Symptoms Of Urgency Research Articles

The natural history of urinary incontinence subtypes in the Nurses’ Health Studies

Urinary incontinence subtypes often differ by symptom severity and treatment profiles; in particular, mixed urinary incontinence is generally associated with worse symptoms and less successful treatment. Yet, limited information exists on the natural history of different urinary incontinence subtypes, which could help to better identify and treat patients prior to development of more intractable disease. To evaluate the onset of urinary incontinence subtypes, and transitions between subtypes over 8 years, using 2 large cohorts of middle-aged and older women with incident urinary incontinence. We identified 10,349 women with incident urinary incontinence (stress, urgency, and mixed subtypes) from the Nurses' Health Study and the Nurses' Health Study II who were 41-83 years of age, using repeated mailed questionnaires. We defined stress urinary incontinence as leakage with coughing, sneezing, or activity; urgency urinary incontinence as urine loss with a sudden feeling of bladder fullness or when a toilet was inaccessible; and mixed urinary incontinence when women reported that stress and urgency symptoms occurred equally. In subsequent questionnaires 4 and 8 years later, we continued to track symptom severity and subtypes. In addition, to obtain predicted probabilities of urinary incontinence subtypes 4 years and 8 years after urinary incontinence onset, we used multivariable-adjusted generalized estimating equations with a multinomial outcome. At urinary incontinence onset in 2004-2005, 56% of women reported stress urinary incontinence symptoms, 23% reported urgency urinary incontinence symptoms, and 21% reported mixed urinary incontinence symptoms. Women with stress urinary incontinence or urgency urinary incontinence at onset were likely to report the same urinary incontinence type 4 and 8 years later (stress urinary incontinence at onset: 70% and 60% reported stress urinary incontinence at years 4 and 8, respectively; urgency urinary incontinence at onset: 68% and 64% reported urgency urinary incontinence at years 4 and 8, respectively). Nonetheless, for both stress and urgency urinary incontinence, women with more severe symptoms at onset were more likely to progress to mixed urinary incontinence. Women with mixed urinary incontinence at onset had more variation over time, although the largest subset continued to report mixed urinary incontinence (45% reported mixed urinary incontinence at year 4; 43% reported mixed urinary incontinence at year 8). Few women across all urinary incontinence subtypes reported resolution of symptoms over 4-8 years of follow-up (4-12%). When considering the likelihood of remaining with or progressing to mixed urinary incontinence over follow-up, according to age, body mass index, and urinary incontinence severity, we found that older and younger women had similar predicted probability of remaining with or progressing to mixed urinary incontinence (eg, women <60 years of age at onset with severe mixed urinary incontinence had a 54% (95% confidence interval, 53-55) probability of mixed urinary incontinence 8 years later, vs 57% (95% confidence interval, 56-58) of women ≥70 years of age with severe mixed urinary incontinence at onset). Obese women were somewhat more likely to progress to mixed urinary incontinence regardless of urinary incontinence type at onset (eg, women with body mass index <25 kg/m2 at onset with severe stress urinary incontinence had a 30% predicted probability of mixed urinary incontinence 8 years after onset, vs 36% of women with body mass index of 30+ kg/m2 at onset with severe stress urinary incontinence). Most women with incident stress and urgency urinary incontinence continued to experience similar subtype symptoms over 8 years. However, obese women and those with more severe symptoms were more likely to remain with or progress to mixed urinary incontinence.

Symptoms of overactive bladder (OAB) in patients treated for depressive disorders

Aim of the studyThe aim of the study was to investigate the correlation between symptoms of overactive bladder (OAB) and severity of depressive symptoms in patients treated for depression.Subject or material and methods102 patients (43 m, 59 f) aged 20–67 (M = 46.1±11,3) treated for depression were included. OAB symptoms were examined with the International Prostate Symptom Score (IPSS) and International Consultation on Incontinence Questionnaire Overactive Bladder Module (ICIQ-OAB). OAB-related quality of life - with the International Consultation on Incontinence Questionnaire Overactive Bladder Quality of Life Module (ICIQ-OABqol). Depressive symptoms - with the 17-item Hamilton Depression Rating Scale (HDRS) and Quick Inventory of Depressive Symptomatology – Self Report (QIDS-SR).ResultsSymptoms of OAB were more severe in women than in men. In the entire group highest scores in IPSS of assessed OAB symptoms were observed in nocturia, followed by urinary frequency and lowest in urgency. Symptoms of OAB were more bothersome in women, than in men. Patients suffering from at least moderate depression assessed with QIDS-SR had significantly more pronounced symptoms of urinary frequency and urgency. A number of other significant correlations were observed.DiscussionOAB symptoms are common among patients treated for depressive disorders. There is a correlation between severity of depressive symptoms and OAB. OAB is bothersome and affects the quality of life in patients treated for depression.ConclusionsComorbidity of OAB and depression has clinical significance and that should enhance interdisciplinary treatment approaches. Due to limitations of this study, further researches are essential to reveal more details of the correlation between OAB and depression.

