Sylvia Weis, Tim A Ludwig, Omar Bahassan, Philipp Gild, Malte W Vetterlein, Margit Fisch, Roland Dahlem, Valentin Maurer
{"title":"Outcomes and Complication Rates of Cuff Downsizing in the Treatment of Worsening or Persistent Incontinence After Artificial Urinary Sphincter Implantation.","authors":"Sylvia Weis, Tim A Ludwig, Omar Bahassan, Philipp Gild, Malte W Vetterlein, Margit Fisch, Roland Dahlem, Valentin Maurer","doi":"10.5213/inj.2346030.015","DOIUrl":"10.5213/inj.2346030.015","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigated the functional outcomes and complication rates of cuff downsizing for the treatment of recurrent or persistent stress urinary incontinence (SUI) in men after the implantation of an artificial urinary sphincter (AUS).</p><p><strong>Methods: </strong>Data from our institutional AUS database spanning the period from 2009 to 2020 were retrospectively analyzed. The number of pads per day was determined, a standardized quality of life (QoL) questionnaire and the International Consultation on Incontinence Questionnaire (ICIQ) were administered, and postoperative complications according to the Clavien-Dindo classification were analyzed.</p><p><strong>Results: </strong>Out of 477 patients who received AUS implantation during the study period, 25 (5.2%) underwent cuff downsizing (median age, 77 years; interquartile range [IQR], 74-81 years; median follow-up, 4.4 years; IQR, 3-6.9 years). Before downsizing, SUI was very severe (ICIQ score 19-21) or severe (ICQ score 13-18) in 80% of patients, moderate (ICIQ score 6-12) in 12%, and slight (ICIQ score 1-5) in 8%. After downsizing, 52% showed an improvement of >5 out of 21 points. However, 28% still had very severe or severe SUI, 48% had moderate SUI, and 20% had slight SUI. One patient no longer had SUI. In 52% of patients, the use of pads per day was reduced by ≥50%. QoL improved by >2 out of 6 points in 56% of patients. Complications (infections/urethral erosions) requiring device explantation occurred in 36% of patients, with a median time to event of 14.5 months.</p><p><strong>Conclusion: </strong>Although cuff downsizing carries a risk of AUS explantation, it can be a valuable treatment option for selected patients with persistent or recurrent SUI after AUS implantation. Over half of patients experienced improvements in symptoms, satisfaction, ICIQ scores, and pad use. It is important to inform patients about the potential risks and benefits of AUS to manage their expectations and assess individual risks.</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 2","pages":"139-145"},"PeriodicalIF":2.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bc/c1/inj-2346030-015.PMC10325935.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9758822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Efstathios Papaefstathiou, Sotirios Gatsos, Konstantinos Tigkiropoulos, Ioannis Apostolidis, Periklis Koukourikis, Ioannis Lazaridis, Apostolos Apostolidis
{"title":"Role of Pelvic Ischemia in Human Lower Urinary Tract Symptoms and Sexual Function Among Patients With Common Iliac Artery Obstruction Undergoing Revascularization Surgery.","authors":"Efstathios Papaefstathiou, Sotirios Gatsos, Konstantinos Tigkiropoulos, Ioannis Apostolidis, Periklis Koukourikis, Ioannis Lazaridis, Apostolos Apostolidis","doi":"10.5213/inj.2346028.014","DOIUrl":"https://doi.org/10.5213/inj.2346028.014","url":null,"abstract":"<p><strong>Purpose: </strong>In this case-control study, we explored the relationships among pelvic ischemia, lower urinary tract symptoms (LUTS), and sexual function in patients with common iliac artery steno-occlusive disease, along with the potential therapeutic role of revascularization.</p><p><strong>Methods: </strong>We recruited 33 men diagnosed with radiologically documented common iliac artery stenosis (>80%) who underwent endovascular revascularization, and 33 healthy controls. Five patients had obstruction of the abdominal aorta (Leriche syndrome). The International Prostate Symptom Score (IPSS), Overactive Bladder Questionnaire, and International Index of Erectile Function were used to evaluate LUTS and erectile function. Medical history, anthropometrics, urinalysis, and blood tests, including levels of serum prostate-specific antigen, urea, creatinine, triglycerides, cholesterol, low-density lipoprotein, high-density lipoprotein, and hemoglobin A1c, were recorded. Uroflow (maximum flow, average flow, voided volume, and voiding time) and ultrasound parameters (prostate volume and postvoid residual [PVR]) were also measured. Patients with moderate-to-severe LUTS (IPSS>7) underwent complete urodynamic investigation. Patients were examined at baseline and 6 months postoperatively.</p><p><strong>Results: </strong>Patients exhibited poorer total IPSS (P<0.001), storage (P=0.001) and voiding symptom (P<0.001) subscores, as well as worse OAB-bother (P=0.015), OAB-sleep (P<0.001), OAB-coping (P<0.001), and OAB-total (P<0.001) scores than control participants. Additionally, erectile function (P=0.002), sexual desire (P<0.001), and satisfaction from intercourse (P=0.016) deteriorated in the patient group. Six months postoperatively, significant improvements were observed in erectile function (P=0.008), orgasm (P=0.021), and desire (P=0.014). Similarly, PVR significantly improved (P=0.012), while fewer patients experienced increased bladder sensation (P=0.035) and detrusor overactivity (P=0.035) upon postoperative urodynamic study. No significant differences were found between patients with bilateral and unilateral obstruction or between either of those groups and Leriche syndrome patients.