Clinical research progress in TCM therapy for underactive bladder / 国际中医中药杂志

Underactive bladder (UAB) belongs to the category of "urinary retention" and "urinary incontinence" in Traditional Chinese Medicine (TCM). Its pathogenesis is based on spleen qi deficiency and kidney deficiency, while dampness heat and blood stasis are the symptoms, and the nature of the disease is basedon the deficiency in nature and excess in superficiality and simultaneous occurrence of deficiency and excess syndrome. TCM treatment of UAB is mainly based on spleen qi deficiency syndrome, kidney deficiency syndrome, water and heat syndrome, deficiency and blood stasis syndrome to be treated with oral taken of Chinese materia medica, or the use of acupuncture, moxibustion, acupoint application and other external treatments, or the combination of acupuncture and medicine, TCM combined with rehabilitation training and other comprehensive treatments. All methods can improve the urodynamic indexes of patients, relieve symptoms and improve the quality of life, with certain efficacy.

Disfunção vesical e intestinal na infância: abordagem multi-metodológica / Disfunción vésico-intestinal en la infancia: enfoque multimetodológico / Bladder and bowel dysfunction in childhood: multi-method approach

Resumo Objetivo Descrever o perfil sociodemográfico, o acesso e interesse em receber informações on-line sobre a disfunção vesical e intestinal, bem como compreender a vivência da família de crianças e adolescentes acometidos por essa disfunção. Métodos Trata-se de estudo multi-metodológico realizado em um ambulatório de Prática Avançada de Enfermagem em Uropediatria de um hospital de ensino da região centro-oeste do país. Resultados A vivência da família da criança com disfunção vesical e intestinal aponta para um impacto negativo no cotidiano podendo estar relacionado às condições sociodemográficas, a falta de conhecimento das famílias sobre os sintomas e aos estigmas associados à sua manifestação. Para tanto, o acesso a informações on-line apresenta-se como potencial ferramenta de apoio para melhorar a experiência da família da criança com os sintomas. Conclusão Os resultados expressam a caracterização sociodemográfica da criança e sua família e o acesso e interesse em receber informações pela internet sobre a disfunção vesical e intestinal, que podem ser importantes para a adesão e percepção de melhora nos sintomas refletindo na vivência familiar. Portanto, o enfermeiro que atua no contexto de cuidado em uropediatria precisa inovar em sua abordagem e implementar novas modalidades de assistência ou intervenções em saúde, principalmente por meio da incorporação de tecnologias baseadas na internet, visando à melhora da qualidade de vida tanto da família quanto da criança com disfunção vesical e intestinal.

Resumen Objetivo Describir el perfil sociodemográfico, el acceso y el interés en recibir información digital sobre la disfunción vésico-intestinal, así como comprender la vivencia de la familia de niños y adolescentes acometidos por esta disfunción. Métodos Se trata de un estudio multimetodológico realizado en consultorios externos de Práctica Avanzada de Enfermería en Urología Pediátrica de un hospital universitario de la región Centro-Oeste del país. Resultados La vivencia de la familia de niños con disfunción vésico-intestinal indica un impacto negativo en la cotidianidad, lo que puede estar relacionado con las condiciones sociodemográficas, la falta de conocimiento de las familias sobre los síntomas y los estigmas asociados a su manifestación. Para eso, el acceso a la información digital se presenta como una potencial herramienta de apoyo para mejorar la experiencia de la familia de niños con los síntomas. Conclusión Los resultados expresan la caracterización sociodemográfica de los niños y su familia y el acceso e interés en recibir información por internet sobre la disfunción vésico-intestinal, que puede ser importante para la adhesión y percepción de mejora de los síntomas y puede reflejarse en la vivencia familiar. Por lo tanto, los enfermeros que actúan en el contexto de cuidado en urología pediátrica necesitan innovar su enfoque e implementar nuevas modalidades de atención o intervenciones en salud, principalmente mediante la incorporación de tecnologías basadas en internet, con el objetivo de mejorar la calidad de vida tanto de la familia como de los niños con disfunción vésico-intestinal.

