, and one patient had minor urine leak which resolved spontaneously. I-LEVUR is a viable and effective alternative to traditional en bloc reimplantation for upper moiety ectopic ureter. It preserves the normal ureteric orifice, reduces surgical trauma, and offers excellent outcomes in terms of renal function and urinary continence. Further studies with larger cohorts, control group of common sheath reimplantation, randomization, robust statistical validation and longer follow-up are recommended.

Tuberculous meningitis leading to stroke: a case report

Introduction: Tuberculosis is a major public health issue in developing countries. Vasculitis, resulting from tubercular meningitis, can lead to stroke. Case presentation: A 33-year-old male presented to the Emergency Department with relapsing-remitting fever with an evening rise in temperature for 1 month, personality changes (aggression and mutism) for 2 weeks, followed by difficulty in moving his lower limbs, and bowel and bladder incontinence. Neck rigidity, a positive Kernig’s sign, bilateral mute plantar responses, and 0/5 power in bilateral lower limbs were noted on examinations. MRI of the brain was suggestive of tubercular meningitis and showed an infarct with hemorrhagic transformation in the relatively uncommon, right basifrontal lobe. Gene Xpert test done on cerebrospinal fluid confirmed the diagnosis. Discussion: Tuberculous meningitis leading to infarct is a challenging diagnosis due to nonspecific symptoms and variable cerebrospinal fluid AFB staining results. Radiological imaging with MRI helps in suggesting the diagnosis and Gene Xpert confirms the diagnosis. Antitubercular therapy, steroids, physiotherapy, and supportive care are part of management. Conclusion: This case highlights the importance of considering tubercular meningitis-related cerebral infarction despite initial negative CSF AFB stain. Radiological investigation may help in guiding the clinician towards a diagnosis of tuberculous meningitis with vasculitis.

The many facets of perceived bladder health in women: Absence of symptoms and presence of healthy behaviors across the life course

Purpose:Qualitative studies exploring bladder health are rare compared to research focusing on lower urinary tract symptoms (LUTS). Our aim was to explore adolescent and adult women’s perceptions about what constitutes a healthy bladder. Methods:We conducted a 7-site focus group study of bladder health with adolescent and adult women across six age categories (11–14 to 65+ years). Transcripts were analyzed using transdisciplinary, directed content analysis and an iterative interpretive consensus building approach to identify key constructs, focusing on “healthy bladder” and “unhealthy bladder” codes. Results:Forty-four focus groups with 360 participants were completed. Three thematic categories were identified: (1) concept of a healthy bladder (conceptual abstraction); (2) experience of a healthy bladder (subjective experience); and (3) lifestyle and life course considerations (bladder health in context). Participants struggled to define the unfamiliar concept of healthy bladder and relied on contextualized experiences and behaviors for characterizing bladder health. They described the concept of a healthy bladder as something that you did not need to think about but did require attention to healthy habits to maintain. Other features of a healthy bladder discussed include having bladder control despite urgency and environmental constraints on voiding, normal voiding frequency, and qualities of urine and urination. Participants struggled with lack of information about healthy bladder habits and noted absence of routine bladder health screening. Discussion:Findings identify need to promote public education and information sharing in health care visits about bladder health. Further they can inform bladder health promotion and clinical research on LUTS prevention.

Efficacy and safety of onabotulinumtoxinA for the treatment of overactive bladder in men and women: A pooled analysis.

This pooled analysis of randomized controlled studies investigated the safety and efficacy of onabotulinumtoxinA in male and female patients with overactive bladder (OAB). Data were pooled from four similarly designed trials in North America and Europe. Adults with idiopathic OAB for ≥6 months inadequately managed by at least one anticholinergic were randomized 1:1 or 2:1 to receive onabotulinumtoxinA 100 U or matched placebo in Cycle 1 and could request open-label retreatment with onabotulinumtoxinA 100 U at ≥12 weeks. Efficacy outcomes at Week 12 included the primary endpoint of mean urinary incontinence (UI) episodes per day and other variables, such as the proportion of patients with ≥50% reduction in daily UI episodes. Safety was assessed by monitoring treatment-emergent adverse events (TEAEs). Analyses by sex were descriptive. Males were further analyzed by benign prostatic hyperplasia (BPH) diagnosis status. In the pooled population (N = 1564), there were 194 males (12.4%) and 1370 females (87.6%). Mean number of baseline UI episodes per day was 4.9 in males and 5.5 in females. At Week 12, numerically greater mean reductions from baseline in number of daily UI episodes were observed with the onabotulinumtoxinA 100 U group (females: -3.0; males: -2.2) versus placebo (females: -1.1; males: -1.3). Achievement of ≥50% reduction in daily UI episodes was numerically greater with onabotulinumtoxinA 100 U (females: 64.8%; males: 61.2%) versus placebo (females: 30.6%; males: 44.8%), and numerically higher in males without BPH (onabotulinumtoxinA: 65.1%; placebo: 50.9%) versus with BPH (onabotulinumtoxinA: 54.3%; placebo: 36.6%). A total of 34.7% of males and 39.4% of females experienced at least one TEAE in the first 12 weeks during treatment Cycle 1. Urinary tract infection rate was 13.1% in females and 4.2% in males; incidence of hematuria was 6.8% in males and 1.1% in females. Incidence of urinary retention (defined as incomplete emptying, requiring catheterization) was 2.7% in females and 4.7% in males. OnabotulinumtoxinA 100 U was efficacious and well tolerated in men and women with OAB, including in males with and without BPH. No new safety findings were identified when data were analyzed by sex.

