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Biomedical subjects

Victor W Nitti

Publications and source records attributed to Victor W Nitti.

At least 19 recordsLinked to original sources
PubMed2007

Comparison between reduction in 24-hour pad weight, International Consultation on Incontinence-Short Form (ICIQ-SF) score, International Prostate Symptom Score (IPSS), and Post-Operative Patient Global Impression of Improvement (PGI-I) score in patient evaluation after male perineal sling.

AIMS: We assessed the utility of three self-assessment instruments: the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), the post-operative Patient Global Impression of Improvement (PGI-I) score, and the International Prostate Symptom Score (IPSS) by correlating them with an objective outcome, the change in 24-hr pad weight, after a male perineal sling. METHODS: Twenty-six men with urodynamically confirmed stress incontinence underwent a male perineal sling. Patients were evaluated pre-operatively and post-operatively with a 24-hr pad test, IPSS and ICIQ-SF. Patients also completed the PGI-I post-operatively. Changes in study parameters were compared via the paired t-test, and correlations were performed using Spearman's rho. RESULTS: There were significant reductions in 24-hr pad weight (-274 g, P < 0.001), percentage 24-hr pad weight (54.2%), ICIQ-SF score (-6.3, P < 0.001), and the three ICIQ-SF subscores (-1.2, -1.7, -3.4 for Questions 3, 4, and 5, respectively, P < 0.001 for all). The change in total ICIQ-SF score and the post-operative PGI-I score correlated strongly with percentage reduction in 24-hr pad weight (r = -0.68, P < 0.001; r = -0.81, P < 0.001, respectively) and with each other (r = 0.79, P < 0.001). The change in all three ICIQ-SF subscores correlated significantly with percentage reduction in 24-hr pad weight and with post-operative PGI-I score. There was no significant change in the IPSS or the voiding or storage subscores, and none correlated with any other study parameter. CONCLUSIONS: This study validates the construct validity of the ICIQ-SF and PGI-I in the assessment of treatment for male stress incontinence and should make clinicians confident in comparing studies of incontinence treatment utilizing the change ICIQ-SF score, the post-operative PGI-I score, and percentage reduction in 24-hr pad weight as outcome measures.

Humans↗
PubMed2006

Comparison of diagnostic criteria for female bladder outlet obstruction.

PURPOSE: There is no universally accepted definition of bladder outlet obstruction in women. We compared 5 contemporary urodynamic definitions and determined how well they correlated with each other and with clinical suspicion of bladder outlet obstruction. MATERIALS AND METHODS: A total of 154 women who underwent videourodynamics were prospectively evaluated. Clinical obstruction was suspected when history, physical examination, symptoms and basic testing before urodynamics raised the suspicion. Women were classified as having obstruction based on 5 contemporary definitions, including 3 pressure flow cutoff point criteria, videourodynamic criteria and the Blaivas-Groutz nomogram. The McNemar Test was used to compare each definition to the others and to suspicion of clinical obstruction. RESULTS: Of the women 91 were evaluable, including 26 (29%) with obstruction by videourodynamic criteria, 28 (31%) with obstruction by 1998 cut point criteria, 18 (20%) with obstruction by 2000 cut point criteria, 13 (14%) with obstruction by 2004 cut point criteria and 38 (42%) with obstruction by the Blaivas-Groutz nomogram. Videourodynamic and 1998 cut point criteria were not significantly different from each other (78.9% concordance) and each agreed with the clinically obstructed category in the comparison. Compared to the other criteria, the Blaivas-Groutz nomogram overestimated obstruction, while 2004 cut point criteria tended to underestimate it. CONCLUSIONS: Each urodynamic definition of female bladder outlet obstruction has merit. Videourodynamic criteria and 1998 cut point criteria have the highest concordance. The Blaivas-Groutz nomogram overestimates obstruction compared to the other criteria. Therefore, it should not be used as the sole or standard definition of obstruction in women.

Adolescent↗
PubMed2006

Tolterodine for treatment of overactive bladder.

Tolterodine was developed as an antimuscarinic agent specifically for the treatment of overactive bladder. Initial in vivo studies demonstrated a functional selectivity for the muscarinic receptors in the urinary bladder over the salivary glands, and subsequent clinical trials showed an overall superior tolerability profile compared with other drugs in the same class (ie, oxybutynin). With immediate- and extended-release formulations and sustained clinical efficacy during long-term treatment, tolterodine gas become an important treatment option for the symptoms of overactive bladder.

