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Biomedical subjects

J L H Ruud Bosch

Publications and source records attributed to J L H Ruud Bosch.

15 recordsLinked to original sources
PubMed2006

Different brain effects during chronic and acute sacral neuromodulation in urge incontinent patients with implanted neurostimulators.

OBJECTIVE: To compare changes in regional cerebral blood flow (rCBF), using positron emission tomography (PET), during chronic and acute sacral neuromodulation (SN). SN is an effective long-term treatment for chronic urge incontinence due to urinary bladder hyperactivity, as sensory nerves, spinal and supraspinal structures are probably responsible for the action of SN. It is not known which brain areas are involved, and the optimum benefit of SN is not immediate, suggesting that induced plasticity of the brain is necessary. PATIENTS AND METHODS: Brain activity was measured in two groups: 12 urge incontinent patients (11 women and one man; mean age 52 years) in whom an implanted unilateral S3 nerve neurostimulator had been effective for >6 months (mean time after implantation 4.5 years); and eight urge incontinent patients (seven women and one man; mean age 49 years) in whom the neurostimulator was activated for the first time in the PET scanner. RESULTS: During SN in chronically implanted patients, there were significant decreases in rCBF in the middle part of the cingulate gyrus, the ventromedial orbitofrontal cortex, midbrain and adjacent midline thalamus, and rCBF increases in the dorsolateral prefrontal cortex. During acute SN in newly implanted patients, there were significant decreases in rCBF the medial cerebellum, and increases in the right postcentral gyrus cortex, the right insular cortex and the ventromedial orbitofrontal cortex. Group analysis between chronic and newly implanted patients showed significant differences in the associative sensory cortex, premotor cortex and the cerebellum, all three involved in learning behaviour. CONCLUSIONS: These findings suggests that chronic SN influences, presumably via the spinal cord, brain areas previously implicated in detrusor hyperactivity, awareness of bladder filling, the urge to void and the timing of micturition. Furthermore, SN affects areas involved in alertness and awareness. Acute SN modulates predominantly areas involved in sensorimotor learning, which might become less active during the course of chronic SN.

Acute Disease↗
PubMed2006

Patient's quality of life and coping style influence general practitioner's management in men with lower urinary tract symptoms: the Krimpen Study.

PURPOSE: To identify patient characteristics associated with general practitioner's (GP) initial treatment decision in men with lower urinary tract symptoms (LUTS) and to test the hypothesis that a different coping style of patients results in different GP behaviour regarding treatment. MATERIALS AND METHODS: A longitudinal, population-based study with a follow-up period of 6.5 years was conducted among 1688 men aged 50-78 years old. Data were collected on quality of life, symptom severity based on the International prostate symptom score (IPSS) and coping. Information on primary care seeking and GP's initial management during 2 years of follow-up of all participants was collected from the general practitioners record. RESULTS: Data were obtained of 68 men, without a history of LUTS, who had a first GP visit for LUTS during the study period. In 54.4% of the cases the GP prescribed medication, independent of symptom severity. In the group of men with a bad disease-specific QOL those with a high passive-reaction-pattern were treated less frequently than those with a low passive-reaction-pattern. CONCLUSION: Findings from this quantitative study are consistent with the hypothesis that different coping styles of patients may result in different GP behaviour regarding treatment. The use of the coping style passive-reaction-pattern has a large influence on GP's initial management in men with LUTS.

Adaptation, Psychological↗
PubMed2006

Determinants of seeking of primary care for lower urinary tract symptoms: the Krimpen study in community-dwelling men.

OBJECTIVES: To determine which factors predict seeking of primary care among men with lower urinary tract symptoms (LUTS). METHODS: A longitudinal, population-based study with a follow-up period of 6.5 yr was conducted among 1688 men aged 50-78 yr. The following data were collected: prostate volume (using transrectal ultrasonometry), urinary flow rate, ultrasound-estimated postvoid residual urine volume, generic and disease-specific quality of life (QOL), and symptom severity (International Prostate Symptom Score [IPSS]). Information on the seeking of primary care by all participants during 2 yr of follow-up was collected from the general practitioner's (GP) record using a computerised search engine and a manual check of electronically selected files. RESULTS: Prostate volume, postvoid residual volume, IPSS, and social generic QOL are important determinants of first GP consultation in men with LUTS. Measurements (physical urologic parameters) and self-reported items (symptom severity and QOL) contribute almost equally to GP consultation in these men. CONCLUSIONS: Both measurements of prostate volume and postvoid residual urine volume and self-reported information about symptoms or QOL can help to select those who will benefit from medical care and to reassure those men not likely to need help in the near future.