Noninvasive spinal neuromodulation to map and augment lower urinary tract function in rhesus macaques

Dysfunction of the lower urinary tract (LUT) is prevalent in neurological disorders, including multiple sclerosis, stroke, spinal cord injury and neurodegenerative conditions. Common symptoms include urgency, incontinence, and urinary retention. Recent advances in neuromodulation have resulted in improved treatments for overactive bladder symptoms of urgency, frequency, and nocturia. However, there are presently no treatments available for the induction of voiding to overcome urinary retention. We demonstrate that transcutaneous spinal cord stimulation (TSCS), a non-invasive intervention, applied over the thoracolumbar spine in neurologically intact rhesus macaques can activate the LUT, including activation of the bladder detrusor muscle, the urethral sphincter and pelvic floor muscles. Urodynamic studies show improved voiding efficiency and decreased post-voiding residual volumes in the bladder, while maintaining coordinated activity in the detrusor and sphincter with physiologic detrusor peak pressure, contraction duration, and urine flow rate remaining unchanged. We conclude that TSCS may represent a novel approach to activate the LUT and enable voiding in select neurological conditions.

Uterus-preserving Laparoscopic Lateral Suspension with Mesh Operation in Pelvic Organ Prolapse: Initial Experience in a Single Tertiary Center with a Median 24-Month Follow-up.

Introduction Laparoscopic lateral suspension with mesh (LLSM) is an effective and less invasive technique for the correction of pelvic organ prolapse. We discuss the primary objectives, subjective success rate and pelvic floor ultrasound outcomes of uterus-preserving LLSM operations. Patients and Methods Seventeen patients who underwent uterus-preserving LLSM (abdominocervicopexy) in a tertiary center were included in this prospective study. Anatomical cure was defined separately for the apical and anterior compartments as a Pelvic Organ Prolapse Quantification (POP-Q) score of less than − 1 cm for each compartment. Subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia and constipation were assessed. Transperineal ultrasonography was used to measure anterior compartment mobility and hiatal anteroposterior diameter. Results The anatomical cure rate was 100% for the apical and 88.2% for the anterior compartment, with one symptomatic stage-II cystorectocele and one asymptomatic stage-II cystocele. The subjective cure and patient satisfaction scores were 94.12 and 100%, respectively. Ba and C points were significantly improved, and vaginal lengthening was 10.14 ± 4.19 mm. Bp ascent was 5.72 ± 11.27 mm (p = 0.053). Proximal urethral rotation and retrovesical angles were reduced by 6.24 ± 11.95° and 27 ± 47.2°, respectively (p1 = 0.047; p2 = 0.032). The hiatal anteroposterior diameter was shortened by 4.36% (p = 0.039). A significant improvement was seen with regard to nocturia episodes but not for constipation. No mesh exposure was observed. Conclusions Uterus-preserving LLSM (abdominocervicopexy) was found to be effective for the correction of apical and anterior prolapse with high levels of patient satisfaction. Significant improvements in urge symptoms and frequency of nocturia were observed. Pelvic floor ultrasound outcomes may be useful when comparing this procedure with other surgical techniques.

The association of vulvar pain and urological urgency and frequency: findings from a community-based case-control study.

