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Discover the most talked about and latest scientific content & concepts.

Concept: Urinary incontinence

181

Stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) are associated with physical and psychological morbidity, and large societal costs. The long-term effects of delivery modes on each kind of incontinence remain uncertain.

Concepts: Mode, Systematic review, Urinary incontinence, Meta-analysis

164

To analyse the severity profiles and progression criteria in patients diagnosed of benign prostatic hyperplasia (BPH) in urology clinics in Spain.

Concepts: Prostate cancer, Urology, Urinary incontinence, Urination, Benign prostatic hyperplasia, Prostate, Urinary retention, Hyperplasia

161

Storage lower urinary tract symptoms (LUTS) including overactive bladder (OAB) and urinary incontinence (UI) affect millions of people worldwide, significantly impacting quality of life. Plant based medicines have been documented both empirically and in emerging scientific research to have varying benefits in reducing bladder symptoms. We assessed the efficacy of Urox®, a proprietary combination of phytomedicine extracts including, Cratevox™ (Crataeva nurvala) stem bark, Equisetem arvense stem and Lindera aggregata root, in reducing symptoms of OAB and UI.

Concepts: Scientific method, Randomized controlled trial, Urology, Urinary incontinence, Urinary bladder, Urinary system, Lower urinary tract symptoms, Equisetum arvense

115

This report evaluates clinical experience with the Rezūm system after US Food and Drug Administration clearance in consecutive cases accrued by multiple community urologists for the treatment of lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH). Treatment techniques for transurethral convective radiofrequency water-vapor thermal therapy and outcomes with up to 12 months' follow-up are presented.

Concepts: Prostate cancer, Urology, Urinary incontinence, Benign prostatic hyperplasia, Prostate, Lower urinary tract symptoms, Prostatic stent, Transurethral microwave thermotherapy

112

Interstitial cystitis/bladder pain syndrome (IC) is a multifactorial syndrome of severe pelvic and genitalia pain and compromised urinary function; a subset of IC patients present with Hunner’s lesions or ulcers on their bladder walls (UIC). UIC is diagnosed by cystoscopy, which may be quite painful. The objective of this study was to determine if a calculated Bladder Permeability Defect Risk Score (BP-RS) based on non-invasive urinary cytokines could discriminate UIC patients from controls and IC patients without Hunner’s ulcers.

Concepts: Medical terms, Urology, Urinary incontinence, Urinary bladder, Urinary system, Pain, Cystitis, Interstitial cystitis

67

Complications of surgical mesh procedures have led to legal cases against manufacturers worldwide and to national inquiries about their safety. The aim of this study was to investigate the rate of adverse events of these procedures for stress urinary incontinence in England over 8 years. This was a retrospective cohort study of first-time tension-free vaginal tape (TVT), trans-obturator tape (TOT) or suprapubic sling (SS) surgical mesh procedures between April 2007 and March 2015. Cases were identified from the Hospital Episode Statistics database. Outcomes included number and type of procedures, including those potentially confounded by concomitant procedures, and frequency, nature and timing of complications. 92,246 first-time surgical mesh procedures (56,648 TVT, 34,704 TOT, 834 SS and 60 combinations) were identified, including 68,002 unconfounded procedures. Peri-procedural and 30-day complication rates in the unconfounded cohort were 2.4 [2.3-2.5]% and 1.7 [1.6-1.8]% respectively; 5.9 [5.7-6.1]% were readmitted at least once within 5 years for further mesh intervention or symptoms of complications, the highest risk being within the first 2 years. Complication rates were higher in the potentially confounded cohort. The complication rate within 5 years of the mesh procedure was 9.8 [9.6:10.0]% This evidence can inform future decision-making on this procedure.

Concepts: Cohort study, Cohort, Clinical trial, Urinary incontinence, Retrospective, Rates, Reaction rate

46

To the Editor: Commercial stem-cell clinics have been highly publicized in the lay press and operate worldwide with limited or no regulation.(1) We report the case of a 66-year-old man who underwent intrathecal infusions for the treatment of residual deficits from an ischemic stroke at commercial stem-cell clinics in China, Argentina, and Mexico. He was not taking any immunosuppressive medications. In reports provided to him by the clinics, the infusions were described as consisting of mesenchymal, embryonic, and fetal neural stem cells. Progressive lower back pain, paraplegia, and urinary incontinence subsequently developed. Magnetic resonance imaging (MRI) revealed a lesion of . . .

