Refractory Overactive Bladder Research Articles

Treatment of refractory overactive bladder with OnabotulinumtoxinA vs PTNS: TROOP trial.

We hypothesized that patients with refractory overactive bladder (rOAB) have similar improvement with percutaneous tibial nerve stimulation (PTNS) and OnabotulinumtoxinA (BTX). This multicenter cohort study compared BTX and PTNS in women with rOAB. Baseline information included Overactive Bladder Questionnaire (OABq) short form, Urinary Distress Inventory-6 (UDI-6), and voiding diary. Primary outcome was cure, defined as "very much better" or "much better" on the Patient Global Impression of Improvement (PGII) AND a reduction in OABq symptom severity scale (SSS) ≥10 at 3 months after treatment. Assuming 80% power to detect a ten-point difference in OABq-SSS, 80 participants were required per group. A total of 150 patients were enrolled; 97 completed 3 months of therapy and were included. At baseline, BTX patients had more detrusor overactivity (70% vs 40%, p= 0.025), urgency incontinence (UUI; OABq-SSS#6 4 vs 3, p = 0.02, SSS 65 vs 56, p= 0.04), but similar health-related quality of life (HRQL 49 vs 54, p= 0.28), voids (7 vs 8, p= 0.13), and UUI episodes (2 vs 2, p= 1.0). At 3months, cure rates were similar: BTX 50% vs PTNS 44.2% (p= 0.56). Both groups had improved SSS (-37 vs -29, p= 0.08) and HRQL (31 vs 24, p= 0.14). Patients receiving BTX had a greater improvement in urgency (ΔOABq-SSS#2-3 vs -2; p= 0.02) and UUI (ΔOABq-SSS#6-2 vs -1; p = 0.02). No characteristics were predictive of cure. BTX resulted in significantly greater improvement in urgency and UUI than PTNS, but no difference in success based on PGII and OABq-SSS, which may be due to a lack of power.

Learning Curve of Botulinum Toxin Bladder Injection for the Treatment of Refractory Overactive Bladder.

PurposeIntradetrusor botulinum toxin injections is an established second-line treatment for patients with refractory overactive bladder syndrome (OAB). We aimed to evaluate the learning curve of intradetrusor injections with botulinum toxin for the treatment of refractory OAB.Patients and MethodsThis retrospective study analyzed all women with idiopathic and refractory OAB who underwent botulinum toxin bladder injections performed by residents with no previous experience with operative cystoscopy under consultant supervision. Baseline International Consultation on Incontinence Questionnaire-Short Form questionnaire (ICIQ-SF) and Euroqol (EQ-5D) questionnaires were collected. Procedural data (operative time, number of valid injections, complications, subjective easiness, perceived tolerability) and patients’ outcomes (Patients Global Impression of Improvement (PGI-I), ΔICIQ-SF, ΔEQ-5D, need for self intermittent catheterization, duration of efficacy) were considered as markers to evaluate learning curves for each resident.ResultsTwenty-seven patients underwent intravesical injection of botulinum toxin performed by residents. Only a grade 1 Clavien-Dindo complication occurred, and none of the patients had urinary retention. PGI-I was very satisfactory, scoring 1.4 ± 0.9. Both ICIQ-SF and EQ-5D 2–2 were statistically improved (p < 0.00001 and p = 0.04, respectively). The mean duration of efficacy resulted to be 8.0±4.3 months. A positive effect of the learning curve was observed only for operative time, subjective easiness, and perceived tolerability.ConclusionIntradetrusor botulinum toxin injection for the treatment of refractory OAB is characterized by high efficacy and very low complications even at the very beginning of the learning curve when performed under proper mentorship.

Comparison of Two Treatment Modalities in Overactive Bladder: A Rapid Overview.

Overactive bladder is a syndrome of urgency with the absence of infection and is usually accompanied by frequency and nocturia. Both sacral neuromodulation (SNM) and intravesical botulinum toxin (BTX) injection are used contentiously in overactive bladder after failure of conservative management. We aimed to provide an updated comparative overview of BTX injection versus SNM in the treatment of overactive bladder. PubMed and Google scholar databases were explored starting from 2016 to 2022 to obtain relevant articles. English studies on adult population were included. Six articles included 648 participants were included in the current overview. Both BTX and SNM are comparable for the treatment of overactive bladder, with no major complications were reported. However, the use of SNM for refractory overactive bladder after failure of BTX was more successful and effective and resulted in patient satisfaction compared to the use of BTX after failure of SNM. Our update provides the latest comparative overview of outcomes of BTX versus SNM in the treatment of overactive bladder.

