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At least 469 records · Page 26Linked to original sources
PubMed2006

Tension-free vaginal tape sling procedure for the treatment of stress urinary incontinence in Hong Kong women with and without pelvic organ prolapse: 1-year outcome study.

OBJECTIVE: To assess the outcome of patients who underwent a tension-free vaginal tape sling procedure alone versus patients who underwent concomitant pelvic floor surgery. DESIGN: Retrospective cohort study. SETTING: Urogynaecology unit of a university teaching hospital, Hong Kong. PATIENTS: Patients diagnosed with moderate-to-severe urodynamic stress incontinence and underwent a tension-free vaginal tape sling procedure from September 1999 to August 2004. MAIN OUTCOME MEASURES: Objective cure rate of stress urinary incontinence 1 year following tension-free vaginal tape sling procedure was assessed. Patients were considered objectively cured if no stress urinary incontinence was evident on urodynamic studies at 1-year follow-up. Subjective cure rates at 4 months and 1 year after tension-free vaginal tape sling procedure were also assessed. Other outcome measures included intra-operative and perioperative complication rates, and the rate of de-novo detrusor overactivity at 1 year. RESULTS: Of 302 patients recruited, 250 (82.8%) completed 1-year follow-up. There were 157 (62.8%) patients who had a tension-free vaginal tape sling alone, and 93 (37.2%) had tension-free vaginal tape sling and concomitant pelvic floor surgery for pelvic organ prolapse. All patients had urodynamic studies before and 1 year following surgery. The objective cure rate was 87.3% for patients with tension-free vaginal tape sling alone, and 80.6% for tension-free vaginal tape sling with concomitant procedures (Chi squared test, P>0.05). The subjective cure rates for tension-free vaginal tape sling alone and tension-free vaginal tape sling plus concomitant procedures were 89.2% and 86.0% at 4 months, and 93.0% and 94.6% at 1 year, respectively (Chi squared test, P>0.05). The most common complication was postoperative urinary retention (15.2%), followed by de-novo detrusor overactivity at 1 year (10%), and bladder perforation (8%). CONCLUSION: The tension-free vaginal tape sling procedure alone or in combination with pelvic floor surgery are equally effective for the treatment of female stress urinary incontinence.

Aged↗
PubMed2006

Post-robotic prostatectomy urinary continence: characterization of perfect continence versus occasional dribbling in pad-free men.

OBJECTIVES: To review and characterize two groups of men who report being pad-free after robot-assisted laparoscopic prostatectomy (RLRP): those with occasional incontinence and those with complete control. METHODS: The study included 106 out of a total of 195 men who underwent RLRP. Inclusion requirements were adequate follow-up and no-pad continence status. All patients completed self-administered American Urological Association symptom score (AUAss) and continence questionnaires and underwent measurement of peak urinary flow rates, postvoid residual volumes, and voided volumes (VV) before and 3 months after surgery. All data and standard clinical characteristics were entered prospectively into an electronic database. RESULTS: Two distinct groups reported wearing no pads: the "perfect" group (n = 32) reported never leaking, and the "imperfect" group (n = 74) reported occasional leakage but did not wear pads. Preoperatively, the "imperfect" group was older (62.2 versus 59 years) and had more urinary symptoms (all P < 0.05). Postoperatively, the "imperfect" group took longer to achieve a pad-free status (median 39.8 versus 19.3 days), had larger prostates (mean 50.9 versus 43.2 g), had lower VV (324 versus 405 mL), and more urinary symptoms (AUAss 7.4 versus 4.3; all P < 0.05). CONCLUSIONS: Sixty-nine percent of men who attain "pad-free continence" after RLRP have occasional urinary leakage. Preoperatively, these men are characteristically older and have larger prostates, AUAss, and bother scores. Postoperatively, the "imperfect" group takes longer to achieve pad-free status and has smaller bladder capacities and more urinary symptoms. These results suggest that an overactive detrusor is the likely contributing etiology.

Humans↗
PubMed2002

Clinical impact of overactive bladder.