Abstract Objective To describe the sociodemographic profile, access and interest in receiving online information about bladder and bowel dysfunction as well as understand the experience of families of children and adolescents affected by this dysfunction. Methods This is a multi-methodological study carried out in an outpatient clinic of Advanced Nursing Practice in uropediatrics of a teaching hospital in midwestern Brazil. Results The experience of families of children with bladder and bowel dysfunction points to a negative impact on everyday life, which may be related to sociodemographic conditions, lack of knowledge of families about the symptoms and stigmas associated with its manifestation. To this end, access to online information is a potential support tool to improve the experience of children's families with the symptoms. Conclusion The results express children's sociodemographic characterization and their family and the access and interest in receiving information on the internet about bladder and bowel dysfunction, which may be important for compliance and perception of improvement in symptoms, reflecting on family experience. Therefore, nurses who work in the context of uropediatrics care need to innovate in their approach and implement new care modalities or health interventions, mainly through the incorporation of internet-based technologies, aimed at improving the quality of life of both the families and children with bladder and bowel dysfunction.

Enuresis and upper airway obstruction: BNP and ADH hormones behavior before and after airway surgery

ABSTRACT Introduction: Upper airway obstruction (UAO) is a common condition in all pediatric population, with a 27% prevalence. Primary monosymptomatic nocturnal enuresis (PMNE) is a condition related to UAO in 8% to 47% of these children. The specific pathophysiological mechanism of this bond is not well understood. Some authors suggest a connection between brain natrituretic peptide (BNP) and anti-diuretic hormone (ADH) during sleep. The aim of this study was to evaluate hormone profile (ADH and BNP) and improvement in dry nights in a sample of children before and after surgical treatment of the UAO. Methods: This is a longitudinal prospective interventionist study in children, 5 to 14 years of age, with UAO and PMNE recruited in a specialty outpatient clinic. Children presenting UAO and PMNE were evaluated with a 30-day dry night diary and blood samples were collected to evaluate ADH and BNP before and after upper airway surgery. Data were analyzed prior to surgery and 90-120 days after surgery. Results: Twenty-one children with a mean age of 9.7 years were included. Mean BNP before surgery was 116.5 ± 126.5 pg/mL and 156.2 ± 112.3 pg/mL after surgery (p<0.01). Mean ADH was 5.8 ± 3.2 pg/mL and 14.6 ± 35.4 before and after surgery, respectively (p=0.26). The percentage of dry nights went from 32.3 ± 24.7 before surgery to 75.4 ± 33.4 after surgery (p<0.01). Conclusion: Surgery for airway obstruction contributed to an increase in BNP without increasing ADH. A total of 85.8% of the children presented partial or complete improvement of their enuresis.

Research advances on exosome miRNA in diabetic cystopathy / 中华老年医学杂志

The pathogenesis of diabetic cystopathy(DCP)is complex and early diagnosis is hindered by a lack of specific and sensitive criteria and more research is needed to establish guidelines for its clinical diagnosis and treatment.Exosomes are membrane vesicles carrying various biological information such as proteins and nucleic acids, which are critical for communication between different tissues and organs.This review discusses the potential role of exosome miRNA in the pathogenesis of DCP and its application in therapy, aiming to provide new insight into the diagnosis and treatment of DCP.

