Efficacy and Safety of Tolterodine and Pilocarpine in Patients with Overactive Bladder.

PURPOSE: We evaluated the efficacy and safety of a combination of 2 mg tolterodine and 9 mg pilocarpine, vs tolterodine monotherapy in patients with overactive bladder. MATERIALS AND METHODS: We enrolled patients with overactive bladder symptoms in a multicenter, randomized, double-blind, parallel, active control study. Patients were randomized to the combination or 2 mg tolterodine twice daily for 12 weeks. After the double-blind period finished all patients were started on the combination for 12 weeks. Study co-primary end points were the change from baseline in the mean number of daily micturitions and cumulative incidence of dry mouth at the end of 12 weeks. Secondary end points were other overactive bladder symptoms, the total xerostomia inventory score and results of a visual analogue scale for dry mouth at the end of 12 and 24 weeks. RESULTS: The mean change in the number of daily micturitions from baseline to 12 weeks was -1.49 and -1.74 in the combination and tolterodine monotherapy groups, respectively. The mean difference was -0.26 (95% CI -0.79-0.27), confirming noninferiority. At 12 weeks the incidence of dry mouth was lower in the combination group than in the tolterodine monotherapy group (30.0% vs 42.9%, p = 0.009). All secondary and other efficacy outcomes related to overactive bladder symptoms improved in each group with no significant differences between the groups at 12 weeks. Changes from baseline in the total xerostomia inventory score and the visual analogue scale for dry mouth were significantly lower in the combination group than in the tolterodine monotherapy group. CONCLUSIONS: Tolterodine and pilocarpine alleviated dry mouth in patients with overactive bladder while maintaining anticholinergic efficacy similar to that of tolterodine.

Oral mucosa stem cells alleviates spinal cord injury-induced neurogenic bladder symptoms in rats.

BACKGROUND: Spinal cord injury (SCI) deteriorates various physical functions, in particular, bladder problems occur as a result of damage to the spinal cord. Stem cell therapy for SCI has been focused as the new strategy to treat the injuries and to restore the lost functions. The oral mucosa cells are considered as the stem cells-like progenitor cells. In the present study, we investigated the effects of oral mucosa stem cells on the SCI-induced neurogenic bladder in relation with apoptotic neuronal cell death and cell proliferation. RESULTS: The contraction pressure and the contraction time in the urinary bladder were increased after induction of SCI, in contrast, transplantation of the oral mucosa stem cells decreased the contraction pressure and the contraction time in the SCI-induced rats. Induction of SCI initiated apoptosis in the spinal cord tissues, whereas treatment with the oral mucosa stem cells suppressed the SCI-induced apoptosis. Disrupted spinal cord by SCI was improved by transplantation of the oral mucosa stem cells, and new tissues were increased around the damaged tissues. In addition, transplantation of the oral mucosa stem cells suppressed SCI-induced neuronal activation in the voiding centers. CONCLUSIONS: Transplantation of oral mucosa stem cells ameliorates the SCI-induced neurogenic bladder symptoms by inhibiting apoptosis and by enhancing cell proliferation. As the results, SCI-induced neuronal activation in the neuronal voiding centers was suppressed, showing the normalization of voiding function.

Chronic Mealtime Shift Disturbs Metabolic and Urinary Functions in Mice: Effects of Daily Antioxidant Supplementation.