Benzhydryl Compounds↗
PubMed2006

Female stress urinary incontinence: how do patient and physician perspectives correlate in assessment of outcomes?

PURPOSE OF REVIEW: This article discusses outcome assessment following surgery for incontinence, by correlating patient perspectives with that of the physician. RECENT FINDINGS: A review of the literature demonstrates a large variance in the 'success rates' published for different stress urinary incontinence procedures. We review the elements essential in formation of a universal and valid incontinence questionnaire. Studies have attempted to correlate common clinical measures (voiding diaries, pad testing, urodynamics) with quality-of-life questionnaires. Sentinel articles in incontinence outcome assessment are discussed. Studies with critical measures of outcome are examined using the recommendations made by the Female Stress Urinary Incontinence Guidelines Panel summary report. Through presentation of our data on tension-free vaginal tape procedures, we give insight into the future of stress urinary incontinence research and outcomes. SUMMARY: Early 'cure rates' were severely limited by their retrospective nature and focus on chart review and physician assessment. Symptom and quality-of-life questionnaires provide subjective outcome assessments. No direct correlation exists between universally accepted objective and subjective measures of improvement. Recent studies are getting closer to the female stress urinary incontinence guidelines. Yet, the pursuit for a universal definition of success continues, in order to bridge patient and physician perspectives on cure.

Female↗
PubMed2006

Efficacy and tolerability of tolterodine extended-release in continent patients with overactive bladder and nocturia.

OBJECTIVE: To evaluate the clinical efficacy and tolerability of tolterodine extended-release (ER) in continent patients with overactive bladder (OAB) and nocturia. PATIENTS AND METHODS: A post hoc analysis was conducted of data from a 12-week, double-blind study of 850 patients randomized to tolterodine ER (4 mg once daily) or placebo, taken within 4 h of going to bed. Patients with a mean of > or = 8 voids/24 h were enrolled, including a mean of > or = 2.5 voids/night. Patients completed 7-day voiding diaries, and for each void an urgency rating was assessed using a 5-point scale (1, none; 5, urgency incontinence); 24-h voids were categorized by urgency rating: total (1-5), non-OAB (1-2), OAB (3-4), and severe OAB (4-5) voids. All adverse events were recorded. RESULTS: The post hoc analysis included 513 patients (243 placebo; 270 tolterodine ER; 58% men) who were continent at baseline; 47% of 24-h voids were classed as non-OAB, and 12% as severe OAB. After 12 weeks of treatment, tolterodine ER significantly reduced mean urgency rating and 24-h OAB, severe OAB, and total voids vs placebo. Tolterodine ER did not affect normal, non-OAB voids, and there were no significant adverse events related to voiding. Other than dry mouth (tolterodine ER, 9% vs placebo, 2%), all the adverse events were reported in <3% of patients; <2% of patients receiving tolterodine ER withdrew because of adverse events. CONCLUSIONS: In continent patients with OAB, tolterodine ER significantly improved urgency rating and reduced 24-h OAB, severe OAB, and total voids, suggesting that it is an effective and well-tolerated treatment option for this subpopulation. More studies are needed to better understand the clinical efficacy of tolterodine ER in this under evaluated group of OAB patients without incontinence.

Adult↗
PubMed2006

Botulinum toxin for the treatment of idiopathic and neurogenic overactive bladder: state of the art.

The pharmacologic treatment of overactive bladder and detrusor overactivity, whether idiopathic or neurogenic, has centered around blocking muscarinic receptors on the detrusor muscle. Although newer agents have been developed with better tolerability and safety, the basic mechanism by which the "irritable" detrusor is treated has not changed in decades. Although effective in many cases of idiopathic and neurogenic detrusor overactivity and overactive bladder, antimuscarinic agents fall short in many other cases because of lack of efficacy and/or tolerability. For the past several years, there has been increasing evidence to support the use of botulinum toxin for the treatment of detrusor overactivity and overactive bladder syndrome not effectively treated by anticholinergics. From early open-label studies to the more recent randomized, controlled trials, efficacy and tolerability data have been very encouraging. Botulinum toxin is not yet approved by the US Food and Drug Administration for the treatment of detrusor overactivity and overactive bladder, but the positive results seen thus far cannot be ignored.