Overactive bladder (OAB) is a medical condition with the symptoms of urinary frequency and urgency, with or without urge incontinence. Traditionally, epidemiologic studies have focused on the symptom of incontinence, and therefore the prevalence and clinical impact have been grossly underestimated. Recently, several population-based studies have been conducted that have provided insight into the true magnitude of OAB. This article will review the latest data on the prevalence of OAB and discuss the impact of the condition on quality of life. Furthermore, it will examine some of the comorbidities associated with OAB and look at the potential economic impact of OAB.

Journal Article↗
PubMed2006

[News in the pharmacological treatment of female urinary incontinence].

The article addresses the issue of pharmacological treatment of female urinary incontinence. It summarizes the two types of incontinence, i.e. stress urinary incontinence (SUI) and urgency incontinence, or even just urgency symptoms (overactive bladder--OAB). It focuses on the role of urethra in maintaining continence for women. The article covers new possibilities of pharmacological treatment of SUI with detailed analysis of the effects of a new drug--duloxetine (YENTREVE). In the second part, the article outlines the drugs most frequently used in the treatment of urgency incontinence or just urgency symptoms, mentioning new preparations and new forms of preparations already in use. It analyzes the effects of tolterodine (DETRUSITOL), oxybutinine (UROXAL) and solifenacine (VESICARE).

Female↗
PubMed2006

Frequency of wetting is predictive of response to anticholinergic treatment in children with overactive bladder.

OBJECTIVES: To examine the variables relative to the response of oxybutynin treatment in children with daytime urinary incontinence. METHODS: The records of patients seen for voiding problems between 1999 and 2003 were reviewed. Patients taking oxybutynin for 3 months or longer were included in the study. Patients with structural or neurologic bladder abnormalities and those taking oxybutynin at the initial visit were excluded. Age, sex, uroflowmetry findings, postvoid residual urine volume, duration and severity of symptoms before oxybutynin, urinary tract infection history, constipation, and the duration, dosage, and adverse effects of oxybutynin treatment were evaluated. Data were analyzed using Fisher's exact test for categorical variables, the two-sample t test or Wilcoxon rank-sum test for continuous and ordinal variables, and the linear mixed model analysis for uroflow data. RESULTS: Eighty-one patients met the inclusion criteria. After an average follow-up of 1.2 years, 31 (38.3%) were dry, 25 (30.9%) had experienced significant improvement, 19 (23.5%) had experienced slight improvement, and 6 (7.4%) were unchanged. No significant differences were detected between those who became dry and those with little to no improvement with respect to age, sex, duration of symptoms, follow-up, uroflow pattern, postvoid residual urine volume, or bladder capacity. Those children presenting with decreased frequency of wetting episodes were significantly more likely to obtain daytime continence. The most common side effects were constipation (18.5%), dry mouth (17.3%), and flushing (13.6%). CONCLUSIONS: Children with daytime incontinence presenting with the lowest frequency of wetting were most likely to achieve continence. The frequency of wetting should be considered a significant prognostic variable when assessing the results of therapeutic intervention trials.

Adolescent↗
PubMed2003

The association of diet and other lifestyle factors with overactive bladder and stress incontinence: a longitudinal study in women.

OBJECTIVES: To investigate the role of diet and other lifestyle factors in the incidence of overactive bladder and stress incontinence in women. Studies have suggested relationships between different aspects of lifestyle and symptoms of urinary incontinence, but there is a lack of firm evidence about their role in its cause. SUBJECTS AND METHODS: A random sample of women aged >or= 40 years living at home took part in a prospective cohort study. Baseline data on urinary symptoms, diet and lifestyle were collected from 7046 women using a postal survey and food-frequency questionnaire. Follow-up data on urinary symptoms were collected from 6424 of the women in a postal survey 1 year later. Logistic regression was used to investigate the association of food and drink consumption and other lifestyle factors with the incidence of overactive bladder and stress incontinence. RESULTS: In the multivariate model for the onset of an overactive bladder, there were significantly increased risks associated with obesity, smoking and consumption of carbonated drinks, and reduced risks with higher consumption of vegetables, bread and chicken. Obesity and carbonated drinks were also significant risk factors for the onset of stress incontinence, while consumption of bread was associated with a reduced risk. CONCLUSIONS: Causal associations with obesity, smoking and carbonated drinks are confirmed for bladder disorders associated with incontinence, and additional associations with diet are suggested. Behavioural modification of lifestyle may be important for preventing and treating these disorders.

