International Neurourology Journal最新文献

{"title":"Artificial Intelligence-Based Speech Analysis System for Medical Support.","authors":"Eui-Sun Kim,&nbsp;Dong Jin Shin,&nbsp;Sung Tae Cho,&nbsp;Kyung Jin Chung","doi":"10.5213/inj.2346136.068","DOIUrl":"https://doi.org/10.5213/inj.2346136.068","url":null,"abstract":"<p><strong>Purpose: </strong>Prior research has indicated that stroke can influence the symptoms and presentation of neurogenic bladder, with various patterns emerging, including abnormal facial and linguistic characteristics. Language patterns, in particular, can be easily recognized. In this paper, we propose a platform that accurately analyzes the voices of stroke patients with neurogenic bladder, enabling early detection and prevention of the condition.</p><p><strong>Methods: </strong>In this study, we developed an artificial intelligence-based speech analysis diagnostic system to assess the risk of stroke associated with neurogenic bladder disease in elderly individuals. The proposed method involves recording the voice of a stroke patient while they speak a specific sentence, analyzing it to extract unique feature data, and then offering a voice alarm service through a mobile application. The system processes and classifies abnormalities, and issues alarm events based on analyzed voice data.</p><p><strong>Results: </strong>In order to assess the performance of the software, we first obtained the validation accuracy and training accuracy from the training data. Subsequently, we applied the analysis model by inputting both abnormal and normal data and tested the outcomes. The analysis model was evaluated by processing 30 abnormal data points and 30 normal data points in real time. The results demonstrated a high test accuracy of 98.7% for normal data and 99.6% for abnormal data.</p><p><strong>Conclusion: </strong>Patients with neurogenic bladder due to stroke experience long-term consequences, such as physical and cognitive impairments, even when they receive prompt medical attention and treatment. As chronic diseases become increasingly prevalent in our aging society, it is essential to investigate digital treatments for conditions like stroke that lead to significant sequelae. This artificial intelligence-based healthcare convergence medical device aims to provide patients with timely and safe medical care through mobile services, ultimately reducing national social costs.</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 2","pages":"99-105"},"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/67/80/inj-2346136-068.PMC10325939.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9764460","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":"Comprehensive Analysis of Individual Anatomical Structures for Micturition Symptoms and Maximum Flow Rate in Men With Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms.","authors":"Dae Ho Kim,&nbsp;Kwang Suk Lee,&nbsp;Kyo Chul Koo,&nbsp;Byung Ha Chung,&nbsp;Jeong Woo Yoo","doi":"10.5213/inj.2346046.023","DOIUrl":"https://doi.org/10.5213/inj.2346046.023","url":null,"abstract":"<p><strong>Purpose: </strong>Individual anatomical structural variations, including intravesical prostatic protrusion (IPP), prostatic urethral angle (PUA), prostatic urethral length, or prostatic apex shape, were correlated with micturition symptoms. We aimed to investigate the effects of these variables on micturition symptoms in men with benign prostatic hyperplasia (BPH)/lower urinary tract symptoms (LUTS).</p><p><strong>Methods: </strong>This observational study was based on data from 263 men with the first visit to health promotion center and without BPH/LUTS treatment between March 2020 and September 2022. A multivariate analysis was performed to determine the variables affecting total international prostate symptom score, maximum flow rate (Qmax), and voiding efficacy (postvoid residual volume to total bladder volume ratio).</p><p><strong>Results: </strong>Of 263 patients, decreasing PUA increases the severity of international prostate symptoms score (mild, 141.9°; moderate, 136.0°; severe, 131.2°; P<0.015). A multivariate analysis reported that the total international prostate symptom score was correlated with age (P=0.002), PUA (P=0.007), and Qmax (P=0.008). Qmax was negatively associated with IPP (P=0.002). In subanalysis for large prostate volume (≥30 mL, n=81), international prostate symptom score was correlated with PUA (P=0.013), Qmax was correlated with prostatic apex shape (P=0.017), and length of proximal prostatic urethra (P=0.007). IPP was not identified as a significant factor. For small prostate volume (<30 mL, n=182), age (P=0.011) and prostate volume (P=0.004) are correlated with increasing Qmax.