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Introduction and Hypothesis This study was aimed at evaluating the therapeutic effects of a modified intravesical botulinum toxin injection technique (fewer injection sites under local anesthesia), in comparison with the conventional technique for patients with idiopathic detrusor overactivity, considering the urodynamic parameters. Methods In this double-blinded randomized clinical trial, 78 adult females with idiopathic detrusor overactivity were divided into two groups: conventional and modified groups. In the conventional method, patients received intradetrusor botulinum toxin injection at 20 sites under general or spinal anesthesia in a trigone-sparing fashion. In the modified group, injections were performed at five intradetrusor sites beyond the trigone, using local anesthetics. The primary end point was the comparison of urodynamic parameters in both groups following the procedure. The secondary endpoints were assessing the safety and tolerability of the modified method compared with the conventional method. Results There were no significant differences between the two treatment groups in terms of urodynamic parameters before the intervention ( p  > 0.05). After the intervention, no significant differences in urodynamic parameters were observed between the two treatment methods. All patients in the modified-method group could tolerate the procedure well. Conclusion The innovation of reducing the number of injection sites and concurrently using local anesthetics was shown to be as effective as the conventional method in terms of improving urodynamic parameters, tolerability, and safety in patients with idiopathic detrusor overactivity.

Introduction and hypothesisThe purpose of the study was to determine if there is a difference in pain during and after multichannel urodynamic testing in women when using 2% lidocaine gel versus water-based lubricant.MethodsThis was a randomized, controlled, double-blinded study. Women scheduled to undergo urodynamic testing were invited to participate. Participants were randomized to lidocaine 2% gel or water-based lubricant for use during testing. Both participant and examiner were blinded to the type of gel. Pain was assessed by the Wong–Baker pain scale from 0 to 10 at four points during the examination. After testing, participants completed a questionnaire to assess their expectations of pain and embarrassment with urodynamic testing. The examiner also completed a questionnaire to assess his/her impression of the participant’s pain during the procedure.ResultsThe women in the lidocaine group had lower pain scores after the cotton tipped swab test (1.3 vs 3.6, lidocaine vs lubricant respectively, p < 0.001) and after placement of urodynamic catheters (1.4 vs 3.9, lidocaine vs lubricant, respectively, p < 0.001). Mean pain scores 30 min post-completion of the study were similar between groups (0.7 vs 1.2, 1.4 vs 3.9, lidocaine vs lubricant respectively, p = 0.19). Participants reported that pain during the study was better than expected in both groups. Physician perception of the participant’s pain during testing was lower in the lidocaine group (2 vs 3, lidocaine vs lubricant respectively p = 0.008).ConclusionUse of 2% lidocaine gel during in and out catheterization, cotton-tipped swab test, and urodynamic testing decreases pain during these procedures.

Background Overactive bladder (OAB) is a common clinical presentation in patients with multiple sclerosis. Objectives The purpose of this study was to compare the effects of transcranial magnetic stimulation (TMS) and biofeedback on overactive bladder in patients with multiple sclerosis. Methods This research included 45 individuals with multiple sclerosis of both sexes. We randomly divided them into three equal groups (A, B, and C). Patients in group A got biofeedback training and pelvic floor exercise (PFME); patients in group B had transcranial magnetic treatment and PFME; and patients in group C had PFME. Urodynamic measurements were utilized to determine bladder parameters (detrusor pressure at maximum flow rate, bladder volume at initial desire to empty, maximum cystometric capacity, detrusor pressure, and maximum flow rate) for all groups before and after a six-week training interval (the end of therapy). Results There was a statistically significant improvement in all urodynamic measurement parameters within the groups (Groups A, B and C). Except for the maximal cystometric capacity and detrusor pressure were non-significant improvement in B before and after therapy. However, there was no significant difference between the three groups following therapy. Conclusion Transcranial magnetic stimulation and biofeedback improved bladder function in patients with multiple sclerosis. These approaches have a high level of safety and effectiveness, but EMG biofeedback has superiority.

