ABSTRACT
INTRODUCTION AND OBJECTIVE: Multiple sclerosis (MS) is the most frequent autoimmune demyelinating disease of the central nervous system. MS patients usually present with lower urinary tract dysfunction (LUTD). Objective of this study is to evaluate and compare the efficacy and safety of treating MS patients with LUTD with either a b3 agonist (mirabegron) or anticholinergics. The study's primary outcome is the LUTD symptom improvement. MATERIAL AND METHODS: This is a multi-center, single-blinded, comparative study including 91 MS patients with LUTD. At baseline, patients underwent thorough clinical examination, urine cultivation and abdominal ultrasound and completed urination diaries and specific, validated questionnaires (NBSS, MusiQoL). At second visit, patients were administered either mirabegron or anticholinergics. Treatment was always carried out alongside with MS treatment. Reevaluation was performed 3 months after first visit. Patients underwent the same clinical and imaging tests that were carried out at first visit. RESULTS: We compared several clinical and imaging parameters between the two groups at first visit and month 3 after treatment. Νo statistical difference was noted between the mirabegron group and the anticholinergic group in terms of LUTD improvement. In both groups, improvement from baseline regarding LUTD was recorded. Statistical analysis was performed using the paired and unpaired t test method. No patient discontinued either medication due to side effects. CONCLUSIONS: MS patients receiving either mirabegron or anticholinergic therapy for LUTD showed improvement. Nevertheless, no statistical difference was noted between the two cohorts at 3 months in terms of drug efficacy in all the statistically significant parameters.
Subject(s)
Acetanilides , Cholinergic Antagonists , Lower Urinary Tract Symptoms , Multiple Sclerosis , Thiazoles , Acetanilides/administration & dosage , Acetanilides/adverse effects , Adrenergic beta-3 Receptor Agonists/administration & dosage , Adrenergic beta-3 Receptor Agonists/adverse effects , Cholinergic Antagonists/administration & dosage , Cholinergic Antagonists/adverse effects , Drug Monitoring/methods , Drug Monitoring/statistics & numerical data , Female , Humans , Lower Urinary Tract Symptoms/diagnosis , Lower Urinary Tract Symptoms/drug therapy , Lower Urinary Tract Symptoms/etiology , Male , Middle Aged , Multiple Sclerosis/diagnosis , Multiple Sclerosis/drug therapy , Multiple Sclerosis/physiopathology , Single-Blind Method , Symptom Assessment/methods , Thiazoles/administration & dosage , Thiazoles/adverse effects , Treatment Outcome , Ultrasonography/methodsABSTRACT
Nowadays, rigid and flexible ureteroscopy is a precise, minimal invasive surgery that can assess the entire collecting system in order to treat a stone with intracorporeal lithotripsy. The implication of laser technology has revolutionized the intracorporeal lithotripsy. Currently, laser lithotripsy is advancing in two different directions: improvements of the existing Ho:YAG laser platform and the development of novel laser systems. Herein, we review the current literature upon intracorporeal lithotripsy.
Subject(s)
Lasers, Solid-State/therapeutic use , Lithotripsy, Laser/methods , Urinary Calculi/therapy , Humans , Kidney Calculi/therapy , Lithotripsy, Laser/trends , Ureteral Calculi/therapyABSTRACT
OBJECTIVE: To assess the results of transurethral implantation of Macroplastique in women with stress incontinence secondary to urethral sphincter deficiency using subjective and objective outcome measures. METHODS: A total of 60 women with genuine stress incontinence secondary to intrinsic urethral sphincter deficiency were treated with transurethral implantation of Macroplastique. The patients had undergone a mean of 1.9 (range 0-7) previous episodes of continence surgery. Up to three treatment episodes were used, if necessary. The outcome was assessed by telephone interview (56 patients, mean follow-up period 19 months) and videocystometry (41 patients, mean follow-up period 16 months). Transurethral ultrasound scanning was performed in a further 9 patients. RESULTS: Symptomatically, 19.6% of the women interviewed by telephone considered themselves cured of their incontinence or were no longer using pads. A further 41.1% said their symptoms had significantly improved. Pad usage was reduced from a median of five to three pads per day (p < 0.001). Videocystometry in 41 women (mean follow-up period 16 months) was normal in 16 patients (39%) and showed genuine stress incontinence in 18 (43.9%) and detrusor instability in 12 patients (29.3%). Overall, 71.4% stated that they would undergo the procedure again under the same circumstances, and 80.4% would recommend this form of treatment to a friend with the same condition. Transurethral ultrasound scanning was performed in 9 patients (5 subjectively improved or cured, 1 patient with persistent symptoms but normal cystometry, and 3 patients with persistent genuine stress incontinence). Hyperechoic foci were seen surrounding the proximal urethra, consistent with implanted Macroplastique boluses. When completely encircling the urethra, the outcome was generally good. A total of 10 patients have undergone or are awaiting open surgery, and 3 are awaiting repeat implantation. CONCLUSION: Sustained improvement or cure of genuine stress incontinence has been achieved using Macroplastique in a large proportion of women with intrinsic sphincter deficiency, often following previous unsuccessful continence surgery. Transurethral ultrasound may prove to be a clinically useful imaging technique for the assessment and subsequent management of treatment failure following Macroplastique implantation.
