The unmet needs in vaginal pessaries.

A pessary is a medical device that is inserted into the vagina to provide structural support to one or more of the descending vaginal compartments in women with pelvic organ prolapse. It is a common management option offered to women in the short and long term. This article will discuss the current use of vaginal pessaries for POP, the current challenges with their use and common complications seen in practise. It will also discuss the unmet needs in the current products available on the market and suggest ideas for product design, materials and considerations for future development.

Can we use machine learning to improve the interpretation and application of urodynamic data?: ICI-RS 2023.

INTRODUCTION: A "Think Tank" at the International Consultation on Incontinence-Research Society meeting held in Bristol, United Kingdom in June 2023 considered the progress and promise of machine learning (ML) applied to urodynamic data. METHODS: Examples of the use of ML applied to data from uroflowmetry, pressure flow studies and imaging were presented. The advantages and limitations of ML were considered. Recommendations made during the subsequent debate for research studies were recorded. RESULTS: ML analysis holds great promise for the kind of data generated in urodynamic studies. To date, ML techniques have not yet achieved sufficient accuracy for routine diagnostic application. Potential approaches that can improve the use of ML were agreed and research questions were proposed. CONCLUSIONS: ML is well suited to the analysis of urodynamic data, but results to date have not achieved clinical utility. It is considered likely that further research can improve the analysis of the large, multifactorial data sets generated by urodynamic clinics, and improve to some extent data pattern recognition that is currently subject to observer error and artefactual noise.

A specialist service evaluation: a cross-sectional survey approach.

This article presents the findings of a service evaluation of a specialist urogynaecology service and highlights the implications for nursing practice. AIMS: To evaluate the overall patient experience and the degree to which individual needs were being met, and make improvements to service delivery. METHOD: A cross-sectional survey questionnaire was sent to a random sample of women (n=350) who were registered on the electronic patient record system from January to June 2020. Two items on the questionnaire related specifically to communication with patients during the first COVID-19 lockdown in March 2020. Routine service data were collected and included in descriptive statistical analysis. Qualitative themes were thematically analysed. RESULTS: The response rate was 39% (n=137). More than 90% of respondents felt listened to during consultations with nursing and medical personnel, and had trust and confidence in their clinical expertise, felt involved with decisions about care and felt comfortable with intimate examinations. Negative responses related to poor communication with administration and rescheduling appointments. CONCLUSION: Findings resulted in a departmental review of admin processes, which resulted in improvements to administrative systems, staff training, communication and information giving, and directly benefited patients.

Healthcare professional's choice for surgical management of stress urinary incontinence in a U.K. tertiary hospital.

OBJECTIVE: In July 2018, NHS England, introduced a pause on vaginal mesh, including the mid-urethral sling (MUS) for treatment of stress urinary incontinence (SUI). NICE guidelines recommend MUS as one of the surgical options for SUI. The aim of our study was to investigate healthcare professionals choices for surgical treatment of SUI, if conservative measures failed. STUDY DESIGN: The urogynaecology department at our tertiary level hospital devised a questionnaire using SurveyMonkey. This was distributed via email to 1058 healthcare professionals of different medical backgrounds. The surgical options were based on the NICE guideline and its patient decision making aid. We also used surgical information from the British society of Urogynaecology (BSUG) and British association of urological surgeons (BAUS). RESULTS: We received 214 responses of which 204 were complete. Twenty six percent of replies were from obstetricians and gynaecologists, 36 % had over 20 years experience and 79 % were female. Forty four percent had no previous knowledge of surgical options. Mid-urethral sling was the most popular choice based on description, success and specific complications. Urethral bulking agent was the only option that increased in popularity after describing complications. Twenty two percent would avoid surgery due to the risk of complications. CONCLUSION: This is the first study evaluating healthcare professionals surgical choice for SUI. Despite negative media publicity and NHS pause on MUS, it was still the most popular choice before and after informing of specific complications. The urethral bulking agent was the only surgical treatment, which increased in popularity after considering complications.