PURPOSE: Through their biological clocks, organisms on this rotating planet can coordinate physiological processes according to the time of the day. However, the prevalence of circadian rhythm disorders has increased in modern society with the growing number of shift workers, elevating the risk of various diseases. In this study, we employed a mouse model to investigate the effects of urinary rhythm disturbances resulting from dietary changes commonly experienced by night shift workers. METHODS: We established 3 groups based on feeding time and the use of restricted feeding: ad libitum, daytime, and early nighttime feeding. We then examined the urinary rhythm in each group. In addition to the bladder rhythm, we investigated changes in mRNA patterns within the tissues constituting the bladder. Additionally, we assessed the urination rhythm in Per1 and Per2 double-knockout mice and evaluated whether the injection of antioxidants modified the impact of mealtime shift on urination rhythm in wild-type mice. RESULTS: Our study revealed that a shift in mealtime significantly impacted the circadian patterns of water intake and urinary excretion. In Per2::Luc knock-in mouse bladders cultured ex vivo, this shift increased the amplitude of Per2 oscillation and delayed its acrophases by several hours. Daily supplementation with antioxidants did not influence the mealtime shift-induced changes in circadian patterns of water intake and urinary excretion, nor did it affect the modified Per2 oscillation patterns in the cultured bladder. However, in aged mice, antioxidants partially restored the urinary rhythm. CONCLUSION: A shift in mealtime meaningfully impacted the urination rhythm in mice, regardless of the presence of circadian clock genes.

An animal study to compare the degree of the suppressive effects on the afferent pathways of micturition between tamsulosin and sildenafil.

BACKGROUND: Tamsulosin, an α1-adrenoceptor antagonist, and sildenafil, a phosphodiesterase (PDE) inhibitor, are reported to improve lower urinary tract symptoms including overactive bladder (OAB). This study is aimed at investing the effects of tamsulosin and sildenafil and comparing the degree of the suppressive effects on the afferent pathways of micturition between them using an animal model of OAB, the spontaneously hypertensive rat (SHR). RESULTS: The cystometric parameters, the basal pressure and duration of bladder contraction, were significantly increased in the SHR group as compared with the Wistar-Kyoto (WKY) group. The intercontraction interval also significantly decreased in the SHR group. In the SHR-Tam 0.01 mg/kg group and the SHR-Sil 1 mg/kg group, however, the basal pressure and duration were significantly reduced and the intercontraction interval was significantly prolonged. Moreover, the degree of the expression of c-Fos and NGF was significantly higher in the SHR group as compared with the WKY group. But it was significantly reduced in the SHR-Tam 0.01 mg/kg group and the SHR-Sil 1 mg/kg group. Furthermore, tamsulosin had a higher degree of effect as compared with sildenafil. CONCLUSIONS: In conclusion, α1-adrenergic receptor antagonists and PDE-5 inhibitors may have an effect in improving the voiding functions through an inhibition of the neuronal activity in the afferent pathways of micturition.

Improving Foley Catheter Insertion Procedure by Developing Foley Introducer: A 100-Year Overdue Innovation.

PURPOSE: Foley catheter (FC) insertion is very basic yet one of the most widely performed procedures all across the fields of medicine. Since FC was first introduced in 19020's, no significant improvement has been made in view of methodology, despite the inconvenience associated with cumbersome preparation, procedure, and the patients' discomfort with having to have their genitalia exposed. We developed a new, easy-to-use FC insertion device, Quick Foley, that provides an innovative approach to introducing FC while simplifying and minimizing time spent without compromising the sterility. METHODS: We developed an all-in-one disposable FC introducer contains all the necessary components in a single-device-kit. Minimal plastic components are necessary to keep accuracy and consistency, but the rest are made of the paper to minimize plastic waste. The preparation is done by connecting to the drainage bag, spurring the lubricant gel through gel insert, separating the tract, and connecting with the ballooning syringe. For the insertion, after sterilizing the urethral orifice, rotate the control knob to feed FC to the end of the urethra. After ballooning, dissembling of the device is done only by opening and removing the module, then only the FC remains. RESULTS: As the device is all-in-one, there is no need to prearrange the FC tray, simplifies the FC preparation and catheterization procedure. This device not only makes it convenient for the practitioner, but ultimately, it will reduce the psychological discomfort experienced by patient by truncating perineal exposure time. CONCLUSION: We have successfully developed a novel device that reduces the cost and burden of using FC for practitioners while maintaining an aseptic technique. Furthermore, this all-in-one device allows the entire procedure to be completed much more quickly compared to the current method, so this minimizes perineal exposure time. Both practitioners and patients can benefit by this new device.