Adult↗
PubMed1999

Pharmacological effects of tolterodine on human isolated urinary bladder.

Tolterodine, (R)-N,N-diisopropyl-3-(2-hydroxy-5-methylphenyl)-3-phenylpropanamine+ ++, is an antimuscarinic drug developed for the treatment of overactive bladder with symptoms of frequency, urgency and urge incontinence. We investigated the effects of tolterodine and its major active metabolite, DD 01 (PNU-200577), (R)-N,N-diisopropyl-3-(2-hydroxy-5-hydroxymethylphenyl)-3-phenylpropa namine, on the contractions induced by carbachol, KCl, CaCl2 and electrical field stimulation in human isolated urinary bladder smooth muscles, using the muscle bath technique. Specimens of human urinary bladder were obtained from 20 patients who underwent total cystectomy due to malignant bladder tumor. The detrusor preparations were taken from the intact part of the dome region of the bladder. Carbachol (10(-9)-10(-2) M) caused concentration-dependent contraction of human detrusor smooth muscles. Tolterodine (10(-9)-10(-6) M), DD 01 (10(-9)-10(-6) M), oxybutynin (10(-8)-10(-6) M), propiverine (10(-8)-10(-6) M), atropine (10(-9)-10(-6) M), pirenzepine (10(-8)-10(-5) M), methoctramine (10(-8)-10(-5) M) and 4-diphenylacetoxy-N-methylpiperidine (4-DAMP) (10(-9)-10(-6) M) caused typical shifts to the right of the concentration-response curves for carbachol, except for higher concentrations (10(-5) M) of oxybutynin and propiverine, which caused a decrease of about 30% of the maximum contractile responses to carbachol. All the slopes of the regression lines of Schild plots were close to unity, and the rank order of pA2 values was: atropine = DD 01 = tolterodine = 4-DAMP = oxybutynin > propiverine = pirenzepine > methoctramine. Tolterodine (10(-9)-10(-6) M) and DD 01 (10(-9)-10(-6) M) did not inhibit the KCl-induced (80 mM) and CaCl2-induced (5 mM) contractions, while oxybutynin (10(-8)-10(-5) M) and propiverine (10(-8)-10(-5) M) significantly inhibited the contractions. Electrical field stimulation (2-60 Hz) caused frequency-dependent contraction of human detrusor smooth muscles, which were significantly inhibited by various drugs. In the presence of 10(-6) M atropine, tolterodine and DD 01 did not inhibit the residual contractions induced by electrical field stimulation at any of the frequencies, while oxybutynin (10(-5) M) and propiverine (10(-5) M) significantly inhibited the atropine-resistant part of the contractions. The results suggest that the inhibitory effects of tolterodine and DD 01 are mediated only by their antimuscarinic action, which is equal to that of oxybutynin and significantly greater than that of propiverine, and that tolterodine and DD 01 have neither Ca2+ channel antagonist action nor inhibitory effect on the atropine-resistant part of the contractions in human detrusor smooth muscles. These findings support the usefulness of tolterodine as a therapeutic drug for overactive bladder with symptoms of frequency, urgency and urge incontinence.

Aged↗
PubMed2006

Central acute D2 stimulation worsens bladder function in patients with mild Parkinson's disease.

PURPOSE: The different roles of D1 and D2 dopamine receptors in LUT behavior have been demonstrated in animal studies. In particular D2 selective agonists and D1 selective antagonists seem to produce a reduction of the bladder capacity in conscious rats. This finding has never been confirmed in human studies. Thus, in this study we investigated the role of D1 and D2 agonists/antagonists on LUT behavior in patients with PD. MATERIALS AND METHODS: A total of 87 patients with mild PD were evaluated. Patients were evaluated with urodynamic studies (cystometry followed by a pressure flow study with perineal floor electromyography) performed in off status and after oral administration of 250 mg of LD. In 70 patients a third urodynamic evaluation was conducted in one of the following conditions: after simultaneous administration of 250 mg oral LD and 60 or 120 mg oral domperidone (D2 peripheral antagonist); after simultaneous administration of 250 mg oral LD and 25, 50 or 150 mg intramuscular L-sulpiride (D2 central and peripheral antagonist). Several urodynamic parameters were evaluated and results obtained in different conditions compared. RESULTS: LD alone worsened detrusor overactivity: in particular, a reduction of first urinary sensation, involuntary detrusor contraction threshold (reflex volume) and bladder capacity was observed. L-sulpiride (central and peripheral D2 antagonist) coadministration counteracted the worsening in a dose dependent manner. Domperidone (peripheral D2 antagonist) coadministration failed to determine the same counteraction. CONCLUSIONS: According to our results, a central acute D2 stimulation seems to be responsible of a reduction of bladder capacity with worsening of detrusor overactivity in patients with mild PD.

