Urge Incontinence Research Articles

Younger Age Is Associated With Pelvic Floor Muscle Dysfunction in Women With Urinary Symptoms.

Recent articles have highlighted the existence of pelvic floor myofascial dysfunction in women presenting with pelvic floor disorders. The aim of the study was to evaluate whether younger age is associated with pelvic floor muscle dysfunction in women with lower urinary tract symptoms, including urinary urgency, frequency, nocturia, and urinary incontinence. This retrospective cohort study included women seeking an initial outpatient urogynecology evaluation for urinary symptoms from 8/2018 to 2/2022. The primary outcome was the presence of pelvic floor muscle dysfunction, defined as a diagnosis of levator myalgia/spasm. Multivariable logistic regression was used to evaluate the association. Four hundred twenty-one women with lower urinary tract symptoms were included, and 115 (27.3%) were diagnosed with pelvic floor muscle dysfunction. Women with pelvic floor dysfunction were 13 years younger, less likely to report any incontinence (60% vs 71.9%, P = 0.026) and urgency incontinence (8.7% vs 17.3%, P = 0.04). There was no difference in reported urgency, frequency, or nocturia. Women with pelvic floor dysfunction were more likely to report dysuria (19.1% vs 9.5%, P = 0.012), dyspareunia (39% vs 7.5%, P < 0.001), vulvodynia (11.3% vs 2.3%, P < 0.001), and pelvic pain (25.2% vs 7.2%, P < 0.001). The odds of pelvic floor muscle dysfunction in women <40 years old was 2.34 times greater than women ≥40 years old, after adjusting for other factors (adjusted odds ratio 2.341, 95% confidence interval [1.102, 4.972]). Younger women with lower urinary tract symptoms were significantly more likely to have pelvic floor muscle dysfunction compared to older women with similar symptoms, even after controlling for other associated characteristics.

Effects of Nitric Oxide on Bladder Detrusor Overactivity through the NRF2 and HIF-1α Pathways: A Rat Model Induced by Metabolic Syndrome and Ovarian Hormone Deficiency.

Metabolic syndrome (MetS) includes cardiovascular risk factors like obesity, dyslipidemia, hypertension, and glucose intolerance, which increase the risk of overactive bladder (OAB), characterized by urgency, frequency, urge incontinence, and nocturia. Both MetS and ovarian hormone deficiency (OHD) are linked to bladder overactivity. Nitric oxide (NO) is known to reduce inflammation and promote healing but its effect on bladder overactivity in MetS and OHD is unclear. This study aimed to investigate NO's impact on detrusor muscle hyperactivity in rats with MetS and OHD. Female Sprague-Dawley rats were divided into seven groups based on diet and treatments involving L-arginine (NO precursor) and L-NAME (NOS inhibitor). After 12 months on a high-fat, high-sugar diet with or without OVX, a cystometrogram and tracing analysis of voiding behavior were used to identify the symptoms of detrusor hyperactivity. The MetS with or without OHD group had a worse bladder contractile response while L-arginine ameliorated bladder contractile function. In summary, MetS with or without OHD decreased NO production, reduced angiogenesis, and enhanced oxidative stress to cause bladder overactivity, mediated through the NF-kB signaling pathway, whereas L-arginine ameliorated the symptoms of detrusor overactivity and lessened oxidative damage via the NRF2/HIF-1α signaling pathway in MetS with or without OHD-induced OAB.

Childhood nocturnal enuresis and clinical course of overactive bladder in women

Background. Overactive bladder (OAB) and nocturnal enuresis are among the most common causes of urinary dysfunction in adults and children, respectively. The pathogenesis factors of OAB and nocturnal enuresis largely coincide. Among adults with OAB, a large proportion of patients have a history of nocturnal enuresis. Aim. To study the features of the clinical course of OAB in women with childhood nocturnal enuresis. Materials and methods. The study included 212 women with OAB (mean age 54.1±0.8 years), who were divided into two groups depending on the presence of the history of childhood nocturnal enuresis. Group 1 included 41 (19.3%) patients with childhood nocturnal enuresis, group 2 included 171 (80.7%) women without a history of childhood nocturnal enuresis. All patients underwent a comprehensive urodynamic study. Results. The severity of clinical symptoms of OAB did not differ between patients of groups 1 and 2. Predictors of a more severe clinical course of OAB and a greater likelihood of developing urge incontinence were the presence of a non-monosymptomatic form of enuresis and an age of cessation of enuresis of 10 years or older. Women from group 1 also showed a higher incidence of detrusor overactivity compared to group 2 (29.3% vs 10.5%). Conclusion. The results of the study indicate a connection between childhood nocturnal enuresis and the clinical course of OAB in adult women.