Aged↗
PubMed2006

Simple case definition of clinical benign prostatic hyperplasia, based on International Prostate Symptom Score, predicts general practitioner consultation rates.

OBJECTIVES: To determine which case-definition of clinical benign prostatic hyperplasia (BPH) has the best predictive value for general practitioner visits for lower urinary tract symptoms (LUTS) suggestive of BPH. The incidence and prevalence rates of general practitioner visits for LUTS were also determined. METHODS: A longitudinal, population-based study from 1995 to 2003 was conducted among 1688 men aged 50 to 78 years old. Data were collected on physical urologic parameters, quality of life, and symptom severity as determined from the International Prostate Symptom Score. Information on health-care-seeking behavior of all participants was collected from the general practitioner (GP) record using a computerized search engine and an additional manual check of the electronically selected files. RESULTS: The incidence and prevalence rate of the men at risk was 19.6% and 14.0%, respectively, and these rates increased with age. For sensitivity and the positive predictive value, the case-definition of clinical BPH as an International Prostate Symptom Score greater than 7 had the best predictive value for GP visits for LUTS within 2 years after baseline. CONCLUSIONS: Because only marginal improvement (greater specificity but lower sensitivity) in the prediction of GP visits for LUTS was possible by adding information on prostate volume and flow, for the prediction of future GP visits for LUTS suggestive of BPH, we suggest that the International Prostate Symptom Score questionnaire be used and that estimation of the prostate volume and flow is not required.

Aged↗
PubMed2006

Sacral neuromodulation in women with idiopathic detrusor overactivity incontinence: decreased overactivity but unchanged bladder contraction strength and urethral resistance during voiding.

PURPOSE: We evaluated the effect of sacral (S3) nerve neuromodulation on voiding in women with idiopathic detrusor overactivity incontinence. MATERIALS AND METHODS: Urodynamic measurements in all patients implanted in 1990 to 2003 were reconsidered. Patients were included if these measurements, which were done at baseline and after 6 months, could be analyzed completely and reliably. Maximum detrusor pressure, amplitude of the highest involuntary detrusor contraction and end fill volume were used as parameters characterizing the degree of detrusor overactivity. Urethral resistance and bladder contraction strength during voiding were characterized by the bladder outlet obstruction index, the urethral resistance factor, average pressure, the slope of the low pressure side of the pressure flow plot, the bladder contractility index and the bladder contraction strength parameter. RESULTS: A total of 33 women were included. Detrusor overactivity parameters were significantly improved at followup. In addition, the supine position of the patient during filling in followup measurements proved less provocative with respect to overactivity than the standing position in the majority of measurements at baseline. Consequently bladder volumes at which voiding was initiated were considerably higher at followup. Changes in the parameters characterizing urethral resistance and bladder contraction strength during voiding were not unambiguous. However, exactly those parameters that appeared volume independent in a previous study were not significantly different. CONCLUSIONS: Our study confirmed the depressant effect of sacral (S3) nerve neuromodulation on detrusor overactivity. No effect on urethral resistance and bladder contraction strength during voiding could be demonstrated using volume independent parameters.

Adult↗
PubMed2006

Electrical neuromodulatory therapy in female voiding dysfunction.

Female voiding dysfunction such as urge-frequency syndrome, urge incontinence and unobstructive urinary retention are often refractory to conservative management. Electrical neuromodulation with surface electrodes or with implantable systems has become a valuable addition to the therapeutic options in the last two decades. Interstitial cystitis is an emerging indication. The application of these techniques in non-neurogenic patients is reviewed. The techniques using unimplantable electrodes, anogenital electrical stimulation with plug electrodes, transcutaneous electrical nerve stimulation with surface electrodes, and posterior tibial nerve stimulation using needle electrodes are addressed. Several techniques using implantable systems are discussed, e.g. sacral nerve neuromodulation (Interstim device), pudendal nerve stimulation (Interstim and Bion device) and paraurethral neuromodulation (Miniaturo device). The long-term efficacy of neuromodulation for the established indications is more than half, but 20-50% of the patients initially tested do not respond to a test procedure. The disadvantage is the high surgical revision rate and the high cost of treatment. Technical advances will hopefully be able to address these aspects.

Electric Stimulation Therapy↗
PubMed2005

Chronic pudendal nerve neuromodulation in women with idiopathic refractory detrusor overactivity incontinence: results of a pilot study with a novel minimally invasive implantable mini-stimulator.

