AIMS: We present results of a two-arm pilot study assessing the feasibility of conducting a double-blind randomized controlled trial (RCT) to evaluate the efficacy of sacral neuromodulation (SNM) in patients with multiple sclerosis (MS) suffering from neurogenic lower urinary tract dysfunction (NLUTD). METHODS: Eligible subjects with refractory NLUTD and EDSS < 5 underwent SNM test phase. Those showing more than a 50% improvement of bladder variables, received implantable pulse generators (IPG) and were randomized to either treatment group (IPG ON) or to sham group (IPG OFF) for 1 month. During second month, all patients had the IPG ON until the end of the trial. The primary endpoints were trial feasibility, recruitment potential, and response rate at the end of SNM test phase. Secondary endpoint was safety. Changes in key bladder diary-derived variables and patient reported outcomes were recorded as well. RESULTS: Thirty-two patients were screened, 17 were eligible and 13 were included in the SNM test phase. Eleven were considered responders and were implanted with IPG. Subsequently, six patients were randomized to the treatment group and five to the sham group. No serious adverse events were reported. In the intervention phase, both objective and subjective improvements were seen in the treatment group, while the symptoms in the sham group remained mostly unchanged. At study completion, six patients reported being completely satisfied, three were mostly satisfied, and two were indifferent to the treatment. CONCLUSIONS: This pilot trial demonstrated feasibility of double-blind RCT assessing safety and efficacy of SNM in MS patients. TRIAL REGISTRATION: ClinicalTrials.gov NCT05380856.
- MeSH
- Adult MeSH
- Double-Blind Method MeSH
- Electric Stimulation Therapy * methods adverse effects MeSH
- Middle Aged MeSH
- Humans MeSH
- Urinary Bladder, Neurogenic * therapy etiology physiopathology MeSH
- Pilot Projects MeSH
- Lumbosacral Plexus MeSH
- Multiple Sclerosis * complications MeSH
- Sexual Dysfunction, Physiological * therapy etiology physiopathology MeSH
- Feasibility Studies MeSH
- Lower Urinary Tract Symptoms * therapy etiology physiopathology MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
Tento článek se zaměřuje na urodynamické vyšetření (UDN) jako součást předtransplantačního hodnocení u části pacientů připravujících se na transplantaci ledviny. U pacientů s nezvratným selháním ledvin je transplantace ledviny preferovanou metodou léčby, která přináší významné zlepšení kvality života a snížení morbidity a mortality ve srovnání s dlouhodobou dialýzou. Funkční hodnocení močového traktu je součástí předtransplantačního vyšetření (uroflowmetrie u mužů) a v indikovaných případech poskytuje UDN komplexní hodnocení funkce dolních cest močových. Tato práce zdůrazňuje význam UDN pro identifikaci a léčbu preexistujících urologických problémů, které by mohly ovlivnit úspěch transplantace a funkci dárcovské ledviny. UDN může odhalit různé abnormality, jako jsou nízká compliance močového měchýře, dyssynergie sfinkterů, hyperaktivita detruzoru a vysoké plnící tlaky. Dále článek popisuje specifické urologické situace v předtransplantačním hodnocení, včetně významu fluoroskopického vyšetření a videourodynamiky pro identifikaci anatomických a funkčních abnormalit u pacientů s neurogenním měchýřem a dalšími urologickými diagnózami. Závěrem článek zdůrazňuje význam komplexního předtransplantačního urologického vyšetření pro identifikaci a správné řešení urologických komorbidit, čímž se zvyšuje bezpečnost a úspěšnost transplantace ledvin.