Comparison of Two Treatment Modalities in Overactive Bladder: a Rapid Overview

Background: Overactive bladder is a syndrome of urgency with the absence of infection and is usually accompanied by frequency and nocturia. Both sacral neuromodulation (SNM) and intravesical botulinum toxin (BTX) injection are used contentiously in overactive bladder after the failure of conservative management. Objective: We aimed to provide an updated comparative overview of botulinum toxin versus sacral neuromodulation in the treatment of overactive bladder. Methods: PubMed and Google scholar databases were explored starting from 2016 to 2022 to obtain relevant articles. English studies on the adult population were included. Results: Six articles included 502 participants were included in the current overview. Both BTX and SNM are comparable for the treatment of overactive bladder, with no major complications were reported. However, the use of SNM for refractory overactive bladder after the failure of BTX was successful and effective and resulted in patient satisfaction compared to the use of BTX after the failure of SNM. Conclusion: Our update provides the latest comparative overview of outcomes of botulinum toxin versus sacral neuromodulation in the treatment of overactive bladder.

Axonics Sacral Neuromodulation System for Treating Refractory Overactive Bladder: A NICE Medical Technologies Guidance.

The Axonics sacral neuromodulation (SNM) system can be used by people with refractory overactive bladder (OAB) to reduce symptoms of urge urinary incontinence and urinary frequency, where conservative treatments have failed or are not suitable. It is the first system for this indication that makes use of a rechargeable battery to prolong the lifespan of the implanted device, with the potential advantage of reducing the frequency of surgical replacement procedures and associated complications. We describe the evidence considered by the UK National Institute of Health and Care Excellence (NICE) in their evaluation of this evidence, supported by Cedar Healthcare Technology Research Centre. Two observational studies provided descriptive data that suggested improvement in control of symptoms after implantation of the Axonics SNM system; however, there was no peer-reviewed evidence that directly compared rechargeable and non-rechargeable SNM systems. In the absence of long-term data, economic modelling relies on the accuracy of battery life estimates. The evidence supports the case for adopting the Axonics SNM system for treating refractory OAB, when conservative treatment or treatment with medicines has not worked. This conclusion is consistent with other relevant NICE guidelines. Use of Axonics SNM technology in the UK National Health Service (NHS) is associated with a potential cost saving of £6025 per person over a 15-year period when compared with an equivalent non-rechargeable SNM system, assuming the claimed battery life estimate (a minimum of 15 years) is accurate. The cost savings are estimated to start around 6 years after implantation.

Decision aids and shared decision making in urogynecology.

To examine the efficacy and acceptability of decision aids (DAs) in counseling urogynecology patients with prolapse, stress urinary incontinence, or refractory overactive bladder. This pilot study enrolled 33 patients into a control group that underwent usual care without a DA, followed by 33 patients into an intervention group where providers utilized a DA for counseling. Postvisit patient surveys assessed differences in treatment preference, knowledge, and in patient-physician collaboration using SURE, CollaboRATE, and Shared Decision Making (SDM) Process scales. Postvisit provider surveys assessed their perception of the usefulness and the difficulty of using a DA and visit length. Independent t tests were used for continuous variables (Knowledge and SDM Process scores) and Chi-Square for categorical variables (treatment preference, SURE, and CollaboRATE). The majority of eligible patients 66/71 (93%) completed the survey. The intervention group trended toward higher knowledge scores (72% vs 60%, P = 0.06), clearer treatment preferences (85% vs 67%, P = 0.08), higher rates of top SURE scale scores (91% vs 73%, P = 0.11), and top CollaboRATE scores (75% vs 52%, P = 0.07). SDM process scores were similar across groups (3.2 vs 3.2, P = 0.96). Providers used the DA in 73% of intervention group visits and rated the visit length as "normal" in both groups (70% vs 76%, P = 0.78). There were no statistically significant differences between the control group and the intervention group. The use of DAs was acceptable to providers and indicated a trend toward increased patient knowledge, treatment preference, and satisfaction. A larger study is warranted to examine the impact of DAs on decision making and patient experience.