Therapeutic effects of sacral neuromodulation on detrusor underactivity / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the effects of sacral neuromodulation (SNM) on detrusor underactivity (DUA).@*METHODS@#From December 2019 to April 2020, 6 patients with DUA who had been treated with SNM were assessed retrospectively. The average age was 58 years (46-65 years), with 3 males and 3 females. All the patients were diagnosed with DUA by urodynamics examination. Obstruction of bladder outlet was excluded through the cystoscopy. No patient had the history of neurological disease. All the patients were placed with the bladder colostomy tube before SNM. One female patient accepted the trans-urethral resection of bladder neck. Two male patients accepted the trans-urethral resection of prostate. All the 3 patients had no improvement of void symptom after the urethral operation. Before SNM, the average 24 h times of voiding was 23.8 (18-33), average volume of every voiding was 34.2 mL (10-50 mL), average residual volume was 421.7 mL (350-520 mL). The preoperative and postoperative 24 h urine frequency, average voided volume, and average residual urine volume were compared respectively.@*RESULTS@#Totally 6 patients underwent SNM with stage Ⅰ procedure. The operation time for stage Ⅰ procedure was 62-135 min (average 90 min). After an average follow-up of two weeks, stage Ⅱ procedure was performed on responders. Four patients accepted stage Ⅱ procedure (conversion rate 66.7%), the other two patients refused the stage Ⅱ procedure because the urine frequency did not reach the satisfied level. But all the patients had the improvement of residual urine volume. For the 4 patients at the follow-up of 10-15 months, the improvement of void was still obvious. For the all patients after stage Ⅰ procedure, the average 24 h urine frequency reduced to 13.5 times (9-18 times, P < 0.001), the average voided volume increased to 192.5 mL (150-255 mL, P < 0.001), and the average residual urine volume reduced to 97.5 mL (60-145 mL, P < 0.001). No adverse events, such as wound infection or electrode translocation were detected during an average follow-up of 11.3 months. Only one of the 4 patients who received the stage Ⅱ procedure did the intermittent catheterization for one time each day.@*CONCLUSION@#SNM provides a minimal invasive approach for the management of DUA.

Minimally invasive surgery improves short-term outcomes of nerve-sparing radical hysterectomy in patients with cervical cancer: a propensity-matched analysis with open abdominal surgery / 부인종양

OBJECTIVES: Nerve-sparing radical hysterectomy has been implemented in order to reduce pelvic floor dysfunctions in women undergoing radical surgery for cervical cancer. Here, we aimed to investigate if the adoption of laparoscopic surgery impacts on patients' outcomes. METHODS: Data of consecutive patients affected by cervical cancer who had laparoscopic nerve-sparing radical hysterectomy were matched 1:1 with an historical cohort of patients undergoing open procedure. A propensity-score matched algorithm was applied. RESULTS: Thirty-five patients' pairs (70 patients: 35 undergoing laparoscopic vs. 35 undergoing open abdominal nerve-sparing radical hysterectomy) were included. Demographic and baseline oncologic characteristics were balanced between groups. Patients undergoing laparoscopic surgery had similar operative time than patients undergoing open abdominal procedures (249 [±91.5] vs. 223 [±65.0] minutes; p=0.066). Laparoscopic approach correlated with lower blood loss (30.5 [±11.0] vs. 190 [90.4] mL; p < 0.001) and shorter hospital stay (3.2 [±1.2] vs. 5.4 [2.0] days; p=0.023). Patients undergoing laparoscopy experienced a lower 30-day pelvic floor dysfunction rate than patients having open surgery. Moreover, they experienced shorter recovery of bladder function than patients having open procedures (median, 7 vs. 9 days; p=0.004, log-rank test). CONCLUSIONS: Laparoscopic approach resulted in a faster recovery of bladder function in comparison to open surgery for patients undergoing nerve-sparing radical hysterectomy.

Sexual function, urinary function and quality of life in patients after total proctocolectomy and ileal pouch anal anastomosis / 中华普通外科杂志

Objective@#To investigate the sexual function, urinary function and quality of life in patients of ulcerative colitis(UC) and familial adenomatous polyposis(FAP) after total proctocolectomy and ileal pouch anal anastomosis (IPAA).@*Methods@#The clinical data of patients with UC and FAP undergoing IPAA at Zhongnan Hospital of Wuhan University from Jan 2006 to Sep 2018 were reviewed , postoperative sexual function, urinary function, and long-term quality of life were assessed.@*Results@#There were 45 patients with median age of 35 years , median follow-up time of 31 months. 18 were UC, 27 were FAP, 5 did 1-stage surgery, 37 did 2-stage surgery, 3 for 3-stage surgery, 13 underwent open surgery, and 32 underwent laparoscopic surgery. 7 patients suffered sexual dysfunction after IPAA, and there was no statistical difference between male and female (P=0.992), UC and FAP (P=0.153), 1-stage , 2-stage , and 3-stage surgery (P=0.363) , with statistically significant difference between the open group and the laparoscopic group (P=0.025). 6 patients complicated with urinary dysfunction after IPAA , and there was no statistical difference between male and female (P=0.562), UC and FAP (P=0.325), 1-stage, 2-stage, and 3-stage surgery (P=0.286) , with statistically significant difference between the open group and the laparoscopic group (P=0.007). The Cleveland Global Quality of Life (CGQL) score after IPAA was 0.696±0.085. There were no statistical difference on CGQL scores in males and females (P=0.635), UC and FAP (P=0.664), 1-stage, 2-stage, and 3-stage (P>0.05), open group and laparoscopic group (P=0.205), postoperative long-term QOL was significantly associated only with age at the time of surgery (P=0.001).@*Conclusions@#Compared with open surgery, laparoscopic TPC-IPAA patients had better postoperative sexual function and urination function.