</p><p><strong>Conclusion: </strong>This study presented that individual anatomical structure variations influenced the micturition symptoms according to prostate volume. To identify the major resistant factors in men with BPH/LUTS, further studies are required to investigate which components played a role in major resistant factors for micturition symptoms.</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 2","pages":"146-154"},"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/7c/a9/inj-2346046-023.PMC10325942.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9764462","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":"Effect of Diabetes Mellitus on Symptomatic Improvement After Surgery for Benign Prostatic Hyperplasia in Patients With Lower Urinary Tract Symptom and its Relations With Prostatic Urethral Angulation.","authors":"Jung Ki Jo,&nbsp;Hwanik Kim,&nbsp;Woo Jin Bang,&nbsp;Cheol Young Oh,&nbsp;Jin Seon Cho,&nbsp;Myungsun Shim","doi":"10.5213/inj.2346008.004","DOIUrl":"https://doi.org/10.5213/inj.2346008.004","url":null,"abstract":"<p><strong>Purpose: </strong>To compare improvement of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia in diabetic versus nondiabetic patients after transurethral resection of the prostate (TURP) or holmium laser enucleation of the prostate (HoLEP).</p><p><strong>Methods: </strong>The medical records of 437 patients who underwent TURP or HoLEP at a tertiary referral center from January 2006 to January 2022 were retrospectively analyzed. Among them, 71 patients had type 2 diabetes. Patients in the diabetic mellitus (DM) and non-DM groups were matched 1:1 according to age, baseline International Prostate Symptom Score (IPSS), and ultrasound measured prostate volume. Changes in LUTS were assessed at 3 months after surgery using IPSS and evaluated by categorizing patients according to prostatic urethral angulation (PUA; <50° vs. ≥50°). Medication-free survival after surgery was also investigated.</p><p><strong>Results: </strong>No significant differences were noted between the DM and non-DM groups in baseline characteristics except for comorbidities (i.e., hypertension, cerebrovascular disease, and ischemic heart disease, P=0.021, P=0.002, and P=0.017, respectively) and postvoid residual urine volume (115±98 mL vs. 76±105 mL, P=0.028). Non-DM patients showed significant symptomatic improvement regardless of PUA, while DM patients demonstrated improvement in obstructive symptoms only in those with large PUA (≥51°). Among patients with small PUA, DM patients had worse medication-free survival after surgery compared to controls (P=0.044) and DM was an independent predictor of medication reuse (hazard ratio, 1.422; 95% confidence interval, 1.285-2.373; P=0.038).</p><p><strong>Conclusion: </strong>DM patients experienced symptomatic improvement after surgery only in those with large PUA. Among patients with small PUA, DM patients were more likely to reuse medication after surgery.</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 2","pages":"116-123"},"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/cb/cb/inj-2346008-004.PMC10325943.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9764467","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":"All Clinical Practice Should Embrace Research.","authors":"Khae Hawn Kim","doi":"10.5213/inj.2323edi03","DOIUrl":"https://doi.org/10.5213/inj.2323edi03","url":null,"abstract":"Copyright © 2023 Korean Continence Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. “In the medical field, all practices must be supported by research.” In general, medical research can be broadly classified into basic, clinical, and translational research, with more specific subdivisions depending on the topics and methods involved. The ultimate goal of medicine is to provide high-quality, evidencebased medical services to patients, and it must always prioritize patient safety and evidence-based medical decision-making by physicians. Prioritizing value for patients, medical professionals have been exploring various research-based practices. This necessitates ongoing efforts in both basic and clinical research to achieve successful treatment outcomes. Numerous domestic and international studies on topics applicable to patient