Sacral neuromodulation in the management of non-obstructive urinary retention: Test phase and predictive factors.

AIM: The aim of this study is to evaluate the success of the test phase of sacral neuromodulation in management of chronic non-obstructive urinary retention and the factors predictive of good response. MATERIALS AND METHODS: This is a retrospective study carried out on a cohort of patients followed up in a tertiary University Hospital in France. Fifty-two patients with chronic non-obstructive urinary retention were included in this study. These patients were seen over the past 20 years, from the year 2000 to 2020. The initial evaluation of patients included a summary of medical and surgical history, age, BMI, history of pelvic floor disorders, initial voiding pattern, physical examination, voiding diary, initial uroflowmetry and a urodynamic study. Postoperative follow-up and analysis of complications were also carried out. RESULTS: A total of 52 patients were included in this study, 13 males and 39 females. Out of these patients, 17 patients (32.7%) with a median age of 47.3 years±18.1 benefited from definitive implantation of the sacral neuromodulation. The univariate analysis showed that age was the only significant variable in this study and the optimal age threshold was<58.5 years. CONCLUSION: SNM is a therapy with significant clinical benefits and low morbidity for patients with chronic non-obstructive urinary retention. The results obtained need to be confirmed with a prospective study with a larger number of patients.

Real-life outcomes after artificial urinary sphincter explantation in women suffering from severe stress incontinence.

PURPOSE: Artificial urinary sphincter (AUS) implantation in female patients results in high satisfaction rates and high functional outcomes, but implantation can be challenging and explantation of the device is fairly common. The objective of this study was to review outcomes after AUS explantation in women. METHODS: This is a retrospective, monocentric study of all women who underwent open or laparoscopic AUS implantation between November 1994 and July 2019, and patients with AUS explantation were included. Management after AUS explantation using descriptive analysis was assessed. RESULTS: Over a span of 26 years, 111 women had an AUS implanted by a single surgeon. Of these surgeries, 35 explantations in 29 patients were later required: 20 initial AUSs, nine revised AUSs and six reimplanted AUS (rAUSs). The median time to explantation was 15.5 month (± 0.55). After explantation, 13 rAUSs in 10 patients were successful and two attempts failed. The median time between explantation and rAUS was 8 months (± 0.95). At the last follow-up, five patients still had their rAUS and six rAUSs had required explantation after a median time of 6.5 months (± 0.65). Surgery was still possible for 12 patients who did not have a rAUS: three cystectomies, one bladder neck closure with continent urinary diversion, and six mid-urethral slings or adjustable continence therapy balloon implantations. Among the 23 patients who did not need a cystectomy or a bladder neck closure with continent urinary diversion, four were completely dry (17.4%), 11 were improved (47.8%), and eight (34.8%) experienced unchanged incontinence with the post-explantation management. Limitations include retrospective design, heterogeneous management over time and a relatively small population of patients in our cohort. CONCLUSION: Reimplantation of an AUS after an explantation seems feasible after at least 6 months. However, the surgery will be more difficult and satisfaction is not guaranteed. Multicenter databases should be created to help surgeons and patients decide on appropriate management strategies after explantation of an AUS.

Prevalence of oral lesions of autoimmune etiology in patients with primary Sjogren's syndrome.

OBJECTIVE: The primary objective of this study was to determine the prevalence of oral lesions of autoimmune etiology (OLAIE) in a cohort of patients with primary Sjögren's syndrome (pSS). MATERIALS AND METHODS: A multi-center retrospective cohort study was conducted at the oral medicine practices of Carolinas Medical Center (CMC), Baylor College of Dentistry (BCD), and the University of Florida (UF). Each site performed a chart review of patients with well-characterized pSS. Clinical variables such as OLAIE, traumatic lesions, and medical conditions were compiled at each site. The association between clinical variables and the presence of OLAIE was then assessed for significance. RESULTS: We evaluated 155 patients diagnosed with pSS. Nineteen patients with pSS (12.3%) had an OLAIE. CMC reported 11 (21.2%) patients with OLAIE, while BCD and UF reported 4 (7.3%) and 4 (8.3%), respectively. Eleven of the 19 (58%) patients with OLAIE had lichen planus, 6 (32%) had aphthous stomatitis, 1 (5%) had chronic ulcerative stomatitis, and 1 (5%) had lesions of systemic connective tissue disease by immunofluorescence. CONCLUSION: The results of our analysis suggest that patients with pSS have a 12% prevalence of OLAIE with a wide range (7.3-21.2%) found between practices. This difference is likely related to the different screening protocols for oral dryness between sites.

