Prevalence of urinary incontinence subtypes in women / Prevalência dos subtipos de incontinência urinária em mulheres

Abstract Introduction: Urinary incontinence (UI) is present in the lives of a considerable number of women worldwide. This condition and its associated factors have been sufficiently investigated in recent years, however, prevalence estimates are still not fully clarified, as UI is seen as stigmatizing in a cultural context, and the search for treatment is not always considered by affected individuals. So, this dysfunction and its subtypes must be better understood so that it is possible to alleviate its consequences. Objective: To identify the prevalence of urinary incontinence subtypes, in women from a reference clinic in a public hospital in Curitiba, PR, Brazil. Methods: This was an observational and analytical study, with 227 women affected by UI, evaluated by means of a questionnaire including sociodemographic and general health information, in addition to defining the UI subtype. The SPSS version 25 was used for statistical analysis. Results: The patients presented a mean age of 60.33 ± 12.26 years. Mixed UI was the prevalent subtype (87.2%; n = 198), followed by stress (7.5%; n = 17), and urge (5.3%; n = 12). Among women with mixed UI, 60.6% had only completed elementary school, 59.1% were housewives, and 87.6% had experienced two or more pregnancies. Conclusion: Outlining UI subtypes, and the general and obstetric characteristics of the studied population enables the development of coping strategies for this condition, ranging from planning, diagnosis and treatment, to costs and public health management.

Resumo Introdução: A incontinência urinária (IU) está presente na vida de considerável número de mulheres no mundo. Essa condição e fatores associados a ela vêm sendo suficientemente investigados nos últimos anos, no entanto, as estimativas de prevalência ainda não são totalmente esclarecidas visto que a IU é vista como estigmatizante em âmbito cultural e a procura por tratamento nem sempre é considerada por indivíduos acometidos. Torna-se importante, portanto, esclarecer cada vez mais essa disfunção e seus subtipos para que seja possível amenizar suas consequências. Objetivo: Identificar a prevalência dos subtipos de IU em mulheres de um ambulatório de referência em um hospital público de Curitiba, PR. Métodos: Estudo observacional e analítico com 227 mulheres com IU, avaliadas por meio de um questionário para coleta de informações sociodemográficas e de saúde geral, além da definição do subtipo de IU. Utilizou-se o pacote estatístico SPSS versão 25 para a análise estatística. Resultados: A idade média da amostra foi de 60,33 ± 12,26 anos. IU mista foi o subtipo mais prevalente (87,2%; n = 198), seguida por esforço (7,5%; n = 17) e urgência (5,3%; n = 12). Das mulheres com IU mista, 60,6% tinham apenas o ensino fundamental, 59,1% eram donas de casa e 89,4% passaram por duas ou mais gestações. Conclusão: Delinear os subtipos de IU e as características gerais e obstétricas da população estudada permite que sejam elaboradas estratégias de enfrentamento desta condição, que vão desde planejamento envolvendo diagnóstico e tratamento até custos e gestão de saúde pública.

Clinical study of urinary incontinence in women at a tertiary care centre

Background: Urinary Incontinence is often underreported, undiagnosed and untreated. Though the prevalence increases with age it can occur even in younger age women. Validated questionnaires are available to establish the association of risk factors and diagnose the type of incontinence. Objective: To study risk factors and the impact of Urinary Incontinence on quality of life in women. Methods: Descriptive Cross-Sectional study was carried out among 230 women with symptoms of urinary incontinence. ICIQ-FLUTS a brief and psychometrically robust patient-completed questionnaire for evaluating female lower urinary tract symptoms and impact on quality of life (QoL) was used. The data was analysed using proportions. Results: Most commonly affected age group was 41-50 years (42%). Storage phase symptoms were seen in 78.6% women, and Incontinence was seen in 36.08% women. Stress incontinence was commonest (55.65%) with an average bothersome score of 3.1/10. Moderate to severe degree of Stress Incontinence with a score >5/10 was seen in 15.65% of women. Frequency incontinence was seen in 33.47% of respondents. Average bothersome score of stress and urge incontinence was 3.1/10. They showed as average score of 1.36 and 1.44 respectively. Nocturia was commonest symptom in storage phase symptoms (78.69%). Urgency and Frequency was noted in 55.65% and 50.43% of women respectively. Intermittency was the commonest in voiding phase symptoms seen in 19.56% with an average score of 1.44/4. Conclusion: Stress urinary incontinence was the most common type of urinary incontinence. Urinary incontinency significantly affected the quality of life of women.

