Continence Reports最新文献

{"title":"Unsuccessful mid-urethral sling division is associated with development and persistence of pelvic pain: A case series","authors":"Eva Fong ,&nbsp;Vincent Tse","doi":"10.1016/j.contre.2023.100034","DOIUrl":"https://doi.org/10.1016/j.contre.2023.100034","url":null,"abstract":"<div><h3>Introduction:</h3><p>Voiding dysfunction following mid-urethral synthetic sling surgery is a well-recognized complication with an established treatment algorithm.</p><p>Our case series describes patients with clinically significant voiding dysfunction where a decision to proceed to early sling release (&lt;12 months) was made and operatively attempted but subsequent presentation shows the sling was not successfully divided.</p></div><div><h3>Methods:</h3><p>Retrospective case series of 16 women from a database of 330 women who underwent treatment for mid-urethral synthetic sling (MUSS) complications between 2014 and 2023 in Aotearoa New Zealand and Australia.</p></div><div><h3>Results:</h3><p>We found 16 patients with unrecognized unsuccessful sling division, from database of 330 mesh complications Initially, after sling implantation, these patients presented with characteristic obstructive symptoms including 8/16 having post-operative retention with failed TROC and prolonged catheterization or CIC.</p><p>The median time to first sling division for symptoms of bladder outlet obstruction was 9 months. Median time from implantation to the second (or definitive division) was 82 months.</p><p>Urodynamic findings after first unsuccessful division were median Qmax of 12 mls/s and median Pdet@max of 32cmh20.</p><p>Comparison of pre- and post-operative findings after delayed successful sling division showed significant improvement in recurrent UTIs (from 10/14 to 1/14). However, there was little improvement in pelvic pain/dyspareunia (from 9 to 7/14) and overactive bladder symptoms (9 to 6/14). One patient had a critical outcome, requiring cystectomy for pelvic pain and bladder pain following successful division.</p></div><div><h3>Discussion:</h3><p>This case series is the first to describe unrecognized, unsuccessful sling division for post-operative voiding dysfunction documented by subsequent objective radiologic and/or operative findings.</p><p>The clinical course shows significant urinary and pelvic pain morbidity after the failed division although it is difficult to ascribe causation with a retrospective lens.</p><p>These findings suggest that a high index of suspicion and low threshold for investigation should be maintained where clinical symptoms persist after a sling division.</p></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"7 ","pages":"Article 100034"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49734676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional and molecular alterations in a rat model of detrusor underactivity induced by bilateral pelvic nerve crush injury","authors":"Tsuyoshi Majima ,&nbsp;Yoshihisa Matsukawa ,&nbsp;Yasuhito Funahashi ,&nbsp;Keishi Kajikawa ,&nbsp;Naoto Sassa ,&nbsp;Momokazu Gotoh","doi":"10.1016/j.contre.2023.100036","DOIUrl":"https://doi.org/10.1016/j.contre.2023.100036","url":null,"abstract":"<div><h3>Objective:</h3><p>To investigate the functional and molecular alterations in detrusor underactivity (DU) in a rat model of bilateral pelvic nerve crush injury.</p></div><div><h3>Methods:</h3><p>This study included 39 female Sprague-Dawley rats separated into three groups (sham, 2-week DU, and 4-week DU), with 13 rats in each group. A bilateral pelvic nerve crush injury was induced in each group to develop a DU model. Similarly, the sham group was identically prepared but without crushing nerves. Awake continuous cystometry was performed two weeks post-surgery in the sham and 2-week DU groups and four weeks post-surgery in the 4-week DU group (n = 7/each group). In another group of rats (n = 6/each group), the bladders were harvested for western blotting, and the expression of moesin, ezrin, and transthyretin in the bladders was evaluated.</p></div><div><h3>Results:</h3><p>On cystometry, voided volume, post-void residual urine volume, bladder capacity, and number of non-voiding contractions were significantly higher in the 2- and 4-week DU groups than in the sham group. Furthermore, voiding efficiency was significantly decreased in the 2- and 4-week DU groups compared to that in the sham group.</p><p>The expression of moesin in the bladder was significantly higher in the 2-week DU group than that in the sham group. The expression of transthyretin in the bladder was significantly higher in the 2- and 4-week DU groups than that in the sham group.</p></div><div><h3>Conclusion:</h3><p>The significant increase in the expression of moesin and transthyretin in the bladder in bilateral pelvic nerve crush injuries may be related to the pathophysiology of DU.