Urgency and pain in patients with overactive bladder and bladder pain syndrome. What are the differences?

BACKGROUND: The Overactive Bladder Syndrome (OAB) and the Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC) are different urological conditions sharing 'urgency' as a common symptom. The aim of this review is to address our existing knowledge and establish how these symptoms are interrelated and to determine whether or not there is a common link between both symptoms complexes that help to distinguish one from the other. METHODS: Pubmed was used to obtain references for this non-systematic review aiming to discuss differences between OAB and BPS/IC. Guidelines of several professional associations and discussions based on expert opinion from the authors were implemented. RESULTS: Whilst in BPS the hallmark symptom is pain on bladder filling, urgency is the defining symptom of OAB. Whilst it is likely that the pain in BPS/IC arises from local inflammation in the bladder wall, the nature of urgency as a symptom, its origin, and the relationship between urgency and pain, as well as the different afferent mechanisms associated with the genesis of these sensory symptoms, remains unknown. Although the aetiology of both OAB and PBS/IC is unclear, the influence of environmental factors has been suggested. Both are chronic conditions with very variable symptom resolution and response to therapy. The relationship with voiding dysfunction, gynaecological causes of chronic pelvic pain or the possible alteration of the hypothalamic-pituitary-adrenal axis and psychological disorders has not been established. Inflammation has been suggested as the common link between OAB and BPS/IC. CONCLUSIONS: OAB and BPS/IC are different symptoms complexes that share urgency as a common symptom. None of them have a specific symptom although pain on bladder filling is the hallmark symptom in BPS/IC. Bladder pain with urgency should be a trigger for referral to the provider with appropriate knowledge and expertise in this disease state, whereas the management of OAB should be part of normal routine care in the community.

Impacto del tratamiento del cáncer de cérvix sobre la función miccional y sexual / Impact of Cervical Cancer Treatment on Micturition and Sexual Function

Contexto: El cáncer de cérvix es el segundo tumor más frecuente en mujeres, y debido a los avances diagnósticos y terapéuticos las cifras de supervivencia global a 5 años se aproximan al 70%. Se han descrito trastornos en la función miccional, defecatoria, sexual y en la calidad de vida, debidas en gran parte a las secuelas originadas por los distintos tratamientos. El abordaje de estas comorbilidades en las consultas médicas de seguimiento es escaso o inexistente. Métodos: Se realizó una revisión sistemática para identificar los artículos relacionados con las secuelas uroginecológicas del tratamiento del cáncer de cérvix. Resumen de evidencia: Durante la histerectomía radical, la disrupción de las fibras nerviosas del sistema nervioso autónomo que inervan la vejiga es probablemente la causa principal de las alteraciones miccionales. Hasta un 36% de las mujeres sufren disfunción de vaciado, y entre el 10 y 80% incontinencia urinaria de esfuerzo, debida a la disminución de la resistencia uretral. Tras la histerectomía radical y/o radioterapia se observa con frecuencia un acortamiento y estenosis de la vagina. La función sexual está alterada en estas mujeres, y aquellas que son sexualmente activas tras la cirugía con frecuencia refieren dispareunia y falta de lubricación vaginal. Conclusiones: La disfunción de vaciado y la incontinencia urinaria son las disfunciones miccionales más frecuentes tras el tratamiento del cáncer cervical. Durante el seguimiento oncológico de estas pacientes, la valoración sistemática de los síntomas sugestivos de disfunciones miccionales permite detectar los casos que pueden ser evaluados y tratados en una Unidad de Uroginecología (AU)

Context; Cervical cancer is the second most common tumor in women worldwide and due to diagnostic and therapeutic advances, the overall survival rates at 5 years is approaching 70%. Disorders in micturition, defecation, sexuality and quality of life have been described, frequently caused by different treatments. Addressing these comorbidities in the medical follow-up is often limited or nonexistent. Methods: A systematic review of studies to identify the articles related with urogynecological sequels from cervical cancer treatment was carried out. Summary of evidence: During radical hysterectomy, disruption of the autonomic nerve fibers which innervate the bladder appears to be the main cause of voiding dysfunction. Up to 36% of women report voiding dysfunction; from 10 to 80%, stress urinary incontinence (SUI), due to the decrease in urethral closure pressure. After radical hysterectomy and/or radiotherapy, vaginal shortening and stenosis after is often observed. Sexual function is altered in these women and those who are sexually active women after the surgery frequently report sexual dysfunction due to lack of lubrication and pain. Conclusions: Voiding dysfunction and urinary incontinence are the most frequent urinary problems that occur in patients treated for cervical cancer. Systemic urogynecologic assessment of the symptoms suggestive of micturition dysfunctions during oncologic follow-up may be useful to detect the cases that can be evaluated and treated in an Urogynecology Unit (AU)

[Impact of cervical cancer treatment on micturition and sexual function]. / Impacto del tratamiento del cáncer de cérvix sobre la función miccional y sexual.

