Effect of Pelvic Floor Function Exercises Based on the ERAS Concept on Lower Urinary Tract Symptoms after Radical Hysterectomy for Cervical Cancer: A Retrospective Cohort Study.

OBJECTIVE: This study aimed to analyse the effect of pelvic floor function exercises based on the enhanced recovery after surgery (ERAS) concept on lower urinary tract symptoms after radical hysterectomy for cervical cancer. METHODS: The retrospective study was conducted using clinical data of patients admitted to our hospital from January 2021 to December 2022 and underwent radical hysterectomy for cervical cancer. In accordance with the nursing method, the patients were divided into the routine group (conventional care) and the ERAS pelvic floor function exercise group, for which ERAS concept-based pelvic floor function exercises were carried out on the basis of the former group. The confounders between the two groups were matched by propensity score, and the scores of urination, pelvic floor muscle strength, lower urinary tract symptoms and quality of life (QoL) were compared between the two groups after matching. RESULTS: A total of 180 patients were included in the study, of whom 60 patients were identified after propensity score matching, consisting of 30 patients each in the ERAS and routine groups. The baseline characteristics of the two groups were balanced, and the difference was not statistically significant (p > 0.05). Compared with the routine group, the observation group showed significantly shorter first spontaneous urination time, greater first urination volume (p < 0.05), better pelvic floor muscle strength, considerably lower urinary tract symptoms and better QoL at discharge and 3 months after discharge (p < 0.05). CONCLUSIONS: Pelvic floor function exercises based on the ERAS concept can relieve lower urinary tract symptoms, accelerate urination and improve pelvic floor muscle strength and QoL after radical hysterectomy for cervical cancer.

Racial disparities in bladder management in veterans with spinal cord injury and disorders.

AIMS: Neurogenic lower urinary tract dysfunction is common in individuals with spinal cord injury and disorders (SCI/D). The purpose of this study was to identify specific demographic, neurologic, and urologic factors associated with different bladder management methods (BMMs) in individuals with SCI/D. METHODS: A retrospective review of BMMs at a large Veterans Affairs SCI/D center was performed to identify associated risk factors including demographics, neurologic factors, and urologic factors. Bivariate analysis was performed to identify factors associated with specific BMMs. Then, a propensity-matched racial group analysis was performed to identify independent factors associated with differences in BMM. RESULTS: Data from 833 patients with SCI/D were reviewed and included 52.1% Caucasians and 39.6% African Americans. On bivariate analysis, current age, years since the injury, the severity of functional impairment, nonmedical mechanism of injury, and Caucasian race were associated with increased rates of indwelling catheter use. In an analysis of propensity-matched racial groups, African-American race was found to be an independent risk factor for not using indwelling catheters on multivariate analysis (odds ratio = 0.55). This finding was not related to access to care, as the rate of urodynamic testing was similar between races ( P = 0.174). CONCLUSIONS: Caucasians were more likely to use indwelling catheters and less likely to use conservative BMMs despite proper urodynamic evaluation. The racial discrepancy suggests a need for future research aimed at identifying unknown psychosocial factors associated with the use of indwelling catheters in individuals with SCI/D.

Is Pelvic Floor Muscle Training Effective for Men With Poststroke Lower Urinary Tract Symptoms? A Single-Blinded Randomized, Controlled Trial.

The aim of the current study was to evaluate the effect of pelvic floor muscle training in men with poststroke lower urinary tract symptoms. Thirty-one poststroke men, median age 68 years, were included in this single-blinded randomized controlled trial. Thirty participants, 15 in each group, completed the study. The intervention consisted of 3 months (12 weekly sessions) of pelvic floor muscle training in groups and home exercises. The effect was evaluated by the DAN-PSS-1 (Danish Prostate Symptom Score) questionnaire, a voiding diary, and digital anal palpation of the pelvic floor muscle. The DAN-PSS-1, symptom score indicated a statistical significant improvement ( p < .01) in the treatment group from pretest to posttest, but not in the control group. The DAN-PSS-1, total score improved statistically significantly in both groups from pretest to posttest (treatment group: p < .01; control group: p = .03). The median voiding frequency per 24 hours decreased from 11 at pretest to 7 (36%; p = .04) at posttest and to 8 (27%; p = .02) at follow-up in treatment group, although not statistical significantly more than the control group. The treatment group but not the control group improved statistically significantly in pelvic floor muscle function ( p < .01) and strength ( p < .01) from pretest to posttest and from pretest to follow-up ( p = .03; p < .01). Compared with the control group the pretest to posttest was significantly better in the treatment group ( p = .03). The results indicate that pelvic floor muscle training has an effect for lower urinary tract symptoms, although statistical significance was only seen for pelvic floor muscle.