This article focuses on urodynamic evaluation (UDN) as a part of the pre-transplant assessment in a subset of patients preparing for kidney transplantation. In patients with end-stage renal disease, kidney transplantation is a preferred treatment method, offering significant improvement in quality of life and reduction in morbidity and mortality compared to long-term dialysis. Functional evaluation of the urinary tract is an essential component of the pre-transplant examination, and in indicated cases, UDN provides a comprehensive assessment of lower urinary tract function. This work highlights the importance of UDN in identifying and treating pre-existing urological problems that could impact success of the transplant and function of the donor kidney. UDN can reveal various abnormalities, such as low bladder compliance, sphincter dyssynergia, detrusor overactivity, and high filling pressures. Furthermore, the article describes specific urological situations in the pre-transplant evaluation, including the significance of fluoroscopic examination and video urodynamics in identifying anatomical and functional abnormalities in patients with neurogenic bladder and other urological diagnoses. In conclusion, the article emphasizes the importance of a comprehensive pre-transplant urological examination in identifying and appropriately managing urological comorbidities, thereby enhancing the safety and success of kidney transplantation.
- MeSH
- Diagnostic Techniques, Urological * MeSH
- Humans MeSH
- Surgical Clearance methods MeSH
- Kidney Transplantation * MeSH
- Urodynamics MeSH
- Urologic Diseases diagnosis pathology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
INTRODUCTION: Our objective was to conduct an individual patient data meta-analysis (IPDMA) of the two published randomized placebo-controlled trials of mirabegron in people with neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) or multiple sclerosis (MS). METHODS: We identified two randomized, placebo-controlled trials. We extracted individual patient data from the trials and evaluated two primary outcomes: change in maximum cystometric capacity and change in the patient perception of bladder condition (PPBC). We also evaluated several secondary outcomes related to urodynamic function and quality of life. We conducted three exploratory analyses to test hypotheses based on our clinical experiences with mirabegron in NLUTD. Analysis of covariance with adjustment for baseline values was used for the statistical analysis. RESULTS: Our IPDMA included 98 patients from the two trials. The results showed that mirabegron was associated with a significant improvement in maximum cystometric capacity (+41 mL, p = 0.04) and in the PPBC (-0.8, p < 0.01) compared to placebo. Secondary outcomes including peak neurogenic detrusor overactivity pressure (-20 cm H2O, p < 0.01), incontinence-QOL score (+12, p < 0.01), and 24 h pad weights (-79 g, p = 0.04) also improved significantly compared to placebo. Exploratory analyses found similar improvements in people with MS and SCI; some outcomes improved to a greater degree among people with incomplete SCI, or SCIs that were below T7. CONCLUSIONS: Our IPDMA provides evidence supporting the use of mirabegron in patients with NLUTD due to SCI or MS. Further work evaluating differential responses in people with different SCI lesion characteristics may be warranted.
- MeSH
- Acetanilides * MeSH
- Urinary Bladder, Overactive * MeSH
- Quality of Life MeSH
- Humans MeSH
- Urinary Bladder, Neurogenic * MeSH
- Spinal Cord Injuries * complications MeSH
- Multiple Sclerosis * complications MeSH
- Thiazoles * MeSH
- Urodynamics physiology MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
Inkontinence moči je významnou příčinou osobního i společenského hendikepu. Odbornou pomoc však vyhledá pouze relativně malá část inkontinentních žen. V přehledovém článku jsou popsány hlavní charakteristiky jednotlivých typů močové inkontinence s ohledem na jejich správnou diagnostiku a adekvátně vedenou léčbu. Vhodný diagnosticko‐terapeutický management vede ke zkvalitnění života žen s tímto symptomem.
Urinary incontinence is a cause of a significant personal and social handicap. Only a small part of women with urinary incontinence seek professional help. In this review article, the main characteristics of different types of female urinary incontinence about proper diagnosis and optimal treatment are described. Precise diagnostic and therapeutic management improves the quality of life in women with this symptom.