AIMS: To assess the results of chronic pudendal nerve neuromodulation with a novel technique in a pilot study on women with idiopathic refractory detrusor overactivity incontinence. MATERIALS AND METHODS: A percutaneous screening test (PST) was performed in patients with urodynamically demonstrated detrusor overactivity incontinence. Such a test includes the performance of a cystometrogram without and with percutaneous pudendal nerve stimulation and is considered positive if stimulation results in a more than 50% increase in the bladder volume at the first involuntary detrusor contraction or the maximum cystometric capacity. Patients with a positive PST qualified for the implantation of a mini-neurostimulator with an integrated electrode, a so-called bion(R), adjacent to the pudendal nerve at Alcock's Canal. Five-day voiding-incontinence diaries were the main tool for the evaluation of therapy. RESULTS: A PST was performed in 14 women. Six patients responded positively and received a bion. The degree of incontinence decreased significantly in this group, which also included patients in whom sacral neuromodulation had failed. There were no severe adverse events. CONCLUSIONS: Chronic pudendal nerve stimulation may reduce the degree of detrusor overactivity incontinence, even in patients in whom sacral neuromodulation fails. Bion therapy is relatively simple and minimally invasive and is well tolerated by the patient.

Adult↗
PubMed2005

Changes in disease specific and generic quality of life related to changes in lower urinary tract symptoms: the Krimpen study.

PURPOSE: We determined if and to what extent longitudinal changes in lower urinary tract symptoms are related to disease specific and generic quality of life in men. MATERIAL AND METHODS: A longitudinal, population based study with a followup of 4.2 years was done in 1,688 who were 50 to 79 years old. Data were collected through self-administered questionnaires, including the Sickness Impact Profile (3 domains), Inventory of Subjective Health, International Prostate Symptom Score (I-PSS) and Benign Prostatic Hyperplasia Impact Index. Moreover, they completed various physical and urological measurements. Mean I-PSS and quality of life scores at baseline and followup were analyzed for certain subgroups. Multiple linear regression was used to determine the change in quality of life in relation to baseline I-PSS, I-PSS changes between baseline and followup, and age. RESULTS: Although mean I-PSS increased with time, the average generic quality of life improved and almost a third of the men reported better disease specific quality of life. Multiple linear regression revealed that disease specific quality of life was associated with I-PSS at baseline, changes in I-PSS between baseline and followup, and age. However, generic quality of life scores were not associated with these parameters. CONCLUSIONS: Changes in lower urinary tract symptoms severity had little impact on disease specific quality of life in 50 to 79-year-old men or on generic quality of life during the 4.2-year followup.

Activities of Daily Living↗
PubMed2005

Loss to follow-up in a longitudinal study on urogenital tract symptoms in Dutch older men.

OBJECTIVE: To describe loss to follow-up (LTFU) in a longitudinal community-based study on urogenital tract dysfunction in older men. PATIENTS AND METHODS: A cohort study of men recruited from a Dutch municipality was performed. A baseline study and two follow-up rounds--all with questionnaires and additional measurements--were performed with, on average, 2.1-year intervals. Baseline characteristics were compared between participants and non-participants in the first and in the second follow-up study. RESULTS: The response rates in the first and in the second follow-up were 78.0 and 80.0%, respectively. Various characteristics were found to be related to LTFU (i.e., more than 5% difference in response rate). Lower urinary tract symptoms were related to LTFU in the first and second follow-up. Sexual dysfunction was related to LTFU only in the second follow-up. Adjustment for confounders yielded odds ratios for the primary outcome variables (lower urinary tract symptoms, sexual dysfunction, and health status) that approximated the value of 1. LTFU according to these variables was different in men with and without other chronic illnesses. CONCLUSIONS: LTFU seems not to be related to the primary outcome variables in this study. Describing response patterns in longitudinal studies is important, especially in studies involving older participants, as often is the case in urological research.

Age Factors↗
PubMed2004

Bladder contraction strength parameters poorly predict the necessity of long-term catheterization after a pubovaginal rectus fascial sling procedure.

PURPOSE: We verified if the necessity of long-term catheterization after a pubovaginal rectus fascial sling procedure can be predicted by preoperatively determined bladder contraction strength. MATERIALS AND METHODS: We analyzed the files of 58 consecutive nonneurogenic women who underwent a sling procedure for severe or refractory stress urinary incontinence. Preoperative urodynamic measurements in these patients were re-analyzed using the power factor WF and the bladder contractility index as bladder contraction strength parameters. Catheterization was considered necessary if the patient self-catheterized at least once daily. RESULTS: One patient was lost to followup. Three and 6 months after surgery 24 (42%) of 57 and 18 (33%) of 54 patients were on catheterization. On average patients who were not on catheterization had a stronger bladder but the results were not consistently statistically significant. CONCLUSIONS: A trend toward higher bladder contraction strength in patients not on catheterization was found. However, preoperative urodynamic examination can only poorly predict the necessity of long-term catheterization after sling surgery.

