Clinical and Urodynamic Predictors of the Q-Tip Test in Women With Lower Urinary Tract Symptoms / 대한배뇨장애요실금학회지

Purpose@#The Q-tip test is used to measure urethral hypermobility and can predict surgical outcomes. However, certain factors may affect the reliability of this test. Our aim was to identify independent clinical and urodynamic predictors of the results of the Q-tip test. @*Methods@#Between January 2014 and June 2019, 176 consecutive women with lower urinary tract symptoms who underwent the Q-tip test and urodynamic studies were included in this retrospective study. @*Results@#Multivariable regression analysis revealed that age (regression coefficient, -0.55), point Ba (regression coefficient, 4.1), urodynamic stress incontinence (regression coefficient, 9.9), maximum flow rate (Qmax) (regression coefficient, 0.13), pressure transmission ratio (PTR) at maximum urethral pressure (MUP) (regression coefficient, -0.14), and the score on the fifth question of the Incontinence Impact Questionnaire (IIQQ5; “Has urine leakage affected your participation in social activities outside your home?”; regression coefficient, -4.1) were independent predictors of the Q-tip angle, with a constant of 87.0. The following Spearman rank correlation coefficients were found between the Q-tip angle and the following variables: age, -0.38; point Ba, 0.34; urodynamic stress incontinence, 0.32; Qmax, 0.28; PTR at MUP, -0.28; and IIQQ5, -0.23. A receiver operating characteristic curve (ROC) analysis for the prediction of urodynamic stress incontinence found that the optimum cutoff for PTR at MUP was <81%, with an area under the ROC curve of 0.70. @*Conclusions@#Age, point Ba, urodynamic stress incontinence, Qmax, PTR at MUP, and IIQQ5 were independent predictors of the Q-tip angle. However, none of these could be used as effective surrogates for the Q-tip test due to their lack of a sufficient correlation.

Urodynamic and Bladder Diary Factors Predict Overactive Bladder-wet in Women: A Comparison With Overactive Bladder-dry / 대한배뇨장애요실금학회지

PURPOSE: To identify factors predicting the presence of overactive bladder syndrome (OAB)-wet, compared with OAB-dry. METHODS: Between September 2007 and September 2013, the medical records of 623 women with OAB who completed a 3-day bladder diary and underwent urodynamic studies in a medical center were retrospectively reviewed. OAB-wet was diagnosed in patients who complained of at least one episode of urgency incontinence in the previous month; otherwise, OAB-dry was diagnosed. Multivariable logistic regression analysis was used to predict the presence of OAB-wet. RESULTS: Age (odds ratio [OR], 1.05; P<0.001), maximal flow rate (Qmax) (OR,1.06; P<0.001), voided volume (OR, 0.996; P=0.001), detrusor pressure at maximal flow rate (PdetQmax) (OR, 1.02; P=0.003), urgency episodes (OR, 1.04; P<0.001) and urodynamic stress incontinence (OR,1.78; P=0.01) were independent predictors for the presence of OAB-wet vs. OAB-dry. If we use bladder contractility index as a variable for multivariable logistic regression analysis, bladder contractility index (OR, 1.012; P<0.001) become an independent predictor for OAB-wet. CONCLUSIONS: A smaller bladder capacity and more frequent urgency episodes were predictors of OAB-wet, and the above findings indicate that OAB-wet and OAB-dry might be a continuum of OAB. Old age, high Qmax, high PdetQmax and urodynamic stress incontinence were also predictors for OAB-wet, and the above results reveal that OAB-wet and OAB-dry have partially different clinical and urodynamic features. Further studies might be performed to elucidate whether different treatment strategies between OAB-dry and OAB-wet can improve treatment efficacy.

