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1.
J Urol ; 203(1): 185-192, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31347955

RESUMO

PURPOSE: Sacral neuromodulation is a guideline recommended treatment of urinary dysfunction and fecal incontinence in patients in whom conservative treatments have failed. Historically sacral neuromodulation has been delivered using a nonrechargeable device with an average life span of 4.4 years. Surgery is required to replace the implanted neurostimulator due to battery depletion. Implantation of a long-lived implanted neurostimulator can eliminate the need for replacement surgeries, potentially reducing patient surgical risks and health care costs. The Axonics r-SNM System™ is a miniaturized, rechargeable sacral neuromodulation system designed to deliver therapy for at least 15 years. The ARTISAN-SNM (Axonics® Sacral Neuromodulation System for Urinary Urgency Incontinence Treatment) study is a pivotal study using rechargeable sacral neuromodulation therapy to treat urinary urgency incontinence. Six-month results are presented. MATERIALS AND METHODS: A total of 129 eligible patients with urinary urgency incontinence were treated. All participants were implanted with a tined lead and the rechargeable sacral neuromodulation system in a nonstaged procedure. Efficacy data were collected using a 3-day bladder diary, the validated ICIQ-OABqol (International Consultation on Incontinence Questionnaire Overactive Bladder quality of life) questionnaire and a participant satisfaction questionnaire. Therapy responders were identified as participants with a 50% or greater reduction in urinary urgency incontinence episodes compared to baseline. We performed an as-treated analysis in all implanted participants. RESULTS: At 6 months 90% of participants were therapy responders. The mean ± SE number of urinary urgency incontinence episodes per day was reduced from 5.6 ± 0.3 at baseline to 1.3 ± 0.2. Participants experienced a clinically meaningful 34-point improvement on the ICIQ-OABqol questionnaire. There were no serious device related adverse events. CONCLUSIONS: The Axonics r-SNM System is safe and effective with 90% of participants experiencing clinically and statistically significant improvements in urinary urgency incontinence symptoms.


Assuntos
Neuroestimuladores Implantáveis , Incontinência Urinária de Urgência/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fontes de Energia Elétrica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Qualidade de Vida , Sacro , Incontinência Urinária de Urgência/fisiopatologia
2.
Int Braz J Urol ; 45(6): 1186-1195, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31808407

RESUMO

INTRODUCTION: This study aimed to evaluate the effects of transobturator tape (TOT) on overactive bladder (OAB) symptoms and quality of life. MATERIALS AND METHODS: Patients with stress-predominant mixed urinary incontinence (MUI) who had undergone TOT procedures were considered candidates for this research. Preoperative assessment included anamnesis, pelvic examination, cough stress test (CST), and validated symptom severity and quality of life (QoL) questionnaires. The primary outcome, improvement and cure rates of OAB symptoms were determined based on the patient's baseline scores in symptom-related questions in OAB-V8. Secondary outcomes included the success rates of SUI, changes in the QoL score and patient satisfaction rates. RESULTS: A total of 104 patients were included in the study. Sixty-two patients underwent TOT placement alone, and 42 patients underwent TOT placement along with prolapse surgery. The mean follow-up period of the patients was 30.47 months range: 13-52 months. At the fi rst-year follow-up, 52 patients (50.0%) and 59 patients (56.7%) reported cure in preoperative urgency and urgency incontinence, respectively. The objective and subjective cure rates were 96.2% and 56.7%, respectively. A total of 80.7% of the cases had a 15-point improvement in QoL scores. CONCLUSIONS: MUS is not only a gold standard treatment in SUI but also presents as a promising treatment modality in stress-dominant MUI. Although the improvement rates of OAB symptoms signifi cantly decrease over time, QoL and patient satisfaction rates remain higher than any other treatment in this patient group at the third-year follow-up.


Assuntos
Qualidade de Vida , Slings Suburetrais , Bexiga Urinária Hiperativa/cirurgia , Incontinência Urinária por Estresse/cirurgia , Incontinência Urinária de Urgência/cirurgia , Adulto , Idoso , Análise de Variância , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Período Pós-Operatório , Período Pré-Operatório , Estudos Prospectivos , Estatísticas não Paramétricas , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Adulto Jovem
3.
Actas urol. esp ; 43(5): 221-227, jun. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-181088

RESUMO

Objetivo: Evaluar las diferencias clínicas y urodinámicas en mujeres con vejiga hiperactiva (VH) referidas a urología funcional y unidades urodinámicas en España, asociadas con la presencia o ausencia de hiperactividad del detrusor (HD). Material y métodos: Estudio observacional, transversal, multicéntrico y prospectivo realizado en España en mujeres con diagnóstico clínico de VH derivadas para estudio urodinámico (EUD) del cual se realizó lectura centralizada. Las pacientes completaron el diario miccional de 3días (DM3d) con la Patient Perception of Intensity of Urgency Scale (PPIUS), el Cuestionario de Autoevaluación del Control de la Vejiga (CACV) y la Overactive Bladder Questionnaire Short Form (OABq-SF). Se compararon los cuestionarios y las variables del EUD de mujeres con VH con y sin HD empleándose el test de Mann-Whitney (variables continuas) y el test de χ2 (variables categóricas). Resultados: Se evaluaron 247 mujeres con VH, de ellas 103 presentaron HD. Según la presencia o no de HD se observaron diferencias significativas en el número de episodios de incontinencia urinaria de urgencia (IUU), frecuencia miccional, nicturia, volumen miccional medio y número de absorbentes (p < 0,05 para todas las comparaciones). En pacientes con VH y HD un mayor porcentaje presenta capacidad vesical reducida, urgencia, IUU y volúmenes menores para el primer deseo miccional, fuerte deseo miccional y capacidad cistomanométrica máxima en EUD vs pacientes sin HD (p < 0,05 para todas las comparaciones). En los cuestionarios solo hubo diferencias en la subescala de síntomas del CACV entre ambos grupos (p = 0,011). Conclusiones: La presencia de HD en mujeres con VH se relaciona con una alteración más severa de la fase de llenado vesical


