Bladder management during pregnancy in women with spinal-cord injury: an observational, multicenter study.

INTRODUCTION AND HYPOTHESIS: Pregnancy in women with spinal-cord injury (SCI) poses a clinical challenge. We hypothesized that changes in the management of neurogenic bladder during pregnancy are commonly required and should receive more attention. METHODS: Data were collected by retrospective analysis of medical records and via cross-sectional survey of 52 women with SCI, representing 67 pregnancies, at ten Italian neurourological clinics. All participants provided informed consent. RESULTS: Between 1976 and 2013, 39 participants had one child, 11 had two children, and two had three children. Mean age at the time of SCI was 18 years and at the time of first pregnancy was 30 years. Delivery occurred from weeks 32 to 40 in 98% of first and second pregnancies, and 94% of neonates were healthy. Oxybutynin was used by four women during five pregnancies, which resulted in delivery of healthy babies. Intermittent catheterization was used before 54% of first pregnancies and 39% of second pregnancies. Bladder management was altered during 45% of these pregnancies, and the most common changes were increased use or frequency of intermittent catheterization or use of an indwelling catheter. Urinary tract infections occurred in 48% of pregnancies, and an irregular course was reported in 13% of pregnancies mainly related to tetraplegia and urological complications. CONCLUSIONS: Pregnancy in women with SCI generally has good outcomes and limited risks but frequently necessitates changes in the management of neurogenic bladder. High levels of awareness and focused monitoring of bladder issues are recommended.

Effectiveness on mild stress and mixed urinary incontinence and impact on Quality of Life of a phytotherapic product containing astragalus, thyme, lavender, hop, equisetum, red clover, cypress and agrimonia at titrated concentrations. Results from a monocentric study.

OBJECTIVES: To assess any beneficial effect on quality of life of a daily treatment with a phytotherapic product containing astragalus, thyme, lavender, hop, equisetum, red clover, cypress and agrimonia at titrated concentrations in a cohort of female patients complaining mild stress urinary incontinence (SUI) or mixed urinary incontinence (MUI). MATERIALS AND METHODS: 42 non-consecutive female out-patients with mild SUI or mild MUI were assessed with a clinical evaluation, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) and Patients' Perception of Intensity of Urgency Scale (PPIUS) at baseline the start of the study and after two months of therapy with the phytotherapic product. At the end of the therapy the patients also compiled Patient Global Impression of Improvement (PGI-I). RESULTS: After the completion of the study there was a trend towards better results in each item of ICIQ-SF, but without any statistical significance with an average score in ICIQ-SF-1 of 3.12 ± 0.981 versus 3.21 ± 0.914 (p = 0.556), in ICIQ-SF-2 of 3.69 ± 1.422 versus 3.79 ± 1.372 (p = 0.68) and in ICIQ-SF-3 of 5.95 ± 1.618 versus 6.14 ± 1.670 (p = 0.462). The average reduction of PPIUS was of 0.09 (1.26 ± 1.481 versus 1.357 ± 1.509, p = 0.705). There was a reduction of average consumption of pads/die from 1.69 ± 0.636 to 1.54 ± 0.543 (p = 0.101). In relation to the PGI score, 23/42 patients (54.7%) reported no changes after the completion of the therapy, 13/42 (30.9%) reported a slight improvement, 5/42 (11.9%) were much improved and 1/42 (2.3%) was slightly worsened. Only 2/42 (4.7%) patients discontinued the treatment before of the completion of the study. We did not observe any adverse effects during the period of the study. CONCLUSIONS: The phytotherapic product seems to cause a slight improvement of the symptoms in a good rate of patients. Moreover it has a low rate of withdrawal, due to the lack of adverse events.

Urethral Bulking in the Treatment of Stress and Mixed Female Urinary Incontinence: Results from a Multicenter Cohort and Predictors of Clinical Outcomes.

The aim of the present study is to analyze the outcomes of urethral bulking in the treatment of non-neurogenic female stress and mixed urinary incontinence and to assess predictors of clinical outcomes. We retrospectively included all consecutive patients affected by stress or mixed urinary incontinence and treated with urethral bulking. Outcomes were evaluated via the PGI-I questionnaire and the 24-h pad test. Between January 2010 and January 2020, we treated 216 patients (Bulkamid n = 206; Macro-plastique n = 10). The median age at surgery was 66 years (IQR 55−73.75). The median follow-up was 12 months (IQR 12−24). In total, 23.8% of patients were subjected to prior incontinence surgery, 63.8% of patients were affected by genuine stress urinary incontinence, 36.2% reported mixed urinary incontinence, whereas detrusor overactivity was confirmed in only 24.9%. The dry rate was 32.9%; nevertheless, 69.9% of patients declared themselves "very improved" or "improved" (PGI-I1-2). Low complications were observed, mostly classified as Clavien I. After univariate and multivariate analyses, the only statistically significant independent predictor of "dry" outcome was the 24 h pad test, p < 0.001. Urethral bulking could be proposed with more expectations of success in patients with mild urinary incontinence. Patients affected by moderate−severe incontinence are less likely to obtain clinical success; therefore, they should be carefully counselled about clinical expectations before the procedure.