Journal Article↗
PubMed2005

Correlation of abdominal leak point pressure with objective incontinence severity in men with post-radical prostatectomy stress incontinence.

AIMS: To determine if the abdominal leak point pressure (ALPP) correlates with objective incontinence severity in patients suffering from post-prostatectomy stress incontinence. METHODS: Twenty-nine men were evaluated for urinary incontinence after radical prostatectomy with videourodynamics and a 24-hr pad test. ALPP was determined with and without a 7-French urodynamics catheter and the lowest value was accepted. Six patients with urgency incontinence associated with detrusor overactivity or decreased bladder compliance were excluded leaving 23 patients for analysis. The relationship between the variables of ALPP, 24-hr pad weight, age and time from prostatectomy were examined with Pearson correlation. RESULTS: The mean age was 66.4 years (SD +/- 7.9, range: 45-81) and the median time from radical prostatectomy was 23 months (IQR = 14-64, range: 9-204). The mean ALPP was 92.8 cm H(2)O (SD +/- 42.4 cm H(2)O) and the mean pad weight was 279.1 g (SD +/- 238.3 g). There was only a weak inverse correlation between ALPP and 24-hr pad weight which was not statistically significant (r = - 0.191, P = 0.38). Age and time from prostatectomy did not significantly correlate with ALPP (r = - 0.122, P = 0.58 and r = - 0.23, P = 0.29, respectively). CONCLUSIONS: ALPP did not correlate significantly with the 24-hr pad test in patients with post-prostatectomy stress incontinence. This suggests that in this patient subset, the ALPP is a relatively poor predictor of incontinence severity and, therefore, has limited clinical value in the urodynamic evaluation of post-prostatectomy incontinence. The urodynamic assessment of these patients should focus on the presence or absence of stress incontinence and on the presence of associated bladder dysfunction.

Abdomen↗
PubMed2005

A urodynamics protocol to optimally assess men with post-prostatectomy incontinence.

AIMS: To propose a urodynamic protocol to comprehensively assess all parameters of post prostatectomy incontinence (PPI). METHODS: Sixty men with a history of PPI after radical prostatectomy prospectively underwent a standardized video urodynamics protocol. A 7F urethral catheter was used for standard cystometry, abdominal leak point pressure (ALPP), and pressure flow measurements. The International Continence Society nomogram classified obstruction and further classification of obstruction was based on fluoro voiding cystourethrography and non-invasive flow rates (free Qmax). RESULTS: Twenty-four (40%) men had detrusor overactivity with 8 (13%) also having detrusor overactivity incontinence. Only one patient had impaired compliance. All men had urodynamic stress incontinence, but 21 (35%) men demonstrated it only after removal of the urethral catheter. For men leaking with and without the urethral catheter, the respective ALPP was significantly different, 86.3 and 67 cmH2O, respectively (P = 0.002). The men who leaked only in the absence of the urethral catheter had significantly higher ALPP measurements, P < 0.001. After reclassification using the fluoroscopic images of the bladder outlet and free Qmax, only 13.3% patients were obstructed. CONCLUSIONS: The proposed urodynamic protocol allows for an optimal assessment of bladder and sphincter dysfunction and outlet obstruction in men with PPI.

Aged↗
PubMed2005

Diagnosis and treatment of primary bladder neck obstruction in men.

Although primary bladder neck obstruction was first described approximately 70 years ago, it is within the past 20 years that the symptoms, signs, and methods of diagnosis and treatment have been elucidated. This article describes its typical presenting symptoms and signs that commonly may lead to a missed diagnosis for a number of years in many cases. The treatments typically available are pharmacologic or surgical. Unfortunately, most treatments have not been studied in prospective, randomized trials to assess true efficacy. The natural history of this disorder, both treated and untreated, demands much further study to determine its effect on progression of symptoms and bladder and renal function.

Cystoscopy↗
PubMed2005

Patient perception of videourodynamic testing: a questionnaire based study.