Vulvodynia is chronic debilitating burning vulvar pain or pain on contact. Although women who suffer from vulvodynia are more likely than others to experience co-morbid interstitial cystitis (IC) and urinary tract infections (UTIs), few studies have explored whether women with vulvodynia experience adverse urinary symptoms (lower urinary tract symptoms [LUTS]) in the absence of urological pain. Two hundred and eleven participants with and 226 participants without clinically confirmed vulvodynia completed the Pelvic Pain and Urgency/Frequency (PUF) questionnaire and were scored using all questions, and then a subset of questions relating only to their current frequency and bother of urination during day and night, and the frequency, severity and bother of urgency after voiding. Total, symptom, and bother scores were compared in women with and without vulvodynia, and regression models estimated adjusted odds ratios and 95% confidence intervals for the various LUTS symptoms. As expected, 40% of women with vulvodynia met the criteria for IC (PUF > 12) compared with 2% without vulvodynia. After excluding questions related to bladder or vulvovaginal pain, women with vulvodynia, compared with those without, were skewed toward higher PUF scores, including being 2.4 times more likely to report usually or always bothered by night-time voiding (95% CI 1.22-4.74), and 18 times more likely to report moderate/severe urgency after urination (95% CI 5.48-64.12). Women with vulvodynia are substantially more likely to report voiding dysfunction and symptoms of urgency than women with no history of vulvar pain. These findings are independent of comorbid interstitial cystitis or history of UTIs.

Treatment efficacy of tolterodine versus belladonna mixture in children with idiopathic overactive bladder

ObjectivesChildren with symptoms of urinary urgency, frequency and incontinence are common in the clinic. The aim of the present study was to compare the tolerability and efficacy of tolterodine, a...

A Low FODMAP Diet May Reduce Symptoms in Patients With Fecal Incontinence.

INTRODUCTION:Fecal incontinence (FI) is a common complaint and is often associated with diarrhea and urgency. Foods high in fermentable oligo-, di-, and mono-saccharides and polyols (FODMAP) cause symptoms of diarrhea and urgency. Therefore, this study assesses the impact of a low FODMAP diet on the occurrence of FI due to loose stool.METHODS:This study is a retrospective chart review of patients with FI seen in the Michigan Bowel Control Program clinic between August 2012 and December 2017. Patients who had FI with loose stool without red flag signs and who were recommended a low FODMAP diet and underwent formal dietary instruction with a Michigan Medicine dietician were included.RESULTS:Sixty-five patients with FI who underwent formal dietary teaching were included in this study. Eighty-eight percent of the patients were white, and 87% were women with a mean age of 62 years (±14 years). Additionally, the chart review showed that 35% of the patients had FI daily, 21.5% had FI weekly, and 5% had FI monthly. About 64.6% of the patients (42) had reported a reduction in their FI symptoms with the low FODMAP diet. There was no demographic or clinical characteristic that predicted the response to a low FODMAP diet.DISCUSSION:In this case series, dietary manipulation with a low FODMAP diet was a useful tool to treat patients who suffer from FI due to loose stool. Further confirmatory, prospective randomized controlled trials are required to see the true efficacy of a low FODMAP diet in patients who suffer with FI.

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.

Botulinum toxin type A intravesical injections for overactive bladder under local anaesthesia the causeway experience

Introduction: Overactive Bladder (OAB) and Detrusor Overactivity (DO) are associated with symptoms of urgency, frequency and nocturia, with or without incontinence. Botulinum Toxin has rapidly become established as a treatment option for an Overactive Bladder (OAB).

Improving our understanding of the relationship between emotional abuse and substance use disorders: the mediating roles of negative urgency and posttraumatic stress disorder

Background: Emotional abuse is associated with an increased risk for substance use disorders (SUDs) as well as with negative urgency and posttraumatic stress disorder (PTSD) following a subsequent trauma. Both negative urgency and PTSD are key contributors to the relationship between emotional abuse and SUDs when examined separately. A comprehensive model including both factors can inform models of PTSD-SUD comorbidity. Furthermore, the comparison of these mechanistic roles in emotional versus other types of abuse can shed light on the specificity of these effects. Objectives: The present study tested whether negative urgency and PTSD symptom severity serially mediated the relationship between emotional abuse and substance use across two separate samples. Method: Participants were recruited from a detoxification center and completed a battery of surveys examining abuse history, PTSD symptom severity, and impulsivity measures including negative urgency and substance use history during the last 3 months. The samples consisted of predominantly (59% and 62%) males with an average age of 35 (age range: 18–65). The majority of participants (90% and 93%) were Caucasian. Results: Study 1 (N = 368) and Study 2 (N = 274) both found that negative urgency and PTSD symptom severity serially mediated the relationship between emotional abuse and substance use. When comparing indirect effects, both contributed equally. Conclusion: These findings suggest that negative urgency and PTSD symptom severity together account more for the link between emotional abuse and SUDs than either alone and argue for the inclusion of negative urgency in models of PTSD-SUD comorbidity.

