Use of low-intensity extracorporeal shock wave therapy in the management of interstitial cystitis/bladder pain syndrome patients: A thirty case study in a tertiary medical center.

INTRODUCTION: Low-energy extracorporeal shock wave therapy (LiESWT) is a new potential treatment for intractable interstitial cystitis/bladder pain syndrome (IC/BPS), and this paper will evaluate its therapeutic effects on IC/BPS. MATERIALS AND METHODS: This prospective clinical trial enrolled 30 women who have been diagnosed with IC/PBS to receive LiESWT treatment at an intensity of 0.25 mJ/mm2 and a frequency of 3 pulses/second, for a total of 3000 pulses within 8 weeks. And we assessed questionnaires (including O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI)), 3-day voiding diary, and urodynamic study at the following intervals: 4 weeks of LiESWT (W4), 8 weeks of LiESWT (W8), 1-month follow-up (F1), 3-month follow-up (F3) after LiESWT, and 1 year follow-up (F12). RESULTS: The primary outcome of questionnaires showed significant improvement of symptoms compared to baseline (W0), especially on ICSI(12.87 ± 3.44 before treatment and 7.87 ± 5.27 at F12, p < 0.05). 3-day voiding diary also revealed significant decrease in daytime voiding frequency (15.57 ± 5.22 times before treatment and 10.70 ± 4.21 times at F1, p < 0.05) and significant increase on average voiding volume (95.85 ± 35.30 mL before treatment and 161.27 ± 74.21 mL at F1, p < 0.05). However, there were no significant differences in all parameters of the urodynamic study. CONCLUSION: LiESWT can mitigate pain and lower urinary tract symptoms and improve the quality of life in IC/PBS patients, but does not increase the maximal cystometric capacity.

Correlation between overactive bladder and detrusor overactivity: a retrospective study.

INTRODUCTION: The primary objective of this study is to determine the prevalence of overactive bladder (OAB) and detrusor overactivity (DO) in female patients who were referred for urodynamic study (UDS) because of lower urinary tract symptoms (LUTS). The secondary objective is to determine the subjective and objective differences between female OAB patients with and without DO. MATERIALS AND METHODS: All female patients who underwent UDS for LUTS between June 2016 and September 2019 were retrospectively reviewed. Personal history, medical history, physical examination, and validated questionnaires were collected. One-hour pad test and multichannel urodynamic study was performed. All statistical analyses were conducted by SAS 9.4. P-value < 0.05 was considered statistically significant. RESULTS: A total of 4184 female patients underwent UDS because of LUTS between June 2016 and September 2019; 1524 patients were analyzed for OAB or DO. The occurrence of OAB was 36.4%. The overall incidence of DO in OAB patients was 15.5%; 9.5% of all patients had DO findings on UDS, and 4.6% were incidental findings. There were significant differences among mean age, parity, ICIQ-UI SF, OABSS, POPDI-6, and all UDS parameters (except for maximal urethral pressure and pressure transmission ratio) between patients with and without DO. In patients with DO, there were no significant differences among age, parity, and BMI with or without OAB symptoms. However, there were significant differences among mean OABSS, ICIQ-UI SF, UDI-6, POPDI-6, IIQ-7, and pad test. CONCLUSIONS: Patients with DO are associated with older age, increased parity, greater urine leakage, and worse storage and micturition functions on UDS. Combinations of subjective and objective measurements are better predictive models for OAB patients.

Human amniotic fluid stem cells can improve cerebral vascular remodelling and neurological function after focal cerebral ischaemia in diabetic rats.