Artificial Intelligence-Based Patient Monitoring System for Medical Support.

PURPOSE: In this paper, we present the development of a monitoring system designed to aid in the management and prevention of conditions related to urination. The system features an artificial intelligence (AI)-based recognition technology that automatically records a user's urination activity. Additionally, we developed a technology that analyzes movements to prevent neurogenic bladder. METHODS: Our approach included the creation of AI-based recognition technology that automatically logs users' urination activities, as well as the development of technology that analyzes movements to prevent neurogenic bladder. Initially, we employed a recurrent neural network model for the urination activity recognition technology. For predicting the risk of neurogenic bladder, we utilized convolutional neural network (CNN)-based AI technology. RESULTS: The performance of the proposed system was evaluated using a study population of 30 patients with urinary tract dysfunction, who collected data over a 60-day period. The results demonstrated an average accuracy of 94.2% in recognizing urinary tract activity, thereby confirming the effectiveness of the recognition technology. Furthermore, the motion analysis technology for preventing neurogenic bladder, which also employed CNN-based AI, showed promising results with an average accuracy of 83%. CONCLUSION: In this study, we developed a urination disease monitoring system aimed at predicting and managing risks for patients with urination issues. The system is designed to support the entire care cycle of a patient by leveraging AI technology that processes various image and signal data. We anticipate that this system will evolve into digital treatment products, ultimately providing therapeutic benefits to patients.

Transfer Learning for Effective Urolithiasis Detection.

PURPOSE: Urolithiasis is a common disease that can cause acute pain and complications. The objective of this study was to develop a deep learning model utilizing transfer learning for the rapid and accurate detection of urinary tract stones. By employing this method, we aim to improve the efficiency of medical staff and contribute to the progress of deep learning-based medical image diagnostic technology. METHODS: The ResNet50 model was employed to develop feature extractors for detecting urinary tract stones. Transfer learning was applied by utilizing the weights of pretrained models as initial values, and the models were fine-tuned with the provided data. The model's performance was evaluated using accuracy, precision-recall, and receiver operating characteristic curve metrics. RESULTS: The ResNet-50-based deep learning model demonstrated high accuracy and sensitivity, outperforming traditional methods. Specifically, it enabled a rapid diagnosis of the presence or absence of urinary tract stones, thereby assisting doctors in their decision-making process. CONCLUSION: This research makes a meaningful contribution by accelerating the clinical implementation of urinary tract stone detection technology utilizing ResNet-50. The deep learning model can swiftly identify the presence or absence of urinary tract stones, thereby enhancing the efficiency of medical staff. We expect that this study will contribute to the advancement of medical imaging diagnostic technology based on deep learning.

Dutasteride, who is it more effective for? Second to fourth digit ratio and the relationship with prostate volume reduction by dutasteride treatment.