Sacral Neuromodulation in the Treatment of Non-Neurogenic Female Lower Urinary Tract Dysfunction; First Case-series and Systematic Review of Literature

Objective: To demonstrate which types of non-neurogenic female lower urinary tract dysfunction (LUTD) respond to sacral neuromodulation (SNM) after the failure of all non-invasive treatments.Materials and Methods: Female LUTD performed SNM between 2017 and 2019 were retrospectively reviewed. A case with anatomical or neurological abnormalities were excluded by thorough physical examination and investigations. The specific type of LUTD, including midurethral obstruction (MUO), was diagnosed by videourodynamics (VUDS). Clinical diagnoses, including idiopathic urinary retention (IUR), voiding dysfunction (VD) and refractory overactive bladder (OAB), were used instead of VUDS diagnosis when the result was normal or inconclusive. The International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) in Thai version were used to compare between pre and post-treatment. Responder was defined as an IPSS and/or OABSS decreased more than 50% from baseline.Results: Total 21 cases were performed SNM. The average age was 49.6 (24–80) years. The average pre-treatment IPSS and OABSS were 23.4 and 6.4 as well as average post-treatment IPSS and OABSS were 13.7 and 3.8. Only 9 out of 21 cases (42.9%) showed improvement after SNM. The responders included 7 out of 11 MUO (63.6%), 1 out of 4 IUR (25.0%), and 1 out of 3 OAB (33.3%). None of the VD cases responded to SNM.Conclusion: SNM is another option for female patients with LUTD who have failed to respond to conservative treatments. After completely excluding anatomical and neurological abnormalities, the types of LUTD having a chance to respond to SNM are MUO, IUR, and OAB.

Cost-Effectiveness Analysis Between Sacral Neuromodulation and OnabotulinumtoxinA for the Treatment of Refractory Overactive Bladder in Women: A Systematic Review

(Abstracted from Female Pelvic Med Reconstr Surg 2021;27:481–487) Sacral neuromodulation (SNM) and onabotulinumtoxinA (BONT/A) are well-established treatments for refractory overactive bladder (OAB) syndrome. SNM inhibits urination by stimulating the sacral portion of the spinal court, and BONT/A inhibits acetylcholine by causing detrusor muscle paralysis.

Female Urgency, Trial of Urodynamics as Routine Evaluation (FUTURE study): a superiority randomised clinical trial to evaluate the effectiveness and cost-effectiveness of invasive urodynamic investigations in management of women with refractory overactive bladder symptoms

BackgroundOveractive bladder (OAB) syndrome is a symptom complex affecting 12–14% of the UK adult female population. Symptoms include urinary urgency, with or without urgency incontinence, increased daytime urinary frequency and nocturia. OAB has a negative impact on women’s social, physical, and psychological wellbeing. Initial treatment includes lifestyle modifications, bladder retraining, pelvic floor exercises and pharmacological therapy. However, these measures are unsuccessful in 25–40% of women (refractory OAB). Before considering invasive treatments, such as Botulinum toxin injection or sacral neuromodulation, most guidelines recommend urodynamics to confirm diagnosis of detrusor overactivity (DO). However, urodynamics may fail to show evidence of DO in up to 45% of cases, hence the need to evaluate its effectiveness and cost-effectiveness. FUTURE (Female Urgency, Trial of Urodynamics as Routine Evaluation) aims to test the hypothesis that, in women with refractory OAB, urodynamics and comprehensive clinical assessment is associated with superior patient-reported outcomes following treatment and is more cost-effective, compared to comprehensive clinical assessment only.MethodsFUTURE is a pragmatic, multi-centre, superiority randomised controlled trial. Women aged ≥ 18 years with refractory OAB or urgency predominant mixed urinary incontinence, and who have failed/not tolerated conservative and medical treatment, are considered for trial entry. We aim to recruit 1096 women from approximately 60 secondary/tertiary care hospitals across the UK. All consenting women will complete questionnaires at baseline, 3 months, 6 months and 15 months post-randomisation. The primary outcome is participant-reported success at 15 months post-randomisation measured using the Patient Global Impression of Improvement. The primary economic outcome is incremental cost per quality-adjusted life year gained at 15 months. The secondary outcomes include adverse events, impact on other urinary symptoms and health-related quality of life. Qualitative interviews with participants and clinicians and a health economic evaluation will also be conducted. The statistical analysis of the primary outcome will be by intention-to-treat. Results will be presented as estimates and 95% CIs.DiscussionThe FUTURE study will inform patients, clinicians and policy makers whether routine urodynamics improves treatment outcomes in women with refractory OAB and whether it is cost-effective.Trial registrationISRCTN63268739. Registered on 14 September 2017.

