Symptoms Of Urge Incontinence Research Articles

A randomized trial of retropubic vs single-incision sling among patients undergoing vaginal prolapse repair

The choice of midurethral sling type may impact efficacy and complications in women undergoing transvaginal native tissue repair of pelvic organ prolapse. The primary aim was to determine if the single-incision sling is noninferior to retropubic sling for the management of stress urinary incontinence among patients undergoing reconstructive or obliterative native tissue vaginal repair. The secondary aims were to compare adverse events and surgeon ease of use with sling assignment. A multicenter, noninferiority, randomized trial of women with ≥ stage II pelvic organ prolapse and objectively confirmed stress urinary incontinence undergoing reconstructive or obliterative vaginal repair was performed. Women were randomized to concomitant single-incision (Altis sling, Coloplast Minneapolis, MN) with suprapubic sham incisions or retropubic slings. The primary dichotomous outcome was abnormal lower urinary tract function within 12 months postsurgery, defined as bothersome stress urinary incontinence symptoms (>1 Pelvic Floor Distress Inventory question no. 17); retreatment for stress urinary incontinence or treatment for urinary retention. Secondary outcomes were adverse events, Patient Global Impression of Improvement of bladder function, and surgeon ease of use (1, worst; 10, best). All subjects completed validated questionnaires and underwent a Pelvic Organ Prolapse Quantification, cough stress test, and postvoid residual preoperatively, at 6 weeks and 12 months postoperatively. Assuming a subjective cure rate for retropubic of 82%, 80% power, and 1-sided 5% significance level, we estimated that 127 patients in each arm were needed to declare noninferiority of the single-incision sling if the upper bound of the 95% confidence interval for the between-group difference per protocol in abnormal bladder function was <12%. Assuming a 10% loss to follow-up, the total enrollment goal was280. Between December 2018 and January 2023, 280 subjects were enrolled across 7 sites, and 255 were randomized: 126 were for single-incision, and 129 were for retropubic sling. There were no preoperative or operative characteristic differences between groups. Overall, 81% had reconstructive, and 19% had obliterative native tissue repairs. The primary outcome, abnormal lower urinary tract function at 12 months, occurred in 29 (25%) of single-incision vs 24 (20%) of the retropubic sling group (risk difference, 0.04472 [95% confidence interval,-0.03 to 0.1133]; P=.001 for noninferiority). Bothersome stress urinary incontinence occurred in 20% vs 17% (P=.27) and was retreated in 4% vs 2% (P=.44) of single-incision vs retropubic groups, respectively. Adverse events were reported in 24 (16%) of single-incision vs 14 (9%) of the retropubic group (95% confidence interval, 0.95-3.29; P=.70) and included de novo or worsening urgency incontinence symptoms, urinary tract infection, mesh exposure, need for prolonged catheter drainage, and de novo pain, without differences between groups. Patient Global Impression of Improvement (very satisfied and satisfied) was 71% vs 67% (P=.43), and median surgeon ease of sling use was 8 (7-10) vs 9 (8-10), P=.03 in single-incision vs retropubic, respectively. For women undergoing vaginal repair, single-incision was noninferior to retropubic sling for stress urinary incontinence symptoms, and complications, including treatment for urinary retention, did not differ.

Food Insecurity Is Associated With Urge Urinary Incontinence: An Analysis of the 2005-2010 National Health and Nutrition Examination Survey.

Urge urinary incontinence is the involuntary leakage of urine associated with a sudden compelling urge to void. A previous study found an association between urge urinary incontinence and household income, indicating that social determinants of health may influence urge urinary incontinence. Food insecurity is a relevant social determinant of health, as a diet with bladder irritants may worsen urge urinary incontinence symptoms. This study aimed to investigate the association between urge urinary incontinence and food insecurity. We collected data from the 2005-2010 cycles of the National Health and Nutrition Examination Survey, a nationally representative health survey administered by the Centers for Disease Control and Prevention. The association between urge urinary incontinence and food insecurity was analyzed using survey-weighed logistic regression with adjustments for demographic, socioeconomic status, behavioral, and medical comorbidities covariates. We included 14,847 participants with mean age 50.4±17.9 years; 22.4% of participants reported at least 1 episode of urge urinary incontinence. We found that participants who reported food insecurity had 55% greater odds of experiencing urge urinary incontinence compared to those who have not (OR=1.55, 95% CI=1.33-1.82, P < .001). When comparing diets, food-insecure participants reported significantly less intake of bladder irritants (caffeine and alcohol) compared to food-secure participants. When the sample was stratified by food insecurity status (yes vs no), consumption of caffeine did not differ by urge urinary incontinence status and consumption of alcohol was lower among participants with vs without urge urinary incontinence. Adults reporting food insecurity in the past year are significantly more likely to experience urge urinary incontinence than those who did not. Consumption of bladder irritants including caffeine and alcohol was significantly less in food-insecure compared to food-secure participants. When the sample was stratified by food insecurity status (yes vs no), consumption of caffeine did not differ by urge urinary incontinence status and consumption of alcohol was lower among participants with vs without urge urinary incontinence. These data indicate that diet alone does not drive the association between urge urinary incontinence and food insecurity. Instead, food insecurity may be a proxy for social inequity, perhaps the greatest driver of disease.