Pilocarpine tablets for the treatment of dry mouth and dry eye symptoms in patients with Sjögren syndrome: a randomized, placebo-controlled, fixed-dose, multicenter trial. P92-01 Study Group.

BACKGROUND: Patients with Sjögren syndrome (SS) experience slowly progressive infiltration of lacrimal and salivary glands by mononuclear cells. This leads to diminished secretions, with resultant symptoms of xerostomia and xerophthalmia. Although pilocarpine hydrochloride tablets are currently indicated for the treatment of radiation-induced xerostomia, their effects on dry mouth or dry eyes in patients with SS are unclear. OBJECTIVE: To assess the safety and efficacy of pilocarpine (Salagen) tablets as symptomatic treatment for dry mouth and dry eyes caused by SS in a multicenter, doubleblind, placebo-controlled trial. METHODS: After providing written informed consent, 373 patients with primary or secondary SS and clinically significant dry mouth and dry eyes were randomized to receive 2.5-mg pilocarpine, 5-mg pilocarpine, or placebo tablets 4 times daily for 12 weeks. Symptoms were assessed by questionnaires with visual analog scales or categorical checkboxes. Whole-mouth salivary flow rates were measured. RESULTS: A significantly greater proportion of patients in the 5-mg pilocarpine group showed improvement compared with the placebo group (P< or =.01) in global assessments of dry mouth, dry eyes, and other symptoms of dryness (P< or =.05). Salivary flow was significantly increased 2- to 3-fold (P<.001) after administration of the first dose and was maintained throughout the 12-week study. The most common adverse effect was sweating, and no serious drug-related adverse experiences were reported. CONCLUSION: Administration of 5-mg pilocarpine tablets 4 times daily (20 mg/d) was well tolerated and produced significant improvement in symptoms of dry mouth and dry eyes and other xeroses in patients with SS.

Structural aspects of salivary glycoproteins.

The protective functions of saliva are attributed, in part, to its serous and mucous glycoproteins. We have studied, as representative molecules, the proline-rich glycoprotein (PRG) from human parotid saliva and the high (MG1) and low (MG2) molecular weight mucins from submandibular-sublingual saliva. PRG (38.9 kDa) contains 40% carbohydrate consisting of 6 triantennary N-linked units and a single peptide chain of 231 amino acids, 75% of which = PRO + GLY + GLN. PRG's secondary structure is comprised of 70% random coil (naked regions) and 30% beta-turns (glycosylated domains). MG1 (greater than 10(3) kDa) contains 15% protein (several disulfide linked subunits), 78% carbohydrate (290 units of 4-16 residues), 7% sulfate, and small amounts of covalently linked fatty acids. MG2 (200-250 kDa) contains 30% protein (single peptide chain), 68% carbohydrate (170 units of 2-7 residues), and 2% sulfate. The major carbohydrate units of MG2 are: NeuAc alpha 2,3Gal beta 1,3GalNAc,Gal beta 1,3GalNAc, and Fuc alpha 1,2Gal beta 1,3GalNAc. MG1 contains hydrophobic domains, as evidenced by its ability to bind fluorescent hydrophobic probes; MG2 does not. Collectively, the biochemical and biophysical comparisons between MG1 and MG2 indicate that these two mucins are structurally different. Several functional properties of MG1, MG2, and PRG have been examined, including their presence in two-hour in vivo enamel pellicle, binding to synthetic hydroxyapatite, lubricating properties, and interactions with oral streptococci. The data presented suggest that these glycoproteins may have multiple functions which are predicated, in part on their carbohydrate units. The potential significance of the structure-function relationships of these glycoproteins to the oral ecology is discussed.

The status of lactoferrin and total iron binding capacity of human parotid saliva in Sjögren's syndrome.