Prevalence, bother, and impact on pelvic floor muscles of vaginal noise among middle-aged women

BackgroundVaginal noise (VN) is a natural phenomenon that arises when air is forced into the vagina and then expelled as the vaginal wall muscles naturally contract. It has been described as involuntarily passing gas from the vagina. VN is a symptom of pelvic floor (PF) dysfunction and can cause social and psychological issues. Data on it is limited, and women rarely voluntarily report it. So, this study was conducted to determine the prevalence, bother, and relation between VN and PF muscle dysfunction.Material and methodsIt was a cross-sectional study that included females with age ranges from 30 to 60 years old, body mass index (BMI) ranges from 18 to 30 kg/m2, married, single, virgin, nulliparous, and multiparous women; those with previous one or more vaginal deliveries or cesarean sections (CS) or history of anterior and/or posterior vaginal wall prolapses; and those who had undergone medical interventions such as vaginal surgeries (e.g., pelvic floor reconstruction, hysterectomy), stress urinary incontinence, urge incontinence, and fecal incontinence. The Vaginal Wind Questionnaire, Pelvic Floor Impact Questionnaire-Short Form 7 (PFIQ-7), and Pelvic Floor Bother Questionnaire were used as methods of evaluating the VN prevalence and bother and its relation to PF dysfunction.ResultsIt was noted that there was a 76.3% prevalence of VN and 75% bother among the study population. Eighty-eight percent of them did not seek any treatment, and VN occurred in 84.3% of females with pelvic floor muscle weakness.ConclusionVN is common in middle-aged Egyptian women, most frequently occurring with sexual intercourse, vaginal delivery, and pelvic floor muscle weakness.

Recurrence of spinal schwannomas in a patient with neurofibromatosis type 1: a case report

Introduction and importance: Spinal schwannomas are benign tumors usually attached to peripheral nerves, consisting of a clonal population of Schwann cells. Neurofibromatosis type 1 is an autosomal dominant neurocutaneous disorder that predominantly affects the skin, bone and nervous system. Neurofibromatosis type 1 is a clinically and genetically distinct from neurofibromatosis type 2. This case report highlights the rare association between spinal schwannoma and neurofibromatosis type 1. Case presentation: The patient with a past medical history of spinal schwannoma, operated 1 year back, presented with back pain, weakness of lower limbs and urge incontinence. On examination, she had cutaneous features suggestive of neurofibromatosis type 1 and there was impairment of all sensory modalities below hip region. MRI revealed spinal schwannoma at D9 level for which laminectomy with removal of schwannoma was performed. Clinical discussion: The occurrence and recurrence of spinal schwannoma in neurofibromatosis type 2 is a common finding. But such an association has not been established between spinal schwannoma and neurofibromatosis type 1. In this case, the recurrence of spinal schwannoma has been linked to neurofibromatosis type 1 in the absence of other well-defined etiologies. Conclusion: The occurrence of spinal schwannoma can be genetic or sporadic. The recurrence is usually associated with familial tumor syndrome. The available literature has not established association between neurofibromatosis type 1 and spinal schwannoma, thus, emphasizing the need of more focused studies.

3 - First in human exploratory study of adaptive pudendal nerve stimulation in women with refractory urge or mixed urinary incontinence: short term results in 11 patients.

3 - First in human exploratory study of adaptive pudendal nerve stimulation in women with refractory urge or mixed urinary incontinence: short term results in 11 patients.