Diabetes causes vascular injury and carries a high risk of ischaemic stroke. Human amniotic fluid stem cells (hAFSCs) can enhance cerebral vascular remodelling and have the potential to improve neurological function after stroke in diabetic rats. Five groups of female rats were examined: (1) normal control, (2) type 1 diabetic (T1DM) rats induced by streptozotocin injection (DM), (3) non-DM rats receiving 60-minute middle cerebral artery occlusion (MCAO), (4) T1DM rats receiving 60-minute MCAO (DM + MCAO) and (5) T1DM rats receiving 60-minute MCAO and injection with 5 × 106  hAFSCs at 3 h after MCAO (DM + MCAO + hAFSCs). Neurological function was examined before, and at 1, 7, 14, 21 and 28 days, and cerebral infarction volume and haemorrhage, cerebral vascular density, angiogenesis and inflammatory were examined at 7 and 28 days after MCAO. hAFSCs treatment caused a significant improvement of neurological dysfunction, infarction volume, blood-brain barrier leakage, cerebral arterial density, vascular density and angiogenesis and a reduction of brain haemorrhage and inflammation compared with non-treatment. Our results showed that the effect of hAFSCs treatment against focal cerebral ischaemia may act through the recovery of vascular remodelling and angiogenesis and the reduction of inflammation in ischaemic brain.

Beneficial effect of Bletilla striata extract solution on zymosan-induced interstitial cystitis in rat.

AIMS: Interstitial cystitis (IC) is a chronic pain syndrome that is characterized by suprapubic pain upon bladder filling. Bletilla striata, a well-known traditional Chinese herb with established efficacy in wound healing and anti-inflammation, was hypothesized to improve the symptoms of IC possibly though forming a physical barrier that could isolate the bladder tissue from irritants. This study was conducted to evaluate the beneficial effects of intravesical treatment with B. striata extract solution (BSES) on visceral pain and bladder function of rats with zymosan-induced IC. METHODS: Thirty female rats were randomly divided into control group, zymosan-induced cystitis rats treated with normal saline (Z + NS), and zymosan-induced cystitis rats treated with BSES (Z + BSES). All rats underwent evaluation for abdominal withdrawal reflex (AWR) scores to assess visceral hypersensitivity, cystometrography, and electromyogram (EMG) of both external urethral sphincter and bladder detrusor. Data were analyzed by one way analysis of variance. RESULTS: The Z + NS group had an increased visceral hypersensitivity as compared to control group. Rats treated with BSES (Z + BSES group) had decreased AWR scores and amplitude of bladder detrusor-EMG. Besides, BSES treatment improved overactive bladder with significant effects on the extend of micturition interval and increase of storage of urine. CONCLUSIONS: Intravesical instillation of BSES can significantly alleviate zymosan-induced visceral hypersensitivity and bladder overactivity associated with IC. This study suggested that intravesical instillation with BSES might be a promising treatment for IC.

Pregnancy weight gain may affect perinatal outcomes, quality of life during pregnancy, and child-bearing expenses: an observational cohort study.

PURPOSE: We aimed to examine the effect of gestational weight gain (GWG) on perinatal outcomes, quality of life (QoL) during pregnancy, and medical costs of childbirth. METHODS: The observational cohort comprised 2210 pregnant women who were classified into three groups based on their pre-pregnancy body mass index (BMI) and GWG in relation to the 2020 Institute of Medicine (IOM) recommendations. The data were collected on perinatal outcomes, urinary incontinence (UI) during pregnancy, changes in sexual function, and medical costs of hospitalization for delivery. Univariate and multivariable logistic regression models were employed to explore those associations. RESULTS: Only 42.1% of women met the 2020 IOM guidelines. After adjustments for potential confounding factors, women with above-normal GWG had adverse pregnancy outcomes, including a large fetal head circumference and macrosomia, and women with below-normal GWG were more likely to deliver low-birthweight fetuses preterm than women with normal GWG. Only 16.8% of women reported sexual activity during pregnancy. There were not significant differences in sexual activity and satisfaction, or QoL among the three GWG groups. Child-bearing expenses were higher for women with above-normal GWG than for women with normal GWG. Although the child-bearing expenses were higher for the above-normal GWG, the proportion of women with expenses above the median increased according to pre-pregnancy BMI. CONCLUSION: Our results show that inappropriate GWG is associated with a greater risk of adverse perinatal outcomes and increased medical expenses for delivery. Healthcare providers are advised to counsel women to maintain their GWG following the 2020 IOM recommendations throughout pregnancy.