Domperidone↗
PubMed2005

[Surgery (TUR-P) as a recommended initial treatment modality for the presented case].

The pathophysiology of lower urinary tract dysfunction in the presented case comprised voiding dysfunction and overactive bladder. Two etiologies for voiding dysfunction in this case could be considered, bladder outlet obstruction due to benign prostatic hyperplasia (BPH) or detrusor underactivity. Prospected efficacies of pharmacological and surgical treatment (transurethral resection of prostate: TUR-P) for this case were compared based on a literature review. Alpha-1 blockers improve both voiding and storage symptoms in patients with BPH. However, improvement of maximum flow rate (Qmax) on uroflowmetry is limited within a small range and there is no evidence of significant reduction in residual urine volume. Alpha-1 blockers have no significant efficacy in improvement of objective measures in patients with detrusor underactivity. Although anticholinergics improve overactive bladder symptoms, they are contraindicated for patients with severe voiding dysfunction with residual urine. There is a lack of study on efficacy of apha-1 blocker administration combined with anticholinergics available in our hands for patients with BPH and overactive bladder. On the other hand, TUR-P brings remarkable improvement in voiding and storage symptoms, increase of flow rate and reduction of residual urine as a gold-standard surgical treatment for BPH. Urge incontinence and uninhibited detrusor contraction on cystometry reportedly disappeared in 60% of patients following TUR-P. TUR-P also improves subjective symptom and objective measures in patients with BPH and detrusor underactivity. Based on the literature review, surgery is recommended as a standard initial therapy for the presented patient with significant voiding dysfunction (Qmax 9.4 ml/sac and residual urine 72 ml).

Adrenergic alpha-Antagonists↗
PubMed2004

Endothelial nitric oxide synthase expression in neurogenic urinary bladders treated with intravesical resiniferatoxin.

OBJECTIVE: To investigate endothelial nitric oxide synthase (eNOS) immunoreactivity in bladder biopsies from patients with neurogenic detrusor overactivity (NDO) before and after treatment with intravesical resiniferatoxin, and compare this with control material; the distribution of two other vascular markers, von Willebrand Factor (vWF) and the vascular endothelial growth factor (VEGF), was also studied. PATIENTS AND METHODS: Flexible cystoscopic bladder biopsies from eight controls investigated for asymptomatic microhaematuria and 19 patients with refractory spinal NDO enrolled in a clinical trial of intravesical treatment with escalating doses of resiniferatoxin were immunostained with polyclonal rabbit antibodies for eNOS, vWF and VEGF. Fewer baseline NDO specimens (eight) were available for vWF and VEGF staining. Computerized image analysis was used to quantify immunoreactivity, and the Mann-Whitney test for statistical analysis. RESULTS: eNOS immunoreactivity was found in the suburothelium and less often in the urothelium, with a distribution indicating a location in small blood vessels at the urothelium-suburothelium junction. Immunostaining for vWF showed a similar location. There was a trend to higher eNOS values before treatment in those responding than in those not responding to resiniferatoxin (P = 0.059), and a significant reduction in eNOS immunoreactivity after successful treatment (P = 0.016). VEGF staining was weaker but there was a significant increase in pretreatment biopsies of responders to resiniferatoxin (P = 0.048). Clinical and histopathology features were similar in both groups. CONCLUSIONS: The trend for higher eNOS expression in patients with NDO who responded to resiniferatoxin suggests that increased vasculature or vasodilatation in the suburothelium may be necessary for successful intravesical treatment. Further studies with more patients are required to confirm this relationship and to examine the mechanisms underlying changes in vasculature with levels of bladder overactivity.

Administration, Intravesical↗
PubMed1999

Tolterodine for overactive bladder: time to onset of action, preferred dosage, and 9-month follow-up.