Concepts: Neuron, Stem cell, Stem cells, Stroke, Urinary incontinence, Nuclear magnetic resonance, Magnetic resonance imaging, Neurogenesis

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PURPOSE: To report the long-term efficacy and safety of PTNS with the Urgent® PC Neuromodulation System for OAB after three years of therapy. MATERIALS AND METHODS: Fifty participants in the randomized, double-blind SUmiT Trial who met the primary effectiveness endpoint after 12-weekly PTNS treatments were enrolled in this prospective study to assess long-term outcomes with PTNS. STEP patients were prescribed a fixed-schedule 14-week tapering protocol followed by a personal treatment plan aimed at sustaining OAB symptom improvement. OAB and quality-of-life questionnaires were completed everythree months andthree -day voiding diaries were completed everysix months. RESULTS: Twenty-nine patients completed the 36-month protocol and receiveda median of 1.1 treatments per month after a 14-week treatment tapering protocol. A Bayesian model estimated 77% (95% CI, 64%-90%) of patients maintained moderate or marked improvement in OAB symptoms at three years. Compared to baseline, median voids per day decreased from 12.0 (IQR, 10.3-13.7) to 8.7 (IQR, 7.3-11.3), nighttime voids per night decreased from 2.7 (IQR, 1.7-3.3) to 1.7 (IQR, 1.0-2.7), and urge incontinence episodes per day decreased from 3.3 (IQR, 0.7-6.0) to 0.3 (IQR, 0.0-1.0) (all p<0.0001). All quality of life parameters remained markedly improved from baseline through three years (all p<0.0001). One patient experienced two mild treatment-related adverse events ofbleeding at needle site during follow-up. CONCLUSIONS: Most STEP participants with an initial positive response to 12 weekly PTNS treatments safely sustained OAB symptom improvement to three years with an average of one treatment per month.

Concepts: Improve, Urinary incontinence, Symptoms, Tibial nerve, Percutaneous tibial nerve stimulation, Void, Sustain

30

To evaluate prospective relationships between body composition and muscle strength with predominantly stress urinary incontinence (SUI) and urgency urinary incontinence (UUI) in older women.

Concepts: Health, Death, Urinary incontinence, Muscle, Urinary bladder

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BACKGROUND: Urinary incontinence (UI) is a common condition in women causing reduced quality of life and withdrawal from fitness and exercise activities. Pregnancy and childbirth are established risk factors. Current guidelines for exercise during pregnancy have no or limited focus on the evidence for the effect of pelvic floor muscle training (PFMT) in the prevention and treatment of UI. AIMS: Systematic review to address the effect of PFMT during pregnancy and after delivery in the prevention and treatment of UI. DATA SOURCES: PubMed, CENTRAL, Cochrane Library, EMBASE and PEDro databases and hand search of available reference lists and conference abstracts (June 2012). METHODS: Study eligibility criteria: Randomised controlled trials (RCTs) and quasiexperimental trials published in the English language. Participants: Primiparous or multiparous pregnant or postpartum women. Interventions: PFMT with or without biofeedback, vaginal cones or electrical stimulation. Study appraisal and synthesis methods: Both authors independently reviewed, grouped and qualitatively synthesised the trials. RESULTS: 22 randomised or quasiexperimental trials were found. There is a very large heterogeneity in the populations studied, inclusion and exclusion criteria, outcome measures and content of PFMT interventions. Based on the studies with relevant sample size, high adherence to a strength-training protocol and close follow-up, we found that PFMT during pregnancy and after delivery can prevent and treat UI. A supervised training protocol following strength-training principles, emphasising close to maximum contractions and lasting at least 8 weeks is recommended. CONCLUSIONS: PFMT is effective when supervised training is conducted. Further high-quality RCTs are needed especially after delivery. Given the prevalence of female UI and its impact on exercise participation, PFMT should be incorporated as a routine part of women’s exercise programmes in general.

Concepts: Pregnancy, Childbirth, Uterus, Randomized controlled trial, Urinary incontinence, Urinary bladder, Pelvic floor, Pelvic girdle pain