Biomarcadores na bexiga hiperativa: artigo de revisão / Biomarkers in overactive bladder: review article

A bexiga hiperativa caracteriza-se pela urgência miccional, geralmente acompa- nhada de noctúria e aumento da frequência urinária. Trata-se de afecção preva- lente, com enorme comprometimento da qualidade de vida, em todos os seus as- pectos. Diversos biomarcadores vêm sendo estudados para melhor caracterização dos diferentes fenótipos da afecção, entre eles as neurotrofinas urinárias, o ATP, a genômica e a microbiota urinária. Acredita-se que tal caracterização poderá ter implicações para prevenção, fisiopatologia e individualização do tratamento.(AU)

The overactive bladder is characterized by urinary urgency, usually accompanied by nocturia and increased urinary frequency. It is a prevalent condition, with enormous impairment of quality of life, in all its aspects. Several biomarkers have been studied to better characterize the different phenotypes of the condition, including urinary neurotrophins, ATP, genomics and urinary microbiota. It is believed that such charac- terization may have implications for prevention, pathophysiology and individualiza- tion of treatment.(AU)

Effects of Electroacupuncture at Zhongji and Guanyuan on Urge Urinary Incontinence after Stroke / 中国康复理论与实践

Objective:To observe the effects of electroacupuncture on urge urinary incontinence after stroke. Methods:From May, 2015 to May, 2018, 40 patients with urge urinary incontinence after stroke were randomly divided into control group (n = 20) and electroacupuncture group (n = 20). Both groups accepted routine rehabilitation, while the electroacupuncture group accepted electroacupuncture at Zhongji (CV3) and Guanyuan (CV4) in addition, for four weeks. They recorded the urination log (72 hours), and were assessed with Incontinence Scale, and tested with urodynamics before and after treatment. Results:There were 17 cases in the control group and 18 in the electroacupuncture group finishing the trial. The total number of urination, the number of urge incontinence and the number of calls for urination carer at night decreased, the average volume of urine increased, and the score of Incontinence Scale decreased (|t| > 4.770, P < 0.001) in both groups, which were better in the electroacupuncture group than in the control group (|t| > 2.962, P < 0.01). The maximum cystometric bladder capacity and bladder compliance increased in both groups, while the maximum bladder pressure and maximum detrusor pressure decreased after treatment (|t| > 4.052, P < 0.001), which were better in the electroacupuncture group than in the control group (|t| > 2.716, P < 0.05). Conclusion:Electroacupuncture at Zhongji and Guanyuan is effective on urge urinary incontinence, which relates with reducing detrusor and bladder pressure, increasing bladder volume, and improving bladder compliance.

Incontinência urinária em mulheres: fatores de risco segundo tipo e gravidade / Incontinencia urinaria en mujeres: factores de riesgo de acuerdo con el tipo y la gravedad / Urinary incontinence in women: risk factors according to type and severity

RESUMO Objetivo: verificar fatores associados a incontinência urinária em mulheres por tipo e gravidade. Metodologia: estudo transversal, realizado de novembro de 2018 a abril de 2019, com 30 mulheres em um hospital escola de Pernambuco. Foi utilizado o instrumento Gaudenz-Fragebogen para identificar os tipos de incontinência e o Incontinence Severity Index para classificar a gravidade da perda urinária. Utilizou-se o teste Exato de Fisher para analisar variáveis qualitativas e t-Student para variáveis racionais Resultados: incontinência urinária de esforço foi o tipo mais frequente (66,7%), na forma moderada (43,3%) e esteve associada a baixa escolaridade (p<0,001), índice de massa corporal de 28,6 (p=0,043), circunferência abdominal de 103,4 (p<0,001), diabetes (p<0,001), número de partos superior a 4 (p=0,046), cirurgia ginecológica (p=0,023) e falta de atividade física (p=0,001). Considerações Finais: a identificação do tipo, da gravidade e dos principais fatores de risco modificáveis poderá subsidiar intervenções preventivas e curativas mais eficientes e efetivas.

RESUMEN: Objetivo: verificar factores asociados con la incontinencia urinaria en mujeres, por tipo y por gravedad. Metodología: estudio transversal realizado entre noviembre de 2018 y abril de 2019 con 30 mujeres en un hospital escuela de Pernambuco. Se utilizó el instrumento Gaudenz- Fragebogen para identificar los tipos de incontinencia y el Incontinence Severity Index para clasificar la gravedad de la pérdida de orina. Se utilizó la prueba exacta de Fisher para analizar las variables cualitativas, y el t-Student para las variables racionales. Resultados: la incontinencia urinaria por esfuerzo fue el tipo más frecuente (66,7%), en su forma moderada (43,3%) y estuvo asociada a un bajo nivel de escolaridad (p<0,001), a un Índice de Masa Corporal de 28,6 (p=0,043), a una circunferencia abdominal de 103,4 (p<0,001), diabetes (p<0,001), cantidad de partos superior a 4 (p=0,046), cirugía ginecológica (p=0,023) y a la falta de actividad física (p=0,001). Consideraciones finales: identificar el tipo, la gravedad y los principales factores de riesgo modificables podrá ayudar a diseñar intervenciones preventivas y curativas más eficientes y efectivas.