- MeSH
- Urinary Bladder, Overactive drug therapy physiopathology therapy MeSH
- Urinary Incontinence * diagnosis classification therapy MeSH
- Humans MeSH
- Risk Factors MeSH
- Urinary Incontinence, Stress diagnosis physiopathology therapy MeSH
- Urodynamics MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Review MeSH
OBJECTIVE: We aimed to explore the long-term outcomes of bipolar transurethral enucleation and resection of the prostate (B-TUERP) in patients with benign prostatic hyperplasia (BPH). METHODS: A total of 1195 patients with BPH who underwent B-TUERP from July 2006 to June 2010 were enrolled in this retrospective study. Preoperative data, particularly urodynamic study (UDS) parameters, were collected by questionnaire and examination. Postoperative follow-up was performed at 3, 6, 12, 36, 60 and 120 months, respectively. Demographic, perioperative and functional data were analysed. International Prostate Symptom Score, quality of life and overactive bladder syndrome score (OABSS) were used to assess the functional scores. Predictors of postoperative urgency incontinence were identified by univariate analysis. RESULTS: Long-term outcomes of functional score were significantly better than the preoperative values. All UDS variables, including maximum urinary flow rate, postvoid residual urine volume, compliance, maximum cystometric capacity (MCC), bladder outlet obstruction index, prostatic urethral pressure and detrusor pressure at maximum urinary flow rate, were all significantly improved. No one required reoperation due to recurrent BPH. The postoperative rate of transient urinary incontinence was 31.7%, while the long-term incontinence rate was 0%. Retrograde ejaculation occurred in 44.3% patients who remained sexually active after operation. Patients who had transient urge incontinence were older with preoperative higher OABSS, prostate-specific antigen (PSA) and detrusor overactivity rate and lower MCC. CONCLUSION: B-TUERP is a safe, successful and highly effective treatment for BPH at 10-year follow-up. Increased age, OABSS, PSA level and detrusor overactivity rate are potential predictors for urge incontinence after B-TUERP.
- MeSH
- Prostatic Hyperplasia * surgery diagnosis MeSH
- Quality of Life MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Prostate * MeSH
- Prostate-Specific Antigen MeSH
- Retrospective Studies MeSH
- Urinary Incontinence, Urge MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- MeSH
- Child MeSH
- Enuresis surgery MeSH
- Humans MeSH
- Urinary Bladder Diseases MeSH
- Urinary Bladder, Neurogenic MeSH
- Urodynamics MeSH
- Urologic Surgical Procedures methods MeSH
- Urologic Diseases * diagnosis therapy MeSH
- Constipation MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Publication type
- Review MeSH
Urodynamika (UDN) je funkční vyšetření dolních cest močových, tedy močového měchýře a subvezikální oblasti (sfinkteru a prostaty), vyhodnocení se provádí na základě měřených a vypočítaných hodnot tlaku a průtoku moče. Urodynamické vyšetření se skládá z neinvazivního měření průtoku moče (uroflowmetrie) a invazivních metod - vyšetření plnící fáze (plnící cystometrie) a mikční fáze (mikční cystometrie neboli PQ studie). Indikaci k invazivnímu urodynamickému vyšetření by měla předcházet neinvazivní vyšetření, zejména anamnéza, funkční vyšetření reflexů S2-S4, dotazníky a pitný mikční deník. Předmětem tohoto krátkého článku je prezentace základních neurofyziologických podkladů důležitých k indikaci a provedení UDN a poté zkrácený přehled jednotlivých metod s indikacemi k jejich využití.
Urodynamics (UDN) is a functional examination of lower urinary tract, i. e. the bladder and the subvesical area (sphincter and prostate), the evaluation is carried out based on measured and calculated pressure values and urine flow. Urodynamic examination consists of non-invasive measurement of urine flow (uroflowmetry) and invasive methods - examination of the filling phase (filling cystometry) and micturition phase (micturition cystometry or PQ study). The indication to invasive urodynamic examination should be preceded by a non-invasive examination, especially a patient history, functional examination of the S2-S4 reflexes, questionnaires and a drinking and voiding diary. The subject of this short article is the presentation of basic neurophysiological data important for the indication and performance of UDN, followed by a brief overview of individual methods with indications for their use.