Percutaneous tibial nerve stimulation versus sham efficacy in the treatment of refractory overactive bladder: outcomes following a shortened 6‐week protocol, a prospective randomized controlled trial

It is a prospective randomized controlled trial comparing the efficacy of percutaneous tibial nerve stimulation versus sham for a shortened 6-week protocol of treatment in management of refractory OAB in non-neurogenic adult patients. A total of 50 adults with refractory non-neurogenicoveractive bladder symptoms were randomized 1:1 to 6weeks of treatment with weekly percutaneous tibial nerve stimulation or sham therapy. Overactive bladder symptom score as well as 3-day voiding diaries were completed at baseline and at 7th week, 3rd and 6th month. The 7th week, 3rd and 6th month symptom score assessment for overall bladder symptoms demonstrated that percutaneous tibial nerve stimulation patients achieved statistically significant improvement in bladder symptoms with 52% reporting moderately improved responses compared to non-response of sham patients from baseline (P = 0.001). Voiding diary parameters after 6weeks of therapy showed that PTNS patients had statistically significant improvements in frequency, voided volume and urgency urinary incontinence episodes compared to sham. No serious device-related adverse events or malfunctions were reported. A shortened 6-week treatment protocol with PTNS appears to be successful and more effective than sham in the treatment of refractory OAB. PTNS therapy is safe and effective in treating OAB symptoms with 52% success rate following a shortened 6-week protocol. The duration of treatment with PTNS can be halved compared to the conventional 12weeks, which would make it more acceptable and cost effective for patients.

Subjective Efficacy of Suburothelial Versus Intradetrusor Botulinum Toxin for Overactive Bladder: A Retrospective Cohort Study

Objective: The goal of this study was to compare patient-reported efficacy of suburothelial versus intradetrusor onabotulinumtoxin A (BTX-A) in patients with refractory overactive bladder (OAB). Ma...

PD06-11 CHANGES IN URINE METABOLITES AFTER ONABOTULINUMTOXIN-A INJECTIONS FOR REFRACTORY OVERACTIVE BLADDER

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy I (PD06)1 Sep 2021PD06-11 CHANGES IN URINE METABOLITES AFTER ONABOTULINUMTOXIN-A INJECTIONS FOR REFRACTORY OVERACTIVE BLADDER Laura Tellechea, Samantha Freeman, Ilir Agalliu, Melissa Laudano, Sylvia Suadicani, and Nitya Abraham Laura TellecheaLaura Tellechea More articles by this author , Samantha FreemanSamantha Freeman More articles by this author , Ilir AgalliuIlir Agalliu More articles by this author , Melissa LaudanoMelissa Laudano More articles by this author , Sylvia SuadicaniSylvia Suadicani More articles by this author , and Nitya AbrahamNitya Abraham More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001974.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Overactive Bladder (OAB) is diagnosed based on symptoms and often treated based on patient preference. A urine biomarker could phenotype refractory OAB and identify those who would benefit from chemodenervation vs neuromodulation. Metabolomics is the analysis of metabolic profiles. Urine metabolites may be potential biomarkers for OAB yet little is known about the effect of third line treatments like bladder onabotulinumtoxin-A (BTX-A) on the urinary metabolome. Our study objective was to evaluate changes in the urinary metabolome and correlate with OAB-V8 symptom score change after BTX-A injections in women with refractory OAB. METHODS: Women over 18 years with non-neurogenic refractory OAB were recruited from our female urology clinic. OAB-V8 questionnaires and urine samples were collected before and after 100 units BTX-A injection. Samples were aliquoted, frozen on dry ice, and stored in a -80ºC freezer. Urine metabolomic analysis was conducted by Human Metabolome Technology Inc., Tsuruoka, Japan, and data was expressed as percent change from pre-treatment values. These were correlated with improvement in OAB-V8 Scores categorized as: no improvement (<8), mild improvement (8-16), marked improvement (>17). Change in metabolite levels was compared between groups using ANOVA, and correlations between metabolites and OAB-V8 scores evaluated using linear regression. RESULTS: Fifty-four urine samples were collected from 21 women. Mean age was 56 (46-56). 3 patients had diabetes, 10 had chronic pain disorders, 8 had prior pelvic surgery. Of 42 metabolites, Quinic Acid (p=0.01), N-o-Toluoyl-glycine-1-Phenaceturic acid-1 (p=0.02) and Adenosine (p=0.01) levels were significantly lower and N8-Acetylspermidine (p=0.01) levels significantly higher in the marked improvement vs. no improvement group. In linear regression models, N8-acetylspermidine (p=0.02) and Quinic Acid levels (p=0.009) significantly correlated with improvement in OABV-8 scores, Figure 1. CONCLUSIONS: Bladder BTX-A injection changes the urinary metabolome, with corresponding OAB score improvement. Further investigation of urine metabolites could provide objective data and biomarkers to follow OAB treatment response, and ultimately identify a subset of women who would benefit from certain third line therapies. Source of Funding: Urology Department © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e104-e104 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Laura Tellechea More articles by this author Samantha Freeman More articles by this author Ilir Agalliu More articles by this author Melissa Laudano More articles by this author Sylvia Suadicani More articles by this author Nitya Abraham More articles by this author Expand All Advertisement Loading ...

