Neurourology and Urodynamics最新文献

{"title":"Transvaginal Electrical Stimulation for Treatment of Overactive Bladder Without Incontinence: A Pilot Cross-Over Clinical Trial.","authors":"Michele Torosis, Lynn Stothers, Crystal Cisneros, Georgina Dominique, A Lenore Ackerman","doi":"10.1002/nau.70034","DOIUrl":"https://doi.org/10.1002/nau.70034","url":null,"abstract":"<p><strong>Objectives: </strong>Few studies look at therapeutic efficacy specifically in the OAB population that lacks urgency incontinence (OAB-dry). Transvaginal electrical stimulation (TES) improves urgency incontinence in OAB-wet by targeting the detrusor muscle by reflex inhibition but has not yet been trialed for the improvement of urgency and frequency symptoms alone without incontinence. This study sought to measure the efficacy of an at-home TES program on urgency and frequency symptoms alone in OAB-dry.</p><p><strong>Methods: </strong>This was a prospective, randomized, cross-over, controlled trial of women > 18 years old presenting to a urogynecology clinic with urinary urgency and frequency without incontinence. Participants were randomized to receive 4 weeks of sham, followed by a 3-week washout period, and then 4 weeks of intervention (Arm 1), or the reverse (Arm 2). Intervention included 15 min/day of TES using a TENS unit and transvaginal probe with stimulation width of 100 µs, rate of 12 Hz, and amplitude set by participant based on sensation. Baseline bladder symptoms were captured with voiding diaries and standardized questionnaires. Standardized pelvic floor muscle exam was performed at the beginning and end of treatment. Participants were categorized as responders if the participants stated they planned to continue the TES as their primary treatment after study completion. Outcomes were compared using t-tests, χ², and Fisher exact tests.</p><p><strong>Results: </strong>In total, 19 enrolled and 15 (79%) completed the study and had primary outcomes data available for analysis. There were no demographic differences between arms. Mean OAB-q scores for all at baseline was 25.1, post-sham was 22.9, and post-TES was 17.60, for a mean change of -7.73 points (95% CI, -21.5 to 5.9), p = 0.007). There was a reduction in voids per 24 h from 11.3 (± 3.7) to 9.0 (± 3.6) posttreatment (p = 0.048). Response, defined as continuation of therapy, had a significant association with lack of pelvic floor tenderness on baseline standardized exam (OR 0.96, CI 0.94-0.99).</p><p><strong>Conclusions: </strong>These data suggest there are two phenotypes within OAB-dry, those with pelvic floor myofascial dysfunction that do not respond to bladder directive therapy, and those who represent a population of less severe OAB-wet with detrusor overactivity, which respond to bladder directive therapy. TES is a viable treatment option for this population, resulting in clinically significant improvements in urinary symptoms and patient-reported disease severity.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov: NCT04957524.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medium-Term Outcomes of Total Autologous Fascia Lata Anterior and Apical Pelvic Organ Prolapse Repair.","authors":"Ava A Delu, Joel T Funk, Christian O Twiss","doi":"10.1002/nau.70042","DOIUrl":"https://doi.org/10.1002/nau.70042","url":null,"abstract":"<p><strong>Purpose: </strong>The recognition of synthetic vaginal mesh as a high-risk device in pelvic organ prolapse (POP) repair has led to a resurgence in the utilization of autologous graft and emphasizes the need for long-term studies into the use of autologous materials. In a 33-patient cohort, we highlighted our earliest results of a transvaginal repair for apical and anterior prolapse using a graft harvest of autologous fascia lata. In an updated cohort of 63 patients with up to 5 years of follow-up, we report our current findings.</p><p><strong>Methods: </strong>The Autologous Anterior and Apical Pelvic Organ Prolapse (AAA-POP) repair begins with a solitary, lateral 7-10 cm thigh incision, through which, a 4 × 14 cm segment of fascia lata is harvested. Transvaginal reconfiguration of the graft results in apical fixation to the sacrospinous ligaments and distal fixation to the obturator fascia. Concurrent procedures, including autologous pubovaginal sling, were performed as indicated. Several patient parameters were monitored including medical history, Visual Analog Pain (VAP) Score, SEAPI scores, POP-Q scores, and Baden-Walker grading. We defined a successful repair as absent symptomatic apical or anterior POP.