</p><p><strong>Conclusion: </strong>Patients with steno-occlusive disease of the common iliac artery experienced more severe LUTS and sexual dysfunction than healthy controls. Endovascular revascularization alleviated LUTS in patients with moderate-to-severe symptoms and improved bladder and erectile function.</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 2","pages":"129-138"},"PeriodicalIF":2.3,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1c/39/inj-2346028-014.PMC10325937.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9764463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intravesical Bladder Treatment and Deep Learning Applications to Improve Irritative Voiding Symptoms Caused by Interstitial Cystitis: A Literature Review.","authors":"Yongwon Cho, Seunghyun Youn","doi":"10.5213/inj.2346106.053","DOIUrl":"10.5213/inj.2346106.053","url":null,"abstract":"<p><p>Our comprehension of interstitial cystitis/painful bladder syndrome (IC/PBS) has evolved over time. The term painful bladder syndrome, preferred by the International Continence Society, is characterized as \"a syndrome marked by suprapubic pain during bladder filling, alongside increased daytime and nighttime frequency, in the absence of any proven urinary infection or other pathology.\" The diagnosis of IC/PBS primarily relies on symptoms of urgency/frequency and bladder/pelvic pain. The exact pathogenesis of IC/PBS remains a mystery, but it is postulated to be multifactorial. Theories range from bladder urothelial abnormalities, mast cell degranulation in the bladder, bladder inflammation, to altered bladder innervation. Therapeutic strategies encompass patient education, dietary and lifestyle modifications, medication, intravesical therapy, and surgical intervention. This article delves into the diagnosis, treatment, and prognosis prediction of IC/PBS, presenting the latest research findings, artificial intelligence technology applications in diagnosing major diseases in IC/PBS, and emerging treatment alternatives.</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 Suppl 1","pages":"S13-20"},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/ed/77/inj-2346106-053.PMC10263162.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9641860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyoung-Sun Choi, Jae-Seoung Kim, Taeg-Keun Whangbo, Khae Hawn Kim
{"title":"Transfer Learning for Effective Urolithiasis Detection.","authors":"Hyoung-Sun Choi, Jae-Seoung Kim, Taeg-Keun Whangbo, Khae Hawn Kim","doi":"10.5213/inj.2346110.055","DOIUrl":"10.5213/inj.2346110.055","url":null,"abstract":"<p><strong>Purpose: </strong>Urolithiasis is a common disease that can cause acute pain and complications. The objective of this study was to develop a deep learning model utilizing transfer learning for the rapid and accurate detection of urinary tract stones. By employing this method, we aim to improve the efficiency of medical staff and contribute to the progress of deep learning-based medical image diagnostic technology.</p><p><strong>Methods: </strong>The ResNet50 model was employed to develop feature extractors for detecting urinary tract stones. Transfer learning was applied by utilizing the weights of pretrained models as initial values, and the models were fine-tuned with the provided data. The model's performance was evaluated using accuracy, precision-recall, and receiver operating characteristic curve metrics.</p><p><strong>Results: </strong>The ResNet-50-based deep learning model demonstrated high accuracy and sensitivity, outperforming traditional methods. Specifically, it enabled a rapid diagnosis of the presence or absence of urinary tract stones, thereby assisting doctors in their decision-making process.</p><p><strong>Conclusion: </strong>This research makes a meaningful contribution by accelerating the clinical implementation of urinary tract stone detection technology utilizing ResNet-50. The deep learning model can swiftly identify the presence or absence of urinary tract stones, thereby enhancing the efficiency of medical staff. We expect that this study will contribute to the advancement of medical imaging diagnostic technology based on deep learning.</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 Suppl 1","pages":"S21-26"},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e6/01/inj-2346110-055.PMC10263166.