Female↗
PubMed2003

High-resolution endovaginal MR imaging in stress urinary incontinence.

The causes of stress urinary incontinence are not completely known. Recent papers have stressed the importance of more anatomical information, which may help to elucidate the mechanism of stress urinary incontinence. The purpose of this study was to evaluate the prevalence of lesions of the urethral support mechanism and lesions (defects and scars, thinning) of levator ani muscle with endovaginal MRI in a case-control study. Forty women (median age 52 years, age range 40-65 years)--20 patients with stress urinary incontinence (cases) and 20 age-matched healthy volunteers (controls)--underwent endovaginal MRI: axial, coronal, and sagittal T2-weighted turbo spin echo. The examinations were evaluated for the presence of lesions of urethral supporting structures and levator ani and scar tissue of the levator ani. The thickness of the levator ani muscle was measured. Lesions of the urethral support system and levator ani were significantly more prevalent in cases than in controls ( p<0.01). Median levator ani thickness in patients was significantly lower than in healthy controls [2.5 mm (range 0.9-4.1 mm) vs 3.9 mm (range 1.4-7 mm)] ( p<0.01). This study indicates a relationship between stress urine incontinence and the presence of lesions of the urethral support and levator ani and levator ani thinning.

Case-Control Studies↗
PubMed2002

Relation between nocturnal voiding frequency and nocturnal urine production in older men:a population-based study.

OBJECTIVES: To describe the normal values for nocturnal urine production and its determinants, as well as the relation between nocturnal urine production and voiding frequency. METHODS: Data were collected from 1688 men aged 50 to 78 years without bladder or prostate cancer, radical prostatectomy, neurogenic bladder dysfunction, or negative advice from their general practitioner. Measurements included self-administered questionnaires, a 3-day frequency-volume chart, transrectal ultrasonography of the prostate, uroflowmetry, and postvoid residual urine volume measurement. The mean nocturnal urine production was computed from the frequency-volume charts. Linear regression analyses were performed to determine associated factors for nocturnal urine production. Areas under the receiver operating characteristic curves were used to describe the discriminative value of nocturnal urine production on nocturnal voiding frequency. A cutoff value for "increased" nocturnal urine production was defined using logistic regression analysis. RESULTS: The nocturnal urine production was 60.6 mL/hr for the total study population; it increased with age and was significantly higher in men with 24-hour polyuria. Nocturnal urine production was on average higher in men with increased nocturnal voiding frequency, but had only a reasonable discriminative value on nocturnal voiding frequency (areas under receiver operating characteristic curve of 0.71 and 0.76). Nocturnal urine production exceeding 90 mL/hr is suggested as abnormal. CONCLUSIONS: On average, nocturnal voiding frequency is indicative of nocturnal urine production. However, nocturnal urine production is only a modest discriminator for increased nocturnal voiding frequency. Therefore, the use of nocturnal urine production as an explanatory variable for nocturnal voiding frequency in daily practice is of little value.

Age Factors↗
PubMed2002

Health status and its correlates among Dutch community-dwelling older men with and without lower urogenital tract dysfunction.

OBJECTIVE: To study health status and its correlates in older men with and without lower urogenital tract dysfunction. METHODS: Cross-sectional population-based study on 1688 men aged 50-78 years without bladder or prostate cancer, radical prostatectomy, neurogenic bladder dysfunction or a negative advice from their general practitioner. Data were collected through self-administered questionnaires, including Sickness Impact Profile (SIP, three domains), Inventory of Subjective Health (ISH), International Prostate Symptom Score (IPSS) and International Continence Society (ICS) Male Sex questionnaire, medication use, socio-economic and lifestyle factors. Additional information was collected by measurement of blood pressure, transrectal ultrasonography of the prostate and uroflowmetry. Four health status domains were analyzed using the ISH and three domains of the SIP. Lower urinary tract symptoms (LUTS) were categorised using IPSS, erectile and ejaculatory dysfunction were defined using the ICS questionnaire. RESULTS: All urogenital characteristics and parameters were related to at least two of the health status domains. Multivariate regression analyses yielded that LUTS and cardiac symptoms were associated with suboptimal scores of all four domains. Chronic obstructive pulmonary disease and drugs for abdominal symptoms were related to three domains; erectile and ejaculatory dysfunction, muskuloskeletal or psycho(ana)leptic drugs and marital status to two domains. CONCLUSIONS: The impact of LUTS on health status was equally important as the impact of cardiac symptoms. The impact of sexual dysfunction was smaller than expected. Longitudinal studies are needed to determine how health status and illnesses interact.

Aged↗