ABSTRACT Objective: To verify factors associated with urinary incontinence in women by type and severity. Methodology: A cross-sectional study conducted from November 2018 to April 2019 with 30 women in a teaching hospital of Pernambuco. The Gaudenz-Fragebogen instrument was used to identify incontinence types, and the Incontinence Severity Index to classify urinary loss severity. Fisher's exact test was used to analyze qualitative variables, and the t-Student test for rational variables. Results: Stress-induced urinary incontinence was the most frequent type (66.7%), in its moderate form (43.3%), and was associated with low schooling (p<0.001), Body Mass Index of 28.6 (p=0.043), abdominal circumference of 103.4 (p<0.001), diabetes (p<0.001), number of deliveries above 4 (p=0.046), gynecological surgery (p=0.023), and lack of physical activity (p=0.001). Final Considerations: Identifying the type, severity, and main modifiable risk factors may support more effective and efficient preventive and curative interventions.

Clinical Aspects of Premonitory Urges in Patients with Tourette's Disorder

Most patients with Tourette's disorder experience an uncomfortable sensory phenomenon called the premonitory urge immediately before experiencing tics. It has been suggested that premonitory urges are associated with comorbidities such as obsessive compulsive disorder, anxiety disorders, and attention-deficit/hyperactivity disorder, although these associations have been inconsistent. Most patients experience tics as a result of the premonitory urges, and after the tics occur, most patients report that the premonitory urges are temporarily relieved. As a consequence, several studies have assessed the premonitory urge and its potential therapeutic utility. Based on the concept that the premonitory urge induces tics, behavioral treatments such as Exposure and Response Prevention and Habit Reversal Therapy have been developed. However, it is still unclear whether habituation, the main mechanism of these therapies, is directly related to their effectiveness. Moreover, the observed effects of pharmacological treatments on premonitory urges have been inconsistent.

Satisfacción de las pacientes y síntomas pélvicos posterior a colpocleisis / Patient's satisfaction and pelvic symptoms after colpocleisis technique

La colpocleisis como técnica obliterante se va realizando desde el año 1823 y se ofrece como alternativa para tratamiento quirúrgico de prolapso tipo III y IV a pacientes sin deseo de vida sexual y con riesgos de morbilidad transquirúrgica. No existe mucha evidencia del grado de satisfacción post-quirúrgica de las pacientes Objetivo: determinar el grado de satisfacción de las pacientes sometidas a colpocleisis y los síntomas pélvicos más frecuentemente encontrados a lo largo del primer año post- quirúrgico. Método: studio transversal no experimental. Se aplicó cuestionario validado de satisfacción post-quirúrgica en pacientes sometidas a colpocleisis durante periodos 2013 a 2014, vía telefónica, dentro de su primer año post-quirúrgico. Se tabularon los datos obtenidos. Resultados: El total de pacientes encuestadas se encontraban entre satisfechas y muy satisfechas e indicaban que volverían a someterse a la cirugía. La edad promedio de las pacientes fue de 76 años. El 50% de las pacientes presentaron incontinencia urinaria de urgencia, 15% incontinencia anal, el restante 35% no presentó ninguna sintomatología. Los síntomas pélvicos se presentaron con más frecuencia en las pacientes con prolapsos tipo IV. Conclusiones: el nivel de satisfacción delas pacientes sometidas a colpocleisis es alto, se puede seguir ofreciendo como alternativa quirúrgica en mujeres sin actividad sexual, la sintomatología pélvica más frecuente fue incontinencia urinaria de urgencia e incontinencia anal, en las pacientes con mayor grado de prolapso.

The colpocleisis as obliterans technique is conducted since 1823 and is offered as an alternative to surgical treatment of prolapse type III and IV patients with no sexual desire for life and morbidity risks transsurgical. There is much evidence of the degree of post-surgical patient satisfaction Objective: to determine the degree of satisfaction of patients undergoing colpocleisis and urinary symptoms most frequently encountered throughout the first year post-surgery Methods:cross-sectional study is not experimental. validated questionnaire post-surgical satisfaction in patients undergoing colpocleisis during periods 2013-2014, by telephone, in his first post-surgical year was applied. The data obtained are tabulated Results: total patients were surveyed between satisfied and very satisfied and indicated they would undergo surgery. The average age of patients was 76 years. 50% of patients had urinary urge incontinence, anal incontinence 15%, 35% showed no symptoms. Patients who had type IV prolapses, presented some pelvic symptoms. Conclusion: The level of satisfaction delas patients undergoing colpocleisis is high, you can continue to offer as surgical alternative for women without sexual activity, the most common pelvic symptoms were urinary urge incontinence and anal incontinence in patients with higher degree of prolapse.

