Intravesical electrical stimulation treatment for overactive bladder: An observational study.

Purpose: Intravesical electrical stimulation treatment (IVES) has been successfully used to treat neurogenic bladder. We report the results of an observational study regarding the use of IVES for women with overactive bladder syndrome (OAB) and/or urgency urinary incontinence (UUI). Materials and Methods: IVES was performed in women with OAB (defined by frequency ≥8/day, nocturia ≥2/night, or ≥3 episodes of UUI on 3-day voiding diary) who failed prior medical therapy. Subjects underwent 4 weeks of treatment with an 8-Fr Detruset™ IVES catheter. Primary outcome was Patient Global Impression of Improvement (PGI-I) at 3 months. Secondary outcomes included Visual Analog Scale (VAS), Short Form OAB Questionnaire (OAB-q SF), Pelvic Floor Distress Inventory (PFDI), Pelvic Floor Impact Questionnaire (PFIQ), reduction in frequency and UUI on voiding diary, and adverse effects. Analysis was done with paired t-tests and Wilcoxon signed rank tests. Results: Seventeen subjects completed the study. At 4 weeks post-treatment, 15 improved on PGI-I (11 subjects: 'a little better', 2: 'much better', 2: 'very much better'). There were significant improvements in symptom bother and health-related quality of life as measured by OAB-q SF and pelvic organ prolapse and urinary distress as measured by PFDI. Frequency decreased from 10.3±4.3 at baseline to 8.9±2.3 (p=0.04) at 3 months. No pain was reported during treatment. There was one urinary tract infection during the study period. No other adverse events were reported. Conclusions: IVES appears to be a safe and effective novel treatment for OAB. Larger comparative studies are needed to investigate its potential for long-term treatment.

Postoperative urinary retention after pelvic organ prolapse repair: Vaginal versus robotic transabdominal approach.

AIMS: Postoperative urinary retention has been reported in 13-32% of patients that undergo pelvic organ prolapse (POP) repair. The purpose of our study was to compare rates of urinary retention between transvaginal and robotic transabdominal approaches and identify risk factors for postoperative urinary retention following POP repair. METHODS: Medical records of patients that underwent POP repair were reviewed. Surgeries included transvaginal high uterosacral ligament suspension (HUSLS) and robotic-assisted sacral colpopexy (RASCP). All patients underwent a retrograde fill voiding trial (RGVT) postoperatively. Demographics, comorbidities, preoperative urodynamic findings, and surgical procedures were compared between women that passed their RGVT and those that did not. RESULTS: Out of 484 patients reviewed, 333 underwent POP repair with a transvaginal HUSLS and 151 underwent RASCP. Postoperative urinary retention was identified in 128 (26.4%) patients where 113 underwent transvaginal HUSLS and 15 underwent RASCP. The odds ratio (OR) of postoperative urinary retention following transvaginal HUSLS was 3.26 (CI 1.72-6.18; P < 0.001) compared to RASCP. Older age was also a risk factor for postoperative urinary retention (OR 1.03, CI 1.01-1.05; P = 0.012). While parity, preoperative post-void residual (PVR), and rates of concomitant transvaginal anterior/posterior repair were significantly higher in patients that developed postoperative urinary retention on univariate analysis, these factors did not demonstrate significance on multivariate analysis. CONCLUSIONS: Transvaginal HUSLS demonstrates a 3.26 OR for postoperative urinary retention compared to the robotic transabdominal approach. Older age is also a significant risk factor whereas parity, preoperative PVR, and rates of concomitant transvaginal anterior/posterior repair were not significant risk factors on multivariate analysis.

What Is the Best Lens Angle for Rigid Diagnostic Cystoscopy? A Comparison of 30-Degree and 70-Degree Lenses.

The optimal degree of cystoscope to perform diagnostic cystoscopy is dependent on the surgeon's discretion because there are no studies addressing the superiority of one degree of cystoscope over another. The objective was to determine which lens, 70-degree versus 30-degree lens, was better in identifying lesions scattered throughout the bladder. METHODS: A simulation was created using 3 different artificial bladder models complete with sutures representing lesions placed at different locations in each bladder. Gynecologists and urologists performed cystoscopy using both the 30- and 70-degree lenses on the bladder models in a randomized and single-blinded fashion. The physicians performed routine diagnostic cystoscopy and noted the number of lesions throughout the bladder. The number of lesions each physician identified and the time to complete cystoscopy were noted. A total of 16 physicians participated, and there were a total of 18 lesions among the 3 different bladder models. RESULTS: A total of 86 cystoscopy trials were obtained from all physicians and bladder models attempted. The odds of detecting a lesion with the 70-degree lens cystoscope was 1.77 times greater than the 30-degree lens cystoscope (95% confidence interval, 1.24-2.53; P = 0.002). There was also difference in the average number of lesions found between the 30- and 70-degree cystoscopes with 2.6 ± 2.7 more lesions identified using the 70-degree cystoscope compared with the 30-degree cystoscope. In terms of specific location, 2.6 ± 1.7 more lesions were found at the bladder neck using the 70-degree lens scope versus the 30-degree lens scope (95% confidence interval, 1.37-3.83; P = 0.013). CONCLUSIONS: The results suggested that the 70-degree lens was the better choice for the identification of bladder lesions when compared with the 30-degree lens in rigid diagnostic cystoscopy.