MP07-11 IMPACT OF PREOPERATIVE URODYNAMICS ON THE SURGICAL TREATMENT OF ADVANCED PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyCME1 Apr 2023MP07-11 IMPACT OF PREOPERATIVE URODYNAMICS ON THE SURGICAL TREATMENT OF ADVANCED PELVIC ORGAN PROLAPSE Susane Hwang, Luis Gustavo Toledo, Silvia Carramao, Raphael Moreira, Carolina Jesus, Sarah Carvalho, Raquel Richetti, and Antônio Auge Susane HwangSusane Hwang More articles by this author , Luis Gustavo ToledoLuis Gustavo Toledo More articles by this author , Silvia CarramaoSilvia Carramao More articles by this author , Raphael MoreiraRaphael Moreira More articles by this author , Carolina JesusCarolina Jesus More articles by this author , Sarah CarvalhoSarah Carvalho More articles by this author , Raquel RichettiRaquel Richetti More articles by this author , and Antônio AugeAntônio Auge More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003222.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: One quarter of women without urinary incontinence can develop de novo stress urinary incontinence (SUI) after surgery for pelvic organ prolapse (POP). This condition has been reported more frequently in women with occult SUI. However, studies are diverse as far as the investigation of occult SUI is concerned, and it has not been possible to reach a consensus on the benefits of preoperative urodynamics (UDS). The aim of this study was to investigate the impact of preoperative UDS on the surgical treatment of POP by analyzing whether performing UDS added diagnoses, modified surgical planning, and changed postoperative outcomes in women with advanced POP. METHODS: Retrospective observational study including women having POP stages III and IV, without symptoms of SUI, undergoing surgery for POP, between May 2015 and January 2020, with a minimum three-month follow-up period. Preoperative evaluation included the patients' standard clinical history, a physical examination (PE) to quantify genital prolapse, and stress testing with and without prolapse reduction at PE. Multi-channel UDS was performed when the surgeon so indicated. Postoperative outcomes were measured by excluding women with occult SUI on PE, and analyzing the incidence of de novo SUI, and need for a second approach for midurethral sling or urethrolysis. RESULTS: A total of 226 patients met the inclusion criteria, and 102 (45.1%) performed UDS. UDS added diagnoses in 64/102 (62.6%), having added 21/102 (20.6%) occult SUI cases. After UDS, there was a change in surgical procedure in 20/102 (19.6%) cases (18 indications for sling and two contraindications for it). The overall rate of occult SUI in the 226 patients was 28.8% (65/226). Among the 182 patients that were continent upon physical examination (PE), 68 (37.4%) underwent UDS. Postoperatively, patients in the UDS group maintained more urge incontinence (p=0.006) and storage symptoms (p<0.001) than the PE group. No statistical difference was found in the incidence of de novo SUI between the UDS group 6/68 (8.8%) and the PE group 11/114 (9.6%) (p=0.853), nor in the need of postoperative sling: 4/68 (5.9%) and 5/114 (4.4%), respectively. CONCLUSIONS: Preoperative UDS in women with POP stages III and IV increments diagnoses, changes surgical planning, increases the number of concomitant slings placement and does not change outcome in continent women upon PE. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e88 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Susane Hwang More articles by this author Luis Gustavo Toledo More articles by this author Silvia Carramao More articles by this author Raphael Moreira More articles by this author Carolina Jesus More articles by this author Sarah Carvalho More articles by this author Raquel Richetti More articles by this author Antônio Auge More articles by this author Expand All Advertisement PDF downloadLoading ...

CO2 Surgical Laser for Treatment of Stress Urinary Incontinence in Women: A Randomized Controlled Trial