UNLABELLED: Sjögren's syndrome (SS) is chronic salivary gland disorder characterized by a reduction in salivary and lacrimal secretion. Elevation in salivary lactoferrin has been reported in SS patients. Fluctuation in the iron binding capacity of lactoferrin has been associated with cellular damage. OBJECTIVE: The purpose of this study was to compare the levels of salivary lactoferrin, total iron, and iron binding capacity in Sjögren's syndrome (SS) patients and healthy controls. METHODS: SDS-PAGE was used to examine the presence of lactoferrin in 102 patients and 20 healthy controls. A colorimetric assay was used to examine the level of total salivary iron and iron binding capacity in patients and controls. RESULTS: A higher number of SS patients exhibited elevated levels of lactoferrin as compared to controls (86% vs. 20%, respectively). No significant difference was observed in the mean level of total iron in the saliva between patients and controls (12.6 micrograms/100 ml vs. 11.1 micrograms/100 ml, respectively). However, the total iron binding capacity of lactoferrin was significantly lower among SS patients than healthy controls (38.2 micrograms/100 ml vs. 61.8 micrograms/100 ml, respectively), p = 0.019. CONCLUSION: The overall results of this study suggest a possible impairment of the iron binding capacity of saliva in SS patients. Such impairment may contribute to the cellular damage of the salivary glands observed in SS patients.

Effects of nicotine on the strength of attachment of gingival fibroblasts to glass and non-diseased human root surfaces.

BACKGROUND: The aim of this study was to evaluate the effect of nicotine on the strength of attachment of human gingival fibroblast cells to glass and non-diseased human root surfaces. METHODS: Human gingival fibroblast cells (HGF) were trypsinized, suspended in RPMI 1640 medium, and incubated with autoclaved human root and glass sections and nicotine (NIC) concentrations of 0 (control), 25, 50, and 100 ng/ml for 1 week. HGF attached and grew on glass and root surfaces for 4 weeks at all NIC concentrations. HGF cultures were subjected to a rotary shaker machine for 30 minutes to test the strength of attachment of these cells at 100, 150, and 200 rpm. The root and glass sections were examined at 48 hours by light microscopy. RESULTS: Control groups exhibited a monolayer of long, spindle-shaped fibroblasts with a parallel alignment and minimal overlapping. With a concentration of NIC of 50 or 100 ng/ml as well as with increasing "speeds," the number of cells attached to these surfaces decreased dramatically. When 200 rpm was used for both groups at all NIC concentrations, very few HGF remained attached to these surfaces. CONCLUSIONS: This study showed that the nature of cell attachment to either glass or root surfaces is altered by nicotine, and marked detachment was noted when nicotine exposure was coupled with vigorous agitation at different rpm. Marked detachment noted in all specimens at 200 rpm indicates that this speed is excessive for use in subsequent experimentation.

Characterization of in vivo salivary-derived enamel pellicle.

Salivary proteins and glycoproteins that participate in the formation of 2-h in vivo enamel pellicle were determined utilizing polyacrylamide gel electrophoresis [sodium dodecyl sulphate (SDS)-PAGE and anionic PAGE]/Western transfer analyses, and specific radiolabelling/SDS-PAGE fluorography. The sensitivity of these methods permitted the identification of individual members of different salivary protein families. The major components of this pellicle were salivary alpha-amylase, cysteine-containing phosphoprotein (CCP or cystatins), salivary mucin and sIgA. Glycosylated amylase was present in larger quantity than the non-glycosylated species. Only CCP1 (cystatin SA-I) of the cysteine-containing phosphoprotein family was identified. The higher molecular-weight salivary mucin (MG1), but not the lower molecular-weight species (MG2), was detected. These results extend earlier observations regarding the selective nature of salivary protein adsorption to enamel surface by demonstrating that only specific members of salivary protein families are involved in 2-h in vivo enamel pellicle formation. The findings also suggest that individual family members may have different functions in the mouth.

A pilot study on the effect of radiation on calmodulin in rat submandibular salivary glands.

Xerostomia and loss of salivary gland secretion is one of the most common complications of the radiation treatment of head-and-neck malignancies. The secretory mechanism in the salivary glands can be modulated by the concentration of intracellular Ca2+. Calmodulin is a calcium-binding protein that is widely distributed in nature and is involved in regulating intracellular calcium. In this study the effect of radiation on the concentration of calmodulin in rat salivary glands was investigated. Fourteen rats were divided into three groups: R1 (n = 4) and R2 (n = 5) received a single dose of 15 Gy and group C (n = 5) received no radiation. R1 and R2 animals were killed at weeks 2 and 10 post-irradiation, respectively. The submandibular glands were removed, homogenized and their total calmodulin was determined. The mean calmodulin concentrations were 6.4+/-1.1 microg/gland for controls, 14.1+/-3.7 microg/gland for R1 and 68.2+/-14.4 microg/gland for R2. Kruskal-Wallis ANOVA revealed a significant increase in the concentration of calmodulin following irradiation (p = 0.003). The relationship between this increase and the loss of salivary gland function is not yet clear.