MP52-11 PATIENT-REPORTED ONSET OF SYMPTOM IMPROVEMENT FOLLOWING INITIAL INTRADETRUSOR ONABOTULINUMTOXINA INJECTIONS FOR OVERACTIVE BLADDER

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence: Therapy II (MP52)1 Sep 2021MP52-11 PATIENT-REPORTED ONSET OF SYMPTOM IMPROVEMENT FOLLOWING INITIAL INTRADETRUSOR ONABOTULINUMTOXINA INJECTIONS FOR OVERACTIVE BLADDER Neil J. Kocher, Jacqueline Zillioux, Sarah Martin, Raymond R. Rackley, Sandip P. Vasavada, and Howard B. Goldman Neil J. KocherNeil J. Kocher More articles by this author , Jacqueline ZilliouxJacqueline Zillioux More articles by this author , Sarah MartinSarah Martin More articles by this author , Raymond R. RackleyRaymond R. Rackley More articles by this author , Sandip P. VasavadaSandip P. Vasavada More articles by this author , and Howard B. GoldmanHoward B. Goldman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002082.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Intradetrusor onabotulinumtoxinA (BTX-A) is a common third-line therapy for treatment of refractory overactive bladder (OAB), however several gaps exist in pre- and post-procedural standard of care. Prior studies have demonstrated BTX-A efficacy at 2-3 weeks, but there are limited data documenting when patients should begin to note symptom improvement. We performed a prospective study evaluating several factors involved in the BTX-A patient care pathway. The primary aim of this abstract was to determine patient-reported temporal improvement in symptoms following initial BTX-A therapy. METHODS: A prospective, non-randomized study of patients with non-neurogenic, refractory urgency-frequency syndrome and urgency urinary incontinence undergoing first-time BTX-A injection under local anesthesia was performed. Intradetrusor injection of 100 units BTX-A was performed by one of 3 FPMRS-trained providers using a standard 20-site template. Patients were required to discontinue their OAB medication(s) at the time of BTX-A injection for 3 weeks and complete a daily Patient Global Impression of Improvement (PGI-I) diary during this time. Data were collected at 1 month, including final satisfaction score and adverse outcomes. Descriptive analysis was performed in R programming. RESULTS: 25 patients were included (24 female, 1 male). Median age was 75 years and BMI was 34.3. Figure 1 shows a jitter plot with loess smoothed fit of patient-reported PGI-I over time following BTX-A injection. 24 patients (96%) reported symptom improvement (PGI <4) by 3 weeks, with 19 patients (76%) documenting at least “much better” (PGI >2). Median time to first improvement (PGI <4) was 1 day, at least “much better” was 4 days, and median time to maximum patient improvement was 6 days. Median final satisfaction score was PGI 2 (“much better”). Adverse outcomes included UTI in 2 patients (8%) and incomplete emptying requiring transient intermittent catheterization in 1 patient (4%). CONCLUSIONS: Patients with refractory OAB undergoing first-time 100 units BTX-A injection reported median time to first improvement (PGI <4) at 1 day, at least “much better” at 4 days, and median time to maximum patient improvement at 6 days. These data may help further counsel patient expectations following initial BTX-A therapy. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e934-e934 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Neil J. Kocher More articles by this author Jacqueline Zillioux More articles by this author Sarah Martin More articles by this author Raymond R. Rackley More articles by this author Sandip P. Vasavada More articles by this author Howard B. Goldman More articles by this author Expand All Advertisement Loading ...