ABSTRACT The common condition of stress urinary incontinence (SUI) has a reported prevalence of 10% to 39% in adult women in most studies. Although treatment of SUI via surgical means is an option, factors such as adverse effects of surgery and mesh-related risks lead many to seek alternative options. In overweight and obese patients, lifestyle changes for improving SUI symptoms entail mainly weight loss. Although pelvic floor muscle training (PFMT) can lead to improvements, further treatment is often necessary. Because of this, interest is high for developing effective nonsurgical treatments for SUI. One such possible treatment is vaginal laser therapy, which has been used as treatment for various vaginal conditions. The authors therefore carried out a randomized controlled trial (RCT) comparing CO2 laser with sham treatment for SUI. This multicenter, participant-blinded, sham-controlled, parallel-group, superiority RCT involved participants from 2 hospitals in Southeast Melbourne in the outpatient setting. Patients aged 18 to 80 years experiencing symptomatic and objective SUI and seeking conservative management participated. Women with prior surgery for SUI were excluded. A positive cough stress test with a comfortably full bladder and uroflow was used to determine objective SUI. Participants lacking positive cough stress test were still eligible for study inclusion with a positive pad weight test in the absence of urgency incontinence symptoms. Intervention took place using FemTouch delivery system in conjunction with the AcuScan 120 Microscanner and the AcuPulse CO2 laser system for fractional treatment. Laser energy was delivered via a standard foot pedal in a fractional manner. The sham treatment used identical methods and settings but used an inactive pedal, which only made mechanical clicks and no electronic beeps. A total of 3 treatments were administered to participants, 4 weeks apart, with incrementally greater density settings. The primary outcome of the study was subjective SUI (defined as positive answers to the inquiries: “Do you leak when you cough or sneeze?” or “Do you leak when physically active/exercising?”). Secondary outcomes were assessed via the Patient Global Impression of Improvement, and International Consultation on Incontinence Questionnaire–urinary incontinence change, International Consultation on Incontinence Questionnaire-overactive bladder, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, the Incontinence Impact Questionnaire–Short Form, and EQ-5D scores. In addition, adverse events (such as pain during the procedure as measured on a visual analog scale) and objective SUI were recorded. A sample size of 101 was chosen to provide 80% power to detect differences between groups for the primary outcome (even assuming a 10% rate of attrition). A total of 97 participants ultimately were treated. Randomization of participants occurred with equal probability to sham treatment or the CO2 laser using a computer-generated random sequence, which allocated participants to blocks of 4, 6, and 8. Unblinding of participants to their allocation occurred following the 3-month review. Participants had a mean age of 53 years and a mean body mass index of 26.1 kg/m2, and 90% were vaginally parous. Most participants had attempted PFMT either independently or under supervision. No detectable difference was found between the sham and active treatment arm in the primary outcome of leak with laughter or cough. Furthermore, there were no significant differences between groups with regard to any of the secondary, patient-reported outcomes of questionnaires. The authors tested the reliability of their masking by assessing whether patients could identify their allocation group. Between the 2 groups, 17 (54%) of the sham group and 15 (63%) of the active treatment group believed they received sham treatment. Adverse events were rare in both groups, with similar visual analog pain scores during treatment and only rare vaginal bleeding and urgency incontinence in both groups. Strengths of this study are several and include its blinded design and randomization methods. The primary outcome was focused on patient-reported outcomes. Responsive and validated questionnaires were utilized for assessment of secondary outcomes. Study limitations include a lack of blinding for investigators, which could have introduced an element of detection bias for SUI. In conclusion, no benefit was shown for 3 treatment sessions of the CO2 vaginal laser when compared with sham therapy. Additional trials with various laser modalities are necessary to determine whether this may produce varying results. Women considering CO2 vaginal laser therapy for SUI should be made aware of the lack of consistent high-quality evidence in support of this treatment.

Efficacy of overactive neurogenic bladder treatment: A systematic review of randomized controlled trials.

Overactive bladder (OAB) symptoms of frequency, urgency and urge incontinence are frequently associated with known neurological diseases like multiple sclerosis (MS), spinal cord injury (SCI), Parkinson's disease (PD), stroke. The aim of our study was to review the efficacy of pharmacological and non-pharmacological treatments for neurogenic overactive bladder. We searched two electronic databases (PubMed and EMBASE) for randomized controlled trials focusing on pharmacological and non-pharmacological medical treatments for overactive bladder symptoms associated with neurological diseases published up to 30 April 2022. A total of 157 articles were retrieved; 94 were selected by title and abstract screening; after removal of 17 duplicates, 77 records were evaluated by full-text examination. Sixty-two studies were finally selected. The articles selected for review focused on the following interventions: anticholinergics (n = 9), mirabegron (n = 5), comparison of different drugs (n = 3), cannabinoids (n = 2), intravesical instillations (n = 3), botulinum toxin (n = 16), transcutaneous tibial nerve stimulation (TTNS) (n = 6), acupuncture (n = 2), transcutaneous electrical nerve stimulation TENS (n = 4), pelvic floor muscle training (PFMT) (n = 10), others (n = 2). Anticholinergics were more effective than placebo in decreasing the number of daily voids in patients with PD (mean difference [MD]- 1.16, 95 % CI - 1.80 to - 0.52, 2 trials, 86 patients, p < 0.004), but no significant difference from baseline was found for incontinence episodes and nocturia. Mirabegron was more effective than placebo in increasing the cystometric capacity in patients with MS (mean difference [MD] 89.89 mL, 95 % CI 29.76 to 150.01, 2 trials, 98 patients, p < 0.003) but no significant difference was observed for symptom scores and bladder diary parameters. TTNS was more effective than its sham-control in decreasing the number of nocturia episodes (MD -1.40, 95 % CI -2.39 to -0.42, 2 trials, 53 patients, p < 0.005) but no significant changes of OAB symptom scores were reported. PFMT was more effective than conservative advice in decreasing the ICIQ symptom score (MD, -1.12, 95 % CI -2.13 to -0.11, 2 trials, 91 patients, p = 0.03), although the number of incontinence episodes was not significantly different between groups. The results of the meta-analysis demonstrate a moderate efficacy of all considered treatments without proving the superiority of one therapy over the others. Combination treatment using different pharmacological and non-pharmacological therapies could achieve the best clinical efficacy due to the favorable combination of the different mechanisms of action. This could be associated with fewer side effects due to drug dosage reduction. These data are only provisional and should be considered with caution, due to the few studies included in metaanalysis and to the small number of patients.