Treatment outcomes of patients with stage II pure endometrioid-type endometrial cancer: a Taiwanese Gynecologic Oncology Group (TGOG-2006) retrospective cohort study / 부인종양

OBJECTIVE: Choice of hysterectomy and adjuvant treatment for International Federation of Gynecology and Obstetrics (FIGO) 2009 stage II endometrioid endometrial cancer (EEC) is still controversial. Aims of this study were to evaluate survival benefits and adverse effects of different hysterectomies with or without adjuvant radiotherapy (RT), and to identify prognostic factors. METHODS: The patients at 14 member hospitals of the Taiwanese Gynecologic Oncology Group from 1992 to 2013 were retrospectively investigated. Patients were divided into simple hysterectomy (SH) alone, SH with RT, radical hysterectomy (RH) alone, and RH with RT groups. Endpoints were recurrence-free survival (RFS), overall survival (OS), disease-specific survival (DSS), adverse effects and prognostic factors for survival. RESULTS: Total of 246 patients were enrolled. The 5-year RFS, OS, DSS and recurrence rates for the entire cohort were 89.5%, 94.3%, 96.2% and 10.2%, respectively. Patients receiving RH had more adverse effects including blood loss (p < 0.001), recurrent urinary tract infections (p = 0.013), and leg lymphedema (p = 0.038). Age over 50-year (HR = 9.2; 95% confidence interval [CI], 1.2–70.9) and grade 3 histology (HR = 7.28; 95% CI, 1.45–36.6) were independent predictors of OS. Grade 3 histology was an independent predictor of RFS (HR = 5.13; 95% CI, 1.38–19.1) and DSS (HR = 5.97; 95% CI, 1.06–58.7). Patients receiving adjuvant RT had lower locoregional recurrence (p = 0.046), but no impact on survival. CONCLUSION: Different treatment modalities yield similar survival outcomes. Patients receiving SH with RT had lower locoregional recurrent with acceptable morbidity. Age and tumor grading remained significant predictors for survival among patients with FIGO 2009 stage II EEC.

The Overactive Bladder Symptom Score, International Prostate Symptom Score–Storage Subscore, and Urgency Severity Score in Patients With Overactive Bladder and Hypersensitive Bladder: Which Scoring System is Best? / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the correlations among the Overactive Bladder Symptom Score (OABSS), International Prostate Symptom Score–Storage Subscore (IPSS-S), and the modified Urgency Severity Scale (USS) in patients with overactive bladder (OAB) and hypersensitive bladder (HSB) and to identify the most useful diagnostic tool for classifying the severity of OAB. METHODS: We retrospectively reviewed the charts of consecutive patients with OAB who visited our urologic clinics for treatment. All patients underwent a detailed history, physical examination, urinalysis, uroflowmetry, and postvoid residual volume measurement, and completed a 3-day voiding diary. All patients answered the Chinese versions of the IPSS, OABSS, and USS, according to which they were classified as having wet or dry OAB based on whether their chief complaint was urgency urinary incontinence or urgency without incontinence. HSB was defined as a functional bladder capacity OABSS>IPSS-S. The simplest survey, the USS, with a single item scored from 0 to 4, had the strongest correlation with the OAB severity subgroups.

Duration of Antimuscarinic Administration for Treatment of Overactive Bladder Before Which One Can Assess Efficacy: An Analysis of Predictive Factors / 대한배뇨장애요실금학회지

PURPOSE: To determine the duration of antimuscarinic therapy for overactive bladder syndrome (OAB) appropriate for assessment of the efficacy of treatment, and to evaluate the possible predictive factors for response to therapy. METHODS: All OAB patients who visited a urology outpatient clinic of a tertiary referral center and who were prescribed 5 mg of solifenacin or 4 mg of tolterodine extended release capsules daily were enrolled in the study. Patients were asked to continue therapy for 6 months. All enrolled patients completed the patient perception of bladder condition, overactive bladder symptom score (OABSS), and the modified Indevus Urgency Severity Scale questionnaires. All patients underwent uroflowmetry. RESULTS: A total of 164 patients were enrolled and 125 patients (76%) had at least one follow-up visit. The mean follow-up interval was 1 month (range, 0.5-6 months). Sixty-two patients (49.6%; 95% confidence interval [CI], 40.7-58.5) responded to antimuscarinic treatment. The median time for the onset of response was 3 months (95% CI, 1-6). Multivariate Cox proportional-hazards model revealed that elevated baseline OABSS was an independent predictor of responsiveness to therapy. Receiver operating characteristic (ROC) curve analysis revealed an optimal OABSS cutoff value of > or =7, with an area under the ROC curve of 0.79 (95% CI, 0.70-0.88; sensitivity, 91.9%; specificity, 60.7%). CONCLUSIONS: The median time for a therapeutic response was 3 months, and OABSS was the only predictor for responsiveness. These findings may serve as a guideline when prescribing antimuscarinic treatment for OAB patients.