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9641859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Metaverse for Healthcare: Trends, Applications, and Future Directions of Digital Therapeutics for Urology.","authors":"Eun Joung Kim, Jung Yoon Kim","doi":"10.5213/inj.2346108.054","DOIUrl":"10.5213/inj.2346108.054","url":null,"abstract":"<p><p>In recent years, the emergence of digital therapeutics as a novel approach to managing conditions has garnered significant attention. This approach involves using evidence-based therapeutic interventions that are facilitated by high-quality software programs to treat, manage, or prevent medical conditions. The incorporation of digital therapeutics into the Metaverse has increased the feasibility of their implementation and application in all areas of medical services. In urology, substantial digital therapeutics are being produced and researched, including mobile apps, bladder devices, pelvic floor muscle trainers, smart toilet systems, mixed reality-guided training and surgery, and training and telemedicine for urological consultations. The purpose of this review article is to provide a comprehensive overview of the current impact of the Metaverse on the field of digital therapeutics and identify its current trends, applications, and future perspectives in the field of urology.</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 Suppl 1","pages":"S3-12"},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9e/0b/inj-2346108-054.PMC10263160.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9641857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chung Lyul Lee, Jong Mok Park, Ji Yong Lee, Seung Woo Yang, Hyun Seok Na, Jaegeun Lee, Sunkyung Jung, Ju Hyun Shin
{"title":"A Novel Incisionless Disposable Vaginal Device for Female Stress Urinary Incontinence: Efficacy and Quality of Life.","authors":"Chung Lyul Lee, Jong Mok Park, Ji Yong Lee, Seung Woo Yang, Hyun Seok Na, Jaegeun Lee, Sunkyung Jung, Ju Hyun Shin","doi":"10.5213/inj.2346092.046","DOIUrl":"10.5213/inj.2346092.046","url":null,"abstract":"<p><strong>Purpose: </strong>This clinical study sought to evaluate the possible clinical effectiveness and practicality of URINO, an innovative, incisionless, and disposable intravaginal device, designed for patients suffering from stress urinary incontinence.</p><p><strong>Methods: </strong>A prospective, multicenter, single-arm clinical trial was carried out, involving women diagnosed with stress urinary incontinence who used a self-inserted, disposable intravaginal pessary device. Comparisons were made between the results of the 20-minute pad-weight gain (PWG) test at baseline and visit 3, where the device was applied. After 1 week of device usage, compliance, satisfaction, the sensation of a foreign body, and adverse events were assessed.</p><p><strong>Results: </strong>Out of 45 participants, 39 completed the trial and expressed satisfaction within the modified intention-to-treat group. The average 20-minute PWG of participants was 17.2±33.6 g at baseline and significantly dropped to 5.3±16.2 g at visit 3 with device application. A total of 87.2% of participants exhibited a reduction ratio of PWG by 50% or more, surpassing the clinical trial success benchmark of 76%. The mean compliance was recorded as 76.6%±26.6%, the average visual analogue scale score for patient satisfaction was 6.4±2.6, and the sensation of a foreign body, measured on a 5-point Likert scale, was 3.1±1.2 after 1 week of device use. No serious adverse events were reported; there was 1 instance of microscopic hematuria and 2 cases of pyuria, all of which recovered.</p><p><strong>Conclusion: </strong>The investigated device demonstrated significant clinical effectiveness and safety for patients with stress urinary incontinence. It was easy to use, showing favorable patient compliance. We propose that these disposable intravaginal pessaries could potentially be an alternative treatment for patients with stress urinary incontinence who are seeking nonsurgical options or are unable to undergo surgery. Trial Registration: The study was registered as a clinical trial (KCT0008369).</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 Suppl 1","pages":"S40-48"},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4a/5f/inj-2346092-046.PMC10263161.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9641861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Improving Foley Catheter Insertion Procedure by Developing Foley Introducer: A 100-Year Overdue Innovation.","authors":"Khae Hawn Kim, Kyung Jin Chung","doi":"10.5213/inj.2346098.049","DOIUrl":"10.5213/inj.2346098.049","url":null,"abstract":"<p><strong>Purpose: </strong>Foley catheter (FC) insertion is very basic yet one of the most widely performed procedures all across the fields of medicine. Since FC was first introduced in 19020's, no significant improvement has been made in view of methodology, despite the inconvenience associated with cumbersome preparation, procedure, and the patients' discomfort with having to have their genitalia exposed. We developed a new, easy-to-use FC insertion device, Quick Foley, that provides an innovative approach to introducing FC while simplifying and minimizing time spent without compromising the sterility.</p><p><strong>Methods: </strong>We developed an all-in-one disposable FC introducer contains all the necessary components in a single-device-kit. Minimal plastic components are necessary to keep accuracy and consistency, but the rest are made of the paper to minimize plastic waste. The preparation is done by connecting to the drainage bag, spurring the lubricant gel through gel insert, separating the tract, and connecting with the ballooning syringe. For the insertion, after sterilizing the urethral orifice, rotate the control knob to feed FC to the end of the urethra. After ballooning, dissembling of the device is done only by opening and removing the module, then only the FC remains.