UNLABELLED: Study Type--Prognosis (cohort) Level of Evidence 2b. What's known on the subject? and What does the study add? The second to fourth digit ratio (hereafter the digit ratio) of the right hand is related to the activity of the androgen receptor. Five α-reductase inhibitor (5ARI) reduces the prostate volume of patients with BPH. In terms of prostate volume reduction, large-scale placebo-controlled studies show that patients with BPH do not always respond well to 5ARI treatment. Patients with a higher digit ratio respond well to dutasteride treatment compared to those with a lower digit ratio. These results suggest that the digit ratio might be a predictor of the response to dutasteride treatment. OBJECTIVE: • To investigate the relationship between second to fourth digit ratio (hereafter the digit ratio) and prostate volume reduction by dutasteride treatment. PATIENTS AND METHODS: • A total of 142 men aged ≥ 40 years with a clinical diagnosis of benign prostatic hyperplasia and an enlarged prostate (prostate volume ≥ 30 mL) were prospectively enrolled. • Before prostate-specific antigen (PSA) level determination and transrectal ultrasonography (TRUS), the lengths of the second and fourth digits of the right hand were measured by an investigator using a digital vernier calliper. • Using TRUS, pre- and post-treatment prostate volume (PV1 and PV2) were measured by an uroradiologist who was unaware of finger lengths. We investigated the change in prostate volume and PSA level at least 6 months after the initiation of dutasteride therapy. RESULTS: • When the patients were divided into two groups according to digit ratio (A: digit ratio <0.95, n = 71; B: digit ratio ≥ 0.95, n = 71), there was a greater reduction in prostate volume in group B compared to group A (PV2-PV1: -9.4 mL vs -13.2 mL, P = 0.042; [PV2-PV1]/PV1: -17.5% vs -24.5%, P = 0.027; [PV2-PV1]/duration: -1.1 mL/month vs -1.6 mL/month, P = 0.041; [PV2-PV1]/PV1/duration: -2.0%/month vs -3.0%/month, P= 0.016). • Significant negative correlations were found between the digit ratio and reduction rate ([PV2-PV1]/duration: r = -0.165, P = 0.049; [PV2-PV1]/PV1/duration: r = -0.191, P = 0.023). CONCLUSIONS: • Patients with higher digit ratios respond well to dutasteride treatment. • The results obtained in the present study suggest that the digit ratio is a predictor of the response to dutasteride treatment.

Association between the self-perception period of lower urinary tract symptoms and the International Prostate Symptom Score.

OBJECTIVES: The timing of visiting a hospital after self-perception of lower urinary tract symptoms (LUTS) is different between individuals. The association between the self-perception period (S-PP) of LUTS and the progression of LUTS has seldom been documented. The aim of this study was to investigate the association between the S-PP of LUTS and the International Prostate Symptom Score (IPSS). SUBJECTS AND METHODS: This was a cross-sectional study comprising 267 men aged 40 years and older who participated in a prostate examination survey between February and May 2009. Survey questionnaires included items on the IPSS, the S-PPs of seven individual LUTSs assessed in the IPSS. RESULTS: The S-PP of LUTS became significantly longer as the severity of LUTS increased. Of the seven symptoms, a weak urinary stream and nocturia showed longer S-PPs than others. Partial correlation between the S-PP and IPSS showed a statistically significant positive correlation. Linear regression analysis showed a statistically significant relationship that unstandardized coefficients included 0.051 and 0.005 for IPSS and quality of life. CONCLUSIONS: These findings suggest that the S-PP is an independent risk factor for LUTS progression. S-PPs have to be considered for treatment or prevention of LUTS.

Nonselective blocking of the sympathetic nervous system decreases detrusor overactivity in spontaneously hypertensive rats.

The involuntary dual control systems of the autonomic nervous system (ANS) in the bladder of awake spontaneously hypertensive rats (SHRs) were investigated through simultaneous registrations of intravesical and intraabdominal pressures to observe detrusor overactivity (DO) objectively as a core symptom of an overactive bladder. SHRs (n = 6) showed the features of overactive bladder syndrome during urodynamic study, especially DO during the filling phase. After injection of the nonselective sympathetic blocking agent labetalol, DO disappeared in 3 of 6 SHRs (50%). DO frequency decreased from 0.98 ± 0.22 min(-1) to 0.28 ± 0.19 min(-1) (p < 0.01), and DO pressure decreased from 3.82 ± 0.57 cm H(2)O to 1.90 ± 0.86 cm H(2)O (p < 0.05). This suggests that the DO originating from the overactive parasympathetic nervous system is attenuated by the nonselective blocking of the sympathetic nervous system. The detailed mechanism behind this result is still not known, but parasympathetic overactivity seems to require overactive sympathetic nervous system activity in a kind of balance between these two systems. These findings are consistent with recent clinical findings suggesting that patients with idiopathic overactive bladder may have ANS dysfunction, particularly a sympathetic dysfunction. The search for newer and better drugs than the current anticholinergic drugs as the mainstay for overactive bladder will be fueled by our research on these sympathetic mechanisms. Further studies of this principle are required.