</p><p><strong>Results: </strong>A total of 63 patients with an average age of 64 years underwent AAA-POP repair. Mean follow-up was 17 months (range 1-65); 18 patients had 24 months or more of follow-up. Complete POP symptom resolution was reported in 49 (78%) patients. In total, 11 patients (17%) experienced treatment failure; 5 of this subgroup (45%) underwent a uterine sparing procedure. Urinary retention postoperatively occurred in 20 patients and pubovaginal sling was concurrently performed in 18 of the patients in this subgroup (90%). Minor harvest site issues occurred and were managed expectantly. Nonbothersome thigh bulges occurred in 15 patients. Nine patients experienced a seroma at the harvest site, and five underwent aspiration. Mild paresthesia was reported by 37 patients. Mean VAP score of the fascia lata harvest site was 0.37.</p><p><strong>Conclusion: </strong>The AAA-POP repair medium-term follow-up results reaffirm the procedure's efficacy as a transvaginal and nonmesh repair of POP. Patients should be advised of several precautions including the higher frequency of treatment failure with the uterine sparing approach, potential for urinary retention if pubovaginal sling placement is performed concurrently, and morbidities associated with the harvest site. Our results continue to uphold the AAA-POP repair and its role as a treatment option for patients desiring a nonmesh approach to POP repair.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143710851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Predictive Tool for Midterm Success of Sacral Neuromodulation in Non-Neurogenic Overactive Bladder Syndrome.","authors":"Samy Hafez, Morgane Pere, Louise Olivier, Benjamin Carolus, Marie-Liesse De Guerry, Jérôme Rigaud, Xavier Biardeau, Marie-Aimée Perrouin-Verbe","doi":"10.1002/nau.70041","DOIUrl":"https://doi.org/10.1002/nau.70041","url":null,"abstract":"<p><strong>Objectives: </strong>To identify factors that can predict both test phase and midterm success of sacral neuromodulation (SNM) in refractory non-neurogenic overactive bladder syndrome (nnOAB) based on preoperative clinical and urodynamic data.</p><p><strong>Materials and methods: </strong>We conducted a two-center retrospective study and included all individuals with nnOAB who underwent a test phase between 2005 and 2021, with or without subsequent implantation of an SNM device. Only those with preoperative urodynamic assessment data were included. SNM success was defined as <math> <semantics> <mrow><mrow><mo>≥</mo></mrow> </mrow> <annotation>$ge $</annotation></semantics> </math>  50% improvement in one of the bladder diary parameters, associated with <math> <semantics> <mrow><mrow><mo>≥</mo></mrow> </mrow> <annotation>$ge $</annotation></semantics> </math>  50% symptom improvement. Individuals underwent follow-up evaluation at 2 years.</p><p><strong>Results: </strong>In total, 191 individuals were included (163 women), 69% of whom underwent SNM device implantation. At the preoperative urodynamic exam, 115 individuals had detrusor overactivity (DO). Test phase success was associated with younger age (p = 0.009). 24-month SNM success was associated with lower maximal detrusor pressure at DO (Pdet max DO) at baseline (p = 0.045). Other predictive factors for success at 2 years were female (p = 0.03), a history of stress incontinence surgery (p = 0.01), a low maximum urethral closure pressure (MUCP) (p = 0.04), a low volume at first DO (VFDO) (p = 0.03), and a high maximum cystometric capacity (MCC) (p = 0.03). We developed a tool to predict success at 2 years. The following threshold values were significantly associated with treatment success: MUCP < 58 cmH₂O, VFDO < 170 mL, and MCC > 254 mL.</p><p><strong>Conclusion: </strong>Age predicted test phase success. Pdet max DO, gender, history of incontinence surgery, high MUCP, MCC, and VFDO predicted midterm success of SNM in people with nnOAB.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143691753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravesical Botulinum Toxin Injection for Treating Detrusor Overactivity and Poor Compliance in Posterior Urethral Valves-A Preliminary Experience.","authors":"Sharon Mohan Kunnath, Eskinder Solomon, Pankaj Mishra, Anne J Wright, Joanna Clothier, Massimo Garriboli","doi":"10.1002/nau.70039","DOIUrl":"https://doi.org/10.1002/nau.70039","url":null,"abstract":"<p><strong>Purpose: </strong>To report our preliminary experience on the use of Botulinum toxin A in boys with posterior urethral valves for treating detrusor overactivity and/or reduced bladder compliance not responsive to medical treatment.