Voiding dysfunction, characterized by abnormally slow and/or incomplete micturition, is a clinical challenge that significantly impacts quality of life among women. Dysfunctional voiding, a subtype of voiding dysfunction is identified by intermittent and/or fluctuating urine flow caused by involuntary periurethral striated muscle contractions during voiding in individuals without neurological abnormalities. Interferential stimulation is a non-invasive surface electrical stimulation modality widely employed in physiotherapy. The current evidence supports its clinical efficacy in managing both urinary and fecal disorders. However, its role in treating dysfunctional voiding in women remains understudied. Thus, we present a study protocol to investigate the effects of interferential electrical stimulation on clinical symptoms and urodynamic findings in women with dysfunctional voiding. This double-blind, randomized controlled trial will employ a parallel-group design and will be conducted at the Physiotherapy Clinic of Iran University of Rehabilitation Sciences, Tehran, Iran. The study population will comprise women aged 18-50 years diagnosed with dysfunctional voiding. This trial will enroll 28 participants, equally allocated to two parallel groups (n = 14 per group). Both groups will receive standard urotherapy and pelvic floor exercises as baseline interventions. The experimental group will additionally undergo 20-minute interferential stimulation twice weekly for 10 sessions under clinical supervision. Primary outcomes include maximum urine flow rate (Qmax) and severity of lower urinary tract symptoms, assessed at three times: before treatment, after treatment, and after a three-month follow-up. All statistical analyses will be conducted using SPSS software (version 26), with statistical significance set at p <0.05. It is hypothesized that using interferential stimulation will have a positive effect on clinical symptoms and urodynamic parameters in women with dysfunctional voiding. This trial is registered in the Iranian Registry of Clinical Trials (IRCT) under the registration number IRCT20180611040061N2.

Purpose To explore the dose response to onabotulinumtoxinA 50, 100, and 200 U in patients with spinal cord injury (SCI) with urinary incontinence (UI) due to neurogenic detrusor overactivity (NDO). Methods Patients ( N  = 73) with SCI (level T1 or lower) with NDO and UI (≥14 UI episodes/week) received 30 intradetrusor injections of onabotulinumtoxinA (50 U [ n  = 19], 100 U [ n  = 21], or 200 U [ n  = 17]) or placebo ( n  = 16) via cystoscopy, avoiding the trigone. Changes from baseline in UI episodes/week, volume voided/micturition, maximum cystometric capacity, and maximum detrusor pressure (MDP) during first involuntary detrusor contraction (IDC) were evaluated. Adverse events (AEs) were assessed. Results A significant linear dose response for UI episodes/week was identified at weeks 18, 30, 36, 42, and 54 ( P  < 0.05) with a similar trend ( P  = 0.092) at week 6 (primary time point). A significant linear dose response was observed in volume/void at all post-treatment time points up to week 54 ( P  < 0.05) and in MDP during first IDC at week 6 ( P  = 0.034). The proportion of patients who achieved continence at week 6 was highest in the 200 U group. Duration of effect was longest with the 200 U dose, compared with other treatment groups. The AEs were comparable across groups; urinary tract infection was the most common AE across all treatment groups. Conclusions In this exploratory dose–response study of SCI patients with UI due to NDO, onabotulinumtoxinA 200 U was the most effective dose. The AE profile was comparable across all groups.