Amniotic fluid stem cells ameliorate bladder dysfunction induced by chronic bladder ischemia in rat.

AIMS: This study investigated the protective effect of human amniotic fluid-derived stem cells (hAFSCs) against bladder overactivity in rat model of atherosclerosis-induced chronic bladder ischemia. METHODS: Adult female Sprague-Dawley rats were divided into six groups: (1) Normal control with a regular diet for 8 weeks, (2) Sham-operation, (3) arterial balloon endothelial injury (AEI) of common iliac artery (AEI only), and post-AEI consecutive hAFSCs treatment for (4) 1 day, (5) 3 days, and (6) 7 days. Groups 2-6 were given 2% cholesterol diet for 8 weeks after operation (sham or AEI). Bladder functions were analyzed by cystometry at 8 weeks in controls and after operation in groups 2-6. Wall morphology of common iliac artery was examined by hematoxylin and eosin stain. Bladder oxidative stress and inflammatory markers were studied by immunohistochemistry of 8-hydroxy-2'-deoxyguanosine (8OHdG), malondialdehyde (MDA), and tumor necrosis factor-alpha (TNF-alpha). RESULTS: Bladder overactivity with decreased voided volumes and intercontraction intervals and increased residual volumes was seen in AEI only group, but improved after hAFSCs treatment for 1, 3, and 7 days. Compared with controls and shams, the wall thickness of iliac artery was increased in AEI only group, but improved after hAFSCs treatment for 3 and 7 days. The expressions of 8OHdG, MDA, and TNF-alpha were increased in AEI only group, but improved after hAFSCs treatment for 1, 3, and 7 days. CONCLUSIONS: Bladder overactivity caused by chronic bladder ischemia can be improved by hAFSCs treatment, probably by acting through down-regulation of oxidative stress and TNF-alpha expressions.

Comparative study of transobturator sling with and without concomitant prolapse surgery for female urodynamic stress incontinence.

AIM: To demonstrate the clinical and urodynamic outcomes of transobturator sling (TOT) with or without concomitant prolapse surgery for the treatment of urodynamic stress incontinence (USI). METHODS: We recruited 143 consecutive patients diagnosed with USI, who received outside-in TOT in a university hospital. Preoperative and postoperative examinations were implemented using structured urogynecological questionnaires, pelvic organ prolapse quantification examination and urodynamic testing. Patient demographics, surgical and urodynamic results were compared between TOT with and without concomitant prolapse surgery. RESULTS: The mean follow-up was 30.1 months (range 12-57). Postoperative stress urinary incontinence (SUI) occurred in 10 (7%) patients at 3 months and 10 (7%) patients at 12 months postoperatively. There was no significant difference in prevalence of postoperative SUI between groups of TOT only and TOT combined with pelvic surgery. Preoperative urodynamic results demonstrated that TOT only (n = 96) had a higher maximal flow rate and a lower residual urine amount when compared to TOT combined with pelvic surgery (n = 47). A significant decrease in maximal urethral closure pressure (MUCP) was found in 119 patients who received postoperative urodynamic examination. In comparison with preoperative urodynamic data, postoperative urodynamic results showed a significant decrease in MUCP in the TOT combined with prolapse surgery group, but no significant urodynamic changes in the group of TOT only. CONCLUSION: Both TOT and TOT combined with prolapse surgery can be effective in correcting SUI in patients with USI 12 months postoperatively, with significant changes in MUCP.

Outcome of coexistent overactive bladder symptoms in women with urodynamic urinary incontinence following anti-incontinence surgery.