</p></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"8 ","pages":"Article 100036"},"PeriodicalIF":0.0,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49711709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delivery of urethral sphincter botulinum toxin injections for treating urinary retention during the COVID19 pandemic","authors":"Sarah L. Wright ,&nbsp;Piriyankan Ananthavarathan ,&nbsp;Madhumita R. Satish ,&nbsp;Prasad Malladi ,&nbsp;Mahreen Pakzad ,&nbsp;Sara Simeoni ,&nbsp;Jalesh N. Panicker","doi":"10.1016/j.contre.2023.100031","DOIUrl":"https://doi.org/10.1016/j.contre.2023.100031","url":null,"abstract":"<div><h3>Aims:</h3><p>Urethral sphincter botulinum toxin injections is an alternative treatment for urinary retention in women with Fowler’s syndrome and when access to health services were curtailed during the Covid19 pandemic, we continued to offer treatment to prevent increased demand on catheter services due to a recurrence of urinary retention. We describe our experience delivering safe and timely treatment during this period of lockdowns and restricted access to healthcare.</p></div><div><h3>Methods:</h3><p>We retrospectively reviewed the records of all women with Fowler’s syndrome treated with transperineal urethral sphincter botulinum toxin injection between 23rd March 2020 and 31st December 2021 in a tertiary university hospital and clinical outcomes were recorded.</p></div><div><h3>Results:</h3><p>15 women (mean age 35.6 ± 10.1 years) received 100U OnabotulinumtoxinA injected into the external urethral sphincter as an out-patient procedure adopting hospital infection control guidelines. 41 injections were administered in total, and 8 (53%) patients received more than 1 injection (median 2 injections/patient, median inter-injection interval 108.5 days). 10 (66.7%) patients reported improvements in urinary symptoms across 31/41 (75.6%) of injections. Side effects were reported after 21.4% of injections which were mild and transient. No patients developed Covid19 within 4 weeks of the hospital visit.</p></div><div><h3>Conclusion:</h3><p>Real-world data shows that transperineal urethral sphincter botulinum toxin injections could be continued safely and effectively during the Covid19 pandemic. This essential outpatient service played an important role in treatment and quality of life for women with Fowler’s syndrome, and avoided an additional burden on the NHS at the time of a health crisis.</p></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"6 ","pages":"Article 100031"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49716020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute urinary retention in a woman due to large urethral diverticulum: A case report","authors":"K. Gkeka,&nbsp;E. Anaplioti,&nbsp;E. Goulimi,&nbsp;A. Athanasopoulos,&nbsp;K. Giannitsas","doi":"10.1016/j.contre.2023.100030","DOIUrl":"https://doi.org/10.1016/j.contre.2023.100030","url":null,"abstract":"<div><h3>Introduction:</h3><p>The diverticulum of the female urethra is a sac-like protrusion of the urethral mucosa into the adjacent tissue. The classic clinical presentation includes the ‘three Ds’: post-void dribbling, dyspareunia and dysuria. However, these symptoms are rarely encountered. The diverticula affect 0.02%–6% of women worldwide and they are presented between 30 and 60 years old, with a mean age of diagnosis of 36 years. The aim is to present a rare case of acute urinary retention due to a large urethral diverticulum. According to the literature review, no similar case has been reported since 2000.</p></div><div><h3>Materials &amp; Methods:</h3><p>A 47-year-old woman with an unremarkable past medical history and one childbirth presented to the Emergency Department with acute urinary retention. The physical examination revealed a palpable, mobile, soft mass in the anterior vaginal wall. The urodynamic study demonstrated voiding dysfunction due to bladder outlet obstruction. A T2-weighted pelvic MRI showed a contrast-enhanced large (4 × 3, 1 centimeters), horseshoe, cystic mass, that surrounded the urethra. During rigid cystourethroscopy, the ostium of the diverticulum was identified in the left lateral wall (4 o’clock) of the anterior urethra.</p></div><div><h3>Results:</h3><p>The patient underwent transvaginal diverticulectomy and reconstruction of the urethra. The postoperative course was uneventful and she was discharged on postoperative day 2. The urethral catheter was removed at the postoperative week 3 and the patient voided successfully.</p></div><div><h3>Conclusions:</h3><p>Due to the variety of symptoms, the diagnosis is difficult and a high index of suspicion is frequently required. In the majority of cases the investigation is based on imaging and MRI is considered the imaging test of choice. The natural evolution of asymptomatic diverticula left untreated remains unknown, but complications such as carcinogenesis and stone formation have been reported.</p></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"6 ","pages":"Article 100030"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49732506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construct validation of an automated 24-h bladder diary smartphone app","authors":"Katerina Lembrikova ,&nbsp;Dylan T. Wolff ,&nbsp;Mahyar Kashani ,&nbsp;John Barlog ,&nbsp;Jerry G. Blaivas ,&nbsp;Jeffrey P. Weiss","doi":"10.1016/j.contre.2023.100032","DOIUrl":"https://doi.org/10.1016/j.contre.2023.100032","url":null,"abstract":"<div><h3>Introduction:</h3><p>A universal mobile application (WeShare URO by Symptelligence Medical Informatics, LLC) was developed to allow patients to provide diary and symptom information to the provider prior to the visit and to aid in the tracking of treatment progress. The purpose of the present study is to validate that the app correctly calculates the values required for the proper evaluation of a patients’ symptoms.