Sexual function, urinary function and quality of life in patients after total proctocolectomy and ileal pouch anal anastomosis / 中华普通外科杂志

Objective To investigate the sexual function,urinary function and quality of life in patients of ulcerative cohtis(UC) and familial adenomatous polyposis(FAP) after total proctocolectomy and ileal pouch anal anastomosis (IPAA).Methods The clinical data of patients with UC and FAP undergoing IPAA at Zhongnan Hospital of Wuhan University from Jan 2006 to Sep 2018 were reviewed,postoperative sexual function,urinary function,and long-term quality of life were assessed.Results There were 45 patients with median age of 35 years,median follow-up time of 31 months.18 were UC,27 were FAP,5 did 1-stage surgery,37 did 2-stage surgery,3 for 3-stage surgery,13 underwent open surgery,and 32 underwent laparoscopic surgery.7 patients suffered sexual dysfunction after IPAA,and there was no statistical difference between male and female (P =0.992),UC and FAP (P =0.153),1-stage,2-stage,and 3-stage surgery (P =0.363),with statistically significant difference between the open group and the laparoscopic group (P =0.025).6 patients complicated with urinary dysfunction after IPAA,and there was no statistical difference between male and female (P =0.562),UC and FAP (P =0.325),1-stage,2-stage,and 3-stage surgery (P =0.286),with statistically significant difference between the open group and the laparoscopic group (P =0.007).The Cleveland Global Quality of Life (CGQL) score after IPAA was 0.696 ± 0.085.There were no statistical difference on CGQL scores in males and females (P =0.635),UC and FAP (P =0.664),1-stage,2-stage,and 3-stage (P ＞ 0.05),open group and laparoscopic group (P =0.205),postoperative long-term QOL was significantly associated only with age at the time of surgery (P =0.001).Conclusions Compared with open surgery,laparoscopic TPC-IPAA patiems had better postoperative sexual function and urination function.

The study of correlation between female urination abnormality and pelvic floor injury / 中国医师杂志

Objective To study the correlation between female urination abnormalities and pelvic floor injury.Methods A total of 193 adult women with urination abnormalities from January 2015 to January 2017 were selected from Foshan Maternal and Child Hospital of Guangdong Province,including 84 cases of lower urinary tract symptoms (LUTS),71 cases of overactive bladder (OAB) and 38 cases of stress urinary incontinence (SUI).All patients aged 38-82 years (mean 51 ± 3.74) were enrolled according to their clinical symptoms.100 adult female patients without obvious symptoms such as abnormal urination were selected as the control group.Pelvic floor pain points were examined and scored in both groups.Results In the 193 cases,the number of pain points in LUTS,OAB and SUI were 1 093,983 and 415,respectively,a total of 2 491.The total pain scores of pain points were 7 163,6 480 and 2 583,with a total of 16 226 points.There were 100 cases in the control group with 527 pain points,and the total pain points were 1 377 points.According to the pelvic floor injury formula,the injury scores of the inspection group and the control group were calculated to be 3.59 vs 0.24 respectively,with statistically significant difference (P ＜ 0.01).The pelvic floor injury scores of LUTS group,OAB group and SUI group were 3.67,4.18 and 2.46 respectively,with statistically significant difference (P ＜ 0.01).Conclusions Overall,female urination abnormalities are significantly associated with pelvic floor injury,which are consistent with clinical observation.