167 - Two-year Follow-up of Revi™ Therapy, Implantable Tibial Neuromodulation (iTNM) for the Treatment of Urinary Urge Incontinence: The OASIS Study

167 - Two-year Follow-up of Revi™ Therapy, Implantable Tibial Neuromodulation (iTNM) for the Treatment of Urinary Urge Incontinence: The OASIS Study

Urinary Incontinence in Nulliparous Female Elite Athletes: A Mixed Methods Exploration.

Urinary incontinence (UI) occurs in 40-50% of nulliparous female elite athletes. However, causative factors, management, and perceptions of UI in this population are suboptimally understood. The objectives of this study were to (1) identify factors that precipitate UI in nulliparous female elite athletes and (2) explore management strategies for UI and its effect on sports performance and quality of life. This was a cross-sectional, mixed-methods study in Division 1, college-aged nulliparous female athletes. Surveys assessed demographics, sport characteristics, relevant medical history, bladder symptoms during exercise, and validated genitourinary symptom questionnaires (Lower Urinary Tract Dysfunction Network Symptom Index-29, Female Genitourinary Pain Index). Data were compared between symptomatic athletes (who had ever experienced urinary leakage during exercise) and asymptomatic athletes. Symptomatic athletes discussed their experiences with UI in focus groups. Symptomatic athletes (33/67, 49%) had more asthma (21% vs. 2.9%, P = 0.027) and constipation (15% vs. 0%, P = 0.025), were more sexually active (76% vs. 44%, P = 0.008), and had worse overall urinary symptoms and genitourinary pain than asymptomatic athletes. They described both stress and urgency incontinence precipitated by various factors, including running, jumping, sustained efforts, and stressful situations. Many described voiding frequently before and during exercise. Despite increasing normalization of UI in the female athlete population since the onset of adolescence and variable degrees of bother, interest in improving symptom management was common. Urinary incontinence in nulliparous female elite athletes may be multifactorial given its association with medical, behavioral, exercise-specific, and environmental conditions, which may be explored longitudinally to inform prevention and treatment strategies.

Features of lower urinary tract symptoms in patients with multiple system atrophy

Background: Multiple system atrophy (MSA) is a fatally progressive neurodegenerative disease characterized by variable combinations of parkinsonism, cerebellar ataxia and autonomic dysfunction. Lower urinary tract dysfunction, as a manifestation of autonomic failure is one of core clinical features for a diagnosis of MSA, yet it is often underrecognized especially in the early stage of the disease Objective: The study aimed to describe lower urinary tract symptoms and residual urine volume in early MSA. Subjects and methods: This was a cross-sectional study including MSA patients with disease duration of less than 5 years. Demographic and clinical characteristics were collected. All participants were assessed with UMSARS, IPSS, OABSS scores, and abdominal ultrasound was performed to measure residual urine volume. Results: 32 MSA patients were recruited, all of whom reported lower urinary tract symptoms. Urge incontinence was the most common symptom (93.8%). Symptoms related to voiding were found in 85.7% of MSA-C patients and 88.9% of MSA-P patients. Postvoid residual urine volume &gt; 100 ml was recognized in 28% of patients. There is no statistically significant difference observed in the rate of PVR abnormalities between the MSA-C and MSA-P subgroups (p&gt; 0.05). Conclusion: Lower urinary tract symptoms and abnormal residual urine volume are frequently present even in the early stage of MSA with no significant differences between different clinical subtypes.

Individual Factors in Young Female Athletes' Bladder Health (the Y-FAB Study).