Pharmacist's knowledge regarding the management of overactive bladder in elderly women.

OBJECTIVE: Anticholinergic drugs are the mainstay treatment of OAB. Anticholinergic load is the cumulative effect of taking anticholinergic medication. Recent evidence suggests that in the elderly this can have a detrimental affect, with the potential to develop dementia. A previous study found that knowledge of anticholinergic load was lacking in our healthcare professionals. The aim of this study was to assess knowledge of pharmacists, who in the UK have the potential where qualified to prescribe as well as dispense. STUDY DESIGN: A questionnaire was formulated based on the previous study. It was sent out to 418 pharmacists from; a south London hospital trust, a south London clinical commissioning group and United Kingdom Clinical Pharmacists Association. RESULTS: Seventy-five pharmacists completed the questionnaire. Solifenacin and tolterodine was the most popular drug prescribed in the elderly without dementia, whilst mirabegron was the most popular in the elderly with dementia. One pharmacist suggested using oxybutynin. Sixty-two percent discuss anticholinergic load with the patients, 40 % advice prescribers and 42 % consider anticholinergic load when dispensing the drug. Fifteen percent have had patients report confusion/memory loss. Thirty percent know how to assess anticholinergic load. Only 15 % felt dementia was a concern with anticholinergic drugs. Worryingly, 54 % though mirabegron exerted anticholinergic effects. CONCLUSION: This is the first study looking at pharmacist knowledge on the use of anticholinergic medication for OAB in elderly women. Knowledge amongst all healthcare professionals including pharmacists is lacking and needs to be improved.

Social media awareness among non-urogynecologists regarding the current mesh discussions in urogynecology: a survey study.

INTRODUCTION AND HYPOTHESIS: There has been a great deal of discussion about mesh complications in urogynecology in recent years. However, awareness of other doctors who are not urogynecologists is unknown. This study was aimed at determining the level of awareness of mesh discussions among medical doctors whose specialty is not urology or gynecology. METHODS: A survey study was administered, and all medical doctors, except gynecologists and urologists, were invited. Respondent doctors were classified into four groups: King's College Hospital (KCH), UK; Uludag University Hospital (UUH), Turkey; the United States (USA); and the world (WORLD). The primary outcome was the awareness of mesh discussion in urogynecology, and the secondary outcome was the social media awareness of the mesh discussion. RESULTS: 1231 doctors responded to the survey. The awareness of the current mesh problems among the respondent doctors was 15.8% in KCH, 15.4% in UUH, 26.9% in the USA, and 16.2% in WORLD. The social media awareness about mesh problems was 20.8% in KCH, 20.3% in UUH, 32.8% in the USA, and 20.6% in WORLD. Although there were no differences among three of the groups with regard to primary and secondary outcomes, the USA group score was statistically significantly higher than the others. CONCLUSIONS: Social media can influence doctors' thinking on controversial academic issues. In this survey study, non-urogynecologist doctors in the USA cohort have higher awareness levels and a higher social media awareness level than other groups.

Review of the 6th International Consultation on Incontinence: Primary prevention of urinary incontinence.

AIMS: To report the state of the science on primary prevention of urinary incontinence (UI) in adults from the 6th International Consultation on Incontinence with an update through January 2019. METHODS: Online databases PubMed, CINAHL, PsycInfo, and Medline were searched in March 2016 and February 2019 with a focus on literature published after 2010. The International Consultation on Urological Diseases modified Oxford Centre for Evidence-Based Medicine Levels of Evidence and grades of recommendation were used to evaluate the literature. RESULTS: Grade B recommendations to prevent UI in pregnant and postpartum women are available and promising evidence exists for educational interventions to prevent UI up to 2 years in older women. There is little evidence for adding preoperative pelvic floor muscle exercises to postprostatectomy pelvic floor muscle exercises for men to regain continence. Insufficient evidence exists for the effectiveness of screening for UI in women. The absence of information on primary prevention remains for adolescents, nulliparous and perimenopausal women, and middle-aged and aged men and women. CONCLUSIONS: Few primary prevention interventions for UI exist for specific populations, especially pregnant and postpartum women. Research interest in developing foundational knowledge to design these interventions is growing.