Objective To compare the efficacy of combination therapy with an alpha-blocker and an anticholinergic to monotherapy with an alpha blocker on lower urinary tract symptoms (LUTS) following brachytherapy in prostate cancer patients. Material and methods A total of 124 patients that had been clinically diagnosed with localized prostate cancer and underwent prostate brachytherapy were enrolled in the present study. Patients were randomized and allocated to two groups, including 60 to the combination group (tamsulosin 0.2 mg/day and trospium chloride 20 mg twice daily) and 64 to the monotherapy group (tamsulosin 0.2 mg/day). Treatment began 1 day after brachytherapy and continued for 6 months. LUTS were compared between the two groups using the total International Prostate Symptom Score (IPSS), storage and voiding IPSS subscores, quality of life (QoL) scores, maximum flow rate (Qmax), and postvoid residual (PVR) urine volume at 1, 3, 6, and 12 months after implantation. Results In all, 111 patients were ultimately analyzed in the study. Compared with pretreatment scores, a significant increase in total IPSS was found at 1, 3, and 6 months in both groups, but no statistically significant differences were observed between the two groups. The combination therapy group showed a greater decrease in the IPSS storage score compared with the monotherapy group at 1, 3, and 6 months ( p  = 0.031, 0.030 and 0.042, respectively). Patients receiving tamsulosin plus trospium chloride also showed significant improvements in QoL at 1 and 3 months compared with tamsulosin alone ( P  = 0.039, P  = 0.047). Between the two groups, there was no significant difference in IPSS voiding score, Qmax, and PVR from baseline to each point of the study period. Conclusions Combination therapy with tamsulosin and trospium chloride helped to improve IPSS storage symptoms and Qol scores in prostate brachytherapy patients with LUTS compared with tamsulosin monotherapy.

Background Neurogenic bladder (NGB) dysfunction after spinal cord injury (SCI) is generally irreversible. Preliminary animal and human studies have suggested that initiation of sacral neuromodulation (SNM) immediately following SCI can prevent neurogenic detrusor overactivity and preserve bladder capacity and compliance. We designed a multicenter randomized clinical trial to evaluate the effectiveness of early SNM after acute SCI. Methods/Design The scientific protocol comprises a multi-site, randomized, non-blinded clinical trial. Sixty acute, acquired SCI patients (30 per arm) will be randomized within 12 weeks of injury. All participants will receive standard care for NGB including anticholinergic medications and usual bladder management strategies. Those randomized to intervention will undergo surgical implantation of the Medtronic PrimeAdvanced Surescan 97,702 Neurostimulator with bilateral tined leads along the S3 nerve root in a single-stage procedure. All patients will undergo fluoroscopic urodynamic testing at study enrollment, 3 months, and 1-year post randomization. The primary outcome will be changes in urodynamic maximum cystometric capacity at 1-year. After accounting for a 15% loss to follow-up, we expect 25 evaluable patients per arm (50 total), which will allow detection of a 38% treatment effect. This corresponds to an 84 mL difference in bladder capacity (80% power at a 5% significance level). Additional parameters will be assessed every 3 months with validated SCI-Quality of Life questionnaires and 3-day voiding diaries with pad-weight testing. Quantified secondary outcomes include: patient reported QoL, number of daily catheterizations, incontinence episodes, average catheterization volume, detrusor compliance, presence of urodynamic detrusor overactivity and important clinical outcomes including: hospitalizations, number of symptomatic urinary tract infections, need for further interventions, and bowel and erectile function. Discussion This research protocol is multi-centered, drawing participants from large referral centers for SCI and has the potential to increase options for bladder management after SCI and add to our knowledge about neuroplasticity in the acute SCI patient. Trial registration ClinicalTrials.gov # NCT03083366 1/27/2017.

Aims The aims of the present study were to assess the effectiveness of transcutaneous tibial nerve stimulation (TTNS) on overactive bladder (OAB) symptoms and on urodynamic parameters in patients with multiple sclerosis (PwMS) and to seek predictive factors of satisfaction. Methods All PwMS who performed 12–24 weeks of TTNS and who underwent urodynamic assessment before and after treatment between June 2020 and October 2022 were included retrospectively. Data collected were bladder diaries, symptoms assessed with Urinary Symptoms Profile (USP), and urodynamic parameters (bladder sensations, detrusor overactivity, and voiding phase). Patients with improvement rated as very good or good on Patient Global Impression of Improvement (PGI-I) score were considered as responders. Results Eighty-two patients were included (mean age: 47.1 ± 11.5 years, 67 (82%) were women). The mean USP OAB sub-score decreased from 7.7 ± 3.5 to 6.0 ± 3.4 ( p  < 0.0001). On bladder diaries, voided volumes, void frequency, and the proportion of micturition done at urgent need to void significantly improved with TTNS ( p  < 0.05). No significant change was found in urodynamic parameters. According to the PGI-I, 34 (42.5%) patients were good responders. The only parameter associated with higher satisfaction was the percentage of micturition done at urgent need to void before the initiation of the treatment (39.8% ± 30.5 in the responder group vs 25.1% ± 25.6 in the low/no responder group; p  = 0.04). Conclusion TTNS improves OAB symptoms in PwMS, without significant changes on urodynamics. A high rate of strong or urgent need to void in daily life was associated with higher satisfaction.