Bladder Symptoms Prvoked by Short, Rapid Acting Loop Diuretics: A Frequent But Often Overlooked Problem.

Bladder dysfunction entails overactive bladder (OAB) defined as symptoms of urinary urgency, frequency, and/or nocturia with or without incontinence if there is no obvious pathology or infection or lower urinary tract symptoms (LUTS) that includes recognized causes of bladder dysfunction. Literature search. Symptoms of OAB are reported in about 15% of the adult US population. This is increased 2- to 3- fold in patients with congestive heart failure (CHF), hypertension, cardiovascular disease (CVD), chronic kidney disease (CKD) or the elderly where it often accompanies prescription for short, rapid acting loop diuretics. However, less than 2% of patients seeking care for OAB receive treatment. The fear of urinary incontinence from short, rapid acting loop diuretics may contribute to medication nonadherence and less well controlled, apparently resistant hypertension. The bladder contracts to rapid stretch. Thus, less rapid acting diuretics such as thiazides or extended-release formulations of loop diuretics may be preferable for those with bladder dysfunction. Alternatively, the use of a mineralocorticosteroid receptor antagonist, angiotensin receptor antagonist/neprilysin inhibitor or sodium glucose linked transport type 2 inhibitor may allow a reduction in dose of a short, rapid acting loop diuretic for those with bladder dysfunction. A worsening of symptoms from bladder dysfunction by short, rapid acting loop diuretics occurs frequently in patients with CVD, CHF, hypertension and CKD where it can contribute to impaired quality of life and poor adherence and thereby to worsening outcomes.

Intradetrusor OnabotulinumtoxinA outcomes for overactive bladder in older adults

Introduction:In older adults, pharmacological treatment of overactive bladder (OAB) with anticholinergics and beta-3 agonists could be associated with negative cognitive effects; highlighting the need for alternative treatment modalities. Currently, there is relatively little evidence assessing outcomes of onabotulinomtoxin-A injection as thirdline therapy in this population. This study sought to evaluate the outcomes of intradetrusor BTX-A injection in patients over 70 years of age between August 2014 March 2022. Methods:A retrospective chart review was performed on patients with a clinical diagnosis of OAB and who underwent an initial intradetrusor onabotulinomtoxinA injection at 70 years or older from three US centers. Patient characteristics and self-reported symptoms before and after injection were statistically analyzed. Results:Amongst the 210 patients, 94% reported urinary urgency, 92% reported urgency urinary incontinence, and 89% reported daytime frequency. The most common medications initially prescribed were beta-3 agonist at 66% and anticholinergics at 65%. Following treatment, 80% reported >50% improvement in incontinence, 81% in urgency, 79% in daytime frequency, and 78% in nocturia. Temporary de novo intermittent catheterization was initiated in 8/210 (3.8%) patients, and one (0.5%) required indwelling catheter placement; with 67% returning for repeat injections. Thirty-six (17%) had a symptomatic urinary tract infection at follow-up. Seventy-five percent of patients did not require drug therapy following injection. In a subgroup analysis of octogenarians (n = 50/210), 73% showed improvement in urgency and 68% had less incontinence post-injection. Discussion:OnabotulinomtoxinA was well tolerated in patients older than 70 with improvement in overactive bladder symptoms and reduction in requirement of drug therapy.

The association between different levels of depression and overactive bladder: A cross-sectional study of the 2005-2018 National Health and Nutrition Examination Survey.