</p><p><strong>Material and methods: </strong>Primary outcome measures studied were change in baseline end fill pressure (pDet), compliance, maximum Detrusor overactivity pressure (DO), fractional bladder capacity (FBC), vesicoureteric reflux (VUR) grade/resolution. Secondary outcome measures were serum creatinine and estimated glomerular filtration rate (eGFR). Low compliance group was defined as rise in baseline pDet > 20 cmH₂O. High pressure DO was defined as maximum pDet > 40 cmH₂0.</p><p><strong>Results: </strong>A total of 15 children were included in the analysis. The median decrease in end fill pDet in the whole cohort was from 20 cmH₂O (14.5-30) to 16 cmH₂O (10.5-22) (p = 0.065). By analyzing the patients with low compliance, we identified a median decrease in end fill pDet from 32 cmH₂O (26.5-44.5) to 19 cmH₂O (16.5-25.5) (p = 0.028). The median change in compliance for all the boys was from 6 mL/cmH₂O (4.51-7.3) to 12.1 mL/cmH₂O (7.44-17.3) (p < 0.001). The median change in compliance in the low compliance group was from 5.5 mL/cmH₂O (4.42-7.1) to 8.8 mL/cmH₂O (7.39-13.3) (p = 0.018). The median change in fractional bladder capacity for all the boys was from 0.70 (0.55-0.92) to 0.98 (0.79-1.42) (p = 0.061). A complete resolution of DO was observed in 7 out of 11 patients. Complete resolution of VUR was observed in 5 out of 8 renal units.</p><p><strong>Conclusion: </strong>Botulinum toxin A can be considered in the treatment strategy for reduced bladder compliance and detrusor overactivity in boys with PUV.</p><p><strong>Trial registration: </strong>15894.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Potential for Misdiagnosis of Detrusor Underactivity Due to Urodynamic Voiding Position and Seating Characteristics. Vancavage R Et Al. Neurourol Urodyn 2025 Jan 27. Doi: 10.1002/Nau.25650\".","authors":"Juan Pablo Valdevenito, Alejandro Mercado-Campero","doi":"10.1002/nau.70021","DOIUrl":"https://doi.org/10.1002/nau.70021","url":null,"abstract":"","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing our Understanding of the Urothelium and Lamina Propria, Hormone Receptors, Vascular Supply, and Sensory Aspects of the Female Human Urethra.","authors":"Margaret Mueller, Bernard T Drumm, Johanna L Hannan, Hannah Ruetten","doi":"10.1002/nau.70003","DOIUrl":"https://doi.org/10.1002/nau.70003","url":null,"abstract":"<p><strong>Objective: </strong>Urinary continence is important for women's health and wellbeing. The female urethra has been understudied and mechanisms of continence remain poorly understood. Our objective is to provide a summary of current knowledge of the epithelium and lamina propria, hormone receptors, vascular supply, and sensory aspects of the female urethra and highlight continued gaps in knowledge.</p><p><strong>Methods: </strong>In October of 2020, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored a virtual seminar series entitled \"Female Urethral Function and Failure: Advancing Basic and Translational Research for Genitourinary Conditions\". We summarize the information presented during session 3 presentations, provide additional information from recent studies, and highlight continued gaps in knowledge.</p><p><strong>Results: </strong>A sensory role for urethral mucosa seems apparent based on the dense innervation of sensory afferent neurons but how the sensory afferents contribute to continence remains poorly understood. There is a complex relationship with behavior that comes into play when evaluating the contribution of sex hormones to urinary physiology. We need to update our understanding of where hormone receptors are located in the female urinary tract. Many causes of impaired urethral blood flow are also common risk factors for urinary dysfunction but we don't know how vasculature contributes to continence. Altered afferent urethral function has been implicated in several disease states, but is largely understudied.</p><p><strong>Conclusion: </strong>There is much that remains to be learned about the urothelium and lamina propria, expression and influence of sex hormones and hormone receptors, vascular supply, and sensory aspects of the female urethra.</p><p><strong>Trial registration: </strong>No new data was generated for this manuscript, no clinical trial was conducted, and therefore clinical trial registration was not necessary.