OBJECTIVES: To compare brain responses to peroneal electrical transcutaneous neuromodulation (peroneal eTNM®) and transcutaneous tibial nerve stimulation (TTNS), two methods for treating overactive bladder (OAB), using functional magnetic resonance imaging (fMRI). The present study was not designed to compare their clinical efficacy. MATERIALS AND METHODS: This study included 32 healthy adult female volunteers (average age 38.3 years (range 22-73)). Brain MRI using 3 T scanner was performed during three 8-min blocks of alternating sequences. During each 8-min block, the protocol alternated between sham stimulation (30 s) and rest (30 s) for 8 repeats; then peroneal eTNM® stimulation (30 s) and rest (30 s) for 8 repeats; then, TTNS stimulation (30 s) and rest (30 s) for 8 repeats. Statistical analysis was performed at the individual level with a threshold of p = 0.05, family-wise error (FWE)-corrected. The resulting individual statistical maps were analyzed in group statistics using a one-sample t-test, p = 0.05 threshold, false discovery rate (FDR)-corrected. RESULTS: During peroneal eTNM®, TTNS, and sham stimulations, we recorded activation in the brainstem, bilateral posterior insula, bilateral precentral gyrus, bilateral postcentral gyrus, left transverse temporal gyrus, and right supramarginal gyrus. During both peroneal eTNM® and TTNS stimulations, but not sham stimulations, we recorded activation in the left cerebellum, right transverse temporal gyrus, right middle frontal gyrus, and right inferior frontal gyrus. Exclusively during peroneal eTNM® stimulation, we observed activation in the right cerebellum, right thalamus, bilateral basal ganglia, bilateral cingulate gyrus, right anterior insula, right central operculum, bilateral supplementary motor cortex, bilateral superior temporal gyrus, and left inferior frontal gyrus. CONCLUSIONS: Peroneal eTNM®, but not TTNS, induces the activation of brain structures that were previously implicated in neural control of the of bladder filling and play an important role in the ability to cope with urgency. The therapeutic effect of peroneal eTNM® could be exerted, at least in part, at the supraspinal level of neural control.
- MeSH
- Adult MeSH
- Urinary Bladder, Overactive * diagnostic imaging therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging MeSH
- Young Adult MeSH
- Urinary Bladder MeSH
- Brain diagnostic imaging physiology MeSH
- Tibial Nerve MeSH
- Aged MeSH
- Transcutaneous Electric Nerve Stimulation * methods MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
IMPORTANCE: This study compares the long-term efficacy and safety of an innovative single-incision sling (SIS) with the inside-out transobturator tape (TOT) sling in the treatment of female stress urinary incontinence. OBJECTIVES: Women with urodynamic stress urinary incontinence were randomized to either SIS or TOT groups and followed up for 4 years. The primary outcome was objective cure defined with a negative cough stress test result. Secondary outcomes involved subjective cure reported via patient's satisfaction scale, surgery complications, postoperative de novo urgency, and patient's life quality. STUDY DESIGN: This is a randomized noninferiority controlled trial. RESULTS: A total of 168 women were randomized (84 in both groups). After 4-year follow-up, 130 patients were analyzed (66 in the SIS group and 64 in the TOT group). The objective (86.4% vs 84.4%; risk difference [95% confidence interval], 0.020 [-0.101 to 0.141]; P = 0.807) and subjective cure rates (83.3% vs 81.3%; risk difference [95% confidence interval], 0.020 [-0.111 to 0.151]; P = 0.821) were similar with the SIS and TOT groups. Both procedures were associated with low complication rates. Repeated surgery rates were 7.6% in the SIS group and 6.3% in the TOT groups. The mesh exposure rate was 1.5% for the SIS group and 3.1% for the TOT group. Incidence of de novo urgency did not vary between TOT and SIS patients. Both groups registered significant life quality improvement. CONCLUSION: After long-term follow-up, anti-incontinence SIS surgery proved noninferior to the inside-out TOT procedure in terms of objective and subjective cure rates.
