ABSTRACT
PURPOSE: Providing practitioners with an adjunctive guide that will aid implanters in the ability to predict and, immediately recognize, what suboptimal needle placement looks like (based on visualization of needle/lead placement and the patient's sensory and motor responses), allow cultivation of a more complete and comprehensive level of understanding of the sacral neuromodulation procedure as a whole, and inversely provide a guide for what true optimal needle/lead placement should currently demonstrate (based on current International Continence Society guidelines).METHODS: More than 400 patients underwent sacral neuromodulation procedures from 2011–2018 by a practitioner who is in the top 5% of implanting physicians in the United States. Common stimulation patterns with motor and sensory responses were observed in patients with suboptimal needle placement intraoperatively.RESULTS: Reproducible stimulation patterns were observed with common suboptimal needle placement intraoperatively. This allowed the implanting practitioner to immediately identify and correct the needle placement intraoperatively to achieve optimal needle placement and optimal motor and sensory responses for the patients.CONCLUSIONS: By considering the 3-dimensional spatial trajectory of the S3 nerve, and following this presented guide, the most optimal lead placement with consistently reproducible outcomes that include S3 motor and sensory response on all 4 leads at less than, or equal to, 2 volts can be achieved and can potentially maximize the life of the device while potentially affording patients a more successful outcome.
Subject(s)
Humans , Fecal Incontinence , Needles , United States , Urinary Bladder, OveractiveABSTRACT
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.
Subject(s)
Humans , Muscarinic Antagonists/therapeutic use , Urinary Bladder, Overactive/drug therapy , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
OBJECTIVE: The purpose of this study was to evaluate the impact of pelvic organ prolapse (POP) repair on overactive bladder (OAB) symptoms in women with POP and the effect of baseline POP severity on improvement in OAB after surgical repair of POP. And we also tried to identify any preoperative factors for persistent postoperative OAB symptoms. METHODS: A total of 87 patients with coexisting POP and OAB who underwent surgical correction of POP were included and retrospectively analyzed and postoperative data was obtained by telephone interview. OAB was defined as an affirmative response to item no. 15 (urinary frequency) and item no. 16 (urge incontinence) of the Pelvic Floor Distress Inventory. POP severity was dichotomized by Pelvic Organ Prolapse Quantification stage 1 to 2 (n=22) versus stage 3 to 4 (n=65). RESULTS: OAB symptoms were significantly improved after surgical treatment (P<0.001). But there was no significant differences in postoperative improvement of frequency and urge incontinence between stage 1 to 2 group versus stage 3 to 4 group. Preoperative demographic factors (age, parity, and POP stage) were not significantly related to persistent postoperative OAB symptoms. CONCLUSION: Women with coexisting POP and OAB who undergo surgical repair experience significant improvement in OAB symptoms after surgery, but severity of POP had no significant difference in improvement of OAB symptoms. Postoperative persistent OAB symptoms were not related to age, parity, body mass index, and POP stage.
Subject(s)
Female , Humans , Body Mass Index , Demography , Interviews as Topic , Parity , Pelvic Floor , Pelvic Organ Prolapse , Retrospective Studies , Urinary Bladder, Overactive , Urinary Incontinence, UrgeABSTRACT
Objective To analyze the composing principles of herbs in prescriptions for treating nervous urinary frequency of children by using traditional Chinese medicine. Methods The prescriptions for treating nervous urinary frequency of children were searched in CNKI, VIP, Wanfang database to establish relevant database, and the composing principles were analyzed by using revised mutual information, complex system entropy cluster, and unsupervised hierarchical clustering in the TCM inheritance system after data entry. Results Based on the analysis of 117 entries in 63 cases of prescriptions, the frequency of 32 entries was more than 5 times;22 combinations contained 2 to 3 entries, including 10 entries in total 11 medicine association rules and their confidence coefficient were obtained, which leaded to 14 new core combinations and 7 new prescriptions. Conclusion Nervous urinary frequency of children is mainly treated with the tonification by Chinese herbal compound, in particular with the herbs which can nourish kidney and reduce urination. The new prescriptions were generated by TCM inheritance system, which need verification through clinical trials.
ABSTRACT
PURPOSE: We evaluated the effects of amitriptyline in patients with urinary frequency or pelvic pain syndrome and compared with propiverine hydrochloride (BUP-4(R)) and diazepam (Valium(R)). MATERIALS AND METHODS: One-hundred and sixty-eight patients with urinary frequency or pain were included and 38 out of 168 patients were lost to follow up. The patients with interstitial cystitis, UTI and neurogenic bladder were excluded. Amitriptyline group were instructed to take 25mg to 75mg of amitriptyline before bed. Propiverine hy drochloride and diazepam group were instructed to take 20mg, 4-6mg before bed, respectively. The clinical effects and side effects were evaluated after 4 weeks of medication. RESULTS: In the amitriptyline group, 73.1% in 78 patients with frequency, 68.3% in 60 pain, 65.6% in 32 nocturia, 53.8% in 26 weak urinary stream, 53.8% in 13 dysuria, 72.7% in 11 urgency showed symptom improvement. Urinary frequency and pain score were significantly decreased in the amitriptyline group. In the propiverine hydrochloride group, 66.7% in 21 patients with frequency, 38.8% in 18 pain showed symptom improvement. In the diazepam group, 37.5% in 24 patients with frequency, 31.3% in 16 pain showed symptom improvement. Side effects of amitriptyline had appeared in 24 (27.6%) out of 87 patients; 17 cases of dry mouth, 10 drowsiness, 2 agitation, 2 nausea, 1 constipation and 1 skin rash. CONCLUSIONS: Amitriptyline is useful in vague voiding symptoms especially in urinary frequency and chronic pelvic pain syndrome. It is equally effective in both men and women. Side effects are minimal and tolerable. A double-blind placebo-controlled trial is necessary for general acceptance in the future.