Factors associated with overactive bladder syndrome in the elderly community: a cross-sectional study / Fatores associados à síndrome da bexiga hiperativa em idosas: um estudo transversal

Abstract Objective: to identify risk factors related to overactive bladder syndrome. Method: a cross-sectional study was performed with elderly women (>60 years) from the community of Ceilândia, in the Distrito Federal, Brazil, with or without symptoms of OBS, who were evaluated through interviews and questionnaires. The clinical and sociodemographic variables analyzed were: age; body mass index (BMI); parity, schooling, previous abdominal and urogynecologic surgeries, physical activity, smoking, constipation, systemic arterial hypertension (SAH), diabetes mellitus; depression and anxiety. The questionnaires applied were the Overactive Bladder Awareness Tool (OAB-V8), the Geriatric Depression Scale and the Beck Anxiety Scale. Data were analyzed descriptively. Binary logistic regression was used to evaluate the significant associations between the independent variables and the outcome of interest. Risk ratios were calculated for each independent variable with 95% confidence intervals. Result: A total of 372 volunteers were recruited, 292 of whom were eligible. Of these, 172 were allocated to the case group (58.9%) and 120 (41.1%) were control subjects. The two groups were homogeneous between one another. There was a high prevalence of OBS in the study population and significant differences for the variables presence of SAH, abdominal surgery and pelvic surgery, with the case group presenting a higher frequency of these events. In multivariate analysis, it was observed that an active sexual life reduces the chance of having OBS by 70.8%, while urogynecologic surgeries increase this risk 3.098 times. Conclusion: In univariate logistic regression analysis, BMI, SAH, a previous history of abdominal and urogynecologic surgery, number of abortions and the presence of symptoms of depression and anxiety, were found to be factors associated with OBS. AU

Resumo Objetivo: Identificar os fatores clínicos e sociodemográficos associados à Síndrome da Bexiga Hiperativa (SBH). Método: Estudo transversal, realizado com idosas (>60 anos) da comunidade de Ceilândia, DF, Brasil; avaliadas por meio de entrevistas e questionários. As variáveis clínicas e sociodemográficas analisadas foram: idade; índice de massa corpórea (IMC); paridade, escolaridade, cirurgias abdominais e uroginecológicas prévias, prática de atividade física, tabagismo, constipação, hipertensão arterial sistêmica (HAS), diabetes mellitus; depressão e ansiedade. Os questionários aplicados foram Overactive Bladder Awerenees Tool (OAB-V8), Escala de Depressão Geriátrica e Escala de Ansiedade de Beck. Os dados foram analisados descritivamente. Utilizou-se a regressão logística binária para avaliar as associações significativas entre as variáveis independentes e o desfecho de interesse. As razões de risco foram calculadas para cada variável independente com intervalos de 95% de confiança. Resultados: Recrutou-se 372 voluntárias, sendo elegíveis 292, destas, 172 eram grupo caso (58,9%) e 120 (41,1%) eram grupo controle. Observou-se alta prevalência de SBH na população estudada, além de diferenças significativas para as variáveis: presença de HAS; ter realizado cirurgia abdominal ou cirurgia pélvica, sendo que o grupo caso apresentou maior frequência desses eventos. Na análise multivariada, observou-se que vida sexual ativa reduz em 70,8% a chance de ter SBH, e cirurgias uroginecológicas aumentam em 3,098 vezes esse risco. Conclusão: Na análise de regressão logística univariada, o IMC, a HAS, a história prévia de cirurgia abdominal e uroginecológica, quantidade de abortos, presença de sintomas de depressão e ansiedade, apresentaram-se como fatores associados à SBH. AU

To determine сommon types of urinary incontinence among women / Монголын Анагаах Ухаан

Background@#Urinary incontinence is a common and distressful problem worldwide as well as in Mongolia. According to a survey conducted by Dr.Sanjsuren, 32.2% of participated woman were diagnosed with the urinary incontinence. To diagnose and treat this highly prevalent disease, it is important to know the most common types of incontinence in Mongolian woman and its risk factors. However, there is no known studies in Mongolia ultimately concentrated on the prevalence of common types of incontinence and its causes. Therefore, this study aimed at assessing the common types of incontinence among Mongolian woman and its key risk factors.@*Materials and Methods@#We used a cross sectional data collected from the urogynecological cabinet based on the first maternal hospital in Ulaanbaatar from June to November 2016. 117 woman aged 20-80, who has incontinence symptoms participated in this study. The type of urinary incontinence is checked by urodynamical equipment “Uromic Samba”. Participants also answered a questionnaire with a purpose of assessing the risk factors.@*Results@#Descriptive analysis shown that age, body weight, number of birth and type of delivery may be the key risk factors of incontinence. Foreinstance, the prevalence of incontinence was 6.8 % among woman aged 25-35 and increases with age 26.3 % at age 36-45, 36.4 % with age group 46-55, 30.5% with age 56-80 above respectively. According to the BMI, 81.2% percent of the participating woman with incontinence are obese. As a result of birth survey among total respondents, 59.3% had 3 or more deliveries. Association between incontinence and age, body mass index was found to be the strongest and type of the delivery was the weakest. 40% of total respondents have stress incontinence, 27% have mixed incontinence, 25% have urge incontinence, 8% have other type incontinance symptoms.@*Conclusion@#The most prevalent type of incontinence among Mongolian woman is stress incontinence followed by the urge incontinence. Delivery, body weight was associated with incontinence.