Bladder health in high school and collegiate females is not well understood. The objective of this study was to compare toileting behaviors, lower urinary tract symptoms (LUTSs), and fluid intake in female athletes and nonathletes. English-speaking nulliparous females aged 13-23 years were recruited. Participants completed the Toileting Behaviors: Women's Elimination Behaviors Scale, Bristol Female LUTS Questionnaire, and Beverage Questionnaire. Statistical analysis included univariable analyses and multivariable comparisons of athletes to nonathletes adjusting for age and fluid intake. One hundred athletes and 98 nonathletes participated (mean age 20 ± 2, mean body mass index 23 ± 4). Athletes' sports were predominantly high impact. Dysmenorrhea and anxiety were higher in nonathletes (P < 0.01) versus more stress fractures in athletes (P < 0.001). Problematic toileting behaviors were prevalent regardless of athletic status; nonathletes were more likely to hold urine until home and empty away from home without the urge (both P = 0.04). Lower urinary tract symptoms were prevalent regardless of athletic status, including frequency (34.2%), hesitancy (33.3%), urgency (32.8%), stress incontinence (15.3%), and urgency incontinence (11.8%). Athletes had significantly more stress incontinence and urgency and higher incontinence subscores on univariable analysis, although the difference was attenuated after multivariable adjustment. Athletes consumed lower total fluids (P = 0.03). Problematic toileting behaviors and LUTSs were prevalent in high school and collegiate females, regardless of athletic status. Athletes had higher stress urinary incontinence and urgency and lower fluid intake. These findings support future work toward enhancing early bladder health interventions (screening, education, and LUTS prevention) among high school and collegiate females.

Lower urinary tract symptoms among normal-weight, overweight, and obese palestinians: a study of prevalence and impact on the quality of life

BackgroundThis study was conducted to assess the prevalence of lower urinary tract symptoms (LUTS) among non-obese and obese Palestinians. The study also aimed to assess the effects of LUTS on the quality of life of obese and non-obese Palestinians.MethodsThis was a cross-sectional study that was conducted among normal-weight, overweight, and obese Palestinians using the King Health Questionnaire. The data collected from participants were entered and analyzed using SPSS (version 22).ResultsIn this study, data were collected from 378 participants. The median age of the participants was 42.0 [30.0, 55.0] years, and the median body mass index was 27.1 [24.0, 30.8] kg/m2. Of the participants, 149 (39.4%) were overweight and 112 (29.6%) were obese. The prevalence of urinary hesitancy, incomplete emptying, urgency, nocturia, urgency, urge incontinence, stress incontinence, nocturnal enuresis, intercourse incontinence, bladder pain, number of urinations/24 h, and number of urinations/night was significantly higher among obese participants. Similarly, role limitations, physical/social limitation, personal relationships, emotions, and sleep/energy were affected significantly higher in obese compared to nonobese participants.ConclusionHigher prevalence of LUTS among obese patients compared to nonobese patients was observed among the Palestinians. Obese patients reported significantly higher deterioration of the quality of life as a result of LUTS compared to nonobese patients. Urologists, nutritionists, public health specialists, and other healthcare providers should consider measures to reduce LUTS among obese patients and improve their quality of life.

Fecal urgency and incontinence in inflammatory bowel disease perceived by physician and patient: Results from the Swiss fecal urgency survey.

Although increasingly appreciated, little is known about the prevalence of fecal urgency, fecal incontinence and differences between patients' and physicians' perception in inflammatory bowel disease (IBD). We performed an online patient and physician survey to evaluate the assessment, prevalence and impact of fecal urgency and incontinence in IBD. A total of 593 patients (44.0% ulcerative colitis (UC), 53.5% Crohn's disease (CD), 2.2% indeterminate colitis, 2 not specified) completed the survey (65.8% females, mean age 47.1years). Fecal urgency was often reported (UC: 98.5%, CD: 96.2%) and was prevalent even during remission (UC: 65.9%, CD: 68.5%). Fecal urgency considerably impacted daily activities (visual analog scale [VAS] 5, IQR 3-8). Yet, 22.8% of patients have never discussed fecal urgency with their physicians. Fecal incontinence was experienced by 44.7% of patients and 7.9% on a weekly basis. Diapers/pads were required at least once a month in 20.4% of patients. However, 29.7% of patients never talked with their physician about fecal incontinence. UC was an independent predictor for the presence of moderate-severe fecal urgency (OR 1.65, 95% CI 1.13-2.41) and fecal incontinence (OR 1.77, 95% CI 1.22-2.59). All physicians claimed to regularly inquire about fecal urgency and incontinence. However, the impact of these symptoms on daily activities was overestimated compared with the patient feedback (median VAS 8 vs. 5, p=0.0113, and 9 vs. 5, p=0.0187). Fecal urgency and incontinence are burdensome symptoms in IBD, with a similar prevalence in UC and CD. A mismatch was found between the physician and patient perception. These symptoms should be addressed during outpatient visits.