INTRODUCTION AND HYPOTHESIS: The objective was to investigate the outcome of stress urinary incontinence (SUI) and overactive bladder (OAB) symptoms in women with urodynamic stress incontinence (USI) after transobturator sling procedures (TOTs). METHODS: We evaluated 109 consecutive patients with USI, who had undergone TOT in a tertiary hospital between 2012 and 2014. All patients received evaluations, including structured urogynecological questionnaires and pelvic organ prolapse quantification examination before, and 3 and 12 months after surgery. One-hour pad test and urodynamic testing were performed before and 3-6 months postoperatively. Patient demographics, lower urinary tract symptoms, and urodynamic results were analyzed between pure USI and USI with OAB symptoms. RESULTS: Persistent SUI occurred in 8 patients at 3 months (7.3 %) and 7 patients at 12 months (6.4 %) postoperatively. The most common OAB symptom was frequency (54.1 %), followed by urgency urinary incontinence (52.3 %), urinary urgency (42.2 %), and nocturia (33 %). Most of these OAB symptoms were resolved at the 3-month and 12-month follow-ups both in patients treated with TOT only and in those treated with TOT combined with other pelvic surgeries. There was no significant difference in the preoperative urodynamic changes between patients with pure USI and USI without OAB groups. However, postoperative urodynamic results showed a significant decrease in the maximal urethral closure pressure in the group of patients with USI and OAB symptoms, but no significant urodynamic changes in the group with pure USI. CONCLUSIONS: Coexistent OAB symptoms are common in women who were diagnosed with USI and most of these symptoms may resolve 3 and 12 months after TOT.

Predictors of persistent detrusor overactivity in women with pelvic organ prolapse following transvaginal mesh repair.

AIM: The aim of this study was to investigate the contributing factors of persistent detrusor overactivity (DO) in women with advanced pelvic organ prolapse (POP) after transvaginal mesh (TVM) repair. METHODS: We retrospectively evaluated consecutive patients with DO and advanced POP who had undergone TVM in a tertiary hospital between 2010 and 2014. All patients received evaluations, including a structured urogynecological questionnaire, pelvic examination using the POP-Quantification System, scores of the Urogenital Distress Inventory and Incontinence Impact Questionnaire, and urodynamic testing before TVM repair and 6 months after surgery. Patient demographics, lower urinary tract symptoms, including urinary urgency, incontinence and frequency, and urodynamic findings were analyzed between women with and without persistent DO at 12 months after surgery. RESULTS: Of 326 patients with POP who underwent TVM repair, 63 with preoperative DO were included. Urinary urgency was present in 27 (42.9%), and urgency incontinence was present in 26 (41.3%) patients. Nineteen (30.2%) patients had persistent DO after surgery. Patients with persistent DO had lower preoperative maximal flow rate (MFR), higher preoperative detrusor pressure at maximum flow, higher postoperative residual urine volume and higher rates of concomitant sacrospinous ligament suspension compared to those without DO. In the multivariate analysis, preoperative MFR and concomitant sacrospinous ligament suspension were associated with persistent DO. CONCLUSION: Twenty percent of women with advanced POP had DO, and most of these cases resolved after prolapse repair. For women with lower preoperative MFR and concomitant sacrospinous ligament suspension, preoperative counseling should consist of a discussion about persistent DO and relevant urinary symptoms following TVM repair.

Bladder dysfunction induced by cerebral hypoperfusion after bilateral common carotid artery occlusion in rats.