Second to fourth digit ratio: its relationship with core cancer volume and Gleason score in prostate biopsy.

OBJECTIVE: To investigate the relationships between 2nd to 4th digit ratio (digit ratio) and prostate cancer detection rate and biopsy findings, including Gleason score. MATERIALS AND METHODS: In 770 consecutive men aged 40 years or older that presented with lower urinary tract symptoms (LUTS), right hand 2nd and 4th digit lengths were measured prior to PSA determinations, DRE and transrectal ultrasonography (TRUS). Among these, 166 men with a prostate specific antigen (PSA) level ≥ 3 ng/mL or abnormal digit rectal examination (DRE) prospectively underwent prostate biopsies. The relationship between digit ratio and prostate cancer detection rate and biopsy findings was investigated. RESULTS: The study subjects were allocated to two groups by digit ratio (group A: digit ratio < 0.95; n = 420; group B: digit ratio ≥ 0.95; n = 350). Despite similar biopsy rates (22.4% vs. 20.6%, p = 0.544), group A had higher cancer detection rate (46.8% (44/94) vs. 23.6% (17/72), p = 0.002; OR = 2.847, 95% CI = 1.445-5.610). When we analyzed 408 positive biopsy cores (group A: digit ratio < 0.95, n = 282; group B: digit ratio ≥ 0.95, n = 126), group A had higher percentage of core cancer volume (46.7% vs. 37.1%, p = 0.005) and more biopsy cores with high Gleason score (sum of Gleason score ≥ 9: 18/282 (6.4%) vs. 1/126 (0.8%), p = 0.010; primary Gleason score = 5: 12/282 (4.3%) vs. 0/126 (0.0%), p = 0.021). CONCLUSIONS: A lower digit ratio is related to an increased detection rate of prostate cancer, a high percentage of core cancer volume and a high Gleason score.

Development of an Artificial Intelligence-Based Support Technology for Urethral and Ureteral Stricture Surgery.

PURPOSE: This paper proposes a technological system that uses artificial intelligence to recognize and guide the operator to the exact stenosis area during endoscopic surgery in patients with urethral or ureteral strictures. The aim of this technological solution was to increase surgical efficiency. METHODS: The proposed system utilizes the ResNet-50 algorithm, an artificial intelligence technology, and analyzes images entering the endoscope during surgery to detect the stenosis location accurately and provide intraoperative clinical assistance. The ResNet-50 algorithm was chosen to facilitate accurate detection of the stenosis site. RESULTS: The high recognition accuracy of the system was confirmed by an average final sensitivity value of 0.96. Since sensitivity is a measure of the probability of a true-positive test, this finding confirms that the system provided accurate guidance to the stenosis area when used for support in actual surgery. CONCLUSION: The proposed method supports surgery for patients with urethral or ureteral strictures by applying the ResNet-50 algorithm. The system analyzes images entering the endoscope during surgery and accurately detects stenosis, thereby assisting in surgery. In future research, we intend to provide both conservative and flexible boundaries of the strictures.

A Discussion Between Past and Present Editor-in-Chief of the International Neurourology Journal: Three Decades of History.

The International Neurourology Journal (Int Neurourol J, INJ) is a quarterly international journal that publishes high-quality research papers that provide the most significant and promising achievements in the fields of clinical neurourology and fundamental science. Specifically, fundamental science includes the most influential research papers from all fields of science and technology, revolutionizing what physicians and researchers practicing the art of neurourology worldwide know. Thus, we welcome valuable basic research articles to introduce cutting-edge translational research of fundamental sciences to clinical neurourology. In the editorials, urologists will present their perspectives on these articles. The original mission statement of the INJ was published on October 12, 1997. INJ provides authors a fast review of their work and makes a decision in an average of 3 to 4 weeks of receiving submissions. If accepted, articles are posted online in fully citable form. Supplementary issues will be published interim to quarterlies, as necessary, to fully allow berth to accept and publish relevant articles. Science Citation Index Expanded (SCIE, Web of Science), Scopus, PubMed, PubMed Central, KoreaMed, KoMCI, WPRIM, WorldWideScience.org, DOI/Crossref, EBSCO, Google Scholar.