Overactive Bladder Patients With and Without Urgency Incontinence: A Spectrum of One Condition or Different Phenotypes?

The importance of this study is to explore potential differences in pathophysiologies of OAB-wet and OAB-dry. The aim of this study was to define fundamental and unique presenting features of patients exhibiting storage lower urinary tract symptoms (LUTS) with urgency incontinence (OAB-wet) and patients without urgency incontinence (OAB-dry). This was a secondary analysis of cross-sectional data from the National Institutes of Health/National Institute of Diabetes and Digestive and Kidney Diseases-sponsored Symptoms of Lower Urinary Tract Dysfunction Research Network. Demographic, physical examination, and questionnaire responses were analyzed for women seeking care for LUTS at 6 U.S. centers. Differences between OAB-wet and OAB-dry patients were compared using the Fisher exact test and Mann-Whitney U test. Differences in questionnaire data were assessed using a Benjamini-Hochberg false discovery rate correction. Fifty-six, 84, and 67 women were included in the OAB-dry, wet, and control cohorts, respectively. There was no difference in demographic and physical examination characteristics of the 2 groups. OAB-wet patients reported more urgency incontinence symptoms (LUTS 16a, P < 0.001). OAB-dry reported more bladder pain, feeling of incomplete bladder emptying (LUTS 4, P < 0.001), and a need to strain to urinate (AUA-SI 7, P = 0.003). Sensation of incomplete emptying and straining with urination did not correlate with elevated postvoid residual volumes. Although degrees of symptomatic bother were similar, bother in OAB-dry patients was most closely related to pelvic floor tenderness severity, whereas bother in OAB-wet patients was most related to urgency severity. Women with OAB-dry have distinct presenting features of straining with urination, bladder pain, and a feeling of incomplete emptying. These suggest a unique pathophysiology driving OAB-dry symptoms, which we hypothesize is pelvic floor myofascial dysfunction.

EDITORIAL COMMENT

Success rates of retropubic sling in Latina women compare with those published in the clinical trial literature. Urinary urgency and urgency incontinence symptoms may be more predominant in Latina women, and Gonzalez et al. emphasize need for further investigation of potential underlying structural, cultural, environmental, or lifestyle-related factors that may be at play. This amplifies generalizability of sling clinical trial results to an important demographic that is otherwise not well-represented in phase III trials for stress urinary incontinence.

Cystitis Cystica and Cystitis Glandularis of the Urinary Bladder: A Review and Update

Cystitis Cystica and Cystitis Glandularis of the Urinary Bladder: A Review and Update

Prevalence of Overactive Bladder Symptoms Among Women With Interstitial Cystitis/Bladder Pain Syndrome.

Symptoms of urinary frequency, urgency, and urinary leakage are characteristic of overactive bladder (OAB) syndrome. However, frequency and urgency symptoms are also present in most patients with interstitial cystitis/bladder pain syndrome (IC/BPS). Our objective was to describe the urge incontinence among women with IC/BPS, which may indicate true overlap of OAB and IC/BPS. This is a prospective study of women with IC/BPS diagnosed clinically in the Veterans Affairs Health Care system. Patients completed the OAB and Female Genitourinary Pain Index (F-GUPI) questionnaires. Questions from the OAB questionnaire were used to analyze symptoms of urinary urgency and urge incontinence. Pain symptoms, urinary symptoms, and impact on quality of life were assessed based on the F-GUPI. Patient demographics, comorbidities, and symptoms were reviewed. Within the cohort of 144 women with IC/BPS, 100 (69%) had urinary leakage associated with the strong desire to void and were more likely to have incontinence compared with healthy controls (P < 0.001). The IC/BPS group also had higher total and pain scores on the F-GUPI (P < 0.001), but pain scores were not affected by the presence of incontinence (P = 0.478). The prevalence of OAB symptoms of urinary leakage is high among women with IC/BPS. This may explain the efficacy of OAB medication and third-line therapies in this population.

The effectiveness of different electrical nerve stimulation protocols for treating adults with non-neurogenic overactive bladder: a systematic review and meta-analysis.