PURPOSE: We determined the degree of anxiety, embarrassment and discomfort anticipated by patients before undergoing videourodynamics and compared the results to the actual degrees experienced by patients. In addition, we compared these variables between men and women, and younger and older patients. MATERIALS AND METHODS: All patients undergoing urodynamics for the first time were given a 2 part questionnaire. Patients with neurological disease or those requiring an indwelling or intermittent catheter were excluded. Part 1 given immediately prior to the test contained 5 questions regarding expected anxiety, pain, embarrassment, apprehension regarding x-ray exposure and preparedness. Part 2 given immediately after testing contained 5 questions comparing anticipated to actual overall experience, pain and embarrassment, preparation and whether the patient would undergo testing again. Each question had a 5 point scale. RESULTS: A total of 78 men and 88 women respondents completed the questionnaires. Most (greater than 95% per question) expected no to moderate anxiety, pain, embarrassment and apprehension. This did not vary with age, although more women anticipated greater embarrassment and more men expected little or no embarrassment (p <0.001). After testing most respondents (greater than 90% per question) thought that the test was the same or better than expected and it was associated with an expected or less than expected level of pain and embarrassment. This did not vary between the sexes but more younger individuals found that the test experience was worse than expected, while more older individuals found that it was better than expected. Of the patients 95% would undergo urodynamic testing again if medically indicated. CONCLUSIONS: Videourodynamics is well tolerated and is associated with only minimal to moderate degrees of anxiety, discomfort and embarrassment. A suspected lack of tolerance should not be a barrier to performing medically indicated urodynamic testing.

Adult↗
PubMed2005

Bladder-health diaries: an assessment of 3-day vs 7-day entries.

OBJECTIVES: To assess the reliability of symptom reports in 3-day vs 7-day bladder diaries used in clinical trials of patients with overactive bladder (OAB) and to compare those results and related issues with previous reports. MATERIALS AND METHODS: We analysed two large-scale, randomized, phase 3 clinical trials of the use of transdermal oxybutynin for treating patients with OAB. The first trial (Trial A, 520 patients) compared three doses of transdermal oxybutynin (1.3, 2.6 and 3.9 mg/day) with placebo. Patients documented their OAB symptoms in a 7-day diary. The second clinical study (Trial B, 361 patients) compared the efficacy of 3.9 mg/day transdermal oxybutynin with 4 mg/day extended-release tolterodine and with placebo; this trial required symptom recording for only 3 days. The internal consistency of the data from the 7-day trial was determined and then compared with the 3-day trial results. RESULTS: Patients on transdermal oxybutynin or long-acting tolterodine for their OAB symptoms showed a clinically and statistically significant improvement, results that were documented in both 3-day and 7-day bladder diaries. However, compared with 7-day symptom records, 3-day diaries were associated with significantly better compliance with record-keeping (P < 0.001). CONCLUSIONS: Seven-day diaries used in clinical trials supply accurate and reproducible data on clinical manifestations of OAB, but 3-day diaries are equally effective and have the potential for better accuracy through increased patient convenience. Three-day diaries may also reduce the tendency for patients to complete gaps in record-keeping from memory.

Benzhydryl Compounds↗
PubMed2005

Primary bladder neck obstruction in men and women.

Primary bladder neck obstruction (PBNO) is a condition in which the bladder neck does not open appropriately or completely during voiding. Although the true prevalence of PBNO is difficult to ascertain, studies in both men and women with voiding dysfunction demonstrate a marked prevalence of the condition. Symptoms caused by PBNO include storage symptoms (frequency, urgency, urge incontinence, nocturia) and voiding symptoms (decreased force of stream, hesitancy, incomplete emptying). There are multiple theories as to the etiology of PBNO, including muscular and neurologic dysfunction and fibrosis. The diagnosis of PBNO can be made precisely with videourodynamics, urodynamic testing with simultaneous pressure-flow measurement, and visualization of the bladder neck during voiding. Treatments vary from watchful waiting to medical therapy to surgery, depending on the severity of symptoms, urodynamic findings, and response to therapy. This article reviews the current state of the art with respect to the prevalence, etiology, diagnosis, and treatment of PBNO.

Journal Article↗
PubMed2005

Pressure flow urodynamic studies: the gold standard for diagnosing bladder outlet obstruction.