Clinical Approach to Recurrent Voiding Dysfunction, Dysuria, and Pelvic Pain Persisting for at Least 3 Months.

There are several patients with urination problems and urethral and pelvic discomfort. Usually, these patients' symptoms are persistent and ambiguous; therefore, it is difficult to find underlying diseases associated with the patient's symptoms. In addition, there are various conditions such as overactive bladder, cystitis, and interstitial cystitis/bladder pain syndrome (IC/BPS). Sometimes patients with other chronic disorders such as fibromyalgia, inflammatory bowel syndrome, and vulvodynia show urination problems and pelvic pain. Thus, a patient-centered approach is important to find the cause of chronic urination problems and pelvic pain. Moreover, IC/BPS should be considered during the diagnostic process because the clinical characteristics of IC/BPS are diverse. In this narrative review, we suggest an integral approach for the diagnosis and treatment of IC/ BPS.

A Study on the Optimal Artificial Intelligence Model for Determination of Urolithiasis.

PURPOSE: This paper aims to develop a clinical decision support system (CDSS) that can help detect the stone that is most important to the diagnosis of urolithiasis. Among them, especially for the development of artificial intelligence (AI) models that support a final judgment in CDSS, we would like to study the optimal AI model by comparing and evaluating them. METHODS: This paper proposes the optimal ureter stone detection model using various AI technologies. The use of AI technology compares and evaluates methods such as machine learning (support vector machine), deep learning (ResNet-50, Fast R-CNN), and image processing (watershed) to find a more effective method for detecting ureter stones. RESULTS: The final value of sensitivity, which is calculated using true positive (TP) and false negative and is a measure of the probability of TP results, showed high recognition accuracy, with an average value of 0.93 for ResNet-50. This finding confirmed that accurate guidance to the stones area was possible when the developed platform was used to support actual surgery. CONCLUSION: The general situation in the most effective way to the detection stone can be found. But a variety of variables may be slightly different the difference through the term could tell. Future works, on urological diseases, are diverse and the research will be expanded by customizing AI models specialized for those diseases.

Second to fourth digit ratio: a predictor of prostate-specific antigen level and the presence of prostate cancer.

OBJECTIVE: To investigate the relationships between the 2nd to 4th digit ratio (digit ratio) and prostate volume, prostate-specific antigen (PSA) level, and the presence of prostate cancer. PATIENTS AND METHODS: Of the men that presented with lower urinary tract symptoms (LUTS) at a single tertiary academic center, 366 men aged 40 or older with a PSA level ≤ 40 ng/mL were prospectively enrolled. Right-hand 2nd and 4th digit lengths were measured prior to the PSA determinations and transrectal ultrasonography (TRUS). Prostate volumes were measured by TRUS without information about digit length. Patients with a PSA level ≥ 3 ng/mL underwent prostate biopsy. RESULTS: No relationship was found between prostate volume and digit ratio [correlation coefficient (r) = -0.038, P = 0.466]. But, significant negative correlations were found between digit ratio and PSA (r = -0.140, P = 0.007). When the patients were divided into two groups (Group A: digit ratio < 0.95, n = 184; Group B: digit ratio ≥ 0.95, n = 182), Group A had a higher mean PSA level than Group B (3.26 ± 5.54 ng/mL vs 1.89 ± 2.24 ng/mL, P = 0.002) and had significantly higher risks of prostate biopsy [odds ratio (OR) = 1.75, 95% CI = 1.07-2.84] and prostate cancer (OR = 3.22, 95% CI = 1.33-7.78). CONCLUSIONS: Patients with a lower digit ratio have higher risks of prostate biopsy and prostate cancer.