AIMS: The role of forebrain in controlling micturition has been studied extensively using rat model with ischemic injury; however, the influence of cerebral hypoperfusion on voiding function remains unclear. The study was conducted to evaluate the bladder dysfunction and the temporal expression of bladder nerve growth factor (NGF) after cerebral hypoperfusion induced by bilateral common carotid artery occlusion (BCCAO). MATERIALS AND METHODS: Forty female rats were subjected to either BCCAO or sham operation. Cerebral T2-weighted magnetic resonance images (MRI) and diffusion and perfusion change were studied to characterize the extent of the ischemic injury in the cortex and hippocampus. On 1, 7, and 28 days after BCCAO, the bladder dysfunction was assessed by cystometric studies, and the expressions of NGF in bladder muscle and urothelium were measured by immunohistochemistry and real-time polymerase chain reaction. RESULTS: In the MRI study, cerebral blood flow in the cortex and hippocampus was significantly decreased from 1 day and subsequently returned to sham-operated level at 28 days after BCCAO. Compared with the sham-operated group, significant reduction in voided volume and intercontraction interval was found from 1 to 28 days after cerebral hypoperfusion. The NGF immunoreactivity and mRNA in the bladder muscle and urothelium were transiently increased at 1 day, and declined significantly at 28 days after BCCAO. CONCLUSIONS: Our results indicate that bladder dysfunction may be caused by cerebral hypoperfusion and is less likely related to bladder NGF expression.

Trends in reoperation for female stress urinary incontinence: A nationwide study.

AIMS: Using the National Health Insurance (NHI) database in Taiwan, the study aimed to evaluate the rates and associated factors for reoperation of female stress incontinence. METHODS: Records of female patients who had received a primary surgical treatment for stress incontinence from January 2000 to December 2006 were retrieved. Among these, patients who had reoperations during follow-up till December 2010 were identified. The data were analyzed for reoperation rates, surgery methods, patient demography, surgeon, and hospital attributes. RESULTS: Among 14,613 patients with a mean follow-up of 86.28 ± 26.76 months, 563 (3.85%) had reoperations, an incidence rate of 54.37 per 10,000 person year (PY). Injection procedures had the highest reoperation rate of 893.30/10,000 PY. The adjusted hazard ratio (HR) of reoperation was higher for mid-urethral sling when compared to pubovaginal sling (HR 1.54, 95% CI 1.16-2.05) or retropubic urethropexy including Burch operation (HR 1.30, 95% CI 1.04-1.61). Surgeons with high service volumes tended to have fewer reoperations. No correlations were noted between the reoperation rate with patient age, surgeon age/gender, year of operation and hospital status. However, urologists had higher reoperation rates than gynecologists. For repeat surgery, the majority of patients chose the same specialty but different surgical types. Mid-urethral sling was used most commonly in 48.85% of reoperations. CONCLUSIONS: Substantial number of patients need reoperation for stress incontinence. The choice of primary surgery type and surgeon specialty may affect the reoperation rates. Mid-urethral sling is the most common reoperation choice.

Effect of suburethral prolene mesh for suburethral function and histology in a stress urinary incontinence mouse model.

OBJECTIVES: To create a mouse model pertaining to mesh-elicited suburethral functional and histological changes after vaginal distention, and to examine the possible mechanism behind these complications. METHODS: We divided 48 virgin female C57BL/6 mice into four groups: vaginal distention alone, vaginal distention followed by prolene mesh implantation, vaginal distention followed by sham mesh implantation and untreated control. Each group was divided into two subgroups for conscious cystometrogram, leak-point pressure testing and harvesting of suburethral tissue 4 or 10 days after vaginal distention. The suburethral tissues underwent immunohistochemistry and western blot analysis of nerve growth factor, matrix metalloproteinase 2 and tissue inhibitor of metalloproteinase 2. Urodynamic results were compared among groups using one way ANOVA, with Tukey's multiple comparisons post-test for pair wise comparisons. RESULTS: Leak-point pressure in the vaginal distention and vaginal distention + sham mesh groups were significantly lower than in the control and vaginal distention + mesh groups at day 4. Leak-point pressure in the vaginal distention + mesh group were significantly higher than in the other three groups at both day 4 and 10. Immunohistochemistry and western blotting showed increased matrix metalloproteinase 2 and tissue inhibitor of metalloproteinase 2 levels in the vaginal distention + mesh group at day 4 and 10. Furthermore, nerve growth factor expression was increased in the same area and same group at 10 days. CONCLUSIONS: Increased suburethral tissue matrix metalloproteinase and nerve growth factor expression might be related to tissue remodeling after prolene mesh implantation for stress urinary incontinence.