Objective: To evaluate the clinical and urodynamic differences (associated with the presence or absence of detrusor overactivity [DO]) in women with overactive bladder (OAB) referred to Functional Urology and Urodynamic Units in Spain. Material and methods: Observational, cross-sectional, multicenter and prospective study conducted in Spain in women with clinical diagnosis of OAB, who had been referred to urodynamic study (UDS) of which centralized reading was performed. Patients completed the 3-day voiding diary (DM3d) with the PPIUS scale (Patient Perception of Intensity of Urgency Scale), the B-SAQ (Bladder Self-Assessment Questionnaire) and the OABq-SF (Overactive Bladder Questionnaire Short Form). The questionnaires and UDS variables of women with OAV, with or without DO, were compared using the Mann-Whitney test (continuous variables) and the chi-square test (χ2) (categorical variables). Results: A total of 247 women with OAB were evaluated, and 103 of them had DO. According to the presence or absence of DO, significant differences were observed in the number of episodes of urge urinary incontinence (UUI), urinary frequency, nocturia, mean micturition volume and number of pads (P < .05 for all comparisons). A higher percentage of patients with OAB and DO presented reduced bladder capacity, urgency, urge urinary incontinence (UUI) and lower volume for first voiding desire, strong desire to void and maximum cystomanometric capacity in UDS compared with patients without DO (P < .05 for all comparisons). The only significant differences between both groups were regarding the B-SAQ symptoms scale (P = .011). Conclusions: The presence of DO in women with OAB is related to a more severe alteration of the bladder filling phase


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Bexiga Urinária Hiperativa/fisiopatologia , Sintomas do Trato Urinário Inferior/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Incontinência Urinária de Urgência/complicações , Uretra/fisiopatologia , Estudos Transversais , Estudos Prospectivos , Inquéritos e Questionários , Urodinâmica
4.
J Urol ; 202(4): 779-786, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31145033

RESUMO

PURPOSE: We examined prospective associations between physical activity and a range of lower urinary tract symptoms in parous middle-aged women. MATERIALS AND METHODS: We used prospectively collected data on women participating in the ALSPAC (Avon Longitudinal Study of Parents and Children). Physical activity levels were self-reported at a mean ± SD age of 37.2 ± 4.6 years and translated into MET hours per week. A total of 4,126 and 2,770 women reported symptoms of lower urinary tract symptoms, including stress, urgency and mixed incontinence, at 3 and 11.5 years of followup, respectively. RESULTS: The prevalence of any lower urinary tract symptoms at 3 and 11.5 years of followup was 15% and 23% at a mean age of 40.5 and 49.3 years, respectively. At 3 years of followup women in the highest category of physical activity (43.2 MET hours or more per week) had lower odds of stress incontinence (aOR 0.51, 95% CI 0.32-0.80) than women in the lowest category (0 MET hours per week). At 11.5 years of followup women in the highest category of physical activity had lower odds of stress incontinence (aOR 0.56, 95% CI 0.39-0.82), urgency incontinence (aOR 0.34, 95% CI 0.20-0.67) and mixed incontinence (aOR 0.34, 95% CI 0.19-0.63) compared to women in the lowest physical activity category. CONCLUSIONS: Greater physical activity is associated with reduced odds of lower urinary tract symptoms, especially stress incontinence, among middle-aged parous women. Further research is necessary to examine the impact of different types of physical activity on lower urinary tract symptoms.


Assuntos
Exercício/fisiologia , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária de Urgência/epidemiologia , Sistema Urinário/fisiopatologia , Adulto , Fatores Etários , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Qualidade de Vida , Autorrelato/estatística & dados numéricos , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária por Estresse/prevenção & controle , Incontinência Urinária de Urgência/fisiopatologia , Incontinência Urinária de Urgência/prevenção & controle
5.
Gynecol Endocrinol ; 35(2): 155-159, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30324854

RESUMO

The aim of this study was to assess the effectiveness and safety of Ospemifene in the improvement of urgency component in women affected by mixed urinary incontinence (MUI) who underwent surgery with mid-urethral sling (MUS). Eighty-one patients with MUI underwent surgical intervention with MUS were enrolled. After surgical intervention 38 patients received Ospemifene 60 mg one tablet daily per os for 12 weeks. Physical examination, 3-day voiding diary, urodynamic testing were performed at the start and the follow-up after 12 weeks in the Trans-Obturator-Tape (TOT)-Alone group and TOT-Ospemifene. Patients completed the Overactive Bladder Symptom and Health-Related Quality of Life Short-Form (OAB-Q SF), International Consultation on Incontinence Questionnaire (ICIQ-UI-SF), and King' s Health Questionnaire (KHQ). A significant difference between the two groups was observed in peak flow (ml/s), in first voiding desire (ml), in maximum cystometric capacity (ml), and in detrusor pressure at peak flow (cmH2O) at urodynamic evaluation. A significative difference between the two groups at voiding diary was observed in the mean number of voids, urgent micturition episodes/24 h, urge urinary incontinence, and in nocturia events. The OAB-Q symptoms and OAB-Q (HRQL) scores after 12 weeks showed a significative difference between the two groups. Ospemifene is an effective potential therapy after MUSs in women with MUI improving urgency symptoms and quality of life.