Female lower urinary tract microbiota do not associate with IC/PBS symptoms: a case-controlled study.

The current etiology of interstitial cystitis/painful bladder syndrome (IC/PBS) is poorly understood and multifactorial. Recent studies suggest the female urinary microbiota (FUM) contribute to IC/PBS symptoms. This study was designed to determine if the FUM, analyzed using mid-stream voided urine samples, differs between IC/PBS patients and controls. This prospective case-controlled study compared the voided FUM of women with symptoms of urinary frequency, urgency, and bladder pain for > 6months with the voided FUM of healthy female controls without pain. Bacterial identification was performed using 16S rRNA gene sequencing and EQUC, a validated enhanced urine culture approach. Urotype was defined by a genus present at > 50% relative abundance. If no genus was present above this threshold, the urotype was classified as 'mixed.' Group comparisons were performed for urotype and diversity measures. A mid-stream voided specimen was collected from 21 IC/PBS patients and 20 asymptomatic controls. The two groups had similar demographics. Urotypes did not differ between cohorts as assessed by either EQUC or 16S rRNA gene sequencing. We detected no significant differences between cohorts by alpha diversity. Cohorts also were not distinct using principle component analysis or hierarchical clustering. Detection by EQUC of bacterial species considered uropathogenic was high in both cohorts, but detection of these uropathogenic species did not differ between groups (p = 0.10). Enhanced culture and DNA sequencing methods provide evidence that IC/PBS symptoms may not be related to differences in the FUM, at least not its bacterial components. Future larger studies are needed to confirm this preliminary finding.

Yoga for Women With Urgency Urinary Incontinence: A Pilot Study.

The objective of this study was to evaluate the feasibility of a gentle yoga program for women with urgency urinary incontinence (UUI). Also, these preliminary data can evaluate if yoga improves symptom burden, quality of life, and inflammatory biomarkers for women with UUI. This prospective nonrandomized single-arm pilot study evaluated the effectiveness of a twice-weekly, 8-week gentle yoga intervention to reduce UUI symptom burden. Changes in symptom burden were measured using the Pelvic Floor Distress Inventory 20. Secondary measures included quality of life, depressive symptoms, sleep, stress, anxiety, and inflammatory biomarkers. Outcomes were evaluated with paired t testing. Twelve women completed the yoga intervention with no adverse outcomes noted. Urgency symptom burden was significantly improved after the intervention (P = 0.01), and women reported an increase in quality of life (P = 0.04) after the yoga intervention. Following the yoga intervention, the majority of women reported symptoms as "much better" (n = 4 [33%]) and "a little better" (n = 5 [42%]), with 3 women (25%) reporting "no change." Women also reported significant reduction in depressive symptoms (P = 0.03) and better quality of sleep (P = 0.03). No significant changes were found in anxiety or stress perception. Plasma levels of the inflammatory biomarker tumor necrosis factor α were reduced after yoga intervention (P = 0.009); however, no significant postyoga changes were found for interleukin 6 or C-reactive protein. This study provides preliminary evidence that yoga is a feasible complementary therapy that reduces incontinence symptom burden, along with improving quality of life, depressive symptoms, and sleep quality. Additionally, yoga may lower inflammatory biomarkers associated with incontinence.

Annals for Educators - 2 April 2019.

Annals for Educators - 2 April 2019.

Diabetes Decreases HDAC7 Expression and Increases Lysine Acetylation in Bladder Tissue from Type 1 Diabetic Rats: a Potential Posttranslational Mechanism in Diabetic Bladder Dysfunction