How antepartum and postpartum acute urinary retention affects the function and structure of the rat bladder.

INTRODUCTION AND HYPOTHESIS: To examine the effect of acute urinary retention (AUR) on the urodynamic function and molecular structure of rat bladders in pregnancy and after parturition. METHODS: Forty-eight nulliparous rats were distributed into AUR and non-AUR groups. AUR was induced by clamping the distal urethra of each rat after infusing 3 ml of saline for 60 min. Plasma progesterone levels and cystometric data were evaluated on the 14th day of gestation, 3 and 10 days postpartum, and in virgin rats. The immunoreactivity of caveolins and nerve growth factor (NGF) was analyzed. The number of caveolae in bladder muscle cells was evaluated by electron microscopy. RESULTS: Progesterone levels significantly increased during pregnancy and 3 days postpartum. In cystometric results, the AUR group has significantly shorter intercontraction interval, lower void volume and greater residual volume compared with the non-AUR. AUR rats exhibited higher NGF immunoreactivity, lower caveolin-1 immunoreactivity, and less caveolae in the bladder compared with the non-AUR. The caveolin-1 and NGF immunoreactivity and the number of caveolae in the bladder decreased during pregnancy and 3 days postpartum compared with virgin rats. By using Pearson correlations, we found significant correlations between urodynamic variables (residual volumes and intercontraction intervals) and the expressions of caveolin-1, caveolae and NGF in the AUR rats on the 14th day of gestation and 3 days postpartum. CONCLUSIONS: Bladder dysfunction in pregnancy and immediately postpartum in a rat model caused by AUR is associated with the plasma progesterone level change and the expressions of caveolin, caveolae, and NGF in bladder muscle cells.

The surgical trends and time-frame comparison of primary surgery for stress urinary incontinence, 2006-2010 vs 1997-2005: a population-based nation-wide follow-up descriptive study.

INTRODUCTION AND HYPOTHESIS: The purpose of our study was to describe the surgical trends for female stress urinary incontinence (SUI) during 2006-2010, and a time-frame comparison with 1997-2005, based upon the National Health Insurance (NHI) claims data in Taiwan. METHODS: Women who underwent various primary surgeries for SUI during 2006-2010 were identified, with a total of 15,099 inpatients. The variables included surgical types, patient age, surgeon age and gender, specialty, and hospital accreditation levels. Chi-squared tests and SAS version 9.3.1 were used for statistical analysis. RESULTS: During the follow-up study, midurethral sling (MUS) application increased significantly from 53.09 % in 2006 to 78.74 % in 2010. It was associated concomitantly with a decrease in retropubic urethropexy (RPU) from 29.68 % to 12.99 %, and pubovaginal sling treatment (PVS) from 9.33 % to 3.46 %. MUS was most commonly used among all patients' and surgeons' age groups, and different accreditation hospital levels. MUS was more commonly used by gynecologists (71.38 %) than urologists (57.91 %); while PVS and periurethral injection were more commonly performed by urologists than gynecologists. Similar surgical trends were found during time-frame comparison, 2006-2010 vs 1997-2005. SUI surgeries increased in patients aged ≥60, surgeons aged ≥ 50, and in regional hospitals. CONCLUSION: This follow-up study depicts the increase in popularity of MUS and offers evidence of surgical trends and a paradigm shift for female SUI surgery. More older women were willing to seek healthcare and undergo surgery. The surgical skills and knowledge spread from medical centers into regional hospitals. The time-frame shift may have a profound impact on patients, as well as the healthcare providers.

Clinical impact of and contributing factors to urinary incontinence in women 5 years after first delivery.