Assuntos
Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Slings Suburetrais , Tamoxifeno/análogos & derivados , Incontinência Urinária por Estresse/terapia , Incontinência Urinária de Urgência/terapia , Procedimentos Cirúrgicos Urológicos , Idoso , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Tamoxifeno/uso terapêutico , Incontinência Urinária por Estresse/complicações , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária de Urgência/complicações , Incontinência Urinária de Urgência/fisiopatologia , Urodinâmica
6.
Low Urin Tract Symptoms ; 11(2): O21-O27, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29105998

RESUMO

OBJECTIVE: The aim of the present study was to investigate associations between urethral sensation and urge urinary incontinence (UUI) in patients with and without detrusor overactivity (DO). METHODS: The medical records of 80 consecutive patients who underwent filling cystometry and urethral current perception threshold (CPT) tests were examined retrospectively. Following the exclusion of 4 patients not eligible for analysis, patients were classified into neurogenic DO, idiopathic DO, or DO-negative groups based on neurological and cystometric findings (n = 30, 12, and 34, respectively). Eleven DO-negative patients were defined as normal controls on cystometrograms (CMG) using the following exclusion criteria: bladder compliance <12.5 mL/cmH2 O, volume >275 mL at first filling sensation, and comorbidities possibly affecting lower urinary tract function. Thus, 53 patients were finally included in the study. Proximal urethral CPT was evaluated with intraurethral square-wave stimulation at 3 Hz to activate C-fiber afferents. RESULTS: Median CPT was higher in neurogenic and idiopathic DO than in the normal CMG group (11.3 and 9.0 vs. 2.8 mA, respectively; P < .05), as well as in patients with UUI (n = 19) compared with non-UUI patients (n = 34; 12.5 vs. 5.4 mA, respectively; P < .05). The proportion of UUI patients was significantly greater in the DO-positive groups than in the normal CMG group (P < .05). CPTs were not associated with bladder capacity at the first filling sensation (r = 0.11). CONCLUSION: Hyposensitive C-fibers of the proximal urethra may contribute to the development of urodynamic DO as well as UUI in patients complaining of lower urinary tract symptoms.


Assuntos
Fibras Nervosas Amielínicas/fisiologia , Uretra/inervação , Bexiga Urinária Hiperativa/complicações , Incontinência Urinária de Urgência/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Uretra/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Urodinâmica , Adulto Jovem
7.
BJU Int ; 123(5): 877-884, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30216623

RESUMO

OBJECTIVE: To investigate the relationship between oxidative stress and lower urinary tract symptoms (LUTS) in a community-dwelling population. MATERIALS AND METHODS: The cross-sectional study included 1 113 people who participated in the Iwaki Health Promotion Project of 2015 in Hirosaki, Japan. LUTS were assessed using structured questionnaires, including the International Prostate Symptom Score (IPSS) and the Overactive Bladder Symptom Score (OABSS). IPSS > 7, OABSS > 5, nocturia score > 1, or urge incontinence score > 1 were defined as moderate to severe symptoms. 8-Hydroxy-2'-deoxyguanosine (8-OHdG) and advanced glycation end products (AGEs) were measured by urine analysis and skin autofluorescence, respectively. The relationship between oxidative stress and LUTS was investigated using logistic regression analyses. RESULTS: This study included 431 men and 682 women. AGEs and 8-OHdG levels were significantly higher in severe forms of LUTS. Multivariate logistic regression analyses showed that AGE levels were significantly associated with a higher frequency of nocturia but were not associated with IPSS, OABSS or urge incontinence. No significant association was observed between LUTS and 8-OHdG levels. CONCLUSIONS: We observed a significant association between AGE levels and nocturia score > 1. Further research is necessary to clarify a possible causal relationship between oxidative stress and nocturia.


Assuntos
Sintomas do Trato Urinário Inferior/fisiopatologia , Estresse Oxidativo/fisiologia , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Adulto , Estudos Transversais , Inquéritos Epidemiológicos , Humanos , Japão/epidemiologia , Sintomas do Trato Urinário Inferior/complicações , Sintomas do Trato Urinário Inferior/epidemiologia , Pessoa de Meia-Idade , Inquéritos e Questionários , Bexiga Urinária Hiperativa/epidemiologia , Incontinência Urinária de Urgência/epidemiologia
8.
Arch. esp. urol. (Ed. impr.) ; 71(6): 531-536, jul.-ago. 2018. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-178722