</p></div><div><h3>Materials and Methods:</h3><p>Data from paper diaries of men with lower urinary tract symptoms (LUTS) was entered into the app. Total urine volume (TUV), total voids, actual number of nightly voids (ANV), nocturnal urine volume (NUV), maximum voided volume (MVV), nocturia index (Ni), nocturnal polyuria index (NPi), predicted number of nightly voids (PNV), and nocturnal bladder capacity index (NBCi) were calculated. Correlations between manual (Manual and Quickhand) and automatic (App) values were calculated using Spearman’s nonparametric rank coefficient.</p></div><div><h3>Results:</h3><p>The study included 66 paper diaries completed by a total of 51 male patients (median age = 68, IQR = 6) evaluated for LUTS. After applying exclusion criteria, 35 diaries were left for analysis (median age = 68, IQR = 0). Manual calculations were similar to those calculated by the app (0% - 2% difference). Comparison between Quickhand and App calculations had a higher difference (0% – 27%).</p></div><div><h3>Conclusions:</h3><p>Bladder diary applications can improve LUTS care through accurate calculations via an automated scaling equation. The error rate of “Quickhand” (calculations done by a clinician as a back-of-the-envelope method) supports the claim that these calculations are inaccurate and that an automated scaling equation provides more specific values critical to therapeutic decision-making.</p></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"6 ","pages":"Article 100032"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49734726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and postoperative management of autologous fascial pubovaginal slings in females who have failed a midurethral sling","authors":"Surbhi Agrawal ,&nbsp;Maria Smith ,&nbsp;Rachael Sussman ,&nbsp;Victor Nitti ,&nbsp;Nirit Rosenblum ,&nbsp;Benoit Peyronnet ,&nbsp;Benjamin M. Brucker","doi":"10.1016/j.contre.2023.100027","DOIUrl":"https://doi.org/10.1016/j.contre.2023.100027","url":null,"abstract":"<div><h3>Objective:</h3><p>To describe the outcomes and subsequent postoperative management of autologous fascial pubovaginal slings when used for stress urinary incontinence in women who have failed a prior midurethral sling.</p></div><div><h3>Methods:</h3><p>A retrospective review was performed from 2012 to 2017 at a single center of patients who underwent an autologous fascial pubovaginal sling to correct recurrent stress urinary incontinence after a midurethral sling. Postoperative data was abstracted for three years post-procedure. The outcomes examined were patient-reported symptoms consistent with postoperative stress urinary incontinence, overactive bladder, and/or urinary obstruction. Secondary interventions to manage these postoperative urinary symptoms, and the associated success rates, were also reported.</p></div><div><h3>Results:</h3><p>Fifty-five females underwent an autologous fascial pubovaginal sling placement. Postoperatively, 20% of patients reported persistent or recurrent stress urinary incontinence symptoms, which were managed with secondary interventions such as sling tightening and urethral bulking successfully. 49% of all patients reported postoperative overactive bladder symptoms, with some noting improvement after overactive bladder medication therapy and others requiring bladder botulinum toxin injection. 16% of patients presented with postoperative urinary obstruction, for which 67% underwent sling incision with resolution of urinary retention in all cases.</p></div><div><h3>Conclusions:</h3><p>Autologous fascial pubovaginal slings when used as a non-primary surgical treatment for stress urinary incontinence can be effective in many cases. However, the management of these women is complex and often requires additional postoperative interventions to address persistent, recurrent, or <em>de novo</em> lower urinary tract symptoms.</p></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"6 ","pages":"Article 100027"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49732676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurosyphilis-an uncommon cause of neurogenic lower urinary tract dysfunction","authors":"Matthew Playfair ,&nbsp;Blayne Welk","doi":"10.1016/j.contre.2023.100024","DOIUrl":"https://doi.org/10.1016/j.contre.2023.100024","url":null,"abstract":"<div><p>In the modern era, neurosyphilis is rare and its effects on the lower urinary tract are poorly understood. Two cases of neurosyphilis with resultant bladder dysfunction are presented, and the relevant literature on neurosyphilis is reviewed. For our patients, urodynamic studies revealed low-capacity bladders associated with detrusor overactivity in both cases, one with a clinical diagnosis of urge incontinence and the other with urinary retention. These cases highlight the importance of early assessment of urinary function in patients with neurosyphilis and the role of urodynamics in guiding appropriate management.