PD06-08 EXPLANTED SACRAL NERVE STIMULATORS CONSISTENTLY EXHIBIT BIOFILMS WITH DIVERSE MICROBIAL COMPOSITION

INTRODUCTION AND OBJECTIVE:Sacral neuromodulation is an effective treatment for refractory overactive bladder. Based on standard culture, about 25% of explanted stimulators have been shown to be co...

Robot-Assisted Bladder Augmentation and Artificial Sphincter Placement

Abstract Introduction: Augmentation cystoplasty (AC) has traditionally been used in the treatment of low capacity, poorly compliant, or refractory overactive bladder (OAB). The concept of AC is to ...

Head and Neck MRI Imaging Performed Safely in a Patient with Sacral Neuromodulation Device: A Case Report

Introduction: Sacral neuromodulation is a well-established treatment option to manage refractory lower urinary tract and pelvic floor disorders. The technique involves implantation of a lead and an internal pulse generator that delivers electrical impulses to modulate the sacral area. Many patients worldwide have been implanted with MRI-non-compatible devices. Currently, MRI head only can be performed safely in these patients. Therefore, we present a case report of a patient who underwent MRI of the head as well as neck in the presence of a sacral neuromodulator without serious complications. Case Report: A 33-year-old lady known to have systemic lupus erythematosus, refractory overactive bladder, and recurrent urinary tract infection started complaining of right sided neck pain for 3 months in which she required MRI of the head and neck to further assess the nature of the pain. The patient was already implanted with sacral neuromodulator with excellent outcome to manage her refractory overactive bladder. Following careful discussion with the patient and radiologist, MRI study was conducted at 1.5 tesla and total procedure duration was 8 minutes for T1, T2 sagittal and axial cuts. The patient revealed feeling minimal tingling of the right lower limb and mild lower back pain during MRI, all of which disappeared once the study was terminated. Device was functioning well afterwards. Conclusion: MRI may be feasible for certain sacral neuromodulation patients under certain conditions without any serious adverse events.

Sacral Neuromodulation for Lower Urinary Tract Symptoms: Effect of Therapy on Saudi Patient Sexual Function.

BackgroundSacral neuromodulation (SNM) is FDA-approved therapy for lower urinary tract and bowel dysfunction. It is newly introduced therapy in Saudi Arabia.AimTo evaluate the effect of SNM therapy in both male and female Saudi patient's sexual function.MethodsA prospective cohort study was conducted for all patients who underwent SNM implantation from January 2016 till January 2020 at a single center in Jeddah, Saudi Arabia. Sexual function was assessed before and after treatment using International Index of Erectile Function (IIEF-5) for men and the Female Sexual Function Index (FSFI) for women.Main Outcome measuresSexual function score changes from the baseline was reported. Correlation analysis was studied between IIEF-5 to assess erectile dysfunction and FSFI assessing desire, arousal, orgasm, pain and sexual satisfaction and other collected data including patient's age, functional diagnosis and post void residual (PVR).ResultsThe study included 13 total patients (8 female, 5 male) with mean age 47y (33-60). Diagnosis included non-obstructive urine retention (5), refractory overactive bladder (3), combined retention + over active bladder (OAB) (1), pelvic pain syndrome (3) and impotence in 1 patient. All male patients showed significant improvement in their IIEF-5 score from mean pre op 7.8 ±5.7 to post op sore of 19.8±2.3 with significant p value p=0.003.Female patients showed significant improvement in their FSFI total score from baseline of 18.313±7.4 to post-operative mean FSFI score 26.7±1.8 with p value = 0.013. Domains od FSFI which showed significant improvement were desire, arousal, orgasm and sexual satisfaction with p value =0.002, p=00.1,0.012, and p=0.015. Age, functional diagnosis and PVR did not show significant correlation with IIEF-5 and FSFI score.ConclusionOur results suggest that SNM might improve male and female sexual dysfunction regardless of patient's age and diagnosis. Banakhar MA, Younos A. Sacral neuromodulation for lower urinary tract symptoms: effect of therapy on Saudi patient sexual function. Sex Med 2021;9:100388.