RESUMO

Introducción: Diversos autores han argumentado que el componente de urgencia miccional en incontinencia urinaria mixta (IOM) es diferente a la incontinencia de urgencia pura (IOU). En este caso ha sugerido que la incontinencia en IOM puede ser sobrediagnosticada en pacientes con IOE que malinterpretan su pérdida como IOU. Objetivos: Evaluar las características clínicas y urodinámicas de pacientes con IOM e IOU pura. Métodos: Realizamos un estudio retrospectivo de nuestra base de datos de urodinamia evaluando 450 mujeres con IOM e IOU. Se excluyeron pacientes con vejiga neurogénica, fístulas, divertículo uretral, cirugía uroginecológica previa, obstrucción infravesical conocida, radioterapia pélvica previa, infección del tracto urinario e ingesta de psicofármacos. A todos se les realizó historia clínica completa, examen físico, uroflujometría, cistometría de llenado y estudio presión flujo. Resultados: No existen diferencias en relación a edad, menopausia y número de partos. La presencia de nicturia fue mayor en el grupo de IOU (66,4% vs. 46,1%, p 0,0004) al igual que el aumento de la frecuencia miccional (53,6% vs. 34,6%, p 0,0006). Al examen físico la presencia de hipermovilidad uretral e IOE fue mayor en el grupo de IOM, mientras que la presencia de trofismo vaginal reducido fue mayor en IOU. No encontramos diferencias en la sensibilidad y capacidad vesical. La presencia de detrusor hiperactivo fue de 56,4% en IOU pura vs. 33,2% de IOM (p<0,0001). No encontramos diferencias en estudio presión flujo. Conclusiones: Existen diferencias significativas en los parámetros clínicos y urodinámicos entre pacientes con IOM e IOU pura. La urgencia en pacientes con IOU pura estaría más relacionada con detrusor hiperactivo. Es probable que muchos pacientes con IOM solo tengan IOE pura, lo que llevaría a efectos positivos en los resultados de cirugía antiincontinencia


Introduction: Various authors argued that the voiding urgency component in mixed urinary incontinence (MUI) is different than urge urinary incontinence (UUI). In this last case they suggest that incontinence in MUI could be overdiagnosed in patients with SUI, misunderstanding the leak as UUI. Objetives: To evaluate clinical and urodynamic characteristics of patients with MUI and pure UUI. METHODS: A retrospective study of our urodynamics database was performed evaluating 450 women with MUI and UUI. Patients with neurogenic bladder, fistulae, urethral diverticula, previous urogynecologic surgery, known infravesical obstruction, previous pelvic radiotherapy, urinary tract infection or psychiatric drugs intake. A full clinical history, physical exam, uroflowmetry, filling cystometry and pressure flow study were performed. Results: There is no difference relative to age, menopause and number of births. The presence of nocturia was bigger in the UUI group (66.4% vs. 46.1%, p 0.0004) the same as increased voiding frequency (53.6% vs. 34.6%, p 0.0006). The presence of urethral hypermobility and SUI in the physical exam was greater than MUI, meanwhile the presence of reduced vaginal trophism was bigger in the UUI group. Differences in sensibility or specificity were not found. The presence of overactive detrusor was 56.4% in pure UUI vs. 33.2% in MUI (p<0.0001). No differences in pressure flow study were found. Conclusions: There is a significant difference in the clinical and urodynamic parameters between patients with MUI and pure UUI. The urgency in patients with pure UUI could be related to overactive detrusor. It is probable that many patients with MUI just have pure SUI which could lead to positive effects in the outcomes of anti-incontinence surgery


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Incontinência Urinária por Estresse/complicações , Incontinência Urinária por Estresse/diagnóstico , Bexiga Urinária Hiperativa/complicações , Bexiga Urinária Hiperativa/diagnóstico , Incontinência Urinária de Urgência/complicações , Incontinência Urinária de Urgência/diagnóstico , Estudos Retrospectivos , Incontinência Urinária por Estresse/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Urodinâmica
9.
Arch Esp Urol ; 71(6): 531-536, 2018 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-29991661

RESUMO

INTRODUCTION: Various authors argued that the voiding urgency component in mixed urinary incontinence (MUI) is different than urge urinary incontinence (UUI). In this last case they suggest that incontinence in MUI could be overdiagnosed in patients with SUI, misunderstanding the leak as UUI. OBJETIVES: To evaluate clinical and urodynamic characteristics of patients with MUI and pure UUI. METHODS: A retrospective study of our urodynamics database was performed evaluating 450 women with MUI and UUI. Patients with neurogenic bladder, fistulae, urethral diverticula, previous urogynecologic surgery, known infravesical obstruction, previous pelvic radiotherapy, urinary tract infection or psychiatric drugs intake. A full clinical history, physical exam, uroflowmetry, filling cystometry and pressure flow study were performed. RESULTS: There is no difference relative to age, menopause and number of births. The presence of nocturia was bigger in the UUI group (66.4% vs. 46.1%, p 0.0004) the same as increased voiding frequency (53.6% vs. 34.6%, p 0.0006). The presence of urethral hypermobility and SUI in the physical exam was greater than MUI, meanwhile the presence of reduced vaginal trophism was bigger in the UUI group. Differences in sensibility or specificity were not found. The presence of overactive detrusor was 56.4% in pure UUI vs. 33.2% in MUI (p<0.0001). No differences in pressure flow study were found. CONCLUSIONS: There is a significant difference in the clinical and urodynamic parameters between patients with MUI and pure UUI. The urgency in patients with pure UUI could be related to overactive detrusor. It is probable that many patients with MUI just have pure SUI which could lead to positive effects in the outcomes of anti-incontinence surgery.