diagnosis and treatment, are being conducted due to remarkable advancements in basic science, the introduction of new technologies, and increased government investment in research and development. This underscores the significance of diseaseand patient-centered clinical research, with considerable attention being given to the commercial value of clinical research that applies and develops basic research findings in clinical practice. In order to reflect current research trends in the field of neurourology, the June issue of the International Neurourology Journal contains articles featuring various innovative approaches and specialized content. This issue primarily focused on studies [1-5] that assessed effectiveness through high-quality experimental-control group comparisons of surgical and therapeutic interventions, encompassing a wide range of topics, as well as research on issues such as effective disease prevention [6] and reviews of symptom assessment [7]. In the clinical domain, the reliability of the studies was demonstrated through objective test validation, including assessments of drug efficacy and safety, predictions of surgical outcomes and complications, and analyses of anatomical structures related to urinary symptoms and flow rates. In the realm of basic research, a study exploring the use of artificial intelligence technology for diagnosis investigated the potential applications of cutting-edge techniques. Reviews and letters examined effective disease prevention strategies and symptom assessment methods. The results of the articles were excellent, ensuring objectivity and reliability. Although many steps may be necessary before real-world implementation, the applicability of these results to the medical field has been sufficiently validated. This aligns with the previously mentioned commercial value of clinical research, which applies and advances","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 2","pages":"77-78"},"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/9b/cb/inj-2323edi03.PMC10325938.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9764465","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":"A Randomized, Double-Blind, Placebo-Controlled, Bridging Study to Evaluate the Efficacy and Safety of Vibegron in Treating Korean Patients With Overactive Bladder.","authors":"Jung Hyun Shin,&nbsp;Seong Jin Jeong,&nbsp;Sun-Ouck Kim,&nbsp;Cheol Young Oh,&nbsp;Kyung Jin Chung,&nbsp;Dong Gil Shin,&nbsp;Tae Hyo Kim,&nbsp;Joonbeom Kwon,&nbsp;Ju-Hyun Shin,&nbsp;Woong Jin Bae,&nbsp;Kyu-Sung Lee,&nbsp;Myung-Soo Choo","doi":"10.5213/inj.2346022.011","DOIUrl":"https://doi.org/10.5213/inj.2346022.011","url":null,"abstract":"<p><strong>Purpose: </strong>Vibegron, a novel, potent β3 agonist, has been approved for clinical use in overactive bladder (OAB) treatment in Japan and the Unites States. We performed a bridging study to investigate the efficacy and safety of a daily 50-mg vibegron (code name JLP-2002) dose in Korean patients with OAB.</p><p><strong>Methods: </strong>A multicenter, randomized, double-blind, placebo-controlled study was conducted from September 2020 to August 2021. Adult patients with OAB with a symptom duration of more than 6 months entered a 2-week placebo run-in phase. Eligibility was assessed at the end of this phase and selected patients entered a double-blind treatment phase after 1:1 randomization to either the placebo or vibegron (50 mg) group. The study drug was administered once daily for 12 weeks and follow-up visits were scheduled at weeks 4, 8, and 12. The primary endpoint was the change in mean daily micturition at the end of treatment. The secondary endpoints included changes in OAB symptoms (daily micturition, nocturia, urgency, urgency incontinence, and incontinence episodes, and mean voided volume per micturition) and safety. A constrained longitudinal data model was used for statistical analysis.</p><p><strong>Results: </strong>Patients who took daily vibegron had significant improvements over the placebo group in both primary and secondary endpoints, except for daily nocturia episodes. The proportions of patients with normalized micturition and resolution of urgency incontinence and incontinence episodes were significantly higher in vibegron group than in the placebo. Vibegron also improved the patients' quality of life with higher satisfaction rates. The incidence of adverse events in the vibegron and placebo groups was similar with no serious, unexpected adverse drug reactions. No abnormality in electrocardiographs was observed as well as no significant increase in postvoid residual volume.