The peptide regulator Vezusten in the management of overactive bladder syndrome: an efficacy evaluation

Introduction. Overactive bladder (OAB) remains one of the most difficult-to-treat conditions in neurourology. The number of patients seeking help for OAB symptoms does not decrease each year, while a pathogenetic treatment has not yet been developed. This motivates the search for new approaches.Objective. To assess the efficacy of the peptide regulator Vezusten for women with idiopathic OAB based on their health condition and urodynamic assessment of bacterial detrusor overactivity (DO).Materials &amp; methods. A prospective cohort study included 20 patients diagnosed with OAB, which was confirmed by a comprehensive urodynamic study of DO. The patients visited the clinic three times a week. Each patient received ten intramuscular injections of the peptide regulator Vezusten. Within one month after the last injection, the women were given a monitoring voiding diary, a validated Continental Society OAB Symptom Questionnaire, the Overactive Bladder Questionnaire (OAB-q), and a follow-up urodynamic study (UDS).Results. We obtained statistically significant differences in the following indicators: the number of daily urinations according to the urination diary decreased from 14.0 [13.0; 16.3] to 11.0 [8.8; 12.0] (p &lt; 0,001), patient’s episodes of urge incontinence began to be noted for the first time (p = 0.004). At the same time, the urodynamic maximum cystometric capacity (MCC) increased from 267 [158; 332] to 320 [267; 433] ml. Subjectively, participants noted an improvement in the scores of the OAB questionnaire (OAB-q) — the score decreased from 28 [22; 30] to 19 [14; 24] (p = 0.001), and the number of episodes of nocturia decreased from 4 to 2 (p &lt; 0.001). No side effects from therapy were observed in any of the patients.Conclusion. This study demonstrated a statistically significant improvement in subjective symptoms of OAB in DO-women treated with the peptide regulator Vezusten, but further large placebo-controlled studies are required for confirmation.

Association Between Proton Pump Inhibitor Use and Overactive Bladder Risk in Adults: A Cross-sectional Study

ObjectivesTo investigate the association between the use of Proton Pump Inhibitors (PPIs) and Overactive Bladder (OAB) in adults. MethodsThis study adopts a cross-sectional approach to scrutinize data derived from the National Health and Nutrition Examination Survey (NHANES), spanning from 2007 to 2018. It employs multivariable logistic regression along with restricted cubic splines (RCS) to investigate the relationship between the use of PPI and the incidence of OAB. Additionally, through interaction and stratification analyses, the study delves into how specific factors may influence this correlation. ResultsA total of 24,458 adults participated in this study. Individuals using PPIs exhibited higher rates of nocturia, urge incontinence, and OAB compared to non-users. After full adjustment, PPI users had a significantly increased risk of developing OAB (OR = 1.36, 95%CI: 1.17-1.60). Moreover, with each year of continued PPI usage, the frequency of OAB symptoms escalated by 3% (p=0.01). Further examinations within various subgroups maintained a uniform direction in these effect estimates. ConclusionsThe findings of this research highlight a noteworthy positive link between the use of PPIs and the emergence of OAB among adults. Moreover, it was observed that an extended period of using PPIs correlates with a heightened likelihood of encountering OAB.

Differences in Advanced Therapeutic Modalities for Overactive Bladder in the United States by Race

ObjectiveTo investigate the impact of race on prescription patterns of therapies for OAB. MethodsThe TriNetX Diamond network was queried to identify adult females with a diagnosis of urinary urgency incontinence (UUI) or OAB, excluding those with stress incontinence or mixed incontinence. Treatments were defined as behavioral, medical, or minimally invasive in accordance with American Urological Association (AUA) guidelines. Propensity score matching for multiple covariates was performed using the greedy nearest-neighbor algorithm. Cox proportional hazards regression analysis was employed to compare the matched cohorts. Rates of treatment by three-digit zip codes were compared through chi-square tests or Fisher’s exact tests and geographic distribution maps were generated via STATA 17.0. ResultsWe identified 2,687,316 adult females diagnosed with OAB; 767,159 identified as White and 108,464 as Black. Within these cohorts, 16.6% of Black patients and 20.4% of White patients received OAB treatment. Twenty-six-point three percent of US zip-codes contained data for both White and Black patients, and in all these zip codes, White patients received significantly higher rates of prescriptions compared to Black patients. After propensity-score matching, significant differences in prescriptions persisted between the two groups with White patients exhibiting higher rates of any prescription. ConclusionsOur results demonstrate a significantly lower rate of prescriptions of medical and minimally invasive therapies for Black women. These racial differences in prescription of advanced therapeutic modalities for OAB may not be secondary to diagnosis but are likely secondary to prescribing disparities. Further research is needed to understand these differences.