Assuntos
Bexiga Urinária Hiperativa/complicações , Bexiga Urinária Hiperativa/diagnóstico , Incontinência Urinária por Estresse/complicações , Incontinência Urinária por Estresse/diagnóstico , Incontinência Urinária de Urgência/complicações , Incontinência Urinária de Urgência/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Urodinâmica
10.
Neurourol Urodyn ; 37(8): 2763-2775, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30054930

RESUMO

BACKGROUND: The brain's role in continence is critical but poorly understood. Although regions activated during bladder stimulation have been identified, little is known about the interaction between regions. In this secondary analysis we evaluate resting state and effective connectivity in older women treated for urgency urinary incontinence (UUI). METHOD: 54 women ≥60 years old with UUI and 10 continent women underwent fMRI scanning during provocation of urinary urgency, both before and after therapy. Response was defined by >50% reduction in leaks on bladder diary. Regions of interest (RoIs) were selected a priori: right insula, medial prefrontal cortex, and dorsal anterior cingulate cortex. Generalized psycho-physiological interaction (gPPI) was used to calculate "effective connectivity" between RoIs during urgency. We performed a one-way ANOVA pre-treatment between groups (continent/responders/non-responders), as well as a two-way mixed ANOVA between group and time (responders/non-responders; pre-/post-therapy) using false discovery rate (FDR) correction. Principal component analysis was used to assess the variance within RoIs. Exploratory voxel-wise connectivity analyses were conducted between each RoI and the rest of the brain. RESULTS: RoI-RoI connectivity analysis showed connectivity differences between controls, responders, and non-responders, although statistical significance was lost after extensive correction. Principal component analysis confirmed appropriate RoI selection. Voxel-wise analyses showed that connectivity in responders became more like that of controls after therapy (cluster-wise correction P < 0.05). In non-responders, no consistent changes were seen. CONCLUSION: These data support the postulate that responders and non-responders to therapy may represent different subsets of UUI, one with more of a central etiology, and one without.


Assuntos
Mapeamento Encefálico , Encéfalo/fisiopatologia , Rede Nervosa/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Incontinência Urinária/fisiopatologia , Idoso , Encéfalo/diagnóstico por imagem , Conectoma , Feminino , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Bexiga Urinária/fisiopatologia
11.
J Urol ; 200(2): 382-388, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29630979

RESUMO

PURPOSE: The mechanism of sacral neuromodulation is poorly understood. We compared brain activity during urgency before and after sacral neuromodulation in women with overactive bladder and according to the response to treatment. MATERIALS AND METHODS: Women with refractory overactive bladder who elected sacral neuromodulation were invited to undergo functional magnetic resonance imaging before and after treatment. During imaging the bladder was filled until urgency was experienced. Regions of interest were identified a priori and brain activity in these regions of interest was compared before and after treatment as well as according to the treatment response. Whole brain exploratory analysis with an uncorrected voxel level threshold of p <0.001 was also performed to identify additional brain regions which changed after sacral neuromodulation. RESULTS: Of the 12 women who underwent a pretreatment functional magnetic resonance imaging examination 7 were successfully treated with sacral neuromodulation and underwent a posttreatment examination. After sacral neuromodulation brain activity decreased in the left anterior cingulate cortex, the bilateral insula, the left dorsolateral prefrontal cortex and the bilateral orbitofrontal cortex (each p <0.05). No new brain regions showed increased activity after sacral neuromodulation. Pretreatment brain activity levels in the bilateral anterior cingulate cortex, the right insula, the bilateral dorsolateral prefrontal cortex, the right orbitofrontal cortex, the right supplementary motor area and the right sensorimotor cortex were higher in women who underwent successful treatment (each p <0.05). CONCLUSIONS: Brain activity during urgency changes after successful sacral neuromodulation. Sacral neuromodulation may be more effective in women with higher levels of pretreatment brain activity during urgency.


Assuntos
Encéfalo/fisiopatologia , Terapia por Estimulação Elétrica/métodos , Plexo Lombossacral/fisiopatologia , Bexiga Urinaria Neurogênica/complicações , Bexiga Urinária Hiperativa/complicações , Incontinência Urinária de Urgência/terapia , Idoso , Encéfalo/diagnóstico por imagem , Terapia por Estimulação Elétrica/instrumentação , Feminino , Neuroimagem Funcional/métodos , Humanos , Neuroestimuladores Implantáveis , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Resultado do Tratamento , Incontinência Urinária de Urgência/etiologia , Incontinência Urinária de Urgência/fisiopatologia
12.
Orphanet J Rare Dis ; 13(1): 58, 2018 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-29661209

RESUMO

BACKGROUND: Hereditary spastic paraparesis (HSP) is a group of rare genetic disorders affecting the central nervous system. Pure HSP is limited to lower limb spasticity and urinary voiding dysfunction. Complex HSP involves additional neurological features. Beyond the described core symptoms, knowledge about the burden of disease for adults with HSP is limited, particularly regarding gastrointestinal functions, fecal incontinence, and urinary symptoms. METHODS: We conducted a cross-sectional self-report survey with 108 adult HSP patients (Mage = 57.7 years, SD = 11.5, range 30 to 81; 54.2% females) recruited from a national HSP user group association and a national (non-clinical) advisory unit for rare disorders. HSP data was compared to data from a Norwegian population study, HUNT-3 (N = 46,293). RESULTS: The HSP group reported more gastrointestinal and urinary complaints compared to controls. Gastrointestinal complaints included at least "much" complaints with constipation (14.6%) and alternating constipation/diarrhea (8.0%), and at least daily uncontrollable flatulence (47.6%), fecal incontinence (11.6%), and inability to hold back stools (38.5%). Urinary complaints included frequent urination (27.4% > 8 times daily), sudden urge (51.9%) and urinary incontinence (30.5% at least daily/nightly). CONCLUSION: This survey of adults with HSP recruited from non-clinical settings showed constipation, alternate constipation and diarrhea, fecal incontinence, and voiding dysfunction represent considerable problems for many persons with HSP. Health care providers should screen and manage often unrecognized gastrointestinal and fecal incontinence complaints among HSP patients.