Influence of Urinary Dysfunction on Quality of Life in Women with Cervical Cancer after Radical Hysterectomy

PURPOSE: This study was conducted to identify the quality of life (QOL) and the influence of urinary dysfunction on QOL in women with cervical cancer after radical hysterectomy. METHODS: A secondary analysis was conducted using data collected for a previous study of Chun et al. and the same subjects of a group of 157 cervical cancer patients. Novel data from the EORTC QLQ-C30 and QLQ-CX24 were used in addition to the results of urinary dysfunction from the previous study. Descriptive analysis of EORTC QLQ-C30 and QLQ-CX24 results and a multiple regression analysis were conducted to explore the influence of urinary dysfunction on global QOL. RESULTS: Subjects showed low QOL especially for social, physical and role function in the EORTC QLQ-C30 as well as the QLQ-CX24. Intensity of urinary dysfunction (p<.001) as well as daily life distress due to urinary dysfunction (p<.001) were the most significant factors affecting QOL in women with cervical cancer after radical hysterectomy. CONCLUSION: Results suggest that oncology nurses should pay attention to the relatively low QOL of post-hysterectomy patients. They should also consider the influence of urinary dysfunction on QOL when developing nursing intervention programs to increase the QOL for women with cervical cancer after radical hysterectomy.

Prevalence of lower urinary tract symptoms and associated distress among female college students in Xuzhou / 中国学校卫生

Objective@#To explore the prevalence and associated distress of lower urinary tract symptoms among female college students in Xuzhou.@*Methods@#Convenience sampling was used to recruit 1 000 female college students in Xuzhou China. Chinese versions of International Consultation on Incontinence Questionnaire LUTS and General Information Questionnaire was used.@*Results@#The prevalence of lower urinary tract symptoms was 95.7%. The top ten prevalence rates were urgency (88.2%), hesitancy (65.4%), nocturia (48.5%), intermittent stream (47.3%), straining (30.5%), increased daytime frequency (30.1%), bladder pain (21.0%), SUI (18.5%), UUI (13.9%), nocturnal enuresis (7.5%). Urinary urgency was the most disturbing symptom (49.0%). Risk factors of urinary urgency included rural household registration (OR=1.67, 95%CI:1.10-2.55, P=0.017) and premature urination (OR=1.65, 95%CI:1.23-2.21, P=0.00).@*Conclusion@#Female college students have a high prevalence of lower urinary tract symptoms but with moderate severity and distress. Toileting behaviors affect bladder health, which require early intervention.

Effect of auricular acupoint acupuncture and acupressure on bladder function of the patients with urinary retention after operation / 国际中医中药杂志

Objective To evaluate the effect of auricular acupoint acupressure combined with acupuncture and moxibustion on urinary retention after operation. Methods Ninety patients with urinary retention after operation were retrospectively analyzed. They were divided into two groups according to different treatment methods, 45 cases in each group. The control group was treated with acupuncture and moxibustion, while the observation group was treated with auricular acupoint sticking on the basis of the control group. Both groups were treated for 7 days. The urination volume of the two groups was observed 3-5 h, 5-8 h after treatment, and the residual urine volume, maximum urinary flow rate, average urinary flow rate, urination time, bladder compliance (BC), maximum detrusor pressure (MDP) before and 48 h after treatment, and the clinical efficacy were evaluated. Results The urinary outputs of the observation group were significantly higher than this of the control group at 3-5 h and 5-8 h after treatment (t values were 3.189 and 4.325, respectively, P<0.01). After 48 hours of treatment, the maximum urinary flow rate, average urinary flow rate, BC and MDP in the observation group were significantly higher than those in the control group (t values were 5.292, 3.655, 3.364, 5.042 respectively, all Ps<0.01), and the residual urine volume and urination time in the observation group were significantly lower than this in the control group (t values were -5.261, -4.174 respectively, P<0.01). The total effective rate was 95.6% (42/45) in the observation group and 88.9% (40/45) in the control group. There were significant differences in clinical efficacy between the two groups (Z=-2.157, P=0.031). Conclusions The Auricular acupoint pressure with acupuncture can improve the urinary function of patients with urinary retention after operation and improve the clinical efficacy.