Sjögren's syndrome: a condition with features of chronic graft-versus-host disease: does duct cell adhesion or permeability play a role in pathogenesis?

Primary and Secondary Sjögren's syndrome are disease complexes characterized by periductal inflammatory cell infiltration of the salivary and lacrimal glands and manifest as dry mouth and dry eyes. Secondary Sjögren's syndrome may be associated with a connective tissue disorder. Additional extraglandular features in Sjögren's syndrome include a generalized inflammatory exocrinopathy that might be associated with abnormalities of both humoral and cellular mediated immunity. Similar inflammatory changes and extraglandular features, including an altered immune response, have been reported in patients developing graft-versus-host disease after bone-marrow transplantation and in patients with primary biliary cirrhosis. The periductal nature of the inflammatory response involving minor salivary and other glands raises the possibility of altered duct cell adhesion or permeability in playing a role in the aetiopathogenesis of Sjögren's syndrome. The paper pulls together evidence that could be interpreted in this light. Evidence for bacterial or viral factor(s) altering the antigenicity of the histocompartibility (HC) complex on ductal cells in Sjögren's syndrome patients is also described. A hypothesis is proposed for Sjögren's syndrome in which the principal feature is an alteration in salivary gland duct cell adhesion or permeability. A re-evaluation of current knowledge of these two conditions from a clinical and experimental context are interpreted in this light.

Salivary anti-spectrin autoantibodies in Sjögren's syndrome.

OBJECTIVE: The purpose of this study was done to compare the anti-spectrin autoantibody levels in the parotid saliva of Sjögren's syndrome patients and in the parotid saliva of healthy control subjects. METHODS: The salivary anti-spectrin autoantibody levels of 20 Sjögren's patients and of 20 healthy controls were compared by means of the slot blot immunoassay and the alkaline phosphatase method. RESULTS: Various anti-spectrin autoantibody levels were detected in the saliva of both patients and controls. The color intensity of the blots was scored on a scale of 1 to 3. The scores were deemed to indicate the anti-spectrin autoantibody levels in saliva (1 = low, 2 = moderate, and 3 = high). The Mann-Whitney U test did not reveal a significant difference in the anti-spectrin autoantibody levels of patients and the anti-spectrin autoantibody levels of controls (P > or = .31). These results do not support a pathologic role for anti-spectrin autoantibody in Sjögren's syndrome. CONCLUSIONS: The overall result of this study substantiates that anti-spectrin autoantibodies occur naturally in saliva. Their role in immune surveillance or pathology is not clear at present.

A comparison of the hormone levels in patients with Sjogren's syndrome and healthy controls.

OBJECTIVE: The purpose of this study was to compare the level and relative ratio of estrogen, progesterone, and prolactin in patients with Sjögren's syndrome and healthy controls. STUDY DESIGN: Serum samples were collected from 17 SS patients and 19 age-, sex- and race-matched controls. All subjects were postmenopausal females who were not currently on hormone replacement therapy. Prolactin levels were measured using ELISA and progesterone and estrogen were measured using EIA. RESULTS: Mann-Whitney U test revealed a significantly higher levels of prolactin among patients than controls (11.41 ng/ml vs. 6.74 ng/ml, p=0.003) with significantly higher prolactin/ progesterone (18.88 vs. 8.14, p=0.02) and estrogen/ progesterone (71.51 vs. 42.02, p=0.05) ratios. No significant differences were observed in the levels of estrogen and progesterone between patients and controls. CONCLUSION: Abnormal levels and relative ratios of hormones may play a role in the pathogenesis of Sjögren's syndrome.

Evaluation of the levels of oral Candida in patients with Sjögren's syndrome.