Multifocal bladder nephrogenic adenoma following repeated intravesical onabotulinumtoxinA (Botox®) injection for refractory overactive bladder. Case report and literature review

Multifocal bladder nephrogenic adenoma following repeated intravesical onabotulinumtoxinA (Botox^®) injection for refractory overactive bladder. Case report and literature review

Dynamically crosslinked polydimethylsiloxane-based polyurethanes with contact-killing antimicrobial properties as implantable alloplasts for urological reconstruction

A large population of patients is reported to suffer from urinary bladder-associated irreversible physiological disorders, rationalizing a continuous surge for structural and functional substitutes of urinary tissues, including ureters, bladder-wall, and urethra. The current gold standard for bladder reconstruction, an autologous gastrointestinal graft, is proven not to be an ideal substitute in the clinic. While addressing this unmet clinical need, a unique platform of antimicrobial polydimethyl siloxane-modified polyurethanes (TPU/PDMS) is designed and developed for its potential application as a urological implant. To the best of our knowledge, this study reports for the first time the successful integration of varying contents of PDMS within the molten polyurethane matrix using in situ crosslinking methodology. Thus, compatibilized binary blends possess clinically relevant viscoelastic properties to sustain high pressure, large distensions, and surgical manipulation. Furthermore, different chemical strategies are explored to covalently incorporate quaternized moieties, including 4-vinyl pyridine (4-VP), branched-polyethyleneimine (bPEI) as well as bPEI-grafted-(acrylic acid-co-vinylbenzyltriphenyl phosphonium chloride) (PAP), and counter urinary tract infections. The modified compositions, endowed with contact killing surfaces, reveal nearly three log reduction in bacterial growth in pathogenically infected artificial urine. Importantly, the antimicrobial TPU/PDMS blends support the uninhibited growth of mitochondrially viable murine fibroblasts, in a manner comparable to the medical-grade polyurethane. Collectively, the obtained results affirmed the newly developed polymers as promising biomaterials in reconstructive urology. Statement of significanceThe clinical procedure for end-stage bladder disease remains replacement or augmentation of the bladder wall with a section of the patient's gastrointestinal tract. However, the absorptive and mucus-producing epithelium of intestinal segment is liable to short- and long-term complications. The dynamically crosslinked polydimethyl siloxane-based polyurethanes proposed herein, and the associated synthesis strategies to induce polycation grafted non-exhaustive contact-killing surfaces against uropathogents, have a significant clinical prospect in reconstructive urology. As an ‘off-the-shelf’ available alloplastic substitute, these blends offer the potential to circumvent the challenges associated with non-urinary autografts or scaffold based regenerative engineering and, thereby, shorten as well as simplify the surgical treatment. The targeted application has been conceived for a bladder patch to assist in various urinary diseases including, bladder carcinoma, refractory overactive bladder, interstitial cystitis, etc. However, given the ease of fabrication, moldability and the wide spectrum of mechanical properties that could be encompassed, these blends also present the possibility to be manifested into artificial ureteral or urethral conduits.

Adding mirabegron after intravesical onabotulinumtoxinA injection improves therapeutic effects in patients with refractory overactive bladder.

To investigate whether adding an anticholinergic or beta-3 agonist can improve the therapeutic effect of intravesical onabotuliumtoxinA injection in patients with refractory overactive bladder (OAB). Ninety OAB patients who received an intravesical 100-U onabotulinumtoxinA injection 1 month previously were consecutively invited into a prospective, randomized, open-label study. They were randomly adding on solifenacin 5 mg daily (QD) (30 patients), mirabegron 50 mg QD (31 patients), or no medication (29 patients, control). All enrolled patients completed a 3-day voiding diary, Overactive Bladder Symptom Score (OABSS) and Urgency Severity Scale (USS) questionnaires, Global Response Assessment (GRA) scale, and uroflowmetry at baseline (1 month after intravesical onabotulinumtoxinA injection) and 3-, 6-, 9-, and 12-month follow-up. The primary end point was the effective therapeutic outcome defined as no OAB wet during the 12-month period. The secondary end point included changes of GRA, OABSS, and the parameters of the voiding diary at 3 months. The baseline data were comparable among the three groups. The percentage of OAB wet in the mirabegron-added-on group was significantly less than that in the solifenacin-added-on and onabotulinumtoxinA-only groups at four different time points (P=.02). At 3 months, the changes of GRA, OABSS, USS, urge urinary incontinence, frequency, nocturia episodes, and functional bladder capacity in the mirabegron-added-on group were significantly greater than those in the other groups. No serious adverse events were reported. Adding mirabegron could increase the therapeutic effects, mainly on OAB symptoms and GRA scale, after intravesical onabotulinumtoxinA injection in refractory OAB patients.