Diabetes and vaginal surgery are associated with mixed urinary incontinence in patients treated in a tertiary unit of Rio de Janeiro public healthcare system

Introduction: Urinary incontinence (UI) is prevalent in women, and the frequency of its clinical subtypes varies according to the population studied and the choice of diagnostic criteria. The aim of this study was to evaluate the distribution of the most common subtypes ­ stress urinary incontinence (SUI) and mixed urinary incontinence (MUI) ­ and their correlation with demographic, clinical and reproductive factors of patients seen at the university hospital of Universidade Federal do Rio de Janeiro. Methods: This cross-sectional study was conducted in a referral service of a tertiary care center. A retrospective analysis of records of 770 women referred to the urogynecologic outpatient clinic was performed. The clinical diagnosis of UI subtype was established in accordance with international standardization. Women presenting with SUI and MUI were compared in terms of age, reproductive history, comorbidities, medications used and gynecological surgeries. The effect of independent variables was assessed through multiple regression analyses. Results: The frequency of the clinical diagnosis of MUI and SUI was, respectively, 54.6% and 31.8%. Factors associated with MUI when compared with SUI were diabetes mellitus (odds ratio, OR = 1.75; 95% confidence interval, 95% CI = 1.08; 2.85) and perineoplasty (OR = 1.79; 95% CI = 1.18; 2.72). Age showed a borderline significance (p = 0.05). Conclusions: The distribution of UI subtypes was different from the distribution found in populational studies, which shows the specific aspects of women referred for specialized care. MUI was the most common subtype and was associated with previous vaginal surgery and diabetes mellitus when compared with SUI (AU)

Study on the curative effect ofQianzheng powder through the point directional transdermal drug delivery technique for the patients with urge incontinence after stroke / 国际中医中药杂志

Objective To study the effect ofQianzheng powder through point directional transdermal drug delivery technique for the patients with urge incontinence(UI) after stroke.Methods Seventy patients with UI after stroke were randomly divided into treatment group and control group(each group 35 patients). Qianzheng powder through point directional transdermal drug delivery was given to the treatment group, but the tolterodine through mouth was given to the control group. The urinary diary and bladder function at baseline and after 2 weeks' treatment were observed.Results After treatment, the total effect rate(88.2%vs. 63.6%,χ2=5.575) in the treatment group were better than that in the control group (P<0.01).The duration of voided (17.05 ± 6.21 times/48 hvs. 28.63 ± 9.62 times/48 h,t=5.872), the times of urinary incontinence (2.08 ± 1.24 times/48 hvs. 7.19 ± 2.46 times/48 h,t=10.784), the average voided volume (282.38 ± 14.32 mlvs. 185.82 ± 15.43 ml,t=26.561), the times of nocturia (1.38 ± 0.34 times per nightvs. 2.45 ± 1.56 times per night,t=3.906), the initial Sensory capacity of bladder (246.76 ± 21.95 mlvs. 176.43 ± 20.64 ml,t=13.502), the maximum capacity of bladder (495.80 ± 26.72 mlvs. 295.81 ± 28.46 ml,t=29.663), the residual urine volume (12.25 ± 6.83 ml vs. 33.63 ± 7.25 ml,t=12.428) in the treatment group showed significantly more improvement than those in the  control group (P<0.01).Conclusions TheQianzheng powder by point directional transdermal drug delivery could reduce the symptoms of urinary incontinence, and improve the life quality of patients with UI after stroke.