Electrical nerve stimulation is a widely used treatment for overactive bladder but there is no consensus regarding the best placement of electrodes or protocols. We hypothesised that some non-implanted neurostimulation protocols would be more effective compared to others for treating urinary symptoms and improving quality of life among adults diagnosed with non-neurogenic overactive bladder. A systematic review and meta-analyses of randomized clinical trials were performed in five electronic databases: PubMed/MEDLINE, Lilacs, CINAHL, Web of Science, and PEDro. The main outcome was urinary symptoms-frequency, nocturia, and urgency-and the secondary outcome quality of life. Some protocol characteristics were extracted, e.g., frequency, pulse width, intensity, intervention time, and electrode placement. Nine randomized controlled trials were included. Tibial neurostimulation showed better results than sacral neurostimulation for urge incontinence (mean difference = 1.25 episodes, 95% CI, 0.12-2.38, n = 73). On the pooled analysis, the different neurostimulation protocols-intravaginal, percutaneous tibial, and transcutaneous tibial nerve stimulation-demonstrated similar results for urinary frequency, nocturia, and urgency as well as quality of life. In general, effect sizes from meta-analyses were low to moderate. The best reported parameters for percutaneous tibial nerve stimulation were 20-Hz frequency and 200-μs width, once a week. There was evidence that tibial neurostimulation is more effective than sacral neurostimulation for urge incontinence symptoms among patients with non-neurogenic overactive bladder. Overall, there was no superiority of an electrical nerve stimulation electrode placement and protocol over others considering urinary symptoms and quality of life. Further studies with three-arm trials are necessary. This study was registered at PROSPERO: CRD4201810071.

The CO2 ablative laser treatment in perimenopausal patients with vulvovaginal atrophy.

The aim of the study was to evaluate the effectiveness of CO₂ fractional laser therapy on perimenopausal urogenital symptoms. This prospective, open-label study included 205 patients who received three CO₂ laser treatments. Clinical assessment was checked at baseline as well as at six weeks and 12 months post-treatment. The following scores were measured Vaginal Health Index Score (VHIS), International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and assessment of the severity of selected urogenital symptoms. Significant improvements in dryness, dyspareunia, burning, vaginal laxity, urinary incontinence, as were the results on the VHIS and ICIQ-UI SF at six weeks post-treatment (p < 0.05 for all scores), which were maintained through the follow-up visit at 12 months. No complications were observed either during or after laser therapy. CO₂ ablative laser treatment can be effective in reducing vulvovaginal atrophy symptoms such as vaginal laxity, dryness, painful sexual intercourse, burning, and decreases the severity of stress urinary incontinence and urge incontinence symptoms. Positive results were maintained at 12 months after the laser treatment.

URINARY INCONTINENCE AND BTL EMSELLA

In the article, the author analyzes urinary incontinence, the influence of kegel exercises and high-performance fossilized electromagnetic field technology to stimulate deep pelvic floor muscles and restore neuromuscular control using the BTL EMSELLATM device for urinary incontinence. EMSELLA uses high performance fossilized electromagnetic field (HIFEM) technology to stimulate deep pelvic floor muscles and restore neuromuscular control.It is designed for strengthening the muscles of the pelvic floor, shaping the muscles of the seat and treating urine leakage.Materials and methods. The study followed an institutional review board approved protocol. A total of 20 women (54.40 ± 11.70 years, 1.75 ± 1.38 deliveries) who showed symptoms of stress, urge, or mixed urinary incontinence were enrolled. They received six HIFEM treatments (2 per week) in duration of 28 minutes. Outcomes were evaluated after the sixth treatment and at the 3-month follow-up. The statistical analysis was conducted by paired T-test and Pearson correlation coefficient (α=0.05).Results. After the sixth session, 18 out of 20 patients (80.34%) reported significant reduction of their symptoms. The average improvement of 48.90% in ICIQ-SF score was observed after the sixth treatment, which further increased to 63.40% at the follow-up (both P &lt; 0.001). Individually, the highest level of improvement was reached in patients suffering from mixed urinary incontinence (68.95%). The reduction of absorbent pads averaged 45.85% after the sixth treatment and 54.78% at 3 months (both P &lt; 0.001), while almost 75% of patients (reported decreased number of used pads.Conclusions. This study demonstrated that HIFEM technology is able to safely and effectively treat a wide range of patients suffering from urinary incontinence. After six treatments, an improvement in ICIQ-SF score and reduction in absorbent pads usage was observed. Based on subjective evaluation, these changes positively influenced quality of life.

Do hysterectomy techniques affect sexual functions and lower urinary system complaints?