OBJECTIVE: The purpose of this study was to investigate the levels of oral Candida in patients with Sjögren's syndrome METHODS: The Candida count and salivary flow rate of patients with Sjögren's syndrome were compared with those of healthy control subjects. Candida cultures were obtained from oral rinses. The numbers of colony-forming units were determined through use of the Spiral System. RESULTS: The mean Candida count of patients with Sjögren's syndrome was 1672 +/- 1455 colony-forming units per mL; the count of healthy control subjects was 0.00 colony-forming units per mL. The mean salivary flow rate of patients with Sjögren's syndrome was significantly lower than that of healthy control subjects (0.16 +/- 0.13 mL/min/gland vs 0.55 +/- 0.24 mL/min/gland, respectively; p = 0.0001). However, Spearman rank correlation analyses did not reveal a significant correlation between salivary flow rate and Candida count (in colony-forming units per mL) among patients with Sjögren's syndrome. CONCLUSIONS: Alteration in the oral microbial flora in patients with Sjögren's syndrome may be enhanced by the reduction in salivary output.

Salivary electrophoresis in the diagnosis of Sjögren's syndrome.

OBJECTIVE: The purpose of this study was to investigate the potential use of salivary electrophoresis for the diagnosis of Sjögren's syndrome. METHODS: Salivary protein profiles of 43 patients and 39 healthy control subjects were compared on three different gel electrophoresis systems: sodium dodecylsulfate-polyacrylamide gel electrophoresis, anionic polyacrylamide gel electrophoresis, and immobilized pH gradient gel electrophoresis (isoelectric point, 3.5-5.0). RESULTS: Most of the patients with Sjögren's syndrome exhibited an electrophoretic profile that was different from that of the healthy control subjects. Among the three gel electrophoresis systems examined, the immobilized pH gradient system appeared to be the most reliable for Sjögren's syndrome. Tests of accuracy revealed that the immobilized pH gradient system exhibits high specificity (97%), sensitivity (95%), positive predictive value (97%), and negative predictive value (95%) in the diagnosis of Sjögren's syndrome. CONCLUSIONS: Our results suggest that salivary electrophoresis is a potentially useful test for the diagnosis of Sjögren's syndrome.

Evaluation of major parotid glycoproteins in patients with burning mouth syndrome.

OBJECTIVE: This study was to investigate the potential role of salivary glycoproteins in burning mouth syndrome. STUDY DESIGN: This study compared major parotid glycoproteins in a group of patients with burning mouth syndrome and age-, sex-, race-matched healthy controls. RESULTS: By use of a glycoprotein detection kit, saliva from both patients and controls exhibited three major parotid glycoprotein banding patterns consisting of either one or two bands, molecular weights 58 kDa and 77 kDa. The strong lectin reactivity of major parotid glycoproteins with Ricinus communis agglutinin suggests that galactose is the most prevalent terminal sugar. In addition, major parotid glycoproteins were shown to express blood group antigen H. On the basis of metachromatic characteristics and immunologic reactivity, major parotid glycoproteins appear to be members of the proline rich protein multigene family, proline rich glycoprotein, genetic polymorphism G1. No qualitative difference was observed in major parotid glycoprotein banding patterns between patients and controls. CONCLUSION: These findings do not support a role for major parotid glycoproteins in burning mouth syndrome.

Prevalence of periodontal disease in patients with Sjögren's syndrome.

The periodontal status of 25 patients with Sjögren's syndrome was compared with that of an age-, sex-, and race-matched healthy controls. Clinical evaluation included determination of number of teeth, decayed/missing/filled surfaces, probing pocket depth, clinical attachment level, plaque index, gingival index, bleeding on probing, and measurement of alveolar bone level (examined with radiography). Results of the study suggest that patients with Sjögren's syndrome have a significantly higher plaque index score (p < 0.005), higher decayed/missing/filled surfaces scores (p < 0.05), increased alveolar bone loss (p < 0.05), deeper clinical attachment level (p < 0.05), and increased cementoenamel junction-alveolar bone crest distance (p < 0.005). Although no significant difference was found in the number of cases of "established periodontitis" between the Sjögren's syndrome and controls, odds ratio analysis suggests that patients with Sjögren's syndrome are at 2.2 times higher risk of having adult periodontitis than healthy controls.

The management of Sjögren's syndrome in dental practice.