Observation of curative effect of point electric stimulation for urinary incontinence after postoperative cerebral hemorrhage / 国际中医中药杂志

Objective To study the effect of point electric stimulation for urinary incontinence after postoperative cerebral hemorrhage.Methods Eighty patients with urinary incontinence after postoperative cerebral hemorrhage were randomly divided into treatment group and control group(n=40 case). Point electric stimulation was given to the treatment group, and Oxybutynin hydrochloride sustained release tablets was given orally to the control group. Index of urinary diary and bladder capacity in both groups before treatment and after 3 weeks of treatment were observed.Results After 3 weeks of treatment,the total effective rate(87.2%vs. 65.8%,χ2=4.916) in the treatment group were better than the control group (P<0.05). The times of voided (10.15 ± 2.21 times/24 hvs. 18.63 ± 3.42 times/24 h,t=12.956), the times of urinary incontinence (2.18 ± 1.04 times/24 h vs. 6.19 ± 2.16 times/24 h,t=10.421), the average voided volume (293.38 ± 16.32 mlvs. 180.82 ± 15.43 ml, t=31.083), the initial sensory capacity of bladder (276.73 ± 20.95 mlvs. 186.43 ± 21.14 ml,t=18.825), the maximum capacity of bladder (492.81 ± 23.72 mlvs. 293.81 ± 24.46 ml,t=36.244), the residual urine volume(13.25 ± 5.83 mlvs. 34.63 ± 6.25 ml,t=15.527) in the treatment group were significantly better than those in the control group (P<0.01).Conclusions The treatment of point electric stimulation can reduce the symptoms of urinary incontinence.

A resting-state functional MRI study on brain control of bladder storage function / 中华泌尿外科杂志

Objective In order to observe central responses during naturally occurring urinary bladder storage in healthy subjects,we examined brain areas that control strong bladder sensation by resting-state functional magnetic resonance imaging (rs-fMRI).Methods 44 healthy subjects (19 men and 25 women,between 22 and 50 years of age) were screened in the study from October 2014 to October 2016.All subjects were right-handed and scanned twice under the following two conditions:empty bladder (bladder volume ＜ 10 ml)and full bladder (‘strong desire to void’,bladder volume between 200 and 400 ml)without the use of filling with a catheter.Brain imaging softwares (SPM8,DPABI,REST) were adopted to analyze the difference in brain-blood perfusion between these two conditions.Voxel-based analysis of the regional homogeneity (ReHo) was performed to analyze rs-fMRI data including the main excitatory regions and inhibitory areas,peak value (X-axis,Y-axis,Z-axis),clusters size (active volume unit:number of voxel),T value (the excitatory and inhibitory extent of brain active regions).Results The rs-fMRI scans of 44 healthy subjects were analyzed.Nine subjects were excluded because of excessive head movements of more than 1.5 mm and 1.5° in rotation.Data sets were obtained from 35 subjects in two states of bladder,empty bladder and strong desires to void.Increased activity during strong desire to void was observed in the prefrontal cortex (PFC),anterior cingulate cortex (ACC),hypothalamus,temporal lobes and left caudate nucleus.Conclusions There are significant changes in the brain's ReHo during the strong sensation to void.The results suggest that the PFC,the ACC,hypothalamus,temporal lobes and left caudate nucleus play a role in the cerebral control of bladder storage without artificial bladder filling in healthy people.

Analysis of outcomes of tension-free mid-urethral sling procedure in women with mixed urinary incontinence / 北京大学学报(医学版)

Objective: To evaluate the medium and long term outcomes of tension-free mid-urethral sling in the treatment of female patients with mixed urinary incontinence (MUI).Methods: Twenty-six patients who underwent the tension-free mid-urethral sling procedure for MUI from April, 2010 to September, 2016, were followed up.Four of the 26 patients underwent retropubic tension free mid-urethral sling (TVT), and 22 of them underwent transurethral middle obturator sling (TOT).Scales were used in the follow-up, such as urinary incontinence severity score (UISS), detrusor instability score (DIS), incontinence quality of life scale evaluation (I-QOL), Urogenital Distress Inventory short form (UDI-6), and the outcomes before and after the procedure were compared.Results: The mean age was 62 years, with a range of 42-80 years.The mean body mass index (BMI) was 26.82 kg/m2, with a range of 21.48-31.14 kg/m2.The mean follow-up time was 26 months, with a range of 8-69 months.Twelve patients never took M-blockers and the rest 14 patients took M-blockers within two weeks.None of the pa-tients had complications, including dysuria, injury of bladder, urethra, obturator vessel or nerve during the surgery.After pulling out the catheter, no one suffered moderate or severe pain or difficulty of urination.The overall cure rate for stress urinary incontinence (SUI) was 96.15% with 25 patients cured, and for urge urinary incontinence (UUI) was 76.92% with 20 patients cured.The patients'' life quality also improved significantly (P<0.05).Conclusion: Ten of the 26 patients showed an overactive bladder according to urodynamic study, from whom all of the six failed patient were.And 16 patients didn''t show an overactive bladder, which may due to two reasons.One is that their sense of urge is not so serious, the other one is that their sense of urge is from urethra.Proximal urethra is full of nerve, which plays a role in sense and urine control.The sense of urge may come from urethra instead of bladder.Tension-free mid-urethral sling procedure is an effective treatment for women with mixed urinary incontinence.Even without taking the M-blockers, the cure rate for urge incontinence reached 76.92%.The efficacy of surgery remained stable in medium and long term, and the patients'' quality of life improved significantly.