Recommendations and future research initiative to optimize bladder management in pregnancy and childbirth International Consultation on Incontinence - Research society 2018.

With increasing birth rates globally, obstetric bladder care and long term pelvic floor dysfunction continues to be a issue. This paper aims to provide an overview of the concerns in the antenatal, intrapartum an post partum periods and presents recommendation for the research requirements necessary and education to challenge current practice.

Vaginal Pessaries for Pelvic Organ Prolapse and Their Impact on Sexual Function.

INTRODUCTION: Pelvic organ prolapse (POP) is a common condition among parous women and its prevalence increases with age. Vaginal pessaries are one of the management options for women with prolapse. In the current health climate, where there are controversy surrounding surgical procedures, an increasing number of women are considering a pessary over surgical management. AIM: This article aims to provide an overview of POP, its associated symptoms, and the different types of pessaries available. It will go on to describe how sexual activity (SA) and sexual function (SF) needs to be considered as part of the pessary selection discussion, and common concerns expressed by women. METHODS: A literature review was undertaken to record the current evidence regarding SA and pessary use, and clinical practice and experience are discussed. MAIN OUTCOME MEASURES: The main outcome of this study was to consider the preservation or restoration of SF in women using a pessary for prolapse. RESULTS: There are several pessaries available on the market that enable women to maintain SA, and for many of these it will not be noticeable to their partners. If, however, the woman or their partner finds the pessary uncomfortable or obstructing during intercourse, women can be trained to remove and reinsert their pessary as necessary. The evidence suggests that, for those women who are sexually active with their pessaries in situ, they are happy and continue with this form of management in the long term. CONCLUSION: Health care professionals need to ensure that SF or the desire to be sexually active (in whatever form that may be) is assessed and discussed as part of routine care and is considered in all decision making. Rantell A. Vaginal Pessaries for Pelvic Organ Prolapse and Their Impact on Sexual Function. Sex Med Rev 2019;7:597-603.

Ambulatory urodynamics monitoring - a video demonstration.

AIMS: To present a narrated video designed to demonstrate the steps involved in performing and interpreting ambulatory urodynamics monitoring (AUM). METHODS: This video provides an overview of the role of AUM in clinical practice and describes the process of performing AUM using solid state microtip transducers and the MMS / Laborie Luna ambulatory recorder. Line placement, calibration and the urodynamic protocol are discussed along with descriptions of provocation tests that can be used during AUM. Examples of AUM traces are reviewed demonstrating common findings eg detrusor overactivity, urodynamic stress incontinence and voiding difficulties. Good urodynamic practice in relation to the interpretation of AUM is presented. Its application in clinical practice is often limited due to the cost of equipment (particularly the microtip transducers which range from £1200-£2500) and appropriate decontamination of the transducers (in this unit an anti-sporacidal 3 stage wipe system is employed (Tristel) however, many hospital infection control teams do not consider this sufficient so disposable water or air filled lines are used). Other limitations include the requirement for additional training and the time necessary to perform the test. RESULTS: This video will educate and inform health care professionals regarding AUM so that they may consider its use in their armamentarium of investigations of lower urinary tract function and be able to counsel patients appropriately should they choose to refer them to an alternative provider for further investigation if they do not have direct access in their service. CONCLUSION: AUM is a second line investigation of lower urinary tract dysfunction used in patients where conventional urodynamics have failed to make a diagnosis or replicate their symptoms. They allow for a more physiological assessment of bladder function. Protocols may vary from 1 h to 24 h but are dependent on re-creation of patient's symptoms.

AbobotulinumtoxinA for the treatment of overactive bladder.