</p><p><strong>Conclusion: </strong>Once daily vibegron (50 mg) for 12 weeks was effective, safe, and well-tolerated in Korean patients with OAB.</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 2","pages":"106-115"},"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/ea/fe/inj-2346022-011.PMC10325944.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9764466","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":"Competitive Inoculation as an Effective Prophylaxis Against Recurrent Urinary Tract Infections: A Systematic Review.","authors":"Quentin Mak,&nbsp;Julian Greig,&nbsp;Kamran Ahmed,&nbsp;Shamim Khan,&nbsp;Prokar Dasgupta,&nbsp;Sachin Malde,&nbsp;Nicholas Raison","doi":"10.5213/inj.2346052.026","DOIUrl":"https://doi.org/10.5213/inj.2346052.026","url":null,"abstract":"<p><p>Urinary tract infection (UTI) is a common condition defined as the presence of bacteria within the urine above a certain threshold (usually >100,000 m/L). The lifetime risk in women is estimated to be 50%, of whom 25% will develop recurrence within 6 months. Unfortunately, the use of antibiotics to treat and manage recurrent UTI (rUTI) is a growing problem, due to the burden of growing antibiotic resistance on public health. As such, new approaches to manage rUTI are being investigated and developed. Competitive inoculation via instillation of Escherichia coli 83972 or HU2117 in the bladder is a new prophylactic non-antimicrobial therapy for rUTIs. It utilizes the principle of the protective nature of asymptomatic bacteriuria to prevent recurrence of symptomatic UTIs. However, the effectiveness and safety of this technique remains unclear. This systematic review examined the current outcomes data on competitive inoculation as an effective and safe treatment for rUTI prophylaxis. Based on a limited number of studies, current evidence suggests that competitive inoculation is an effective and safe prophylactic measure against UTIs in a select group of patients with incomplete bladder emptying. However, administration of the technology is both resource and time intensive, and there is strong data demonstrating low successful colonisation rates. Competitive inoculation is an alternative to antibiotics only to rUTI patients with incomplete bladder emptying. There is no evidence to suggest that the technology would be suitable for other subsets of rUTI patients. Further randomized controlled trials should be conducted to improve the evidence base before drawing conclusions for clinical practice, and ideas to improve colonisation rates and simplify the administration process should be explored.</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 2","pages":"79-87"},"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/3d/2e/inj-2346052-026.PMC10325934.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9764461","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":"Should Psychiatric Symptoms Be Evaluated in Elderly Males With Lower Urinary Tract Symptoms?","authors":"Dong Yun Lee,&nbsp;Sung Chul Kam","doi":"10.5213/inj.2346038.019","DOIUrl":"https://doi.org/10.5213/inj.2346038.019","url":null,"abstract":"Copyright © 2023 Korean Continence Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Corresponding author: Sung Chul Kam https://orcid.org/0000-0001-5403-3623 Department of Urology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, 15 Jinju-daero 816beongil, Jinju 52727, Korea Email: kamsungchul@hanmail.net Submitted: February 3, 2023 / Accepted after revision: February 21, 2023 The world population is aging rapidly. As the life expectancy of elderly individuals increases, clinicians are focusing their attention on the management of degenerative diseases. Lower urinary tract symptoms (LUTS) are a representative degenerative symptom of old age, and their prevalence increases with age; approximately 80% of men over the age of 80 years old experience LUTS. LUTS interfere with daily functioning, and elderly males with LUTS often feel emotional discomfort, such as depressive mood and anxiety. [1,2] However, elderly patients suspected of depression accompanied by anxiety often do not complain of their mood symptoms as subjective discomfort. Instead, elderly individuals complain of various nonspecific physical symptoms. The physical symptoms include abdominal discomfort, body pain, and urinational impairment [3]. These nonspecific