Intracavitary electrical stimulation as treatment for overactive bladder: systematic review / Eletroestimulação intracavitária como tratamento para bexiga hiperativa: revisão sistemática

Abstract Introduction: Overactive bladder (OAB) is a clinical diagnosis of irritating urinary symptoms that influence on sufferers' life quality. There are effective treatments described in literature, but most of them present adverse effects. One way of treatment is the use of electrical stimulation, which has been widely used, but studies show varying results. Objective: To verify if intracavitary electrical stimulation can be effective in patients with OAB. Methods: online databases were searched with specific descriptors to find randomized clinical trials on overactive bladder treated with intracavitary electrical stimulation. Only articles with score equal or higher than 5 in methodological PEDro scale were used and those that described intra and / or inter-group P-value. Results: 217 articles were found, but only 6 were analyzed by the selection criteria. The studies show that electrical stimulation promotes the reduction of urinary frequency, urinary incontinence, nocturia, urgency and the number of protectors used, and improvements in maximum cystometric bladder capacity, symptoms of OAB and quality of life. Conclusion: Electrical stimulation was effective in patients with OAB and can be used before any invasive treatment due to none side effects.

Resumo Introdução: A bexiga hiperativa (BH) é um diagnóstico clínico de sintomas urinários irritantes que influenciam na qualidade de vida de seus portadores. Existem tratamentos eficazes descritos na literatura, porém a maioria deles apresenta efeitos adversos. Uma das formas de tratar é utilizando a eletroestimulação, a qual vem sendo muito utilizada, porém os estudos publicados apresentam resultados variados. Objetivo: Verificar se a eletroestimulação intracavitária pode ser eficaz nos distúrbios urinários de pacientes com BH. Métodos: Foram utilizadas bases de dados online com descritores específicos para busca de experimentos controlados randomizados, com pacientes portadores de BH tratados com eletroestimulação intracavitária. Foram selecionados apenas artigos com pontuação maior/igual a 5 na escala metodológica PEDro e que descrevessem P-valor intra e/ou intergrupos. Resultados: Foram encontrados 217 artigos, porém somente 6 atenderam aos critérios de seleção. A eletroestimulação promoveu a redução da frequência urinária, perda urinária, noctúria, urgência e do número de protetores utilizados diariamente, além de aumentar a capacidade cistométrica máxima da bexiga, melhorar os sintomas da BH e a qualidade de vida. Conclusão: A eletroestimulação mostrou-se eficaz em pacientes com BH, e por não apresentar efeitos colaterais, pode ser utilizada antes de qualquer tratamento invasivo.

The Effectiveness of Anticholinergic Therapy for Overactive Bladders: Systematic Review and Meta-Analysis / Eficácia da terapia anticolinérgica na bexiga hiperativa: revisão sistemática e metanálise

Abstract The overactive bladder (OAB) has a significant negative impact on the quality of life of patients. Antimuscarinics have become the pharmacological treatment of choice for this condition. The objective of this systematic review and meta-analysis is to examine the evidence from randomized clinical trials about the outcomes of the antimuscarinic drugs available in Brazil on OABs. We searched MEDLINE and the Cochrane Central Register of Controlled Trials from the inception of these databases through to September 2015. The primary outcome measures were the mean decrease in urge urinary incontinence episodes and the mean decrease in the frequency of micturition. The results suggest that there is a moderate to high amount of evidence supporting the benefit of using anticholinergic drugs in alleviating OAB symptoms when compared with placebo. It is still not clear whether any of the specific drugs that are available in Brazil offer advantages over the others. These drugs are associated with adverse effects (dry mouth and constipation), although they are not related to an increase in the number of withdrawals.

Resumo A bexiga hiperativa determina um impacto negativo na qualidade de vida dos nossos pacientes. Os antimuscarínicos tornaram-se o tratamento farmacológico de escolha para essa condição. O objetivo desta revisão sistemática e metanálise é examinar as melhores evidências científicas sobre estas medicações disponíveis no Brasil no tratamento de mulheres com bexiga hiperativa. As bases de dados utilizadas foram MEDLINE e a biblioteca da Cochrane, das quais selecionamos os ensaios clínicos randomizados até setembro de 2015. Os principais desfechos analisados foram a diminuição dos episódios de incontinência urinária de urgência e a diminuição da frequência de micção. Os resultados sugerem que as drogas existentes no Brasil sustentam o benefício dos anticolinérgicos no alívio dos sintomas da bexiga hiperativa quando comparadas como placebo. Emtermos de eficácia, as medicações apresentam resultados semelhantes no controle dos sintomas. Essas drogas estão associadas a efeitos adversos importantes, tais como boca seca e constipação, e esses efeitos adversos não influenciaram no uso da medicação.