Investigating the Prevalence of Autonomic Neuropathy in Diabetic Patients with Urinary Irritation Symptoms Without a Known Cause.

Evaluating pseudomotor performance can be a valuable tool for investigating the peripheral autonomic nervous system in diabetic patients. Sudoscan, a simple and non-invasive method for assessing pseudomotor performance, has been developed in recent years. This study aimed to investigate autonomic neuropathy using Sudoscan in diabetic patients with lower urinary tract symptoms (LUTS) of unknown cause. In this cross-sectional study conducted from April 2022 to April 2023, we included 195 patients with type 2 diabetes who were referred to the urology clinic. We extracted demographic, clinical, and laboratory data from the patient files and evaluated urinary symptoms using the International Prostate Symptom Score (IPSS) questionnaire. Patients underwent Sudoscan testing to evaluate autonomic neuropathy in the physical medicine and rehabilitation clinic. To further assess urinary irritative symptoms, patients underwent urodynamic studies (UDS) and ultrasonography. The Sudoscan test results showed that autonomic neuropathy was present in 77 patients (40%), with 43 (22.1%) having moderate and 44 (22.6%) having severe neuropathy. Patients with autonomic neuropathy were found to be older, had longer diabetes durations, higher average blood glucose levels, and higher creatinine levels. Additionally, we found a significant correlation between autonomic neuropathy and signs of high post-void residue on ultrasound and detrusor contraction disorders on UDS (p-value < 0.05). Our study found a higher prevalence of autonomic neuropathy in diabetic patients with LUTS using Sudoscan (40%). Longer diabetes duration and poor glycemic control were associated with an increased risk of autonomic neuropathy linked with LUTS, such as urge incontinence.

How to set-up an effective Sacral Neuromodulation service

Over the last 30 years, Sacral Neuromodulation (SNM) has become the first-line surgical treatment in patients with fecal and urgency urinary incontinence with over 400,000 patients implanted worldwide. Its favorable long-term functional results and the minimal invasiveness of the technique has broadened potential new indications. Also, more hospitals around the globe have engaged to offer the therapy despite there are important limitations for some regions for access. To obtain the best results, it is crucial to select the patients properly, do the implantation technique correctly, and follow-up the patients regularly. Even though there is an important momentum of SNM in pelvic floor disorders, there is no standardization on how to offer a proper SNM service. This article gives an overview of the main logistic fields to successfully set up a comprehensive and correct SNM provision.

Timing of Trial of Void After Radical Hysterectomy: Long-Term Urinary Outcomes at Two Academic Tertiary Care Institutions.

Many patients develop bladder symptoms after radical hysterectomy. This study compared urinary outcomes following radical hysterectomy based on trial of void (TOV) timing (pre-discharge TOV versus post-discharge TOV). A retrospective non-inferiority study of patients at two academic tertiary referral centers who underwent radical hysterectomy between January 2010 and January 2020 was carried out. Patients were stratified according to timing of postoperative TOV: either pre-discharge or post-discharge from the hospital. Short-term urinary outcomes (including passing TOV, representation with retention) and long-term de novo urinary dysfunction (defined as irritative voiding symptoms, urgency, frequency, nocturia, stress or urgency incontinence, neurogenic bladder, and/or urinary retention) were extracted from the medical record. We hypothesized that the proportion of patients who failed pre-discharge TOV would be within a 15% non-inferiority margin of post-discharge TOV. A total of 198 patients underwent radical hysterectomy for cervical (118 out of 198; 59.6%), uterine (36 out of 198; 18.2%), and ovarian (29 out of 198; 14.6%) cancer. One hundred and nineteen patients (119 out of 198, 60.1%) underwent pre-discharge TOV, of whom 14 out of 119 (11.8%) failed. Of the post-discharge TOV patients (79 out of 198, 39.9%), 5 out of 79 (6.3%) failed. The proportion of patients who failed a pre-discharge TOV was within the non-inferiority margin (5.4% difference, p = 0.23). A greater proportion of patients in the post-discharge TOV group developed long-term de novo urinary dysfunction (27.2% difference, p = 0.005). Median time to diagnosis of de novo urinary dysfunction was 0.5years (range 0-9) in the pre-discharge TOV group versus 1.0year (range 0-6) in the post-discharge TOV group (p > 0.05). In this study, pre-discharge TOV had non-inferior short-term outcomes and improved long-term outcomes.