Can pelvic floor muscle training improve quality of life in men with mild to moderate post­stroke and lower urinary tract symptoms?

BACKGROUND: Lower urinary tract symptoms (LUTS) have a significant impact on quality of life (QoL) in post­stroke patients. AIM: The aim of this study was to evaluate the effect of pelvic floor muscle training (PFMT) on QoL parameters in men with post­stroke LUTS. DESIGN: Randomized, controlled and single­blinded trial. SETTING: Outpatients, University Hospital. POPULATION: Thirty­one men, median age 68 (interquartile range 60-74) years, with post­stroke LUTS were included. Thirty participants completed the study. METHODS: The participants randomized to the treatment group were treated in a systematic, controlled and intensive PFMT program over 3 months (12 weekly sessions). The participants randomized to the control group did not receive specific LUTS treatment. The effect was measured on the 36-Item Short Form Health Survey (SF-36) and the Nocturia Quality­of­Life (N­QoL) Questionnaire. RESULTS: The results on SF-36 indicated significant improvement within pre- and post­test in the domains emotional role (median 77 to 100, P=0.03) and vitality (median 65 to 70, P=0.03) in the treatment group, but not the control group. There were no statistically significant differences between groups at pre­test, post­test or 6-month follow­up. The results on N­QoL indicated statistically significant differences between pre- and post­test in the bother/concern domain in both groups and in sleep/energy for the control group, but not the treatment group. There were no statistically significant differences between groups. CONCLUSIONS: PFMT may improve the emotional health and vitality domains of QoL in men with mild to moderate post­stroke and LUTS; however the improvements in the treatment group were not significantly better than for the control group. PFMT did not improve nocturia­related QoL. CLINICAL REHABILITATION IMPACT: This study is the first to evaluate the effect of PFMT on QoL parameters in men with mild to moderate post­stroke and LUTS. The results indicate some short­term effect on SF-36 but none on N­QoL. However, further studies with larger sample sizes and with less restrictive inclusion and exclusion criteria are requested.

[Objective and subjective requirement of aids and appliances in patients with neurogenic lower urinary tract dysfunction : Multicenter study to determinate the daily necessity of urological aids and appliances]. / Objektiver und subjektiver Hilfsmittelbedarf bei Patienten mit neurogenen Harnblasenfunktionsstörungen : Multicenterstudie zur Ermittlung des täglichen Bedarfs an urologischen Hilfsmitteln.

BACKGROUND: The provision of urological appliances for patients with neurogenic lower urinary tract dysfunction (NLUTD) is essential. Hitherto existing standard guidelines for the estimation of monthly material requirements are based solely on estimates. OBJECTIVE: The goal of this work was to define the objective and subsequently subjective requirements for urological appliances on a scientifically validated basis. MATERIALS AND METHODS: Data concerning bladder management and daily consumption of urological appliances for patients with NLUTD were collected through a standardized survey at six different centers in Germany during the period of October to December 2014 and statistically evaluated. RESULTS: In all, 767 patient records were analyzed: 543 men and 221 woman (N/A = 3). The daily disposable catheter consumption of 577 patients who exclusively used intermittent catheterization was 5.13. Patients who used other means of bladder emptying (n = 31) in addition to catheterization consumed on average 3.17 catheters. The margin of deviation was larger for children. Of the 608 patients with intermittent catheterization, 94 (15.5 %) required additional paddings as absorbent aids (on average 2.29 paddings per day), 34 patients (5.6 %) additionally used pants (2.55 per day) and 46 patients (7.6 %) utilized condom catheters (3.81 per day) between catheterization. Among all surveyed patients, 126 (16.4 %) used paddings (5.03 per day) and 51 patients (6.6 %) pants (3.03 per day). Of all male respondents 82 (15.1 %) used condom catheters (2.80 urinary sheaths per day). CONCLUSION: Applying twice the standard deviation of the mean as a measure of assessing the objective requirement of urological appliances and aids for adult patients with NLUTD allows the following daily thresholds to be defined: 1-9 disposable catheters, 0-7 urinary sheaths, 1-9 paddings and 0-7 pants. These thresholds can serve as a basis for estimating the subjective need. They allow for a scientifically validated benchmark for an economically feasible and patient-tailored supply with urological aids and appliances. Individually required appliances and aids have to be recognized. Verifiable quality standards need to be developed.