INTRODUCTION: Overactive bladder is a common condition that can have a negative impact on quality of life. Botulinum Toxin A is a third line treatment for overactive bladder following conservative measures and anticholinergic medication. At present, OnabotulinumtoxinA is the only preparation licensed for this indication. More recently, trials have been undertaken to compare the efficacy of this to AbobotulinumtoxinA. Areas covered: This article aims to provide an overview of AbobotulinumtoxinA, which is currently not yet licensed for overactive bladder or neurogenic detrusor overactivity. It will detail the pharmacokinetics and dynamics, assess the available clinical trial data and make comparisons with current clinical practice. A systematic literature search was completed, using ovid Medline and Embase, with the aim to review all data concerning the administration of AbobotulinumtoxinA for the treatment of overactive bladder. Expert opinion: Currently, there are a lack of data on the use of AbobotulinumtoxinA for overactive bladder or neurogenic detrusor overactivity. Current evidence concentrates on its use in neurogenic detrusor overactivity, and there are data to show it may be as efficacious as OnabotulinumtoxinA. However, there is a lack of homogenous data to compare the two products and therefore we are unable to recommend this currently.

Selecting an intermittent self-catheter: key considerations.

This article explores the factors that must be considered when assessing patients for intermittent self-catherisation (ISC). It discusses the various types of intermittent catheters and their properties. Key considerations for the health professional when making product recommendations are covered and emphasis is placed on teaching patients the ISC technique. The article also highlights what patients value in terms of product choice and the importance of ongoing support. It concludes by introducing the GentleCath Glide, a new product that incorporates FeelClean™ technology, which leaves less residue on the hands and clothes.

What is the utility of urodynamics, including ambulatory, and 24 h monitoring, in predicting upper urinary tract damage in neuro-urological patients and other lower urinary tract dysfunction? ICI-RS 2017.

AIMS: This article focuses on how, and if, urodynamics can help to identify which kidneys are in danger of deteriorating in function and also gives recommendations for future research. METHODS: At the International Consultation on Incontinence-Research Society (ICI-RS) in 2017, a multi-disciplinary group presented a literature search of what is known about the utility of Urodynamics, including ambulatory, and 24 h monitoring, in predicting upper urinary tract damage in neuro-urological patients and other lower urinary tract dysfunctions. Wider discussions regarding knowledge gaps, and ideas for future research ensued and are presented in this paper along with a review of the evidence. RESULTS: The current treatment strategy both in congenital and acquired neurogenic bladder is rather aggressive and successful when addressing hazards to kidney function. This article has highlighted uncertainties concerning the use of 40 cmH2O DLPP and even the lower value of 20. The current literature suggests that patients with spina bifida and those with spinal cord injury have a higher risk of developing upper urinary tract damage and kidney function impairment than those with multiple sclerosis. CONCLUSIONS: Future research should focus on less invasive methods to assess the risk to the upper and lower urinary tract such as urine and serum measurements of cytokines that are involved in the pathophysiology of urinary tract impairment.

Narrated video demonstrating the procedure of videourodynamics.

AIMS: To present a narrated video designed to demonstrate the steps involved in the procedure of videourodynamics. METHODS: The technique shown and described in this teaching video is that performed in the urogynaecology Department at King's College Hospital, London. The equipment utilizes fluid filled lines and external pressure transducers which provide accurate and consistent results. RESULTS: The advantage of videocystourolodraphy is that as well as incorporating screening fluoroscopy with a cystometric trace, simultaneous assessment of lower urinary tract anatomy and morphology and function is possible. CONCLUSION: Videourodynamics or videocystourogrpahy is a diagnostic tool that incorporates urodynamics with imaging of the lower urinary tract which occurs simultaneously. Thus both functional anatomy and physiology can be assessed.

Lower urinary tract infections in women.

In her lifetime, a woman is highly likely to develop at least one lower urinary tract infection. Early detection and treatment are key. Being aware of predisposing factors for infection and understanding appropriate diagnosis and treatment regimens will help nurses in both primary and acute care manage these patients correctly. This will not only benefit patients but will also help prevent incorrect antimicrobial management and avoid unplanned admissions. This aim of this article is to provide nurses with the information they need to best advise both colleagues and patients on how to manage lower urinary tract infections in women.