Can urethral re-bulking improve the outcomes of a prior urethral bulking?

AIMS: To analyze the outcomes of urethral re-bulking in the treatment of female stress urinary incontinence. MATERIALS AND METHODS: We performed a multicenter observational retrospective study, which included all consecutive patients treated with urethral re-bulking for the treatment of persistent stress or mixed urinary incontinence after a previous urethral bulking. Objective outcomes were evaluated with the 24 h pad-test, while PGI-I questionnaires were administered to evaluate subjective outcomes. Clinical outcomes were assessed before re-bulking procedure and at last follow-up. Mann-Whitney's U test was used for subgroup analysis. Shapiro-Wilk's tests were used as normality tests. RESULTS: In total, 62 patients who underwent urethral re-bulking between 2013 and 2020 in a multicenter setting were included. Most patients did not reach complete continence after the first procedure (n = 56) while the remainder reported recurrence of urinary incontinence after initial benefit. Median age at surgery was 66 (IQR: 55-73). Median overall follow-up was 30 months (IQR: 24-41). Median time occurred between the first procedure and reintervention was 12 months (IQR: 7-27). Bulking agents for the re-bulking procedures were bulkamid(n = 56), macroplastique(n = 4), and Prolastic(n = 2). A statistically significant reduction of median 24 h pad test from 100 g(IQR: 40-200) to 35 g(IQR: 0-120) was observed (p = 0.003). Dry rate after rebulking was 36.6%, while 85.4% patients declared themselves 'very much improved' or 'much improved' (PGI-I 1-2). Very few low-grade complications were observed (n = 4). A single case of major complication occurred. CONCLUSIONS: Urethral re-bulking can be an effective technique for the treatment of stress urinary incontinence refractory to a previous urethral bulking and can determine a cumulative benefit after the first procedure.

The role of clean intermittent catheterization in rehabilitation setting: a survey of healthcare operators' perception in Italy.

BACKGROUND: Clean intermittent catheterization (CIC) is defined as the repetitive temporary placement of a catheter to empty the bladder. It has become the first-line and preferred method of drainage in patients with neurogenic lower urinary tract dysfunction. AIM: We investigated the use of CIC in the real-life setting in Italy. METHODS: We administered interviews to health operators of centers for urinary rehabilitation. RESULTS: Overall, 110 healthcare professionals were invited to fill the questionnaire and 109 (72% males) answered it. Answers to the questionnaire showed that 65.2% of patients with urinary retention used CIC, 22.3% used a transurethral indwelling catheter, and 5.5% used a suprapubic catheter; 6.3% of patients used CIC during the daytime and used the indwelling catheter during the night. The most relevant factor, pertaining the patient, to decide to propose the use of CIC was manual ability, followed by good cognitive function, adequate anatomical condition, age, available adequate caregiver, psychological consistency and good socio-cultural level. Lubrification, usability and easy insertion were the most relevant characteristics of a catheter that favored the choice of the device for CIC. In addition, in the opinion of interviewed operators, the line of catheters with glycerin-water based lubrification had the main characteristics to be preferred for CIC. CONCLUSIONS: CIC is a preferential intervention for urinary retention in the clinical practice in Italy, is chosen on the basis of patient's characteristics, and lubrification, usability and easy insertion are the most important features of catheters.

A "real life" investigation on the prescriptive habits among Italian andrologists: The "CONSER" survey from Italian Society of Andrology (SIA) on Sildenafil oral film.

Even if oral type 5 phosphodiesterase inhibitors (PDE5i) seem an effective treatment for erectile dysfunction (ED), the drop-out is high among patients. For this reason, pharmaceutical companies are encouraged to develop new administration routes, such as the orally disintegrating film. The aim of this study was to analyse the prescription habit of Italian andrologists affiliated to Italian Society of Andrology (SIA) in the era of new oro-dispersible formulation of sildenafil. A 12-items dedicated questionnaire has been distributed to 77 urologists andrologists. As a result of the questionnaire, sildenafil is still the preferred drug of Italian andrologists as it is considered the safest and the most effective. It combines the speed of action and the discretion of the intake that are very important issues for the adherence to the treatment according to the Italian sample. Physicians have also reported the positive feedback of the patients taking sildenafil film as they consider the oro-dispersible formulation either comparable or superior to the old tablet. In conclusion this new formulation has given a new life to an old molecule like sildenafil, and Italian andrologists considered this new pharmaceutical formulation as a good tool to improve the patient's adherence to the treatment and quality of life.