Quality of life after anterior vaginal wall suspension for incontinence and prolapse repair with mixed, urge, or stress urinary incontinence

Purpose:To compare qualify of life outcomes in women with mixed urinary incontinence (MUI), urge (UUI) or stress (SUI) urinary incontinence after treatment with an anterior vaginal wall suspension (AVWS) to correct urethral hypermobility and concomitant anterior compartment prolapse (ACP). Methods:Following IRB approval, a prospective long-term database of women who underwent an AVWS for urinary incontinence (UI) with early stage (stage ≤2) ACP was reviewed. Patients completed the Urogenital Distress Inventory short form (UDI-6 SF) and a one question visual analog scale (VAS) of quality of life (QoL) before and after AVWS. Indication for AVWS was based on demonstrable UI, with documented urethral hypermobility and cystocele on standing lateral cystogram comparing rest and straining views. Three groups (MUI, SUI, and UUI) were analyzed based on urge (Question 2) and stress (Question 3) predominant scores at baseline. Results:From 1997 to 2018, 104 patients met study criteria: 54 with MUI, 30 SUI predominant, and 20 UUI predominant. Total UDI-6 and QoL scores improved significantly from baseline to 1-year post-AVWS and to the last visit (median 3.5 years) in all three groups. Patients with MUI had the most improvement based on UDI-6 total and QoL scores. Conclusions:Regardless of the nature of baseline UI symptoms, restoring support of the anterior vaginal wall compartment can durably improve UI-specific quality of life scores in the short and long-term.

Evaluation of transurethral GreenLight laser-selective vaporization for refractory overactive bladder in women.

Refractory overactive bladder (OAB) in women is a common yet challenging condition for which traditional treatments have been unsatisfactory. This study aimed to evaluate the efficacy and safety of transurethral bladder mucosal GreenLight laser-selective vaporization for treating refractory OAB in women. The female patients with refractory OAB who were admitted to the Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University between May 2022 and July 2023 were examined retrospectively in this study. Transurethral bladder mucosal GreenLight laser-selective vaporization was used to treat the patients, and the perioperative and postoperative parameters were reviewed and compared. Bladder mucosa was examined by immunohistochemical staining to explore the expressions of TRPV1, P2X3, tumor necrosis factor alpha (TNF-α), and interleukin 6 (IL-6) before and after treatments. Surgeries were performed successfully for all 32 patients in 57.38±11.22 minutes with minimal intraoperative bleeding. Twelve weeks post-surgery, there was a significant decrease (P<0.05) in the patients' Overactive Bladder Symptom Score (OABSS), 3-day bladder diary (daytime frequency, nocturia, urgency, and urgency incontinence), and Overactive Bladder questionnaire Short Form (OAB-qSF) score. After treatments, both first desire to void (FDV) and maximum bladder pressure capacity (MCBC) increased significantly (P<0.05). The immunohistochemical analysis revealed that the GreenLight laser significantly reduced the expressions of TRPV1, P2X3, TNF-α, and IL-6 in the bladder mucosa (P<0.05). No severe complications were observed after interventions. For female patients with refractory OAB who have shown poor response to conventional treatment approaches, transurethral bladder mucosal GreenLight laser-selective vaporization may represent a promising alternative treatment option.