Perioperative serum creatinine changes and ureteral injury.

PURPOSE: To illustrate a simple method that screens for ureteral injury in the acute postoperative period after urogynecologic surgeries. METHODS: Serum creatinine measurements in the preoperative (baseline) and postoperative periods of urogynecologic surgeries were determined and the correlation of the change to ureteral injury and/or obstruction analyzed. The sample size calculation showed 7 cases and 28 controls were sufficient to detect significant changes in creatinine. Each of the seven cases was matched for age and type of surgery with a control patient in a 1:4 ratio following standard protocol. RESULTS: Chart review of patients (273 cases) undergoing urogynecologic surgeries from October 2009 to June 2014 were undertaken. There were 7 cases of ureteral injury and 28 matching control cases. All cases had intraoperative cystoscopy confirming bilateral ureteral flow. In the ureteral injury group, blockage of ureter was confirmed by CT scan with IV contrast. There was a 59.8% increase in serum creatinine levels postoperative in the ureteral injury group versus a 3.8% decrease in controls. A difference of creatinine levels greater than or equal to 0.3 mg/dL over baseline was evident in ureteral injury cases. CONCLUSION: A small change in serum creatinine level over baseline after urogynecologic surgery alerted the possibility of ureteral injury or obstruction. A simple and inexpensive evaluation of perioperative creatinine levels can promptly diagnose ureteral damage in the acute postoperative period for gynecologic reconstructive surgeries.

UVA-photoactivated riboflavin effect on isolated vaginal tissues derived from pelvic organ prolapse cases.

PURPOSE: To determine the optimal riboflavin exposure time before UVA irradiation and to study the effects of exogenous collagen on the mechano-tensile stiffness of isolated vaginal tissue strips after riboflavin UVA photoactivation. METHODS: Vaginal tissue strips from pelvic organ prolapse (POP) cases were soaked in 0.1% riboflavin (0, 10, 20, 30 min), exposed to UVA photoactivation, and tensile stiffness was measured with a tensiometer. Collagen solution was injected (0.2 mL) into each strip, exposed to riboflavin with or without UVA photoactivation, and tensile stiffness was measured (n=6). RESULTS: Vaginal tissues treated with riboflavin for 10, 20 or 30 min followed by UVA irradiation displayed 21.2, 32.4 and 33.9% stronger tensile stiffness, respectively. Exogenous collagen administered before riboflavin UVA photoactivation resulted in 20% improvement in tensile stiffness. The tensile stiffness of vaginal tissues injected with collagen without the riboflavin UVA treatment was similar to control tissues. CONCLUSION: The results demonstrated increased tensile stiffness in isolated POP-derived vaginal tissues after riboflavin UVA photoactivation suggesting improved mechanical properties from collagen cross-linking. Administering exogenous collagen before riboflavin UVA treatment also improved tensile stiffness. More studies are needed to corroborate the present minimally invasive approach for strengthening vaginal tissues.

UVA-photoactivated riboflavin treatment of vaginal cells derived from pelvic organ prolapse cases.

BACKGROUND: The pathophysiology of pelvic organ prolapse (POP) involves vaginal collagen degradation. Strengthening collagen by UVA-photoactivated cross-linking has been demonstrated and suggested target applications include the vaginal wall. AIM: To identify UVA irradiation and riboflavin effects on vaginal cells. MATERIALS AND METHODS: Vaginal cells were incubated for 24 h (DMEM/F-12 Ham's media) and were exposed to riboflavin (0, 0.1 and 10%) for 30 min before UVA photoactivation. Percentages of live, apoptotic and necrotic cells were determined by propidium iodide/Hoechst 33342 stains. RESULTS: UVA decreased vaginal cell viability [mean ± standard error of the mean: 26.2 ± 0.5% vs. control (43.9 ± 3.8%)], but riboflavin blocked UVA-induced damage (57.9 ± 2.7 and 56.7 ± 2.1% at 0.1 and 10% riboflavin, respectively). Cells treated with low- and high-dose riboflavin had lower apoptosis (32.9 ± 1.0 and 35.5 ± 0.9%, respectively). Furthermore, riboflavin-treated cells had reduced necrosis (9.3 ± 1.7, 7.8 ± 3.0%) versus UVA-only (32.4 ± 5.5%) or control (17.1 ± 2.8%). Viability was similar for cells from the cervical and hymenal segments. CONCLUSION: The results demonstrated that riboflavin attenuated UVA damage in vaginal cells by inhibiting necrosis. Cervical and hymenal end vaginal cells were equally affected by UVA. UVA phototoxicity was reduced by the presence of riboflavin.