Sacral neuromodulation in patients with neurogenic lower urinary tract dysfunction.

STUDY DESIGN: This is a retrospective chart analysis. OBJECTIVES: The objective of this study was to evaluate the effect of sacral neuromodulation (SNM) in patients with neurogenic lower urinary tract dysfunction (NLUTD). SETTINGS: This study was conducted in a spinal cord injury rehabilitation center in Switzerland. METHODS: The charts of all patients who underwent SNM (testing and/or permanent implantation) because of NLUTD at our institution between 2007 and 2013 were evaluated. Treatment outcomes and complications were recorded. RESULTS: A total of 50 patients, 30 women and 20 men, with a mean age of 46 (±14) years, fulfilled the inclusion criteria. The most frequent cause for SNM was spinal cord injury in 35 patients (70%). Median duration of the underlying disease was 9.5 (±9.3) years. In all, 35 patients (70%) received a permanent implant. The complication rate was 16% (8/50). At the last follow-up, SNM was in use in 32 patients. In 26 patients with SNM because of detrusor overactivity, voiding frequency per 24 h was significantly reduced from 9 to 6, and daily pad use rate was significantly improved (2.6 versus 0.6 pads per 24h). On comparing urodynamic assessment of detrusor function before and under SNM, no significant suppression of neurogenic detrusor overactivity (NDO) was detected. In nine patients with chronic neurogenic urinary retention, median postvoid residual urine was significantly reduced from 370 to 59 ml. In all, 94% of the patients were either very satisfied or satisfied with SNM. CONCLUSION: SNM might be an additional therapy option in carefully selected patients with NLUTD. On the basis of our results, urodynamic evaluation before SNM is mandatory, as the procedure does not seem to be suited to significantly alleviate NDO.

Lower urinary tract symptoms associated with neurological conditions: Observations on a clinical sample of outpatients neurorehabilitation service.

OBJECTIVES: The overall aims of this study were to investigate the lower urinary tract symptoms (LUTS) associated with neurological conditions and their prevalence and impact on a clinical sample of outpatients of a neurorehabilitation service. MATERIALS AND METHODS: We reviewed the files of 132 patients treated in our neurorehabilitation service from December 2012 to December 2013. Patients were divided into several subgroups based on the neurological diagnosis: Multiple Sclerosis (MS), other demyelinating diseases, Peripheral Neuropathy, neurovascular disorders (ND), neoplastic disease, traumatic brain injury (TBI), Parkinson and Parkinsonism, spinal cord injuries (SCI). Urinary status was based on medical evaluations of history of LUTS, type, degree, onset and duration of symptoms. We tried to analyze prevalence, kind of disorder, timing of presentation (if before or after the neurological onset) and eventual persistence of urological disorders (in the main group and in all subgroups). RESULTS: At the time of admission to our rehabilitation service, LUTS were observed in 14 out of 132 cases (11%). A high proportion of these outpatients (64.2%) presented bothersome urinary symptoms such as incontinence, frequency and urgency (storage LUTS). The most frequent symptom was urinary urge incontinence (42.8%). This symptom was found to be prevalent in the multiple sclerosis and neurovascular disorders. In 93% the urinary symptoms arose as a result of neurologic conditions and 78.5% did not present a complete recovery of urological symptoms in spite of improved self-reported functional activity limitations. None of these patients performed urological rehabilitation. CONCLUSIONS: Neurological disorders are a significant issue in rehabilitation services and it can lead to lower tract dysfunction, which causes LUTS. Storage symptoms are more common, especially urge incontinence. Current literature reports that a further optimization of the rehabilitation potential of neurologically ill patients is possible through an implementation of urological basic measures into the neurological treatment routine.