Clinical observation on electroacupuncture at four sacral points for overactive bladder syndrome / 针灸推拿医学（英文版）

Objective:To observe the clinical effect of electroacupuncture (EA) at four sacral points on overactive bladder syndrome.Methods:A total of 120 female patients with overactive bladder syndrome were allocated to a treatment group of 80 cases and a control group of 40 cases on a voluntary basis.The patients in the treatment group received EA at four sacral points,and the treatment was given three times a week for 6 consecutive weeks,while the patients in the control group received oral administration of M-receptor antagonist tolterodine tartrate,which was given 4 mg each time,once a day for 6 consecutive weeks.Then the symptom scores were compared between the two groups before and after treatment.Results:At the end of treatment,the symptom scores showed statistical significant differences in comparing with those before treatment in both groups (both P＜0.01);the symptom score in the treatment group was lower than that in the control group,showing a statistically significant difference (P＜0.05).Conclusion:EA at four sacral points is an effective method for overactive bladder syndrome.

Therapeutic effect observation on acupuncture plus umbilicus application with Chinese medicine in treating detrusor underactivity / 针灸推拿医学（英文版）

Objective:To observe the clinical efficacy of acupuncture plus umbilicus application with Chinese medicine for detrusor underactivity.Methods:A total of 46 male patients with detrusor underactivity who were admitted to our hospital between January and December 2017 were randomized into a control group and an observation group,with 23 cases in each group.The control group received intermittent catheterization and routine nursing,and the observation group was treated with acupuncture plus umbilicus application with Chinese medicine on the basis of the treatment of the control group.The comprehensive efficacy,the improvement of bladder urine residue and maximum flow rate of the two groups were observed.Results:No cases dropped out in the two groups.After the intervention,the total effective rate of the observation group was 78.3％,which was significantly higher than 52.2％ of the control group (P＜0.05).After intervention,the improvements of bladder urine residue and maximum flow rate in the observation group were statistically different from those in the control group (both P＜0.05).Conclusion:The combination of acupuncture and umbilicus application with Chinese medicine added on the basis of intermittent catheterization and routine nursing has a certain effect in treating male patients with detrusor underactivity,and is worth further clinical study.

Predictors of Acute Postoperative Urinary Retention after Transvaginal Uterosacral Suspension Surgery

OBJECTIVES: To investigate the rate of postoperative urinary retention (POUR) and identify the risk factors for this complication in women who underwent transvaginal uterosacral suspension surgery. METHODS: A retrospective chart review was conducted for 75 women who underwent transvaginal uterosacral suspension surgery with vaginal hysterectomy, repair of cystocele, and levator myorrhaphy with/without transobturator anti-incontinence surgery. POUR was defined as a need for continuous intermittent catheterization on the third day subsequent to removal of the urethral indwelling catheter. RESULTS: Acute POUR was reported in 18 women (24.0%). Thirty-six of the 75 patients (48.0%) had undergone anti-incontinence surgery. Crude analysis revealed significant association between the following variables and the risk of POUR: hypertension, the lower average flow rate in the pressure-flow study (PFS), greater post-void residual (PVR) urine volume in PFS, and PVR >30% of the total bladder capacity (TBC) in PFS. In the logistic regression analysis, PVR >30% of the TBC in PFS was identified as the only significant predictor of POUR (odds ratio, 15.4; 95% confidence interval, 2.5–90.9; P = 0.003). CONCLUSIONS: The PVR >30% of the TBC in PFS was identified as the only predictive factor of acute POUR in women who underwent transvaginal uterosacral suspension surgery.

Influence of postoperative pelvic floor function on different surgical procedures of hysterectomy / 中华妇产科杂志