This is a prospective study of 28 patients who had urinary frequency (>8 times/day) and either urgency or urge incontinence (>1 time/day). After a 2-week run-in period (visit 1), the patients were started on tolterodine 1 mg twice a day (bid) (visit 2). They were followed at 4 and 8 weeks (visits 3 and 4). The patients were contacted by telephone 1 week after visit 2. Tolterodine was increased to 2 mg bid if the patient had incomplete improvement at either the initial phone call or during visit 3. Evaluation criteria were daily micturition charts including urinary frequency, nocturia, leakage episodes, average urine volume per day, and average voided volume. Tolterodine was well tolerated without side effects in 20 (80%) of 28 patients. Eight patients (20%) dropped out after enrollment because of side effects in 3, no improvement in 2, and missing visits (>1) in 3. Drug dosage in the 20 patients who tolerated tolterodine was 1 mg bid in 3 and 2 mg bid in 17 (85%). According to micturition charts, urinary frequency, nocturia, and leakage episodes decreased significantly after tolterodine treatment, whereas average urine volume per day and average voided volume did not change significantly. There were no electrocardiographic or biochemical abnormalities due to tolterodine treatment. Mean follow-up was 9.4 months. All 20 patients who tolerated tolterodine continue to take the medication without significant side effects. We conclude that tolterodine is well tolerated and effective for overactive bladders. Two milligrams bid is the dosage preferred by the majority of patients and the onset of action is seen within 1 week of treatment. Long-term compliance and efficacy are excellent, with no dropout in >9 months of follow-up.

Adult↗
PubMed2006

[Vaginal prolapse and stress urinary incontinence: combined treatment by a single prosthesis].

OBJECTIVES: To evaluate the efficacy and possible short-term and medium-term complications of vaginal prosthetic surgery with transobturator fixation to treat prolapse and stress urinary incontinence (SUI) that are often associated in a single operation. MATERIAL AND METHOD: From February 2002 to August 2004, 45 patients with a mean age of 66 +/- 11 years presenting essentially stage 3 or 4 cystocele associated with SUI (documented for 40 cases and revealed by reduction of the prolapse for the other five) were operated according to the transobturator infracoccygeal sling technique. RESULTS: With a mean follow-up of 31 +/- 9 months, the success rate of the technique was estimated to be 98% anatomically (only one failure) and 91% in terms of urinary symptoms (73% of patients were cured, 18% were improved and 9% failed). No cases of urinary retention were observed, except for one patient with a secondarily infected pelvic haematoma requiring evacuation and the partial removal of the prosthesis. The mean residual urine on discharge was 83 ml. Two patients developed de novo overactive bladder The prostheses exposure rate was 18%. CONCLUSION: Combined treatment of vaginal prolapse and associated urinary incontinence is possible by the use of a single transvaginal prosthesis. The medium-term anatomical results are very good. The results on continence are good and a subsequent specific procedure is always possible in the case of failure or insufficient improvement. The prostheses exposure rate is similar to that observed with synthetic transvaginal prostheses.

Adult↗
PubMed2006

TRPV1 (vanilloid receptor) in the urinary tract: expression, function and clinical applications.

The transient receptor potential vanilloid subfamily 1 (TRPV1) is an ion channel activated by capsaicin, heat, protons and endogenous ligands such as anandamide. It is largely expressed in the urinary tract of mammals. Structures in which the receptor expression is firmly established include sensory fibers and urothelial cells, although the presence of TRPV1 in other cell types has been reported. As in other systems, pain perception was the first role attributed to TRPV1 in the urinary tract. However, it is now increasingly clear that TRPV1 also regulates the frequency of bladder reflex contractions, either through direct excitation of sensory fibers or through urothelial-sensory fiber cross talk involving the release of neuromediators from the epithelial cells. In addition, the recent identification of the receptor in urothelial and prostatic cancer cells raise the exciting hypothesis that TRPV1 is involved in cell differentiation. Desensitization of the receptor by capsaicin and resiniferatoxin has been investigated for therapeutic purposes. For the moment, lower urinary tract dysfunctions in which some benefit was obtained include painful bladder syndrome and overactive bladder of neurogenic and non-neurogenic origin. However, desensitization may become obsolete when non-toxic, potent TRPV1 antagonists become available.

Animals↗