Urological Implications Of Falls in the Elderly: Lower Urinary Tract Symptoms And Alpha-Blocker Medications.

Falls are a leading cause of morbidity and mortality in the elderly. In prospective studies, lower urinary tract symptoms (LUTS) have been shown to be an independent risk factor for falls. Alpha-blockers, frequently used to treat LUTS and benign prostatic hyperplasia, can increase the risk of falls in the elderly due to their class effect of orthostatic hypotension. In the urology setting, risk factors for falls may be addressed through evaluation and counseling, and by careful selection and monitoring of medications for LUTS.

Pelvic Floor Dysfunction and Associated Lower Urinary Tract Symptoms--A Case Study.

Lower urinary tract symptoms are a common complaint for women who present with a myriad of symptoms. A thorough history and physical examination, as well as specific diagnostic testing, can help determine the underlying cause and direct the best treatment option as presented in this case study.

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part I.

OBJECTIVE: To compare the use of polypropylene mesh (PM) and the traditional anterior vaginal wall colporraphy in women with anterior vaginal wall prolapse (AVWP) using objective and subjective tests and evaluation of quality of life (QoL). MATERIALS AND METHODS: One hundred women were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a PM implant and the control group (n = 55) was submitted to traditional colporraphy. Postoperatory follow-up was done after 12 months. The primary objective was the correction of the Ba point ≤ -2 POP-Q (Pelvic Organ Prolapse Quantification System) and the secondary objective was the improvement of vaginal symptoms and QoL through ICIQ-VS (International Consultation on Incontinence Questionnaire - Vaginal Symptoms). Complications related to the use of PM or not were also described. RESULTS: There was a significant difference between all POP-Q measures of pre- and postoperatory periods of each group in particular. There was a significant difference of the Ba point of the postoperatory period between the Mesh and Control group. The mean of Ba point in the Mesh group was statistically lower than of the Control group, depicting the better anatomical result of the first group. Both techniques improved vaginal symptoms and QoL. The most frequent complication of the Mesh group was prepubic hematoma in the perioperative period. In 9.3% of the cases treated with mesh it was observed PM exposition at the anterior vaginal wall after 12 months, being most of them treated clinically. CONCLUSION: The treatment of AVWP significantly improved the Ba point in the Mesh group in comparison to the Control group. There were no differences of the vaginal symptoms and QoL between the two groups after 12 months. There were few and low grade complications on both groups.

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part II.

OBJECTIVE: To compare the effects of two surgical procedures for the correction of anterior vaginal wall prolapse (AVWP) on the lower urinary tract symptoms (LUTS) using symptom questionnaires and quality of life (QoL). MATERIALS AND METHODS: One hundred women with Pelvic Organ Prolapse Quantification stage (POP-Q) ≥ 2 were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a polypropylene mesh (PM) implant and the control group (n = 55) was submitted to anterior colporraphy with or without synthetic sling. Postoperatory follow-up was done after 12 months. The primary objective was to compare the effect of the surgeries on LUTS using the final scores of the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and Overactive Bladder Questionnaire (OAB-V8), as well as the analysis of the incapacitating urinary symptoms and ″de novo″ urinary symptoms after 12 months of surgery in both groups. RESULTS: Although there was a different number of women in each group, randomization was adequate, resulted in homogeneous groups that could be compared regarding socio demographic, clinical and gynecological (POP-Q) variables. Patients of both groups showed improvements regarding LUTS and QoL, whether using polypropylene mesh or not, based on the final scores of the ICIQ-UI SF and OAB-V8 questionnaires after 12-month follow-up. There were few incapacitating and ″de novo ″ urinary symptoms, without any significant statistical difference between both groups after 12 months of surgery. CONCLUSION: There was a general improvement of LUTS and QoL in both groups after 12-month follow-up. However, there was no significant difference of LUTS, as well as the more incapacitating and ″de novo ″ urinary symptoms between both groups after 12 months of surgery.