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Gentamicin Intravesical Bladder Instillations on Decreasing Urinary Tract Infections After Spinal Cord Injury and Disease.","authors":"Denise G Tate, Gianna M Rodriguez, Elizabeth Sullivan, Martin Forchheimer, Jonathan Troost, Misty Gravelin, Anne P Cameron","doi":"10.1002/nau.70037","DOIUrl":"https://doi.org/10.1002/nau.70037","url":null,"abstract":"<p><strong>Introduction: </strong>Recurrent urinary tract infections (UTIs) are common and source of significant morbidity for patients with spinal cord injury/disease (SCI/D) who require clean intermittent catheterization (CIC) bladder management. The purpose of this study was to examine the effectiveness of gentamicin bladder instillations in reducing recurrent UTIs and their impact on neurogenic bladder and bowel (NBB) symptoms and common complications; on quality of life (QOL) and community participation for patients with SCI/D performing CIC.</p><p><strong>Materials and methods: </strong>This is a Prospective single arm feasibility trial of gentamicin bladder instillations. The 6 month intervention consisted of nightly bladder instillations of 30 mg of gentamicin diluted in 50 mL of normal saline. Participants underwent blood and urine testing and completed patient reported measures, both before and after treatment. The primary outcome was the count of UTIs compared across time points (pre-, during and post-treatment) using an UTI incidence rate ratio and paired t tests. Qualitative data was collected post-treatment.</p><p><strong>Results: </strong>Twenty-one participants enrolled and 11 completed the trial. The rate of UTIs per person per month decreased significantly over time. Before treatment, the total number of UTIs was 35 (0.53 UTI per person per month); during treatment was 6 (0.09 per person per month) and at follow up, 13 (0.18 per person per month). QOL improved significantly with exception of satisfaction with role activities and community participation. There were no significant changes in NBB symptoms and related complications. Participants reported few adverse events (AEs) and qualitative data indicated high overall treatment satisfaction.</p><p><strong>Conclusions: </strong>Gentamicin instillations were effective in reducing the rate of UTIs by 83% and improving QOL. Findings helped identify potential challenges and opportunities for future studies.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modulation of Gonadotropin-Releasing Hormone Receptor Improves Voiding Hyperreflexia and Detrusor Sphincter Dyssynergia in Male Rats With Severe Spinal Cord Injury.","authors":"Daniel Medina-Aguinaga, Alvaro Munoz, Moises Altamira-Camacho, Jorge Arellano, Ricardo Juarez, Martín Humberto Muñoz-Ortega, Charles Hubscher, Yolanda Cruz, J Luis Quintanar","doi":"10.1002/nau.70031","DOIUrl":"https://doi.org/10.1002/nau.70031","url":null,"abstract":"<p><strong>Aims: </strong>The objective of the current study was to test the beneficial effects of a GnRH analog, leuprolide acetate (LA), over the urinary function in a rat model of lower urinary dysfunction by cystometry and electromyography in fully awake conditions in males with and without SCI.</p><p><strong>Methods: </strong>Male Wistar rats that underwent spinal cord compression at T10 level were divided into three groups consisting of (1) SHAM, (2) SCI, and (3) SCI + LA 10 μg/kg i.m. (once a day for 3 days, then every 72 h until complete 13 doses). We then conducted awake cystometrograms and electromyograms of the external urethral sphincter (EUS) and compared urodynamic parameters between the three groups. The expression of Gonadotropin-releasing hormone receptor (GnRH-R) on the urinary bladder was evaluated and compared among three groups by real-time polymerase chain reaction (qPCR). Additionally, the hind limb movements related to micturition were analyzed.</p><p><strong>Results: </strong>SCI induces detrusor sphincter dyssynergia, urinary malfunction, increased mRNA expression for the GnRH receptor in the urinary bladder in injured rats and increased hind limb movements related to micturition. Meanwhile, treatment with LA partially reverses these changes.</p><p><strong>Conclusion: </strong>The potential of LA for the treatment of urinary disorders associated with SCI opens the way to a new therapeutic option for individuals with SCI who would like to have an impact on their daily lives.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Benefits of Pelvic Floor Muscles Exercises Combined With Biofeedback Therapy for Improving Functional Urinary Incontinence in Children.","authors":"Lida Sharifi-Rad, Mazyar Zahir, Seyedeh-Sanam Ladi-Seyedian, Abdol-Mohammad Kajbafzadeh","doi":"10.1002/nau.70026","DOIUrl":"https://doi.org/10.1002/nau.70026","url":null,"abstract":"<p><strong>Background: </strong>Pelvic floor muscles training (PFMT), with or without biofeedback (BF), is widely utilized as an alternative treatment for various refractory lower urinary tract dysfunctions in adults and children. This study aimed to compare the efficacy of PFMT alone versus in combination with BF on functional urinary incontinence (UI) in children.