INTRODUCTION AND HYPOTHESIS: This study was conducted to investigate the prevalence of and contributing factors to urinary incontinence (UI) in women 5 years after their first birth and to evaluate the associations of UI with delivery mode and quality of life. METHODS: Between 2005 July and 2006 March, primiparous women who delivered at term in a tertiary hospital were recruited into this cohort study. Immediately postpartum, the women completed a structured urogynecological questionnaire regarding lower urinary tract symptoms. Then the same urogynecological questionnaire, the Incontinence Impact Questionnaire (IIQ-7), and the Urinary Distress Inventory (UDI-6) were mailed to them 5 years later to follow up on UI. Three hundred and twelve women responding to the mailed questionnaires were included in the analyses. RESULTS: The prevalence 5 years after first delivery of stress (SUI) and urge (UUI) UI were 43.6 % and 19.2 %, respectively. Women with UI during their first pregnancy were more likely to develop UI 5 years postpartum than those without it; women who delivered their first child vaginally had a greater incidence of UI than those having cesarean birth; UUI in women following cesarean delivery more negatively impacted emotional health than it did following vaginal birth, whereas the impact of SUI did not significantly differ between delivery groups. CONCLUSIONS: UI during the first pregnancy and vaginal delivery in primiparous women may predict an increased risk of having UI 5 years after delivery. UUI adversely affected women's emotional health, especially in those undergoing cesarean section.

Effect of extracorporeal magnetic energy stimulation on bothersome lower urinary tract symptoms and quality of life in female patients with stress urinary incontinence and overactive bladder.

AIMS: The aim of this study was to investigate the efficacy of extracorporeal magnetic stimulation (EMS) for the treatment of bothersome and severe symptoms of stress urinary incontinence (SUI) and overactive bladder syndrome (OAB) in female patients. MATERIAL AND METHODS: A retrospective review was conducted on patients with SUI and OAB who were referred to EMS therapy. Successful treatment for the bothersome symptoms of OAB and SUI was defined as score ≤1 for questions 2 and 3 on the Urodynamic Distress Inventory-6. The objective cure of SUI and OAB was defined as no urinary leakage during the cough stress test and any urgency, urge incontinence and voiding frequency of less than eight times per 24 h based on the 3-day bladder diary, after the 9 weeks of treatment, respectively. RESULTS: Ninety-three patients with SUI or OAB underwent a 9-week course of EMS at 20 min twice weekly. Seventy-two (77%) patients completed EMS treatment. Geographical factor and poor economic status were two main factors for dropout. A total of 94.1% (32 of 34) and 86.8% (33 of 38) of subjects had successful treatment for the bothersome symptoms of OAB and SUI, respectively. In contrast, the cure rate for OAB and SUI was only 61.7% and 42.1%, respectively. There was also a significant improvement in both Urogenital Distress Inventory Short Form (bothersome on lower urinary tract symptoms) and the Incontinence Impact Questionnaire Short Form (quality of life) total score in both groups after EMS. CONCLUSIONS: EMS is a safe and effective alternative method for treating SUI and OAB. Further studies are needed to evaluate the long-term efficacy.

Factors determining the persistence of prenatal stress urinary incontinence 12 months postpartum.

OBJECTIVE: Whilst many studies have explored the mechanisms of stress urinary incontinence (SUI) following various modes of delivery, few have examined outcomes of postpartum SUI in women who experienced new-onset SUI during their pregnancy. Our primary objective was to investigate the risk factors for persistent postpartum SUI in women with new-onset SUI during pregnancy at 1-year follow-up following vaginal delivery. MATERIALS AND METHODS: 303 women with new-onset SUI during pregnancy who underwent vaginal delivery in a university hospital between 2014 and 2015 were included. In-person interviews were conducted for all participants on the second postpartum day, followed by phone interviews at 12 months postpartum, with completion of structured questionnaires, including Urogenital Distress Inventory Short Form (UDI-6) and Incontinence Impact Questionnaire Short Form (IIQ-7). Demographic, obstetrics and questionnaire scores were analyzed and compared between the group of women who experienced persistent postpartum SUI and the group who did not. RESULTS: At 12 months postpartum, 16.5% (n = 50) of women had persistent postpartum SUI, with 83.5% (n = 253) experiencing resolution of SUI symptoms. Maternal age ≥35 years (aOR = 2.62; 95% CI, 1.40-4.87, P = 0.002), gestational age at birth ≥40 weeks (aOR = 2.21; 95% CI, 1.12-4.37, P = 0.022), and severe perineal lacerations (aOR = 2.32; 95% CI, 1.27-4.45, P = 0.013) were independent risk factors for persistent postpartum SUI for women following vaginal delivery at 1-year follow-up. CONCLUSION: The prevalence of persistent postpartum SUI at 1-year following vaginal delivery is 16.5%, with advanced maternal age, gestational age at birth ≥40 weeks and severe perineal lacerations being independent risk factors.