</p></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"6 ","pages":"Article 100024"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49715782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic fistula repair with concurrent Pectopexy: A case report","authors":"John Heusinkveld ,&nbsp;Martina Gabra","doi":"10.1016/j.contre.2023.100025","DOIUrl":"https://doi.org/10.1016/j.contre.2023.100025","url":null,"abstract":"<div><p>This is the first report of a combined laparoscopic Pectopexy and vesicovaginal fistula repair. A 77 year-old woman developed persistent leakage of urine after surgical removal of an impacted pessary, and a vesicovaginal fistula was diagnosed. The fistula was inaccessible through the vagina due to stenosis of the upper vagina resulting from the impacted pessary, so a laparoscopic repair was performed together with a Pectopexy to eliminate the patient’s residual prolapse symptoms. Careful consideration was given to the decision to perform a fistula repair together with a mesh suspension procedure, which included a review of the relevant medical literature as well as our own practice data. The combined operation resulted in relief of both fistula and prolapse symptoms.</p></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"6 ","pages":"Article 100025"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49715418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eccentric cases of genitourinary fistula—Our ten years of experience","authors":"Sakineh Hajebrahimi ,&nbsp;Elham Jahantabi ,&nbsp;Ehsan Sepehran ,&nbsp;Sherif Mourad ,&nbsp;Hanieh Salehi-Pourmehr","doi":"10.1016/j.contre.2023.100026","DOIUrl":"https://doi.org/10.1016/j.contre.2023.100026","url":null,"abstract":"<div><h3>Background:</h3><p>A fistula is an unusual connection between two organs, vessels, or structures. Urological fistulas in developed countries are consequences of iatrogenic injury, and the more common cause of fistula development in these countries is related to labor sequence.</p></div><div><h3>Case presentation:</h3><p>More than 156 cases were treated in our hospitals during the last 10 years, and in this case report, we present only unusual fistula from two different urology departments. Different cases with a variety of fistula including huge stone formation following vesicouterine fistula, vesicosacral fistula and expelling urine from bedsore region of sacrum, fistula in the junction of the orthotopic neobladder, and fistula in a patient with duplicated collecting system are presented in the current study.</p></div><div><h3>Conclusion:</h3><p>Vesicouterine fistula after cesarean section (C/S) led to the formation of a huge intrauterine stone. Vesicouterine fistula is the least common form of fistula, and C/S is the most common cause of this type of fistula. However, this type of fistula is not always associated with urinary incontinence due to the cervix’s sphincter-like mechanism. Vesicocutaneous fistula is another uncommon type. Iatrogenic injury, extensive trauma, irradiation of malignancies, and various other etiologies, can lead to Vesicocutaneous fistula. For these cases, both conservative, and surgery can be considered. However, surgery is the only definitive repair method. Moreover, fistula in the junction of orthotopic neobladder to the vagina, and left ureter to vagina fistula in a patient with duplicated collecting system are among the strangest urogynecological fistulas.</p></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"6 ","pages":"Article 100026"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49715438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial urinary sphincters in males and females and neurogenic patients, techniques, and indications","authors":"Ghazal Ameli ,&nbsp;Emmanuel Jean Chartier-Kastler ,&nbsp;Ralf G. Anding ,&nbsp;Frank Van der Aa ,&nbsp;Craig V. Comiter ,&nbsp;Wilhelm A. Hübner","doi":"10.1016/j.contre.2023.100028","DOIUrl":"https://doi.org/10.1016/j.contre.2023.100028","url":null,"abstract":"<div><p>The introduction of the artificial urinary sphincter (AUS) in 1972 was heralded as a revolution for the treatment of stress incontinence (Scott et al., 1973). The evolution of the AUS has affected the current surgical options for urinary incontinence. With its unique features, the AUS has been an attractive option for the treatment of urinary incontinence regardless of gender. The device has evolved in the last decades and has now been in routine clinical use for nearly 50 years (Burkhard et al., 2019). Furthermore, the indications and surgical principles involved in its use along with short- and long-term outcomes are more clearly defined. The main indications for AUS insertion are post-prostatectomy incontinence (PPI), sphincter weakness incontinence due to neurogenic bladder dysfunction, intrinsic sphincter deficiency (ISD) and rare congenital causes of incontinence. In the following we summarize the conclusions worked out during the expert workshop on artificial urinary sphincter during ICS 2022 in Vienna, Austria; and present some strategies for difficult cases.</p></div>","PeriodicalId":100330,"journal":{"name":"Continence Reports","volume":"6 ","pages":"Article 100028"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49732509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}