CONTEXT: Cervical cancer is the second most common tumor in women worldwide and due to diagnostic and therapeutic advances, the overall survival rates at 5 years is approaching 70%. Disorders in micturition, defecation, sexuality and quality of life have been described, frequently caused by different treatments. Addressing these comorbidities in the medical follow-up is often limited or nonexistent. METHODS: A systematic review of studies to identify the articles related with urogynecological sequels from cervical cancer treatment was carried out. SUMMARY OF EVIDENCE: During radical hysterectomy, disruption of the autonomic nerve fibers which innervate the bladder appears to be the main cause of voiding dysfunction. Up to 36% of women report voiding dysfunction; from 10 to 80%, stress urinary incontinence (SUI), due to the decrease in urethral closure pressure. After radical hysterectomy and/or radiotherapy, vaginal shortening and stenosis after is often observed. Sexual function is altered in these women and those who are sexually active women after the surgery frequently report sexual dysfunction due to lack of lubrication and pain. CONCLUSIONS: Voiding dysfunction and urinary incontinence are the most frequent urinary problems that occur in patients treated for cervical cancer. Systemic urogynecologic assessment of the symptoms suggestive of micturition dysfunctions during oncologic follow-up may be useful to detect the cases that can be evaluated and treated in an Urogynecology Unit.

[Questionnaire for evaluation of sexual function in women with genital prolapse and/or incontinence. Validation of the Spanish version of "Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)"]. / Cuestionario para evaluación de la función sexual en mujeres con prolapso genital y/o incontinencia. Validación de la versión española del "Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)".

This article summarizes the work done to adapt and to validate the short form of Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) for its use in Spain. It will become the first validated questionnaire in this country for the evaluation of the sexual function in women with Pelvic Organ Prolapse and/or Urinary Incontinence. PATIENTS AND METHOD: 49 women who visited a specialized unit with symptoms of pelvic floor were included. Patients filled in the Spanish version of the questionnaire to validate (PISQ-12), the Urinary Incontinence Questionnaire (ICIQ-UI-SF); the Female Sexual Function Questionnaire (FSM) and the Bladder Control Autoevaluation Questionnaire (CACV). Factibility, reliability and validity of the new questionnaire were evaluated. RESULTS: Factibility: 99.83% of the sample answered all the items (only one patient did not answer one of the items); average administration time 3.5 (1.5) minutes. RELIABILITY: Cronbach's alpha was 0,829. VALIDITY: PISQ-12 correlation with FSM was 0,71; with ICIQ-UI-SF it was -0,038; with the CACV "symptoms" dimension the correlation was -0,30 and with the "discomfort" dimension it was -0,40. The existence of the same three dimensions of the PISQ-12 original version in the adapted Spanish questionnaire is checked through a factorial analysis. The score in PISQ-12 was worse (lower) in the case of women with Hyperactive Bladder symptoms and discomfort measured with the CACV questionnaire and in women with sexual dysfunction measured with FSM. PISQ-12 is an instrument with the appropriate psychometric characteristics to evaluate sexual function in women with pelvic floor problems.

Tratamiento farmacológico de la incontinencia urinaria de esfuerzo / Pharmacological treatment of urinary stress incontinence

La incontinencia urinaria de esfuerzo (IUE) es la pérdida involuntaria de orina asociada a un esfuerzo físico que provoca un aumento de la presión abdominal (toser, reír, correr o incluso andar). Se estima que, en aproximadamente el 50 por ciento de las mujeres con incontinencia urinaria (IU), su síntoma principal es la IUE. La uretra en sí misma tiene un importante papel en el conjunto de los mecanismos de continencia, recibe inervación triple: simpática, parasimpática y somática. El estímulo somático llega a la uretra desde el núcleo de Onuf, situado en la médula sacra, a través del nervio pudendo, la estimulación de receptores nicotínicos, en el músculo estriado uretral provoca la contracción refleja y también la voluntaria del esfínter uretral. En estudios experimentales, se ha comprobado la implicación de la serotonina en el control central del aparato urinario inferior, aunque ha resultado difícil establecer el tipo de acción, la mayoría de estudios reconoce que la activación central dependiente de la serotonina produce una inhibición en los mecanismos sensoriales y la estimulación de la actividad somática motora del esfínter estriado uretral. Mediante técnicas inmunohistoquímicas, se ha podido observar que las neuronas del núcleo de Onuf que van al esfínter estriado uretral, están rodeadas de numerosos terminales adrenérgicos y serotoninérgicos y, por tanto, sensibles a los efectos de un inhibidor de la recaptación de serotonina (5-HT) y norepinefrina (NE). El incremento de serotonina y noradrenalina en la zona del núcleo de Onuf, provoca un aumento de actividad neural que trae como consecuencia un estímulo que favorece una contracción prolongada del esfínter uretral. Según esta observación, cualquier fármaco que actúe en el sistema nervioso central (SNC) y produzca un incremento en el aporte de serotonina y noradrenalina tiene un efecto que puede potenciar la continencia. La duloxetina es un inhibidor combinado de la recaptación de 5-HT y NE. Los ensayos clínicos realizados en un total de 1.913 mujeres con IU de predominio de esfuerzo, con duloxetina frente a placebo y el metaanálisis de éstos, proporcionan datos consistentes y de peso que apoyan la seguridad y la eficacia de la duloxetina para el tratamiento de la IUE. Esta forma de tratamiento se podrá ofrecer como primera opción terapéutica, al igual que la reeducación muscular del suelo pélvico a mujeres con diagnóstico de IUE. Los estudios de extensión y el uso del fármaco en la práctica clínica, indicarán el lugar exacto que ocupará el tratamiento farmacológico de la IUE en el contexto de la atención a la IU en la mujer (AU)