Assuntos
Incontinência Fecal/fisiopatologia , Trato Gastrointestinal/fisiologia , Paraplegia Espástica Hereditária/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Incontinência Urinária/fisiopatologia , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
Neurourol Urodyn ; 37(8): 2597-2605, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-29672906

RESUMO

AIMS: Urgency urinary incontinence (UUI) is a major problem for seniors. The underlying mechanisms of disease and therapy are unknown. We sought structural brain abnormalities that might underlie the functional differences previously observed by functional Magnetic Resonance Imaging in UUI patients versus controls, or among UUI responders versus non-responders to therapy-and thereby reveal potential disease mechanisms and therapeutic targets. METHODS: Secondary study of a trial of biofeedback-assisted pelvic floor muscle training (BFB) in 60 women (>60 yrs) with UUI, plus 11 age-matched continent controls. Brain structural abnormalities were investigated using: (1) white-matter hyperintensities (WMH); (2) diffusion tensor imaging (DTI) to reveal white-matter pathways with impaired integrity; and (3) voxel-based morphometry (VBM) to show regions of atrophy or hypertrophy. RESULTS: WMH burden was greater in UUI patients than controls (globally and in superior longitudinal fasciculus and cingulum), suggesting a possible causal connection. WMH burden was unexpectedly greater in responders than non-responders to BFB, and appeared to increase in non-responders but not in responders. DTI revealed even worse integrity of the cingulum than was apparent by WMH. VBM showed parahippocampal atrophy in UUI. CONCLUSIONS: Many women with UUI have white-matter damage that interferes with pathways critical to bladder control; they can be taught by techniques like BFB to exert stronger control over the bladder. For others, in whom abnormalities of key brain areas are less marked, UUI's cause may reside elsewhere, and therapy targeting these brain centers may be less effective than therapy targeting the bladder or other brain centers.


Assuntos
Encéfalo/diagnóstico por imagem , Bexiga Urinária/fisiopatologia , Incontinência Urinária de Urgência/diagnóstico por imagem , Substância Branca/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Biorretroalimentação Psicológica/métodos , Estudos de Casos e Controles , Imagem de Tensor de Difusão , Feminino , Neuroimagem Funcional , Giro do Cíngulo/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Vias Neurais/diagnóstico por imagem , Diafragma da Pelve , Prognóstico , Incontinência Urinária de Urgência/fisiopatologia , Incontinência Urinária de Urgência/terapia
14.
Int Urogynecol J ; 29(8): 1179-1185, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29536139

RESUMO

INTRODUCTION AND HYPOTHESIS: Mixed urinary incontinence (UI) is, on average, more severe than urgency UI or stress UI. We tested the hypothesis that mixed UI is a more advanced stage of UI by comparing transition probabilities among women with stress, urgency, and mixed UI. METHODS: We used data from the General Longitudinal Overactive Bladder Evaluation Study-UI, which included community-dwelling women, aged 40+ years, with UI at baseline. Study participants completed two or more consecutive bladder health surveys every 6 months for up to 4 years. Using sequential 6-month surveys, transition probabilities among UI subtypes were estimated using the Cox-proportional hazards model, with the expectation that probabilities from stress or urgency UI to mixed UI would be substantially greater than probabilities in the reverse direction. RESULTS: Among 6,993 women 40+ years of age at baseline, the number (prevalence) of women with stress, urgency, and mixed UI was 481 (6.9%), 557 (8.0%), and 1488 (21.3%) respectively. Over a 4-year period, the transition probabilities from stress UI (34%) and urgency UI (27%) to mixed UI was significantly higher than probabilities from mixed to stress UI (6%) or to urgency UI (rate = 9%). The adjusted transition hazard ratio for stress UI and urgency UI was 2.06 (95% CI: 1.73-2.92) and 1.85 (95% CI: 1.63-2.57) respectively compared with mixed UI. CONCLUSION: The substantially higher transition from stress UI and urgency UI to mixed UI supports the hypothesis that mixed UI might represent a more advanced stage of UI that may have implications for understanding disease progression.


Assuntos
Progressão da Doença , Incontinência Urinária por Estresse/epidemiologia , Incontinência Urinária de Urgência/epidemiologia , Incontinência Urinária/epidemiologia , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Pennsylvania/epidemiologia , Prevalência , Índice de Gravidade de Doença , Inquéritos e Questionários , Incontinência Urinária/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia
15.
J Womens Health (Larchmt) ; 27(5): 575-583, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29394127

RESUMO

BACKGROUND: Urinary urgency is the primary symptom of overactive bladder (OAB). This study aimed to identify targets for effective intervention to delay progression of urinary urgency. MATERIAL AND METHODS: Secondary analyses of data from a study conducted with female employees of a large academic medical center were conducted. Women were ≥18 years and nonpregnant at the time of the survey. An online questionnaire obtained demographic information, presence of lower urinary tract symptoms, and toileting behaviors. Bivariate analyses and multivariate logistic regression were applied to explore factors related to different stages of urinary urgency. RESULTS: Four stages of urinary urgency were constructed: (1) Stage 1: no urinary symptoms (n = 20), (2) Stage 2: continent but urinary urgency reported (n = 19), (3) Stage 3: nonsevere urgency urinary incontinence (UUI) (incontinent but leakage ≤1/day, n = 74); and (4) Stage 4: severe UUI (leakage ≥1/day, n = 26). In multivariate analyses, older women were more likely to be in Stage 3 than in Stage 2 (aOR 1.053, 95% CI 1.012-1.096). Women who lost urine with defecation were more likely to be in Stage 4 than Stage 3 (aOR 3.828, 95% CI 1.921-7.629). Women who habitually strained to empty the bladder faster were more likely to be in Stage 4 than in Stage 3 (aOR 6.588, 95% CI 1.317-32.971). CONCLUSIONS: Losing urine with defecation and making the bladder empty faster by pushing down should be explored as intervention targets to prevent women from progressing from Stage 3 to Stage 4.