There is growing evidence of a possible correlation between depression and overactive bladder (OAB). However, few studies have classified depression according to its severity. Whether there is an association between different levels of depression and OAB symptoms remains unclear. Participants with complete information about depression, OAB, and covariates in the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were included in this study. Depression symptoms were assessed by the Patient Health Questionnaire-9. OAB symptoms were evaluated by the Overactive Bladder Symptom Score. Weighted multivariate logistic regression models were applied to analyze the relationship between depression and OAB. A total of 30 359 participants were included in this study, consisting of 6245 OAB patients and 24 114 non-OAB participants. The multivariate logistic regression suggested depression independently correlated with OAB (odds ratio [OR] = 2.764, 95% confidence interval [CI] = 2.429-3.146, p < 0.001). Further, mild (OR = 2.355, 95% CI = 2.111-2.627, p < 0.001), moderate (OR = 3.262, 95% CI = 2.770-3.841, p < 0.001), and moderately severe to severe depression (OR = 3.927, 95% CI = 3.246-4.752, p < 0.001) were all associated with OAB. Additionally, depression was also correlated with urgency urinary incontinence (OR = 2.249, 95% CI = 1.986-2.548, p < 0.001) and nocturia (OR = 2.166, 95% CI = 1.919-2.446, p < 0.001). This study indicated different levels of depression, even mild depression, were independent risk factors for OAB. Given the frequent coexistence and potential interactions between depression and OAB, clinicians should be aware of the importance of assessing both physical and psychological symptoms in these patients. Early diagnosis and holistic treatment may improve the treatment outcomes, particularly for those suffering from both conditions.

The association between triglyceride -glucose index and stress urinary incontinence in adult American women: A population-based study.

This investigation seeks to determine the triglyceride glucose (TyG) index's link to stress urinary incontinence (SUI) in American females of adult age. The investigation relied on data acquired via the National Health and Nutrition Examination Survey (NHANES) conducted over the period from 2011 to 2018. The independent relationship between TyG index and SUI was tested using multivariate logistic regression analysis. We applied a smooth curve fitting approach to analyze the interrelation of them. In addition, subgroup analysis was conducted and interaction experiments were conducted. Among 4459 female participants aged 20 and above, TyG index and SUI demonstrated a favorable correlation. Model 3 indicated that with every single-unit rise in the TyG index, the incidence of SUI increases by 18% [1.18 (1.01, 1.38)]. In contrast to individuals in the lowest tertile, subjects within the highest tertile of the TyG index exhibited a 68% increase in SUI incidence [1.68 (95% CI: 1.26, 2.23), 0.0004]. By using smooth curve fitting, a nonlinear positive evidence of an interconnection of the TyG index to SUI was identified. Women exhibiting increased TyG index levels are at a heightened risk of SUI. TyG index displays a stronger correlation than that observed with BMI. According to our findings, the TyG index is viewed as a potential tool for identifying SUI in women, and monitoring the value of TyG index may be helpful for predicting the occurrence of SUI.

Mesh-associated pain syndrome: predictors for continence and prolapse mesh removal surgery in a single centre

ObjectiveOver the last two decades one of the main surgical treatment for stress urinary incontinence (SUI) and pelvic organ prolapse (POP) surgery was the insertion of non-absorbable mesh to restore continence and prolapse respectively. Over time complications arose including mesh-associated pain syndrome (MAPS), mesh exposure, mesh, erosion, chronic bladder/vaginal infections, and dyspareunia. Consequently, women chose surgical mesh removal to counter these problems. However, little is known about the demographics, medical co-morbidities, mesh types involved and the timing from mesh insertion to mesh removal. This retrospective study will look at which of these factors may be closely associated with mesh removal surgery.DesignRetrospective evaluation.SettingFemale Pelvic Medicine and Reconstructive Surgery (FPMRS) Clinic at University College London Hospitals NHS Foundation Trust.PopulationAll patients presenting to the FPMRS Clinic between June 2011 to December 2019, requesting mesh removal surgery with a history of MAPS and other mesh complications were included in this study.MethodsPatient demographics including age, ethnicity, obstetric history, and medical co-morbidities; type of mesh/anatomical route used; onset of symptoms; and time from insertion to removal were recorded.Main Outcome MeasuresDetermination of correlation coefficients between patient demographics, patient reported symptoms and mesh removal surgery.ResultsThree hundred and forty-five women with a history of MAPS were included in the study. Women in the 40–60 year old cohort accounted for 54.4% of mesh removal surgery; 54.8% had a BMI under 30 and almost 90% were Caucasian. 96.5% had had children, with over 77% having had a vaginal delivery. 91.9% of patients reported other health conditions including 18.8% with a concomitant history of mental health problems and 15.4% with a history of heart disease. Over 80% of women undergoing mesh removal surgery had a continence mesh (49% retropubic and 32% obturator continence mesh) removed, whereas 20% had an abdominal prolapse and/or vaginal prolapse mesh removed. The average time from mesh insertion to mesh removal was seven years, with the prevalence of mesh removal surgery averaging 85% (range 50–100%) depending on the comorbidity determined.ConclusionsAll women presented to the clinic with a history of MAPS and other comorbidities which may have influenced their decision to pursue mesh removal surgery. There were no specific predictors, other than chronic pain associated with mesh, determining which women underwent surgery, though those with continence mesh were more likely to do so.