Pubic bone anchoring devices for the surgical treatment of urinary stress incontinence in patients with severe genital prolapse.

The aim of this study was to test a surgical technique for the treatment of stress urinary incontinence associated with genital prolapse through a transvaginal suspension anchored to the pubic bone. Thirty-seven patients with severe genital prolapse and urodynamically proven stress incontinence were operated on with this procedure from February 1998 to May 2000. Preoperatively a detailed history, pelvic examination and urodynamic studies were carried out. The degree of prolapse was assessed pre- and postoperatively in the lithotomy position in accordance with the classification proposed by Baden and Walker [8]. Two titanium bone screws with no. 1 polypropylene sutures attached to them and a battery-operated screw inserter are used to fix the vaginal sutures to the pubic bone bilaterally. The procedure is performed transvaginally with no abdominal or suprapubic incisions. Objective outcomes were assessed by symptom assessment, clinical examination and a full urodynamic evaluation at 6 months postoperatively, and annually by clinical evaluation. Subjective outcomes were assessed by directly interviewing the patients about their postoperative urinary symptoms and asking them to classify their level of satisfaction. An objective cure rate (no objective loss of urine during coughing in the absence of a simultaneous detrusor contraction) at the 6-month postoperative urodynamic evaluation was observed in 23 of 37 patients (62%). Recurrent anterior vaginal wall prolapse (grade 2) had developed in 7 of 37 patients (27%). Subjectively, 73% of the patients expressed satisfaction with the procedure. Early results using two bone screws into the pubis to fix the periurethral and perivesical tissues and vagina to the posterior surface of the pubic bone were disappointing. Based on our results we have abandoned the use of this procedure to correct stress incontinence associated with severe genital prolapse.

Reconstitution of an electrogenic auxin transport activity mediated by Arabidopsis thaliana plasma membrane proteins.

Plasma membrane proteins from Arabidopsis thaliana leaves were reconstituted into proteoliposomes and a K+ diffusion potential was generated. The resulting ionic fluxes, determined in the presence of the plant hormone auxin (indole-3 acetic acid), showed an additional electrogenic and saturable component, with a K(M) of 6 microM. This flux was neither detected in liposomes in the presence of indole-3 acetic acid, nor in proteoliposomes in the presence of an inactive auxin analog and was completely inhibited by 3 microM naphtylphthalamic acid, a specific inhibitor of the auxin efflux carrier. The efficiency of the reconstituted carrier and the mechanism of its regulation by naphtylphthalamic acid are discussed.

Neurogenic bladder in patients with acquired immunodeficiency syndrome.

We have performed a urodynamic study on 3 patients with acquired immunodeficiency syndrome (AIDS), presenting with a neurogenic bladder. The first patient had an ascending myelitis of probable herpetic origin, the second patient had a cerebral abscess caused by Toxoplasma gondii, and the third patient had an AIDS dementia complex. The urodynamic study showed an areflexic detrusor in the first 2 patients, and a hyperreflexic detrusor in the third patient.

[Prolactin secretion in women using IUDs]. / Estudio de la secrecion de prolactina en pacientes portadoras de DIU.

PIP: Prolactin variations in women wearing IUDs (Lippes Loop, Copper T-Device) were evaluated. All had been wearing the devices for at least 6 months. Results are compared to those of a control group during the follicular and luteal phases. There was no increase observed in prolactin secretion in either phase in relation to the control group. However, there was a slight increase in prolactin secretion during the luteal phase in patients wearing IUDs as compared to the follicular phase; nevertheless, this increase was not significant. It is concluded that the IUD does not influence the normal variations in prolactin secretion.^ieng