Desensitization of Triggers and Urge Reduction for Paruresis: A Case Report

Paruresis is a special type of non-generalized social phobia that involves fear and avoidance of urination in public restrooms. We administered eight 60-minute sessions of desensitization of triggers and urge reduction (DeTUR), an addiction protocol of eye movement desensitization and reprocessing (EMDR) therapy, to a 29-year old man with paruresis of 10 year duration. Because phobic avoidance is the hallmark of any anxiety disorder, we applied DeTUR targeting the urge to avoid each anxiety-provoking situation in succession. After treatment, the participant no longer met the requirements for a diagnosis of social anxiety disorder, and the self-reported symptoms of social anxiety had decreased to non-clinical levels; furthermore, these treatment gains were maintained at the one-year follow-up. Further clinical studies are needed to generalize this finding.

The Inhibitory Effect of Korean Antismoking Advertisement on Smoking Urge / 신경정신의학

OBJECTIVES: This study compares the emotional reaction and inhibitory effect on smoking urge between foreign antismoking advertisements and Korean antismoking advertisements. METHODS: Twenty-seven male smokers responded to a self-report survey including a Questionnaire on Smoking Urge and on emotional reactions such as disgust, anger and fear after watching a foreign antismoking advertisement, neutral images, and a Korean antismoking advertisement. We compared the smoking urge between the foreign antismoking advertisement and Korean antismoking advertisement and investigated emotional reactions associated with reduction in the smoking urge. RESULTS: The foreign antismoking advertisement inhibited the smoking urge but Korean antismoking advertisement did not. A significantly higher emotional response was evoked by the antismoking advertisements than in neutral images. However, among the emotions respondents reported about the foreign antismoking advertisement, only disgust was significantly associated with smoking urge. CONCLUSION: These results support published research, in that warning labels with high-rated emotional reactions are associated with reduction in the smoking urge. High emotional reactions such as disgust may enhance the effect of Korean antismoking advertisements.

Oral pharmacological therapy for urinary incontinence

Urinary incontinence (UI) has been a serious health problem which can significantly affect quality of life. UI may occur at any age but more common in the elderly population. Many conditions may leak to UI and differential diagnosis is critical to guide appropriate manage strategy. After a brief description of the pathophysiology, classification, and diagnostic evaluation of UI, this review highlights oral pharmacological therapy mainly in clinical point of view. For urge UI, antimuscarinic are the most commonly used medication supported with high level of evidence. Antimuscarinics competitively block muscarinic receptors with variations in selectivity for the different subtypes. Common adverse effects are dry mouth, constipation, and blurred vision. High caution for cognitive function should be applied in the use of antimuscarinics in the elderly. Mirabegron, a beta3-agonist, is a new class of drug targeting urge UI, which reported similar efficacy with antimuscarinics and favorable adverse effect profile. For stress UI, various type of medications have been clinically investigated but so far none showed satisfactory resolution of stress UI. Duloxetine is the only medication approved for stress UI in European countries but not in US Food and Drug Administration and Korean Food and Drug Administration due to low benefit-risk profile for UI. Conclusively, pharmacological therapy should be tailored to the type of UI. Recent options of medications may give further treatment possibilities for the optimal treatment for each patient.

Sacral Neuromodulation in Patients With a Cardiac Pacemaker / 대한배뇨장애요실금학회지

The objective of this study was to describe our experience using sacral neuromodulation to treat urinary urgency, frequency, urge incontinence, and chronic urinary retention in patients with cardiac pacemakers. With the increasingly widespread use of InterStim for bladder function restoration, we are seeing more complex patients with multiple comorbidities, including cardiac conditions. Herein, we report 3 cases of individuals with cardiac pacemakers who underwent InterStim implantation to treat urinary conditions. This study is a case series of 3 patients with cardiac pacemakers who underwent sacral neuromodulation to treat refractory voiding dysfunction. The initial patient screening for InterStim therapy involved percutaneous nerve evaluation (PNE), in which a temporary untined lead wire was placed through the S3 foramen. Patients who did not respond to PNE proceeded to a staged implant. All patients in this study had a greater than 50% improvement of their urinary symptoms during the initial trial and underwent placement of the InterStim implantable pulse generator (IPG). Postoperative programming was done under electrocardiogram monitoring by a cardiologist. No interference was observed between the Inter-Stim IPG and the cardiac pacemaker. In this group of patients, sacral neuromodulation in the presence of a cardiac pacemaker appears to have been safe.