BackgroundDiabetic bladder dysfunction (DBD) encompasses a broad spectrum of complications that affect over 50% of individuals with diabetes mellitus. While symptoms can greatly affect these individuals' quality of life, there are currently no targeted therapies available. Our focus is the early compensated phase, characterized by symptoms of urinary urgency and overactive bladder. Recent studies have shown that lysine acetylation, a post‐translational modification, may be associated with diabetic complications. We hypothesized that changes in acetyltransferase regulation result in increased lysine acetylation in bladder tissue, which in turn contribute to the pathogenesis of DBD.Materials and MethodsAdult male Wistar rats were randomized into two experimental groups. The diabetic group received a single intraperitoneal injection of 65 mg/kg of STZ in 0.01 M Sodium Citrate. Diabetes was confirmed with fasting glucose levels greater than 150 mg/dL. The control group received an equal volume of vehicle via intraperitoneal injection. 6 weeks post‐injection, DBD was confirmed with void spot assay. Rats were euthanized under isoflurane (via nasal in 100% O2) and the bladders were removed for molecular and histological analysis. Blood samples were collected for biochemical analysis.ResultsDiabetic animals showed higher levels of fasting glucose (433.5 ± 28.7 vs. 90.43 ± 1.36 mg/dL control, p&lt;0.02, n=15), and decreased body weight (516.6 ± 18.8 vs. 376.1 ± 18.1 grams control, p&lt;0.001, n=15). Diabetic animals also exhibited lipid profile changes, including increased triglycerides (522.7 ± 55.4 vs. 68.03 ± 11.7 mg/dL control, p&lt;0.0002, n=10) and increased free fatty acids (0.663 ± 0.047 vs. 0.433 ± 0.034 mM control, p&lt;0.005, n=13). Diabetic animals also showed increased bladder weight (0.2006 ± 0.0189 vs. 0.1344 ± 0.0557 grams control, p&lt;0.015, n=8). Void spot assays confirmed an increase in overall voiding volume in diabetic rats (62.22 ± 12.2 vs. 6.198 ± 2.62 % of paper with urine control, p&lt;0.01, n=10). Histological analysis showed detrusor hypertrophy in diabetic animals (1465.17 ± 62.92 vs. 1073.92 ± 125.84 μm control, p&lt;0.0001). Global lysine acetylation was increased in experimental bladder tissue (55% in comparison to controls, p&lt;0.005). A 90% decrease in HDAC7 expression was detected in diabetic rats compared to controls (p&lt;0.0001, n=12).ConclusionOur findings suggest that downregulation of HDAC7 associated with hyperacetylation of diabetic bladder tissue indicates a potential therapeutic target for DBD. Using molecular and pharmacological approaches to overexpress HDAC7, we will confirm its role in DBD etiology. These molecular insights will improve our understanding of this complex condition, leading to the development of targeted interventions for the early phases of DBD.Support or Funding InformationIn‐house Grant NYITThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

MP62-11 SUPERNATANT FROM ACUTE UROPATHOGENIC E-COLI INFECTION EXCLUSIVELY SENSITISES HIGH THRESHOLD BLADDER AFFERENTS AND RECRUITS ‘SILENT NOCICEPTORS’

INTRODUCTION AND OBJECTIVES:Uropathogenic E. coli (UPEC) is the primary cause of adult urinary tract infection (UTI) inducing the clinical symptoms of urgency, urinary frequency, and acute pelvic p...

Cognitive function assessment in elderly patients with overactive bladder treated with transdermal oxybutynin

Introduction and objectivesOlder patients with overactive bladder under antimuscarinic treatment are especially susceptible to cognitive impairment. The aim was to assess short term changes in cognitive function in elderly patients with overactive bladder treated with transdermal oxybutynin. Materials and methodsObservational, retrospective, multicentre study in patients with overactive bladder aged 65–80 years undergoing treatment with transdermal oxybutynin. Before and after one month of treatment, cognitive function using the Memory Alteration Test and Clock-Drawing Test, changes in symptoms with validated questionnaires, patient perception of treatment response using Treatment Benefit Scale and treatment adherence with the modified Morisky–Green test, were assessed. ResultsFrom 85 eligible patients, 70 completed the assessment (mean age: 71.4±4.5; BMI: 28.7±3.1kg/m2). No cognitive impairment was observed after one month with transdermal oxybutynin: Memory Alteration Test (+1 point; 95%CI: 0.0–1.5), Clock-Drawing Test (0 points; 95%CI: 0.0–0.0). A statistically significant improvement (p<0.001) was observed in all urinary storage symptoms, except stress urinary incontinence. There was an improvement in the Bladder Control Self-Assessment Questionnaire (symptom score: −2.27; 95%CI: −2.8, −1.7; p<0.001; bother score: −2.73; 95%CI: −3.3, −2.1; p<0.001). 70% of patients reported either a stable or improved bladder condition according to the Patient Perception of Bladder Condition questionnaire. 72.8% of patients reported that their urinary problems had improved or greatly improved with an 84.3% treatment adherence. ConclusionsNo cognitive impairment was observed in elderly patients after one month of treatment with transdermal oxybutynin; urinary urgency symptoms improved and there was adequate treatment adherence.