Urinary beta 3-adrenoceptor as a diagnostic biomarker for overactive bladder in women.

This study was to investigate urinary beta 3-adrenoceptor concentration as a biomarker for overactive bladder (OAB) and predictor of treatment outcomes in women receiving the beta 3-adrenoceptor agonist mirabegron. The study comprised 50 women identified with OAB and 35 women considered as healthy controls. All women with OAB received daily dosage of 50 mg of mirabegron for 12 weeks. Bladder diaries, OAB-related questionnaires, and global response assessment scale (GRAS) data were collected. Urinary beta 3-adrenoceptor concentration was measured through enzyme-linked immunosorbent assay. All OAB-related questionnaires and GRAS indicated improved posttreatment urinary health. After mirabegron treatment, the frequency of micturition and urgency episodes decreased, but the urinary beta 3-adrenoceptor/creatinine (Cr) ratio increased. The urinary beta 3-adrenoceptor/creatinine ratio was identified as a sensitive biomarker for OAB with a confidence interval of 0.656 to 0.856 (p < 0.001). A negative correlation (- 0.431, p = 0.040) between this biomarker and health-related quality of life (HRQL) scores. The Beta 3-adrenoceptor/Cr levels increased significantly in the treatment-responsive group, while they remained unchanged in the unsatisfactory outcome group. This study shows that 12 weeks of mirabegron treatment improves OAB symptoms and HRQL. Furthermore, urinary beta 3-adrenoceptor concentration may be a diagnostic biomarker for OAB.

Sexual function in women following transvaginal mesh procedures for the treatment of pelvic organ prolapse.

INTRODUCTION AND HYPOTHESIS: Synthetic mesh kits recently adopted in pelvic reconstructive surgeries have achieved great surgical efficacy, but the effects of transvaginal synthetic mesh procedures on women's sexual function are still controversial. This study was conducted to demonstrate sexual function in women before and after surgery with transvaginal mesh (TVM) repair for pelvic organ prolapse (POP). METHODS: A total of 93 sexually active women scheduled for correcting POP with synthetic mesh kits were recruited. In addition to urogynecological history, pelvic examination by the Pelvic Organ Prolapse Quantification system, and urodynamic testing, consenting participants were asked to complete the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) to evaluate sexual function before and after surgery. RESULTS: At the 3-month urodynamic studies, among the 25 patients with coexistent urodynamic stress incontinence (USI) who had undergone a concomitant transobturator suburethral tape procedure (TOT), 1 (4 %) had persistent USI; 8 of 68 (11.8 %) patients with a negative pessary test developed postoperative USI. Six-month prolapse recurrence rates following TVM alone and TVM with concomitant TOT were 9 and 12 %, respectively. The total PISQ-12 score after surgery showed worse results in the TVM alone group but not in the TVM with concomitant TOT group. The individual scores of PISQ-12 after surgery demonstrated prolapse-related items improved in both TVM groups; sexual function worsened in dyspareunia and behavior domains. CONCLUSIONS: Our data revealed that transvaginal synthetic mesh procedures for the treatment of POP generated favorable clinical outcomes, but situations might worsen in dyspareunia and behavior domains, thereby invoking a negative emotional reaction during intercourse after surgery.