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part I

Objective To compare the use of polypropylene mesh (PM) and the traditional anterior vaginal wall colporraphy in women with anterior vaginal wall prolapse (AVWP) using objective and subjective tests and evaluation of quality of life (QoL). Materials and Methods One hundred women were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a PM implant and the control group (n = 55) was submitted to traditional colporraphy. Postoperatory follow-up was done after 12 months. The primary objective was the correction of the Ba point ≤ -2 POP-Q (Pelvic Organ Prolapse Quantification System) and the secondary objective was the improvement of vaginal symptoms and QoL through ICIQ-VS (International Consultation on Incontinence Questionnaire - Vaginal Symptoms). Complications related to the use of PM or not were also described. Results There was a significant difference between all POP-Q measures of pre- and postoperatory periods of each group in particular. There was a significant difference of the Ba point of the postoperatory period between the Mesh and Control group. The mean of Ba point in the Mesh group was statistically lower than of the Control group, depicting the better anatomical result of the first group. Both techniques improved vaginal symptoms and QoL. The most frequent complication of the Mesh group was prepubic hematoma in the perioperative period. In 9.3% of the cases treated with mesh it was observed PM exposition at the anterior vaginal wall after 12 months, being most of them treated clinically. Conclusion The treatment of AVWP significantly improved the Ba point in the Mesh group in comparison to the Control group. There were no differences of the vaginal symptoms and QoL between the two groups after 12 months. There were few and low grade complications on both groups. .

Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part II

Objective To compare the effects of two surgical procedures for the correction of anterior vaginal wall prolapse (AVWP) on the lower urinary tract symptoms (LUTS) using symptom questionnaires and quality of life (QoL). Materials and Methods One hundred women with Pelvic Organ Prolapse Quantification stage (POP-Q) ≥ 2 were randomly distributed in two preoperatory groups. The first group (mesh) (n = 45) received a polypropylene mesh (PM) implant and the control group (n = 55) was submitted to anterior colporraphy with or without synthetic sling. Postoperatory follow-up was done after 12 months. The primary objective was to compare the effect of the surgeries on LUTS using the final scores of the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) and Overactive Bladder Questionnaire (OAB-V8), as well as the analysis of the incapacitating urinary symptoms and “de novo” urinary symptoms after 12 months of surgery in both groups. Results Although there was a different number of women in each group, randomization was adequate, resulted in homogeneous groups that could be compared regarding socio demographic, clinical and gynecological (POP-Q) variables. Patients of both groups showed improvements regarding LUTS and QoL, whether using polypropylene mesh or not, based on the final scores of the ICIQ-UI SF and OAB-V8 questionnaires after 12-month follow-up. There were few incapacitating and “de novo” urinary symptoms, without any significant statistical difference between both groups after 12 months of surgery. Conclusion There was a general improvement of LUTS and QoL in both groups after 12-month follow-up. However, there was no significant difference of LUTS, as well as the more incapacitating and “de novo” urinary symptoms between both groups after 12 months of surgery. .

Osteopathic manipulative treatment (OMT) for lower urinary tract symptoms (LUTS) in women.

BACKGROUND: Because of its prevalence and impact on women's well-being, and its high financial costs, female LUTS is an important health problem that requires serious attention from health professionals. OBJECTIVE: The objective of this review was to determine the clinical effects of osteopathic treatment on female lower urinary tract disorders. DATA SOURCES: A systematic literature search was performed in May 2011 in the electronic databases Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, PEDro, OSTMED-DR, OSTEOPATHIC WEBRESEARCH and databases of ongoing trials. A manual search in reference lists and a personal communication with experts in the field of osteopathy was also conducted to identify additional studies. STUDY SELECTION: Only randomized clinical studies (RCT) or controlled clinical studies (CCT) were included. Inclusion criteria of the participants were female, at least 18 years old and a diagnosed female urinary tract disorder. Exclusion criteria were neurologic disorders, tumors, urinary tract infections or antibiotic treatment, and pregnancy. DATA EXTRACTION: Two review authors independently extracted the data of the studies using a standardized data extraction form. The updated Cochrane Risk of bias tool from 2011 was used to assess the methodological quality. RESULTS: The quantitative analysis shows a statistically significant and clinically relevant improvement when the osteopathic intervention was compared to an untreated group. Two studies which compare OMT with the pelvic floor muscle training as a reference treatment document almost the same therapeutic effect. CONCLUSION: The findings of this systematic review and meta-analysis are promising and encouraging to conduct larger, rigorous osteopathic intervention studies for female urination disorders. Future studies should compare the osteopathic treatment with established standard procedures in the control group.