Aim: Hysterectomy is the most common gynecological surgical procedure. Therefore, detailed consultation about the postoperative effects of hysterectomy is an integral part of the operation. However, available data on these issues are limited and conflicting. The aim of this study is to evaluate the effects of hysterectomy types on lower urinary tract symptoms (LUTS), sexual function and quality of life. Methods: Patients between 38-60 years of age who underwent total laparoscopic hysterectomy (TLH), vaginal hysterectomy (VH), and, in addition to standard total abdominal hysterectomy (TAH), uterosacral ligament-cuff suturing operation between June 2017 and 2019 were included in this cross-sectional study. Urgency, urge incontinence, frequency, abnormal emptying, hesitancy, nocturia, overflow, and interrupted stream are considered LUTS symptoms. Sexual functions were evaluated by Index of Female Sexual Function Index (FSFI) and the quality of life was evaluated by the EQ-5D (European Quality of Life Five- Dimension Scale) during the post-operative period. Results: There was a significant decrease in urgency, urge incontinence, frequency, abnormal emptying, nocturia and interrupted stream symptoms (P<0.05) in the VH group (n=30), and urge and urge incontinence symptoms in TAH group (n=213) (P<0.05) postoperatively. In terms of the FSFI total score, the highest sexual dysfunction was in the TAH group whereas the lowest was in the TLH (n=60) group. Conclusions: Hysterectomy does not worsen LUTS. The best post-operative sexual functions were found in the TLH group. The post-operative quality of life was better in patients operated vaginally and laparoscopically.

Renal Transplantation and Renovascular Hypertension.

dermal estrogen: RR 1.68, 95% CI 1.41, 2.00; oral estrogen with progestin: RR 1.34, 95% CI 1.24, 1.44; transdermal estrogen with progestin: RR 1.46, 95% CI 1.16, 1.84). There was little risk after the cessation of hormones (RR 1.14, 95% CI 1.06, 1.23) and a decreasing risk of incontinence with increasing time since last hormone use; 10 years after stopping hormones, the risk was identical in women who had and had never taken hormone therapy (RR 1.02, 95% CI 0.91, 1.14). CONCLUSION: Postmenopausal hormone therapy appears to increase risk of developing urinary incontinence. This risk does not vary by route of administration, type of hormones, or dose taken, but is diminished upon cessation of use. Editorial Comment: This large study supports the randomized trials which have indicated that hormone therapy does not improve urinary symptoms. In fact,there was a significant increase in the risk of developing incontinence over 4 years in those taking postmenopausal hormone therapy at baseline,and this risk was similar for users of estrogen alone and estrogen combined with progestin,as well as users of oral or transdermal estrogen. The elevated risk was evident for short-term and long-term users but decreased after cessation of hormone therapy. Symptoms of stress and urge incontinence were not separated,however—a shortcoming of the study,as it is certainly possible that one type could be affected and not the other,and it is even possible that one type could be benefited. The authors acknowledge this in their discussion,and also the fact that (1) all information on hormone therapy and incontinence is self-reported,and (2) in an observational study it is possible that results are due to confounding but they point out that this potential is reduced because health professionals in this subject all had good access to health care and sound health knowledge regardless of their hormone use.

Vaginal estrogen therapy is associated with increased Lactobacillus in the urine of postmenopausal women with overactive bladder symptoms

Previous work has shown that the vaginal microbiome decreases in Lactobacillus predominance and becomes more diverse after menopause. It has also been shown that estrogen therapy restores Lactobacillus dominance in the vagina and that topical estrogen is associated with overactive bladder symptom improvement. We now know that the bladder contains a unique microbiome and that increased bladder microbiome diversity is associated with overactive bladder. However, there is no understanding of how quickly each pelvic floor microbiome responds to estrogen or if those changes are associated with symptom improvement. This study aimed to determine if estrogen treatment of postmenopausal women with overactive bladder decreases urobiome diversity. We analyzed data from postmenopausal participants in 2 trials (NCT02524769 and NCT02835846) who chose vaginal estrogen as the primary overactive bladder treatment and used 0.5 g of conjugated estrogen (Premarin cream; Pfizer, New York City, NY) twice weekly for 12 weeks. Baseline and 12-week follow-up data included the Overactive Bladder questionnaire, and participants provided urine samples via catheter, vaginal swabs, perineal swabs, and voided urine samples. Microbes were detected by an enhanced culture protocol. Linear mixed models were used to estimate microbiome changes over time. Urinary antimicrobial peptide activity was assessed by a bacterial growth inhibition assay and correlated with relative abundance of members of the urobiome. In this study, 12 weeks of estrogen treatment resulted in decreased microbial diversity within the vagina (Shannon, P=.047; Richness, P=.043) but not in the other niches. A significant increase in Lactobacillus was detected in the bladder (P=.037) but not in the vagina (P=.33), perineum (P=.56), or voided urine (P=.28). The change in Lactobacillus levels in the bladder was associated with modest changes in urgency incontinence symptoms (P=.02). The relative abundance of the genus Corynebacterium correlated positively with urinary antimicrobial peptide activity after estrogen treatment. Estrogen therapy may change the microbiome of different pelvic floor niches. The vagina begins to decrease in diversity, and the bladder experiences a significant increase in Lactobacillus levels; the latter is correlated with a modest improvement in the symptom severity subscale of the Overactive Bladder questionnaire.