Clinical and urodynamic effect of methylphenidate for the treatment of giggle incontinence (enuresis risoria).

AIMS: We retrospectively investigated the efficacy of methylphenidate (MPH) in giggle incontinence (GI), and the relationship between GI and urodynamic parameters. METHODS: Nine (n = 9) female GI patients underwent 1 year of treatment with 5 mg MPH. Three questionnaires, voiding diaries, and UDS were conducted before and after treatment. The severity of GI was classified into mild, moderate, and severe. Clinical success was characterized as: full response, response, partial response, and non-response. RESULTS: The mean age of all patients was 16.2 ± 2.3 years. Five patients had mild, one had moderate, and three had severe grade incontinent. All patients reported complete cessation of wetting after MPH treatment. The mean duration of asymptomatic period was 7 ± 3.2 months. There were no statistically significant score changes in all three questionnaires: Urgency Perception Scale (UPS), Overactive Bladder Symptom Score (OABSS) and Primary Overactive Symptom Questionnaire (POSQ), and voiding diaries (P > 0.05). In UDS, there were no statistically significant altered parameters, except maximum urethral closure pressure (MUCP) and maximum urethral pressure (MUP). After treatment, the mean MUCP was increased from 52.2 ± 6.8 to 73.0 ± 5.4 cmH(2) O (P < 0.05), and the mean MUP was increased from 48.6 ± 7.3 to 70.2 ± 5.0 cmH(2) O (P < 0.05). CONCLUSIONS: MPH can be a viable option for the primary treatment of GI, and it may be related to increasing urethral closure pressure. It was not possible to establish if a relationship between GI and detrusor overactivity exists.

Pelvic floor muscle exercise and training for coping with urinary incontinence.

The pelvic floor consists of levator ani muscles including puborectalis, pubococcygeus and iliococcygeus muscles, and coccygeus muscles. Pelvic floor muscle exercise (PFME) is defined as exercise to improve pelvic floor muscle strength, power, endurance, relaxation, or a combination of these parameters. PFME strengthens the pelvic floor muscles to provide urethral support to prevent urine leakage and suppress urgency. This exercise has been recommended for urinary incontinence since first described by Kegel. When treating urinary incontinence, particularly stress urinary incontinence, PFME has been recommended as first-line treatment. This article provides clinical application of PFME as a behavioral therapy for urinary incontinence. Clinicians and physical therapist should understand pelvic floor muscle anatomy, evaluation, regimen, and instruct patients how to train the muscles properly.

Development of urination recognition technology based on Support Vector Machine using a smart band.

The purpose of this study was to explore the feasibility of a urination management system by developing a smart band-based algorithm that recognizes the urination interval of women. We designed a device that recognizes the time and interval of urination based on the patient's specific posture and posture changes. The technology used for recognition applied the Radial Basis Function kernel-based Support Vector Machine, a teaching and learning method that facilitates multidimensional analysis by simultaneously judging the characteristics of complex learning data. In order to evaluate the performance of the proposed recognition technique, we compared actual urination and device-sensed urination. An experiment was performed to evaluate the performance of the recognition technology proposed in this study. The efficacy of smart band monitoring urination was evaluated in 10 female patients without urination problems. The entire experiment was performed over a total of 3 days. The average age of the participants was 28.73 years (26-34 years), and there were no signs of dysuria. The final accuracy of the algorithm was calculated based on clinical guidelines for urologists. The experiment showed a high average accuracy of 91.0%, proving the robustness of the proposed algorithm. This urination behavior recognition technique shows high accuracy and can be applied in clinical settings to characterize urination patterns in female patients. As wearable devices develop and become more common, algorithms that detect specific sequential body movement patterns that reflect specific physiological behaviors could become a new methodology to study human physiological behavior.