Assuntos
Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Mulheres Trabalhadoras , Adulto , Fatores Etários , Feminino , Humanos , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Adulto Jovem
16.
Int Urogynecol J ; 29(10): 1523-1527, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29478111

RESUMO

INTRODUCTION AND HYPOTHESIS: The objective was to evaluate the intra-individual variability of uroflowmetry (UFM) in healthy control subjects and women suffering from stress, urge, and mixed urinary incontinence. METHODS: A total of 35 healthy controls (group A) and 105 women suffering from urinary incontinence were enrolled in the study. Thirty-five women suffered from stress urinary incontinence (group B), 35 women suffered from mixed urinary incontinence (group C), and 35 women with overactive bladder both dry and wet (group D). All participants were asked to perform UFM measurement three times. The following parameters were analyzed: voided volume (VV), peak flow (Qmax), average flow (Qave), volume-corrected peak flow cQmax (cQmax = Qmax/2√ VV), volume-corrected average flow (cQave = Qave/2√ VV), and postvoid residual volume (PVR). Statistical analysis was performed using the analysis of variance on repeated measurements. Relative error was calculated using variation coefficients reported as a percentage of the average. All descriptive characteristics were reported as means ± standard deviation (SD). p values ≤0.05 were considered statistically significant. RESULTS: No statistically significant intra-individual difference in any of the recorded parameters was identified among the three UFM recordings in groups A, C, and D. The intra-individual variability of the following parameters reached statistical significance in patients suffering from stress urinary incontinence (group B): Qmax (p = 0.0016), Qave (p = 0.0005), and cQave (p = 0.0389). A significant difference was only observed in comparison between the first and second consecutive recordings. CONCLUSIONS: This study provides evidence supporting the high yield and good intra-individual reproducibility of UFM.


Assuntos
Reologia/estatística & dados numéricos , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Urodinâmica/fisiologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Reologia/métodos
17.
J Urol ; 199(1): 229-236, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28709886

RESUMO

PURPOSE: We evaluated the therapeutic success rate, changes in quality of life and safety of sacral neuromodulation 5 years after InterStim™ implantation. Included in study were subjects with bothersome symptoms of overactive bladder, including urinary urge incontinence and/or urgency-frequency, in whom at least 1 anticholinergic medication failed and 1 medication had not been tried. MATERIALS AND METHODS: Therapeutic success was defined as a urinary urge incontinence or urgency-frequency response of 50% or greater improvement in average leaks or voids per day, or return to normal voiding, defined as fewer than 8 voids per day. Quality of life was evaluated by ICIQ-OABqol (International Consultation on Incontinence Modular Questionnaire). Safety was evaluated through adverse events. RESULTS: Of the 340 subjects who completed the test stimulation 272 had an implant, of whom 91% were female. Mean age was 57 years. At baseline 202 subjects with urinary urge incontinence had a mean ± SD of 3.1 ± 2.7 leaks per day and 189 with urgency-frequency had a mean of 12.6 ± 4.5 voids per day. The 5-year therapeutic success rate was 67% (95% CI 60-74) using modified completers analysis and 82% (95% CI 76-88) using completers analysis. Subjects with urinary urge incontinence had a mean reduction from baseline of 2.0 ± 2.2 leaks per day and subjects with urgency-frequency had a mean reduction of 5.4 ± 4.3 voids per day (each completers analysis p <0.0001). Subjects showed improvement in all ICIQ-OABqol measures (p <0.0001). The most common device related adverse events were an undesirable change in stimulation in 60 of the 272 subjects (22%), implant site pain in 40 (15%) and therapeutic product ineffectiveness in 36 (13%). CONCLUSIONS: This multicenter study shows that sacral neuromodulation had sustained efficacy and quality of life improvements, and an acceptable safety profile through 5 years in subjects with overactive bladder.


Assuntos
Terapia por Estimulação Elétrica/métodos , Plexo Lombossacral/fisiopatologia , Dor Pós-Operatória/epidemiologia , Bexiga Urinária Hiperativa/terapia , Incontinência Urinária de Urgência/terapia , Terapia por Estimulação Elétrica/instrumentação , Eletrodos Implantados/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia
18.
Neurourol Urodyn ; 37(1): 263-268, 2018 01.
Artigo em Inglês | MEDLINE | ID: mdl-28407394