Effects of an oral supplement based on cucurbita maxima and capsicum annum on symptoms of overactive bladder in female population: an observational study

IntroductionThe prevalence of overactive bladder (OAB) in women increases with age and is present in approximately 30 % of women over the age of 65 years. A high percentage of patients undergoing pharmacological therapy discontinue treatment for side effects and costs. Using an oral supplement (Kubiker®), consisting of vitamins, cucurbita maxima, capsicum annum, polygonum cuspidatum and l-Glutammin, for the control of urinary symptoms, could be a valid alternative. ObjectiveTo assess the efficacy and tolerability of this oral supplement in women affected by OAB. MethodsWe performed a retrospective, longitudinal, observational, cohort study of 84 patients affected by OAB, who received a prescription of Kubiker® for 12 weeks (2 tablets a day for the first month, then 1 tablet a day for 2 months). Primary outcome was to check the efficacy of therapy through questionnaire Patient global impression of improvement (PGI-I) after 12 weeks of therapy. The secondary outcome was to evaluate the difference in the answers of the Overactive Bladder Questionnaire (OAB-Q) before and after therapy. Adherence to therapy was also evaluated. ResultsData showed a positive effect of Kubiker® in the control of urinary symptoms after 12 weeks of therapy. Paired t-test used for the evaluation of OBS before and after the treatment showed a p-value < 0.001. The analysis of this questionnaire especially showed an improvement in the responses concerning the symptoms of urination urgency and urge incontinence. ConclusionTherapy with oral supplement based on vitamins (C and D), cucurbita maxima, capsicum annum, polygonum cuspidatum and l-Glutammin is an effective and well-tolerated treatment for overactive bladder.

Bioapigyn® Ointment of Pelvic Muscle Tonus Versus Pelvic Floor Muscle Training for the Treatment of Urinary Incontinence

Objective/Purpose: The purpose of this work was the assessment of the clinical efficacy and safety of Bioapigyn® vaginal ointment for pelvic muscle tonus compared to pelvic floor muscle training in alleviating the symptoms of stress, urge and mixed urinary incontinence and vulvo-vaginal disorders in child-bearing and menopausal & postmenopausal women. Materials and Methods: The experimental group consisted of 66 women was treated 28 days with Bioapigyn® ointment for pelvic muscle tonus (2.5 mL/day). The control group also consisted of 66 participants was subjected to pelvic floor muscle training during 28 days (five times a day). ICIQ-UI SF score, the residual urine volume, perineometry, the total score of vulvo-vaginal symptoms and vaginal pH were determined before and after the treatment or training. Results: Following the treatment with Bioapigyn® ointment ICIQ-UI-SF score decreased 54.9%, perineometry parameters increased between 31.5 and 34.3%, residual urine decreased for 76.9% and vaginal pH for 14.2%. All the symptoms of vulvo-vaginal disorders disappeared completely in all participants. The control group showed no changes in vaginal pH or the improvement concerning the vulvo-vaginal complaints. ICIQ- UI-SF score decreased for 4.3%, residual urine volume for 9.1% while perineometry parameters increased between 4.3 and 8.3%. Conclusion/Discussion: Bioapigyn® vaginal ointment for pelvic muscle tonus alleviate the symptoms of incontinence by tightening and firming of the smooth muscles of the pelvic floor thanks to the ingredients with smooth muscles contraction/relaxation and astringent properties. Low pH, high osmolarity, viscosity, greasiness and coating effect of the ointment eradicated vulvo-vaginal complaints.

Consideration of pelvic floor myofascial release for overactive bladder

IntroductionPhysical therapy has been shown to be effective for women with overactive bladder (OAB). We report on our experience with pelvic floor physical therapy (PFPT) with or without myofascial release as treatment for women with symptoms of urinary urgency or urge incontinence. MethodsWe performed a retrospective chart review, of patients who presented to our tertiary care Urogynecology practice. These women were evaluated and treated between August 2016 and December 2016. We abstracted for symptoms as per history of present illness and the pelvic floor muscle examination. PFPT progress notes were reviewed to determine whether patients received myofascial release techniques, or if therapy was limited to behavioral interventions and urge suppression techniques. We recorded the number of PFPT sessions attended, and whether the patient reported improvement. Results77 patients with symptoms of OAB met inclusion criteria and initiated PFPT. Myofascial tenderness of the pelvic floor muscles was found in 56.5% of patients. PFPT was limited to behavioral and urge suppression in 18 patients, while 59 patients received myofascial release techniques. Improvement was reported by 71.4% (n = 55/77) of patients. Improvement increased with number of sessions attended: 1–2: 6% (1/17), 3–5: 94% (16/17), 6–8: 91% (29/32), and >8: 80% (9/11) improved, respectively (p < 0.001). Among patients who had myofascial release, 84.7% reported improvement when compared to only 27.8% of patients without myofascial release. ConclusionsThe data support the inclusion of myofascial release during pelvic floor physical therapy for overactive bladder. At least three sessions of PFPT are necessary for patient reported improvement.