Bladder outlet obstruction (BOO) is a common cause of lower urinary tract symptoms (LUTS) in men and women. By definition, BOO is determined urodynamically, assessing the pressure-flow relation during voiding. Since the 1960s much work has been done to standardize the urodynamic definitions of obstruction in men and more recently women. Today, urodynamic testing voiding pressure-flow analysis remains the gold standard for the diagnosis of BOO and the etiology of LUTS. The pressure-flow relation is much better defined in men than in women, but recent work suggests that although the definition of obstruction may differ between men and women, the concept of the pressure-flow relation to diagnose obstruction holds true for both genders.

Journal Article↗
PubMed2005

Is There a Role for alpha-Blockers for the Treatment of Voiding Dysfunction Unrelated to Benign Prostatic Hyperplasia?

alpha-Adrenoreceptor antagonists have become the primary medical treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia (BPH). It was presumed that the primary mechanism by which alpha-blockers reduced lower urinary tract symptoms (LUTS) was by relaxation of smooth muscle in the prostate through a sympathetic response. Reduction of outlet resistance leads to changes in bladder function, thus improving both storage and voiding symptoms. However, it was observed that many patients with BPH-associated LUTS had significant improvement in storage symptoms without subjective or objective improvement in voiding. Storage symptoms associated with detrusor overactivity (frequency, urgency, and urge incontinence) are typically thought of as being parasympathetically mediated, and therefore anticholinergic medications have been the mainstay of pharmacological treatment, but recent work has suggested that several nonparasympathetic-mediated mechanisms may cause detrusor overactivity. Because alpha receptors appear to play a role in lower urinary tract function at multiple sites and levels, alpha-blockers could be used to treat voiding dysfunction not related to BPH. In addition, these nonprostate effects should be gender-independent, making the use of alpha-blockers plausible in women with specific types of voiding dysfunction.

Journal Article↗
PubMed2004

Voiding dysfunction in young, nulliparous women: symptoms and urodynamic findings.

The objective was to determine urodynamic findings in young, premenopausal, nulliparous women with bothersome lower urinary tract symptoms and assess whether or not symptoms are predictive of specific urodynamic abnormalities. The records of 57 women were reviewed. Those with neurological disease or a primary complaint of stress incontinence were excluded. All completed the American Urological Association Symptom Index (AUASI) and underwent videourodynamics. Symptoms were compared in patients with and without bladder dysfunction and/or voiding phase dysfunction. Bladder dysfunction was diagnosed in 86% of patients with urge incontinence vs. 17% of those without (p<0.0001). Patients with voiding phase dysfunction had higher total and voiding AUASI scores. Occult neurological disease was later diagnosed in 4 women (24%) with urge incontinence and bladder dysfunction. Urge incontinence and voiding symptoms are frequently associated with urodynamically demonstrable abnormalities. Urge incontinence and bladder dysfunction may be a sign of occult neurological disease in this population. The presenting symptoms are useful in determining the utility of urodynamics in this population.

Adult↗
PubMed2004

Degree of bother caused by nocturia in women.

AIMS: The prevalence of nocturia in women has been studied, but its severity has not been categorized based on degree of bother. The number of nighttime voids that defines clinically significant nocturia has not been established. The objective of this study was to establish how bothersome nocturia is in women and to determine whether number of nighttime voids correlates with the degree of bother. We also sought to determine if this correlation was affected by age or continence status. MATERIALS AND METHODS: The charts of 1,214 neurologically healthy women that presented to a female urology office were reviewed. All women completed the American Urological Association Symptom Index (AUASI) and the symptom problem index (SPI). Question no. 7 of the AUASI assesses the number of voids per night and question no. 3 of the SPI assesses the bother of nighttime voiding. The correlation of these two variables was evaluated using a proportional odds model. RESULTS: Mean age was 54.6 years (18-93). 87.3% complained of waking at least one time per night to void. Bother score increased as the number of nightly voids increased, irrespective of age or continence status. The proportional odds model showed that as the number of voids increases 1 value on AUASI, the odds of having an increase in bother increases 2.7 times (P<0.0001). CONCLUSIONS: As the number of nighttime voiding episodes increases, the bother increases, independent of age or continent status. Based on the degree of bother, we propose that clinically significant nocturia in women be classified as two or more episodes per night.

Adolescent↗