</p><p><strong>Patients and methods: </strong>Medical records of children who had undergone pelvic floor rehabilitation for non-neuropathic intermittent UI from 2018 to 2022 were retrieved. Patients were categorized based on their treatment regimen. Group I had undergone standard urotherapy and PFMT, twice weekly for 5 weeks. Group II had undergone a similar 5-week treatment with addition of 10 BF sessions conducted at the end of each appointment. All children had been evaluated with kidney and bladder ultrasounds, uroflowmetry/EMG, and a 7-day voiding and bowel diary before and after treatment. Response to treatment was defined according to International Children's Continence Society (ICCS) protocols.</p><p><strong>Results: </strong>A total of 32 patients (71.9% female) with a mean age of 8.4 ± 2.1 (range: 5-13) years were included in the analyses (each group N = 16). In group I, nine (56.2%) and two (12.5%) patients demonstrated complete (100% reduction in UI episodes) and partial (50%-100% reduction in UI episodes) clinical response, respectively. In group II, 11 (68.7%) and 3 (18.8%) patients showed complete and partial response, respectively. The two groups were not significantly different with regard to clinical response (p = 0.430). No significant difference was observed between the two groups in terms of enuresis, urgency, constipation, and uroflowmetry parameters.</p><p><strong>Conclusions: </strong>PFMT under the supervision of an expert physical therapist appears to be as effective as combined PFMT and BF in improving UI in children without underlying neurologic disease.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Randomized Controlled Trial of Percutaneous Tibial Nerve Stimulation in the Treatment of Female Sexual Dysfunction.","authors":"Zhenyue Huang, Sina Mehraban Far, Jonathan Aronov, Arshia Aalami Harandi, Kuemin Hwang, Xiaoyue Zhang, Varun Talanki, Heng Ruan, Tal Meir Cohen, Steven Weissbart, Justina Tam, Jason Kim","doi":"10.1002/nau.70032","DOIUrl":"https://doi.org/10.1002/nau.70032","url":null,"abstract":"<p><strong>Background: </strong>Female sexual dysfunction (FSD) is a prevalent and multifaceted condition affecting women's sexual well-being. This randomized controlled trial aimed to evaluate the efficacy of percutaneous tibial nerve stimulation (PTNS) compared to a validated sham control in the treatment of FSD.</p><p><strong>Methods: </strong>We conducted a single-center randomized controlled trial. Participants with FSD were recruited and randomly assigned at a 1:1 allocation ratio to either PTNS or a validated sham control using transcutaneous nerve stimulation (TENS). Treatment was performed through weekly 30-min session for 12 weeks total. Sexual function was assessed at baseline, 6 weeks, and 12 weeks primarily using the Female Sexual Function Index (FSFI) questionnaire. Urogenital distress inventory-6 was collected to evaluate for any baseline urinary incontinence/voiding dysfunction. Linear mixed-effect models for longitudinal data were used to compare FSFI scores across different time points. Statistical analysis was performed using SAS 9.4 (SAS Institute Inc. Cary, NC).</p><p><strong>Results: </strong>In total, 34 PTNS and 31 TENS subjects were included in our final analysis. Overall, 48% (16/34) of PTNS subjects versus 29% (11/33) of TENS subjects were no longer at risk for FSD (FSFI > 26.55) after 12 weekly treatments. Both PTNS and TENS subjects demonstrated similar improvements in FSFI total scores after 12 weeks of treatments. Interestingly, patients who did not present with baseline urogenital distress symptoms reported a statistically significant larger improvement in sexual satisfaction after PTNS treatments as compared to placebo (p = 0.017).</p><p><strong>Conclusion: </strong>This study demonstrated a sustained efficacy of PTNS in improving sexual function. Specifically, patients who did not have coexisting urinary dysfunction reported significant improvement in sexual satisfaction after PTNS. Our study suggested that PTNS may have a direct neuromodulation effect on sexual dysfunction and may hold promise as a treatment modality for FSD.</p>","PeriodicalId":19200,"journal":{"name":"Neurourology and Urodynamics","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143605807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}