- MeSH
- Urinary Incontinence * surgery MeSH
- Quality of Life MeSH
- Humans MeSH
- Urinary Incontinence, Stress * surgery MeSH
- Suburethral Slings * adverse effects MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Equivalence Trial MeSH
- Randomized Controlled Trial MeSH
Cíl: Zhodnotit střednědobé výsledky léčby symptomů dolních močových cest (LUTS) spojených s nezhoubným zbytněním prostaty (BPH) metodou REZUM. Materiál a metody: Soubor pacientů (N 177) se středně intenzivními až těžkými LUTS, kteří podstoupili v intervalu od prosince 2019 do června 2021 léčbu metodou REZUM a byli prospektivně sledováni. Všichni před léčbou vyplnili dotazníky IPSS a OABv8 a absolvovali měření průtoku moči, transrektální sonografii prostaty, vyšetření moči a test PSA. Sledované parametry byly opakovány za tři měsíce a za rok po výkonu a statisticky vyhodnoceny. Výsledky: Hodnocení symptomů za tři měsíce dokončilo 170 pacientů a za rok 139 pacientů. K signifikantnímu zlepšení (p < 0,001) došlo u IPSS skóre za tři měsíce a za rok (medián 22 vs. 6,9 vs. 7) u QoL skóre (medián 4 vs. 1,1 vs. 1,3), OABv8 (medián 17 vs. 5,4 vs. 6). Signifikantní nárůst byl pozorován rovněž u Qmax (medián 6,9 vs. 19 vs. 17,3), Q prům (medián 3,0 vs. 9,8 vs. 8,9), nárůst mikčního objemu (medián 170 vs. 251 vs. 289) a pokles postmikčního rezidua (medián 125 vs. 0 vs. 0). Signifikantní pokles jsme zaznamenali rovněž u objemu prostaty (medián 59 vs. 37,2 vs. 39) a u celkového PSA (medián 2,8 vs. 1,9 vs. 1,9). Závěr: REZUM je efektivní a bezpečná metoda při léčbě LUTS spojených s BPH při ročním sledování.
Goal: To evaluate medium term results of treatment of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) using the REZUM method. Material and methods: A cohort of patients (N 177) with medium to severe LUTS were treated with the REZUM method from December 2019 until June 2021 and prospectively followed up. Before treatment all patients filled out IPSS and OABv8 questionnaires and underwent uroflometry, transrectal ultrasonography, urine examination and PSA test. These parameters were repeated 3 months and 1 year after procedure and were statistically evaluated. Results: Evaluation of symptoms after 3 months and one year were finished by 170 patients and 139 patients, respectively. Significant improvement (p < 0.001 was observed in IPSS score after 3 months and one year (median 22 vs 6.9 vs 7), in QoL score (median 4 vs 1.1 vs 1.3), OABv8 (median 17 vs 5.4 vs 6). Significant increase was observed also in Qmax (median 6.9 vs 19 vs 17.3), Qave (median 3,0 vs 9.8 vs 8.9), voided volume (median 170 vs 251 vs 289) and decrease in post voided volume (median 125 vs 0 vs 0). Significant decrease was also observed in prostate volume (median 59 vs 37.2 vs 39) and total PSA (median 2.8 vs 1.9 vs 1.9). Conclusion: REZUM is a safe and effective method in treatment LUTS due to BPH after one year follow‐up.
- Keywords
- metoda REZUM,
- MeSH
- Prostatic Hyperplasia * diagnosis therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Minimally Invasive Surgical Procedures MeSH
- Prospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Lower Urinary Tract Symptoms * diagnosis therapy MeSH
- Urodynamics physiology MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