RESUMO

AIMS: To investigate the efficacy and safety of intradetrusor onabotulinumtoxinA (onaBoNT-A) injection in patients with overactive bladder (OAB) refractory to antimuscarinic treatment. METHODS: A total of 80 patients with OAB symptoms were enrolled in this prospective multicenter study and received 100 U intradetrusor onaBoNT-A injection.The changes from baseline in the frequency of voiding, urge urinary incontinence (UI) and urge episodes, mean and maximum bladder capacities, uroflowmetry, post-void residual urine volume (PVR), quality of life score, and treatment benefit scale score were assessed. The need for a second injection,and treatment-related adverse events were also examined postoperatively. RESULTS: OnaBoNT-A injection significantly decreased the UI episodes(P = 0.0001), the mean voiding frequency (P = 0.0001), and the urgency episodes (P = 0.0001) in the third month compared to baseline. Similarly, the mean bladder capacity, and maximal bladder capacity were increased (P < 0,05). The quality of life scores improved by 57.1% compared to the pre-treatment rate (P = 0,0001). No significant change was observed in the PVR or maximum flow rate. Urinary retention developed in 3 (3.75%) patients and urinary infection and transient hematuria were observed in five patients (6.25%) each. The UI episodes, voiding frequency and urgency episodes were significantly lower at the 9th month than at baseline (all P = 0.0001). Overall 67% of the patients continued to experience benefits from the injection. Sixteen patients (20%) required a second injection in the third month. Eight patients were lost to follow-up at the last visit in the 9th month, and 34 of the remaining 56 patients required a second injection at the 9th month. Cumulatively, 50 (63%) patients needed re-injections. CONCLUSIONS: Our results demonstrated that the onaBoNT-A injection produced significant improvement in all OAB symptoms with a low incidence of treatment related adverse events.


Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Fármacos Neuromusculares/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Toxinas Botulínicas Tipo A/efeitos adversos , Feminino , Humanos , Injeções , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/efeitos adversos , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento , Turquia , Bexiga Urinária/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/psicologia , Incontinência Urinária de Urgência/tratamento farmacológico , Incontinência Urinária de Urgência/fisiopatologia , Micção , Adulto Jovem
19.
Low Urin Tract Symptoms ; 10(3): 266-270, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28627109

RESUMO

OBJECTIVE: Urinary incontinence (UI) is one of the most common urinary system diseases that mostly affects women but also men. We evaluated the therapeutic efficacy of functional magnetic stimulation (FMS) as potential UI treatment with improvements in the pelvic floor musculature, urodynamic tests and quality of life. METHODS: A total of 20 UI patients (10 females and 10 men, mean age 64, 14 years), including 10 with stress UI, four with urgency UI and six with mixed UI, were treated with FMS (20 min/session) twice a week for 3 weeks. The patients' impressions, records in urinary diaries, and scores of three life stress questionnaires (overactive bladder symptom questionnaire [OAB-q], urogenital distress inventory questionnaire-short form [UDI-6], incontinence impact questionnaire-short form [IIQ-7]) were performed pre- and post-treatment. RESULTS: Significant reductions (P < 0.01) of micturition number and nocturia after magnetic treatment were evidenced. The urodynamic tests recorded a significant increase in cystometric capacity (147 ± 51.3%), in maximum urethral closure pressure (110 ± 34%), in urethral functional length (99.8 ± 51.8%), and in pressure transmission ratio (147 ± 51.3%) values compared with the baseline values. CONCLUSIONS: These preliminary findings suggest that FMS with Magneto STYM (twice weekly for 3 weeks) improves the UI and may be an effective treatment for this urogenital disease.


Assuntos
Terapia de Campo Magnético , Incontinência Urinária por Estresse/terapia , Incontinência Urinária de Urgência/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imãs , Masculino , Pessoa de Meia-Idade , Noctúria/etiologia , Diafragma da Pelve/fisiopatologia , Qualidade de Vida , Estudos Retrospectivos , Uretra/fisiopatologia , Incontinência Urinária por Estresse/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Micção , Urodinâmica
20.
Neurourol Urodyn ; 37(3): 1060-1067, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-28892221

RESUMO

BACKGROUND: Overactive bladder is a chronic condition affecting lower urinary tract function that has a significant negative impact on QoL. OBJECTIVE: Evaluation of the BlueWind implantable tibial nerve system performance and safety in refractory OAB. DESIGN, SETTING, AND PARTICIPANTS INTERVENTION: A 6-month multi-center prospective intervention study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Objective assessment was done by voiding diary parameters including voids/day, volume voided/day, urgency assessment, leaking episodes/day, pads used/day, leak severity, and clinical success defined as a ≥50% reduction in the number of leaks/day or number of voids/day or number of episodes with degree of urgency >2 or a return to <8 voids/day on a 3 Day diary. Subjective assessment was based on OAB-q including HRQL and symptom severity score. Safety was evaluated by adverse event (AE) analysis. RESULTS AND LIMITATIONS: Thirty-four of the 36 implanted subjects completed the study. One subject withdrew voluntarily and one developed inflammation necessitating removal of the system. In the remaining subjects, 71% experienced clinical success at 6 months. Leaks/day, leak severity, and pad changes/day decreased significantly over time with 27.6% of urge incontinence subjects that became "dry." Voids/day, degree of urgency, volume/void, pads changed improved significantly. All quality of life aspects (concern, coping, sleep, and social) improved as well as symptom severity scores measured by the OAB-q. Adverse events included: implant site pain (13.9%), suspected infection (22.2%), and procedural wound complications (8.3%). CONCLUSIONS: The BlueWind implantable tibial nerve stimulator is a safe, minimally invasive system that affords OAB patients significant improvements. PATIENT SUMMARY: The performance and safety of the BlueWind RENOVA™ implantable tibial nerve neuromodulator for OAB was tested. Our preliminary results demonstrate that the system has a low risk safety profile and may be considered an effective treatment option for OAB management.


Assuntos
Terapia por Estimulação Elétrica/instrumentação , Neuroestimuladores Implantáveis , Qualidade de Vida , Nervo Tibial/fisiopatologia , Bexiga Urinária Hiperativa/terapia , Incontinência Urinária de Urgência/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Bexiga Urinária Hiperativa/fisiopatologia , Incontinência Urinária de Urgência/fisiopatologia , Micção/fisiologia
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