Objective To compare the influence of postoperative pelvic floor function after different surgical procedures of hysterectomy. Methods A total of 260 patients who underwent hysterectomy in Renmin hospital of Wuhan University from January 2012 to January 2014 were enrolled in the study, and divided into 5 groups by different surgical procedures, which were total abdominal hysterectomy (A-TH;46 cases), total laparoscopic hysterectomy (L-TH;59 cases), total vaginal hysterectomy (V-TH;42 cases), abdominal intrafascial hysterectomy (A-CISH;78 cases), laparoscopic intrafascial hysterectomy (L-CISH;35 cases). Pelvic examination, pelvic organ prolapse quantitation (POP-Q), test of pelvic muscle strength, pelvic floor distress inventory-short form 20 (PFDI-20) and the female sexual function index (FSFI) questionnaire were measured after 6 months and 12 months. Results The differences of pelvic organ prolapse incidence after 6 months, A-TH and A-CISH [7%(3/46) versus 3%(2/78)], A-TH and L-CISH [7%(3/46) versus 3% (1/35)] were statistically significance (all P＜0.05).POP-Q grade after 6 months between A-TH and A-CISH was statistically different in degree (P＜0.05). The differences of incidence of abnormal pelvic floor muscle fatigue after 6 months of A-TH and A-CISH [59% (27/46) versus 29% (23/78)], A-TH and L-CISH [59%(27/46) versus 26%(9/35)] were statistically significant (all P＜0.05), after 12 months the difference of L-TH and A-CISH [61% (36/59) versus 29%(23/78)] was statistically different (P＜0.05). The differences of incidence of abnormal pelvic floor muscle strength after 6 months of L-TH and A-CISH [53%(31/59) verus 24%(19/78)], V-TH and A-CISH [60%(25/42) verus 24%(19/78)], V-TH and L-CISH [60%(25/42) verus 23%(8/35)] were statistically significant (all P＜0.05);after 12 months the difference of V-TH and A-CISH [57% (24/42) versus 26% (20/78)] was statistically significant (P＜0.05). Stress urinary incontinence, abnormal bowel movements after 6 months and 12 months were no significant difference between groups (all P＞0.05), PFDI-20 total score was not statistically significant (P＞0.05). FSFI total score after 6 months and 12 months in A-TH and A-CISH, L-TH and A-CISH, A-CISH and L-CISH were statistically significant (all P＜0.05). Conclusion The influences of different surgical procedures to pelvic floor function are no statistical difference; as to the surgical resection of hysterectomy, intrafascia hysterectomy compared with extrafascia hysterectomy, the former is more helpful to the protection of the structure and function of the pelvic floor.

The Risk of Upper Urinary Tract Involvement in Patients With Ketamine-Associated Uropathy / 대한배뇨장애요실금학회지

PURPOSE: The aims of this study were to investigate the prevalence of upper tract involvement in ketamine-associated uropathy, and to determine the predictors of hydronephrosis in patients with a history of ketamine abuse. METHODS: This was a cross-sectional study of a prospective cohort of patients with ketamine-associated uropathy. Data including demographics, pattern of ketamine abuse, pelvic pain and urgency or frequency (PUF) symptom score, uroflowmetry (UFM) parameters, serum renal function, and liver function tests were collected. Upon consultation, ultrasonography was performed to assess the function of the urinary system. RESULTS: From December 2011 to October 2015, we treated 572 patients with ketamine-associated uropathy. Of these patients, 207 (36.2%) had managed to achieve abstinence at the time of their first consultation. Ninety-six patients (16.8%) in the cohort were found to have hydronephrosis on ultrasonography. Univariate analysis identified age, duration of ketamine abuse, PUF symptom score, voided volume on UFM, serum creatinine levels >100 μmol/L, and an abnormal serum liver enzyme profile as factors associated with hydronephrosis. Logistic regression revealed the following parameters to be statistically related to hydronephrosis: age (adjusted odds ratio [OR], 1.090; 95% confidence interval [CI], 1.020–1.166; P=0.012), functional bladder capacity (adjusted OR, 0.997; 95% CI, 0.995–0.999; P=0.029), serum creatinine >100 μmol/L (adjusted OR, 3.107; 95% CI, 1.238–7.794; P=0.016, and an abnormal serum liver enzyme profile (adjusted OR, 1.967; 95% CI, 1.213–3.187; P=0.006). CONCLUSIONS: Ketamine-associated uropathy can involve the upper urinary tract. Patient demographics as well as investigations of UFM, renal function tests, and liver function tests may allow us to identify at-risk patients.