How does lower urinary tract dysfunction affect sexual function in men and women? ICI-RS 2015-Part 1.

AIM: The aim of this paper is to review the literature on the effect of lower urinary tract symptoms (LUTS) on sexual function and dysfunction. METHODS: At the International Consultation on Incontinence-Research Society (ICI-RS) in 2015, a multidisciplinary group presented a literature search of what is known about the effect of lower urinary tract dysfunction (LUTD) on sexual function (SF) in men and women. Wider discussions regarding knowledge gaps and ideal research methodology ensued. RESULTS: A body of evidence supports associations between LUTS/urinary incontinence on SF in both men and women, but the true prevalence of the impact of LUTD on SF remains largely unknown. There is still reluctance among health care professionals (HCP's) to discuss SF with patients and often patients who are not asked will not volunteer their problems. CONCLUSION: A significant knowledge gap in this area remains. Education among HCP's on assessment and treatment of sexual dysfunction and communication skills are essential to encourage, and engage patients with HCP's. Neurourol. Urodynam. 36:949-952, 2017. © 2017 Wiley Periodicals, Inc.

How does lower urinary tract dysfunction (LUTD) affect sexual function in men and women? ICI-RS 2015-Part 2.

AIM: To discuss available data on the links between LUTD and sexual dysfunction, what is still unknown about the causative effect of disease processes on sexual function (SF), and to suggest proposals for further research. METHODS: At the 2015 International Consultation on Incontinence-Research Society (ICI-RS), a multi-disciplinary group presented a literature search of what is known about the effect of LUTD on SF in men and women. Wider discussions regarding knowledge gaps, and ideal research methodology ensued and are presented. RESULTS: The underlying mechanisms of the impact of LUTD on SF remain largely unknown. Risk factors for the metabolic syndrome may cause both LUTS and ED in men, and their improvement may improve both conditions. In women, neurovascular changes may be common in LUTD and FSD. Successful LUTS management results in FSD improvement, but the mechanisms are ill understood. Gaps in standardization of sexual dysfunction terminology, variations of assessment, and treatment in clinical practice and research make most studies not comparable. The sensitive knowledge and subjective nature of the problem present challenges and often result in neglecting it. CONCLUSION: Neurovascular and hormonal factors, but also indirect effects may link LUTD to SD in both sexes, but the evidence is not robust and the mechanisms unclear. There is a need for defining the terminology and standardizing outcomes assessed in clinical trials. The multifactorial nature of SF in both sexes makes trial design challenging and "real world" studies may prove more beneficial for patients' outcomes and clinicians' understanding.

Adolescents with nocturnal enuresis and daytime urinary incontinence-How can pediatric and adult care be improved-ICI-RS 2015?

AIMS: Nocturnal enuresis (NE) and daytime urinary incontinence (DUI) are common in adolescents. The aim of this paper was to review studies on prevalence, clinical symptoms and associated risk factors and to formulate recommendations for assessment and treatment. MATERIALS AND METHODS: A systematic Scopus search was performed and relevant publications were selected. The topic was discussed during the ICI-RS meeting in 2015. RESULTS: One to two percent of older adolescents are affected by NE and 1% by DUI. NE and DUI are associated with multiple risk factors such as fecal incontinence and constipation, obesity, chronic illness, and psychological impairment. Chronic treatment-resistant, relapsing and new-onset cases can occur. Adolescent NE and DUI can be treated by a multidisciplinary team according to pediatric principles. Additional treatment components have been developed for adolescents. Transition from pediatric to adult services is frequently disorganized. CONCLUSIONS: Incontinence in adolescents is a neglected research topic and clinical care is often suboptimal. As adolescents are seen by both pediatric and adult services, alignment and harmonization of diagnostic and therapeutic principles is needed. Also, an organized transition process is recommended to improve care for adolescent patients. Neurourol. Urodynam. 36:843-849, 2017. © 2017 Wiley Periodicals, Inc.