The Temporal Relationship between Catastrophizing and Chronic Pain

POSTER ABSTRACTIntroduction/Aim: Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a chronic pelvic pain syndrome characterized by persistent pain localized to the bladder and urologic symptoms of urgency, frequency, and dysuria (Nickel et al., 2009). While the temporal relationship between catastrophizing and chronic pain has been examined in other chronic pain populations (e.g., Campbell et al., 2012), the present study is the first to investigate this temporal relationship in an IC/BPS sample.Methods: 151 women diagnosed with IC/BPS were recruited from tertiary care urologyclinics and completed the Short Form McGill Pain Questionnaire and the Pain Catastrophizing Scale at baseline (Time 1), 6 months post-baseline (Time 2), and 12-months post-baseline (Time 3). Two cross-lagged panel analysis were conducted using residualized change scores.Results: Increases in catastrophizing between Time 1 and Time 2 (Early Catastrophizing Change) predicted increases in pain between Time 2 and Time 3 (Later Pain Change), after controlling for early changes in pain and later changes in catastrophizing. In contrast, increases in pain between Time 1 and Time 2 (Early Pain Change) did not predict increases in catastrophizing between Time 2 and Time 3 (Later Catastrophizing Change), after controlling for early changes in catastrophizing and later changes in pain.Discussion/Conclusions: Early increases in catastrophizing predict later increases in pain levels among patients with IC/BPS, but not vice versa. These findings add to the growing body of research emphasizing the importance of catastrophizing in the development and maintenance of chronic pain. Clinical implications include targeting catastrophizing for the management of IC/BPS pain.

12: Repair of rectovaginal fistula, external anal sphincteroplasty, and perineorrhaphy

To describe and demonstrate the surgical technique for repair of distal rectovaginal fistula, with concomitant external anal sphincteroplasty, and perineorrhaphy. The patient is a 29 year old G1P1 who underwent a spontaneous vaginal delivery complicated by a fourth degree perineal laceration three weeks prior. This was repaired at the time of delivery. She presented with symptoms of fecal urgency and flatal incontinence. On exam, she was noted to have a large anterior external anal sphincter defect, attenuated perineal body, and a 2 mm rectovaginal fistula 1 cm proximal the external anal sphincter complex. Repair of distal rectovaginal fistula can be accomplished at the time of external anal sphincteroplasty and perineirrhaphy, utilizing the same perineal incision.

Uva-ursi extract and ibuprofen as alternative treatments for uncomplicated urinary tract infection in women (ATAFUTI): a factorial randomized trial

ObjectivesThe aim was to investigate if offering symptomatic therapy (Uva-ursi or ibuprofen) alongside a delayed prescription would relieve symptoms and reduce the consumption of antibiotics for adult women presenting with acute uncomplicated urinary tract infection (UTI). MethodsA 2 × 2 factorial placebo controlled randomized trial in primary care. The participants were 382 women aged 18–70 years with symptoms of dysuria, urgency, or frequency of urination and suspected by a clinician to have a lower UTI. The interventions were Uva-ursi extract and/or ibuprofen advice. All women were provided with a delayed or ‘back-up’ prescription for antibiotics. Missing data were imputed using multiple imputation methods (ISRCTN registry: ISRCTN43397016). ResultsAn ITT analysis of mean score for frequency symptoms assessed on Days 2–4 found no evidence of a difference between Uva-ursi vs. placebo –0.06 (95% CI –0.33 to 0.21; p 0.661), nor ibuprofen vs. no ibuprofen advice –0.01 (95% CI –0.27 to 0.26; p 0.951). There was no evidence of a reduction in antibiotic consumption with Uva-ursi (39.9% vs. placebo 47.4%; logistic regression odds ratio (OR) 0.59 (95% CI 0.22–1.58; p 0.293) but there was a significant reduction for ibuprofen advice (34.9% vs. no advice 51.0%; OR 0.27 (95% CI 0.10 to 0.72; p 0.009). There were no safety concerns and no episodes of upper tract infection were recorded. ConclusionsWe found no evidence of an effect of either intervention on the severity of frequency symptoms. There is evidence that advice to take ibuprofen will reduce antibiotic consumption without increasing complications. For every seven women given this advice, one less will use antibiotics.

N10 Living with and managing symptoms of fatigue, pain and urgency in IBD: an exploratory qualitative study

N10 Living with and managing symptoms of fatigue, pain and urgency in IBD: an exploratory qualitative study