Factors Affecting Quality of Life Among Spinal Cord Injury Patients in Korea / 대한배뇨장애요실금학회지

PURPOSE: Complaints from spinal cord injury (SCI) patients are typically related to physical disability affecting activities of daily life. However, difficulties with voiding and defecation and/or sexual function can also be major concerns. The general population and even physicians are generally unaware of these complaints; therefore, this study focuses on surveying SCI patients regarding challenges that are faced in daily life. METHODS: A questionnaire was administered randomly and anonymously to SCI patients who visited the Korea Spinal Cord Injury Association and several rehabilitation hospitals in the Republic of Korea in 2013. All participants gave their consent prior to filling out the questionnaire. RESULTS: A total of 299 patients answered the questionnaire; the male to female ratio was 5.8:1 and common vectors for injury were motor vehicle accidents, industrial accidents, and falling down. Of the 169 patients who answered the ‘most troublesome’ and ‘wish would improve’ complaints questionnaire properly, urinary problems were most common, specifically incontinence and urinary tract infection. Among all patients, 67% were using clean intermittent catheterization, 63% were taking voiding-related medications, 83% had sexual desires, and among the 122 patients who did not have offspring, 27% had future plans for children. CONCLUSIONS: From this questionnaire, we discovered that SCI patients in the South Korea suffer not only from physical disability but also many other quality-of-life-related problems. When managing SCI patients, physicians should show greater concern and educate patients about problems related to voiding and sexual activity, rather than just physical disability.

Effects of Aroma Foot Bath on Urination Status and Stress related to Urination in Patients with Benign Prostatic Hyperplasia (BPH)

PURPOSE: The purpose of this study is to evaluate effects of aroma foot bath on urination status (Prostatic Symptom and bother score due to urinary symptoms) and stress related to urination in patients with benign prostatic hyperplasia (BPH). METHODS: This study consists of pre- and post-tests in a non-equivalent group design. The 52 BPH patients selected by random sampling in G City were assigned to two groups (experimental group=26, control group=26). Data of their general characteristics, urination status and stress related to urination were collected using self-reported questionnaires. Aroma Foot Bath was performed to the experimental group for 15-20 minutes every day for a week. Descriptive statistics and independent t-test were used for the analyses in this study with the SPSS/WIN 21.0 version program. RESULTS: Prostatic symptom and bother score due to urinary symptoms in the experimental group were improved than those in the control group (t=-7.94, p<.001). Compared to the control group, the stress related to urination in the experimental group (t=-8.78, p<.001) was significantly reduced (t=-5.21, p<.001). CONCLUSION: The results of this study indicate that aroma foot bath is effective in improving urination status and reducing stress related to urination in BPH patients.

Evaluation of female overactive bladder using urodynamics: relationship with female voiding dysfunction

ABSTRACTPurpose:To investigate the role of urodynamic study (UDS) in female patients with overactive bladder (OAB) analyzing the relationship between OAB symptoms and female voiding dysfunction (FVD).Materials and Methods:We analyzed the clinical and urodynamic data of 163 women with OAB symptoms. OAB symptoms were categorized as dry and wet. FVD was described as detrusor underactivity (DUA), which was defined as a maximum flow rate (Qmax) of ≤15mL/s associated with a detrusor pressure at Qmax (PdetQmax) of ≤20cmH2O, along with bladder outlet obstruction (BOO), which was defined as a Qmax of ≤15mL/s with a PdetQmax of >20cmH2O. Clinical and urodynamic results were compared between patients with dry and wet symptoms and between those with and without FVD.Results:78 (47.9%) had dry, and 85 (52.1%) had wet symptoms. The entire group had a relatively low Qmax (15.1±6.6mL/s) and relatively high number of BOO (42.9%, 70/163) and DUA (8.6%, 14/163). A significantly higher number of patients with wet symptoms had detrusor overactivity compared to those with dry, as detected by the UDS (p<0.05). No significant differences were found in BOO and DUA number between dry and wet groups. Further, the international prostate symptom score did not different significantly between patients with and without FVD.Conclusion:A significant number of women with OAB had voiding dysfunction. However, the OAB symptoms themselves were not useful for predicting the presence of FVD. Therefore, UDS may be necessary for accurate diagnosis in women with OAB symptoms.