Colposuspension procedures have increased in the UK following the 2018 suspension of vaginal mesh for stress urinary incontinence. However, significant variation exists in preoperative assessment, patient selection, surgical approach, and postoperative care. This survey aims to explore current national practice. A questionnaire was distributed to members of the British Society of Urogynaecology (BSUG) and the British Association of Urological Surgeons (BAUS). Fifty-three clinicians responded; most were gynecologists with a special interest in urogynecology (60%) or urogynecology subspecialists (34%). Response rates were 12% (51/442) among BSUG members and <1% (2/2622) among BAUS members. Annual case volume was 5 to 10 for 43%, fewer than 5 for 36%, 10-20 for 19%, and >20 for 2%. Most surgeons (85%) perform preoperative urodynamics in all patients, while 15% restrict testing to women with mixed symptoms. Almost all (98.1%) would treat detrusor overactivity or symptomatic overactive bladder prior to offering colposuspension. Forty-five percent will perform colposuspension at any functional or maximum cytometric capacity; others use cutoffs of >400 mL (19%), >300 mL (26%) or >200 mL (10%). Fifty-five percent reported a BMI limit of <35, while 19% have no limit. Most surgeons favored an open approach (58%), followed by laparoscopic (38%) and robotic (4%). Sutures were usually suspended tension-free (75%) using Ethibond (53%) or PDS (40%), with 72% consenting for the use of non-absorbable sutures. For open colposuspension, two sutures bilaterally were preferred (49%), followed by three (40%) and four (11%). Laparoscopic or robotic procedures were mostly intra-peritoneal (89%), with surgeons placing two sutures bilaterally (88%) and tying their knots extracorporeally (75%). Thirty-nine percent close the peritoneum over their sutures. Routine check cystoscopy was performed by 60%. Postoperatively, indwelling urinary catheters are mostly left on free drainage (69%); 17% always use a suprapubic catheter and 4% preferred clean intermittent self-catheterization. Trial without catheter is most commonly attempted on Day 1 post-colposuspension (74%), with variable voiding criteria and acceptable post-void residuals. This national survey highlights marked heterogeneity in UK colposuspension practice. There is a need for comparative studies and national consensus on core technical steps to ensure safety and favorable long-term outcomes.

Introduction The number of urodynamic studies (UDS) has been declining steadily in recent decades, yet the reasons behind this trend remain poorly understood. This study aims to investigate the structural aspects of UDS in urology and explore the factors contributing to this decline. Material & methods We surveyed all urological departments performing UDS as well as a representative sample of private practices in Germany in 2023. We examined structural situation, waiting times, capacities and limitations of UDS. All invasive urodynamic examinations were defined as UDS. Results In 2019, 259/474 (55%) urological departments in Germany performed UDS. 206/259 (80%) urological departments responded to the survey. 163/200 (82%) urological departments stated that their capacities were exhausted, a main reason being lack of medical and nursing staff. 54.8% urological departments performed more than 50% of their UDS for referring physicians. Urological departments with a low number of UDS/year (≤ 100) showed a shorter waiting time (up to 4 weeks: 49% vs. 30%; p  = 0.01), reduced UDS capacities (55% vs. 12%; p  < 0.001) and these capacities were often not fully utilized (25% vs. 9%; p  = 0.007). 122/280 (44%) office urologists responded to the survey. 18/122 (15%) office urologists performed UDS. Main reasons for not offering UDS were lack of personnel and low reimbursement. Conclusion In German urological departments, UDS capacities are consistently fully utilized, primarily due to staffing shortages. This trend towards centralization prompts questions about the role of UDS in urologists’ training.