Treatment of Urinary Urgency Incontinence Using a Rechargeable SNM System: 6-Month Results of the ARTISAN-SNM Study

Sacral neuromodulation is a guideline recommended treatment of urinary dysfunction and fecal incontinence in patients in whom conservative treatments have failed. Historically sacral neuromodulation has been delivered using a nonrechargeable device with an average life span of 4.4 years. Surgery is required to replace the implanted neurostimulator due to battery depletion. Implantation of a long-lived implanted neurostimulator can eliminate the need for replacement surgeries, potentially reducing patient surgical risks and health care costs. The Axonics r-SNM System™ is a miniaturized, rechargeable sacral neuromodulation system designed to deliver therapy for at least 15 years. The ARTISAN-SNM (Axonics® Sacral Neuromodulation System for Urinary Urgency Incontinence Treatment) study is a pivotal study using rechargeable sacral neuromodulation therapy to treat urinary urgency incontinence. Six-month results are presented. A total of 129 eligible patients with urinary urgency incontinence were treated. All participants were implanted with a tined lead and the rechargeable sacral neuromodulation system in a nonstaged procedure. Efficacy data were collected using a 3-day bladder diary, the validated ICIQ-OABqol (International Consultation on Incontinence Questionnaire Overactive Bladder quality of life) questionnaire and a participant satisfaction questionnaire. Therapy responders were identified as participants with a 50% or greater reduction in urinary urgency incontinence episodes compared to baseline. We performed an as-treated analysis in all implanted participants. At 6 months 90% of participants were therapy responders. The mean ± SE number of urinary urgency incontinence episodes per day was reduced from 5.6 ± 0.3 at baseline to 1.3 ± 0.2. Participants experienced a clinically meaningful 34-point improvement on the ICIQ-OABqol questionnaire. There were no serious device related adverse events. The Axonics r-SNM System is safe and effective with 90% of participants experiencing clinically and statistically significant improvements in urinary urgency incontinence symptoms.

Safety and Efficacy of a Non-Invasive High-Intensity Focused Electromagnetic Field (HIFEM) Device for Treatment of Urinary Incontinence and Enhancement of Quality of Life.

Background and ObjectivesUrinary incontinence is a common and distressing condition which interferes with everyday life. Patients frequently experience discomfort related to urine leakage and the subsequent need to use absorbent pads. Since the continence mechanism is primarily maintained by a proper function of pelvic floor muscles (PFM), many treatment methods focused on strengthening of the PFM have been introduced in the past. The aim of this study was to evaluate the safety and efficacy of a high‐intensity focused electromagnetic technology (HIFEM) for treatment of urinary incontinence with emphasis on effects on prospective patients’ quality of life.Study Design/Materials and MethodsThe study followed an institutional review board approved protocol. A total of 75 women (55.45 ± 12.80 years, 1.85 ± 1.28 deliveries) who showed symptoms of stress, urge, or mixed urinary incontinence were enrolled. They received six HIFEM treatments (2 per week) in duration of 28 minutes. Outcomes were evaluated after the sixth treatment and at the 3‐month follow‐up. The primary outcome was to assess changes in urinary incontinence by the International Consultation on Incontinence Questionnaire‐Short Form (ICIQ‐SF) and changes in the number of absorbent pads used per day. The secondary outcome was subjective evaluation of the therapy and self‐reported changes in quality of life. The statistical analysis was conducted by paired T‐test and Pearson correlation coefficient ( α = 0.05).ResultsAfter the sixth session, 61 out of 75 patients (81.33%) reported significant reduction of their symptoms. The average improvement of 49.93% in ICIQ‐SF score was observed after the sixth treatment, which further increased to 64.42% at the follow‐up (both P < 0.001). Individually, the highest level of improvement was reached in patients suffering from mixed urinary incontinence (69.90%). The reduction of absorbent pads averaged 43.80% after the sixth treatment and 53.68% at 3 months (both P < 0.001), while almost 70% of patients (30 out of 43) reported decreased number of used pads. At the follow‐up, a highly significant medium correlation (r = 0.53, P < 0.001) was found between the ICIQ‐SF score improvement and the reduction in pad usage. A substantial decrease in the frequency of urine leakage triggers was documented. Patients reported no pain, downtime or adverse events, and also reported additional beneficial effects of the therapy such as increased sexual desire and better urination control.ConclusionsThis study demonstrated that HIFEM technology is able to safely and effectively treat a wide range of patients suffering from urinary incontinence. After six treatments, an improvement in ICIQ‐SF score and reduction in absorbent pads usage was observed. Based on subjective evaluation, these changes positively influenced quality of life. © 2019 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.