BACKGROUND: Sjögren's syndrome, or SS, is a multisystem inflammatory disorder of the exocrine glands with a wide range of extraglandular involvement. Symptoms of dry eyes and xerostomia, although not invariably present, are characteristic features of SS. An increased risk of oral and dental diseases is a prominent consequence of SS. TYPES OF STUDIES REVIEWED: The author reviewed recent medical and dental studies that have advanced our understanding of the causes and treatment of SS. She particularly focused on studies addressing the diagnosis and treatment of the oral component of the disease. RESULTS: Sjögren's syndrome is a widely underdiagnosed disease. A delay in the diagnosis of SS may have a significant physical, psychological and economic impact on the affected person. The pathogenesis of SS appears to involve a number of factors: immunological, genetic, hormonal and possibly infectious. Successful management of SS requires a multidisciplinary approach, and the dentist plays an essential role in the diagnosis and treatment of the disease. ORAL IMPLICATIONS: Impairment of salivary function in SS increases the risk of developing oral diseases. Effective management of oral health comprises enhancement of salivary output (cholinergic agonist drugs such as pilocarpine or cevimeline) and prevention and treatment of dental caries, oral candidiasis and allergic mucositis. Finally, periodic evaluation of various clinical and laboratory parameters is needed to monitor disease status.

Effect of xerostomic medications on stimulated salivary flow rate in patients with Sjögren's syndrome.

OBJECTIVE: The purpose of this study was to examine the effect of xerostomic medications on the salivary output of patients with Sjögren's syndrome. METHOD AND MATERIALS: Of 62 patients evaluated in this study, 23 were not using medication, and 39 were using between 1 and 6 medications with xerostomic side effect. RESULTS: The mean +/- SEM stimulated parotid output was 0.33 +/- 0.07 mL/min per gland for patients who were not using medication and 0.33 +/- 0.04 mL/min per gland for patients using (1 to 6) medications. Analyses did not reveal a significant difference in salivary output between these groups. The salivary output of patients using various numbers of medications (1 or 2; 3 or 4; 5 or 6) was also compared. Analysis revealed no significant difference in salivary output related to the number of xerostomic medications used. CONCLUSION: The use of xerostomic medications may not necessarily affect stimulated parotid flow rate in patients with Sjögren's syndrome. These results suggested that gustatory stimulation may be adequate to overcome the inhibitory effect induced by xerostomic medications.

The effect of parotid salivary flow rate on the levels of salivary antimicrobial proteins in patients with Sjögren's syndrome.

OBJECTIVE: The purpose of this study was to examine the effect of salivary flow rate on the levels of antimicrobial salivary proteins in 24 patients with Sjögren's syndrome and 22 age- and race-matched healthy control subjects. METHOD AND MATERIALS: Parameters examined included stimulated salivary flow rate, total salivary protein, lactoferrin, lysozyme, amylase, and secretory immunoglobulin A. RESULTS: The mean total salivary protein and the mean salivary amylase were significantly greater in patients than in controls. However, no significant difference was observed in the mean stimulated salivary flow rates or the levels of lactoferrin, lysozyme, or secretory immunoglobulin A of patients and controls. To examine the effect of salivary flow rate on the levels of salivary antimicrobial protein, the levels of these proteins in patients with salivary flow rate of < or = 0.3 mL/min per gland were compared to those in healthy controls with salivary flow rate > or = 0.4 mL/min per gland. Analyses showed the levels of lactoferrin to be significantly higher among patients than among controls. CONCLUSION: The levels of salivary amylase and lactoferrin may be influenced by the levels of salivary output in patients with Sjögren's syndrome. The relationship between salivary flow rate and the levels of amylase and lactoferrin is not clear at the present time.

The level of cariogenic micro-organisms in patients with Sjögren's syndrome.

Sixteen patients with caries-inactive sjögren's syndrome with low parotid salivary flow rates (< 0.25 mL/min) and 18 caries-inactive control subjects with higher salivary flow rates were compared. Mutans streptococci (MS) and lactobacilli (LB) counts were measured by means of Dentocult SM strip mutans and LB assays. The group with Sjögren's syndrome displayed higher counts of MS (P = 0.014) and LB (p = 0.003) when compared with controls. The results of this study indicate that patients with caries-inactive Sjögren's syndrome and low salivary flow may have higher colonization of cariogenic micro-organisms than healthy individuals.