somatic symptoms, which are frequently evaluated in elderly depressed patients, could make it difficult to differentiate them from urological diseases in elderly male patients who complain of LUTS. A psychiatrist could misdiagnose LUTS symptoms among elderly depressed patients as psychiatric symptoms, thereby exacerbating the course of LUTS. Conversely, prejudice or indifference to patients’ psychiatric diagnosis and treatment could delay the evaluation and treatment of psychiatric symptoms in elderly patients with LUTS. In this case, it can also be evaluated as if LUTS do not improve. LUTS are broadly divided into storage and urination symptoms. In a previous study, the association between subclinical symptoms of LUTS and psychiatric symptoms was investigated. Storage symptoms such as frequent urination and nocturia were associated with depression, and voiding symptoms such as discomfort and residual urination were more strongly correlated with anxiety symptoms [1]. Additionally, as the severity of psychiatric symptoms increases, the symptoms of LUTS become more severe. In elderly males, aggravated LUTS exacerbates psychiatric symptoms such as anxiety and depressive mood [1,4]. As mentioned above, LUTS and psychiatric symptoms can interact with each other, exacerbating one another or interfering with treatment. In elderly individuals, these cumulative diseases impair overall functioning in late life. In addition, LU","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 2","pages":"155-156"},"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/d2/13/inj-2346038-019.PMC10325940.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9764468","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":"High Prevalence of Dysplastic Development of Sacral Vertebral Arches in Pediatric Enuresis.","authors":"Hideo Ozawa,&nbsp;Takakuki Shibano,&nbsp;Isao Tanaka,&nbsp;Toshitaka Taniguchi,&nbsp;Michael B Chancellor,&nbsp;Naoki Yoshimura","doi":"10.5213/inj.2346024.012","DOIUrl":"https://doi.org/10.5213/inj.2346024.012","url":null,"abstract":"<p><strong>Purpose: </strong>This is the first report to compare 3-dimensional computed tomography (3D-CT) images between pediatric patients with enuresis and children without lower urinary tract symptoms who underwent pelvic CT for other reasons.</p><p><strong>Methods: </strong>Forty-seven children (33 boys and 14 girls) with primary enuresis underwent 3D-CT of sacrococcygeal bones. The control group consisted of 138 children (78 boys and 60 girls) who underwent pelvic CT for other reasons. First, we determined the presence or absence of unfused sacral arches at the L4-S3 levels in both cohorts. Subsequently, we compared the fusion of sacral arches in age- and sex-matched children from these 2 groups.</p><p><strong>Results: </strong>Dysplastic sacral arches, characterized by lack of fusion at 1 or more levels of the S1-3 arches, were observed in nearly all patients in the enuresis group. In the control group (n=138), 54 of 79 children over 10 years old (68%) exhibited fused sacral arches at 3 S1-3 levels. All 11 control children under 4 years old displayed at least 2 unfused sacral arches at the S1-3 levels. In a comparative study of age- and sex-matched patients with enuresis and control children aged 5 to 13 years (n=32 for each group, with 21 boys and 11 girls; mean age, 8.0±2.2 years [range, 5-13 years]), only 1 patient (3%) in the enuresis group exhibited fusion of all S1-3 arches. In contrast, 20 of 32 control group participants (63%) had 3 fused sacral arches (P<0.0001).</p><p><strong>Conclusion: </strong>Sacral vertebral arches typically fuse by the age of 10 years. However, in this study, children with enuresis exhibited a significantly elevated prevalence of unfused sacral arches, suggesting that dysplastic development of sacral vertebral arches may play a pathological role in enuresis.</p>","PeriodicalId":14466,"journal":{"name":"International Neurourology Journal","volume":"27 2","pages":"124-128"},"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/15/8a/inj-2346024-012.PMC10325941.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9764469","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":"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}

{"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,&nbsp;Sotirios Gatsos,&nbsp;Konstantinos Tigkiropoulos,&nbsp;Ioannis Apostolidis,&nbsp;Periklis Koukourikis,&nbsp;Ioannis Lazaridis,&nbsp;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}