</p><p><strong>Results: </strong>As the device is all-in-one, there is no need to prearrange the FC tray, simplifies the FC preparation and catheterization procedure. This device not only makes it convenient for the practitioner, but ultimately, it will reduce the psychological discomfort experienced by patient by truncating perineal exposure time.</p><p><strong>Conclusion: </strong>We have successfully developed a novel device that reduces the cost and burden of using FC for practitioners while maintaining an aseptic technique. Furthermore, this all-in-one device allows the entire procedure to be completed much more quickly compared to the current method, so this minimizes perineal exposure time. Both practitioners and patients can benefit by this new device.</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 Suppl 1","pages":"S34-39"},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/cc/2e/inj-2346098-049.PMC10263165.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9636038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advancing Patient Care: Innovative Use of Near-Infrared Spectroscopy for Monitoring Urine Volume in Neurogenic Bladder.","authors":"Byeong-Il Kang, Aram Kim, Sehwan Kim","doi":"10.5213/inj.2346100.050","DOIUrl":"10.5213/inj.2346100.050","url":null,"abstract":"<p><strong>Purpose: </strong>Current guidelines recommend clean intermittent catheterization (CIC) at regular time intervals for patients with spinal cord injuries; however, many patients experience difficulties. Performing time-based CIC outside the home is a significant burden for patients. In this study, we aimed to overcome the limitations of the current guidelines by developing a digital device to monitor bladder urine volume in real-time.</p><p><strong>Methods: </strong>The optode sensor is a near-infrared spectroscopy (NIRS)-based wearable device intended to be attached to the skin of the lower abdomen where the bladder is located. The sensor's primary function is to detect changes in urine volume within the bladder. An in vitro study was conducted using a bladder phantom that mimicked the optical properties of the lower abdomen. To validate the data in the human body at the proof-of-concept level, one volunteer attached the device to the lower abdomen to measure the light intensity between the first voiding and immediately before the second voiding.</p><p><strong>Results: </strong>The degree of attenuation at the maximum test volume was equivalent across experiments, and the optode sensor with multiplex measurements demonstrated robust performance for patient diversity. Moreover, the symmetric feature of the matrix was deemed a potential parameter for identifying the accuracy of sensor localization in a deep-learning model. The validated feasibility of the sensor showed almost the same results as an ultrasound scanner, which is routinely used in the clinical field.</p><p><strong>Conclusion: </strong>The optode sensor of the NIRS-based wearable device can measure the urine volume in the bladder in real-time.</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 Suppl 1","pages":"S27-33"},"PeriodicalIF":2.3,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d5/0f/inj-2346100-050.PMC10263163.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9641858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Updates of Overactive Bladder in Pediatrics.","authors":"Jisung Shim, Mi Mi Oh","doi":"10.5213/inj.2244228.114","DOIUrl":"https://doi.org/10.5213/inj.2244228.114","url":null,"abstract":"<p><p>Overactive bladder (OAB) is clinically defined as urinary urgency with or without urinary incontinence. It is associated with daytime frequency or constipation and has a prevalence of approximately 5%-12% among 5- to 10-year-olds. The appropriate functional exchange between the pontine micturition center, periaqueductal gray matter, and prefrontal cortex is important for proper micturition control. Several studies on pediatric cases observed a link between OAB and neuropsychiatric problems, such as anxiety, depression, and attention deficit, and treatment of these comorbidities improved patient symptoms. In this review, we present the pathophysiology of OAB, its associated conditions, and aspects related to updates in OAB treatment, and we propose a step-by-step treatment approach following this sequence: behavioral therapy, medical treatment, and invasive treatment. Although anticholinergic drugs are the mainstay of OAB medical treatment, beta-3 agonists and alpha-blockers are now recommended as a result of significant advancements in pharmacologic treatment in the last 10 years. Electrical stimulation techniques and botulinum toxin are also effective and can be used, especially in conventional treatment-refractory cases.</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 1","pages":"3-14"},"PeriodicalIF":2.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c3/6b/inj-2244228-114.PMC10073000.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9639065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}