Characteristics Associated with Treatment Response and Satisfaction in Women Undergoing OnabotulinumtoxinA and Sacral Neuromodulation for Refractory Urgency Urinary Incontinence.

PURPOSE: We sought to identify clinical and demographic characteristics associated with treatment response and satisfaction in women undergoing onabotulinumtoxinA and sacral neuromodulation therapies. MATERIALS AND METHODS: We analyzed data from the ROSETTA (Refractory Overactive Bladder: Sacral NEuromodulation versus BoTulinum Toxin Assessment) trial. Baseline participant characteristics and clinical variables were associated with 2 definitions of treatment response, including 1) a reduction in mean daily urgency incontinence episodes during 6 months and 2) a 50% or greater decrease in urgency incontinence episodes across 6 months. The OAB-S (Overactive Bladder-Satisfaction) questionnaire was used to assess satisfaction. RESULTS: A greater reduction in mean daily urgency incontinence episodes was associated with higher HUI-3 (Health Utility Index-3) scores in the onabotulinumtoxinA group and higher baseline incontinence episodes (each p <0.001) in the 2 groups. Increased age was associated with a lesser decrease in incontinence episodes in the 2 groups (p <0.001). Increasing body mass index (adjusted OR 0.82/5 points, 95% CI 0.70-0.96) was associated with reduced achievement of a 50% or greater decrease in incontinence episodes after each treatment. Greater age (adjusted OR 0.44/10 years, 95% CI 0.30-0.65) and a higher functional comorbidity index (adjusted OR 0.84/1 point, 95% CI 0.71-0.99) were associated with reduced achievement of a 50% or greater decrease in urgency incontinence episodes in the onabotulinumtoxinA group only (p <0.001 and 0.041, respectively). In the onabotulinumtoxinA group increased satisfaction was noted with higher HUI-3 score (p = 0.002) but there was less satisfaction with higher age (p = 0.001). CONCLUSIONS: Older women with multiple comorbidities, and decreased functional and health related quality of life had decreased treatment response and satisfaction with onabotulinumtoxinA compared to sacral neuromodulation for refractory urgency incontinence.

Anthropomorphic, hormonal, and psychologic correlates of semen quality in endurance-trained male athletes.

Twenty male marathon athletes were evaluated by hormonal profiles, psychologic testing, anthropomorphic indices, and semen evaluations. Although total testosterone (T) was significantly decreased in 14 of 20 subjects, free testosterone (FT) was within the normal range in the majority. Ninety percent of subjects (18 of 20) had normal semen analyses. Running mileage, body fat, T, and FT values did not correlate with semen quality. Two athletes with severe oligospermia were found to have the lowest values of T and FT and significant differences in psychologic stress scores. From these data we conclude that (1) vigorous endurance training may be associated with significantly decreased T values but not sperm production; (2) a subgroup of severely oligospermic athletes may be characterized by an "anorectic" symptom complex including higher stress, increased body leanness, and significantly decreased T levels; (3) male endocrine evaluation should be interpreted within the context of physical activity; and (4) factors other than T levels need to be evaluated when one is formulating a therapy plan in oligospermic male athletes.