Efficacy and safety of vaginal electrical stimulation as an alternative or adjunct treatment for overactive bladder syndrome in women: a meta-analysis of randomized controlled trials.

INTRODUCTION AND HYPOTHESIS: The objective was to evaluate the efficacy and safety of vaginal electrical stimulation (VES) as an alternative or adjunct treatment for overactive bladder (OAB) syndrome in women. METHODS: Five English-language databases and four Chinese-language databases were searched to identify relevant studies. Studies comparing VES (VES alone or VES plus other interventions) with other interventions (medicines, bladder training, or PFMT) were included. Voiding diary, quality of life (QoL), and adverse events were extracted from the included studies for comparison. RESULTS: Seven trials with 601 patients in total were reviewed. The results showed that when compared with other interventions, VES alone significantly improved urgency episodes (p = 0.0008) and voiding frequency (p = 0.01), but did not significantly reduce nocturia (p = 0.85), urinary incontinence episodes (p = 0.90) and number of pads (p = 0.87). When VES plus other interventions was compared with other interventions, the former significantly improved voiding frequency (p < 0.00001), nocturia (p < 0.00001), and number of pads (p = 0.03), but it did not significantly reduce urinary incontinence episodes (p = 0.24). Both VES alone (p < 0.00001) and VES plus other interventions (p = 0.003) showed significant benefit on QoL. CONCLUSIONS: This study demonstrated that VES alone decreased urgency episodes and QoL better than other therapies. Although VES alone reduced voiding frequency better and VES plus other therapies decreased nocturia, number of pads, urgency episodes, and QoL better than other therapies, the results should be interpreted with caution for clinical practice because some of the RCTs included were of low quality and because of the small number of studies included.

Reducing Falls in Older Women with Urinary Incontinence.

Urinary incontinence is common in older women and doubles the risk of falls in this population. The association between urinary incontinence, especially urgency urinary incontinence, and falls is multifactorial and likely the result of a complex interaction between physical, mental, social, and environmental factors. As a result of this multifactorial etiology and based on existing evidence, the integration of different fall prevention strategies including strength and resistance exercises, bladder training, and home hazard reduction have the potential to decrease the risk of falls in older women with urinary incontinence. Given the prevalence of urinary incontinence and the significant morbidity associated with falls, effective interventions to reduce fall risk in older women with urinary incontinence is of high public health significance.

Factors predicting the treatment success of bladder training for urgency urinary incontinence.

OBJECTIVE: To evaluate the efficacy of bladder training (BT) for urgency urinary incontinence (UUI) and to determine women characteristics that are predictors for success. METHODS: Clinical data of 110 women with UUI who had received BT over 8 weeks were analyzed retrospectively. Patients were evaluated in terms of incontinence severity (24-h pad test), 3-day voiding diary (frequency of voiding, nocturia, incontinence episodes, and the number of pads), symptom severity (OAB-V8), incontinence-related QoL (IIQ-7) and treatment success. Treatment success was evaluated at a ≥50% reduction in incontinence episodes at the end of the treatment. RESULTS: A statistically significant improvement was found in all parameters (incontinence severity, frequency of voiding, nocturia, incontinence episodes and the number of pads, symptom severity, and incontinence-related QoL) at the end of the treatment compared to the baseline values in women with UUI who had received BT (p < 0.001). The treatment success rate was 35.5%. In the multivariate analysis (OR, 95% CI), the treatment was found to be more successful in women with higher education levels (p = 0.012, p = 0.029) and of younger ages (p = 0.004). CONCLUSION: It can be concluded that the BT given to women with UUI is effective in reducing incontinence severity, frequency, nocturia, incontinence episodes, number of pads, symptom severity, and improving QoL. Young age and high education levels are the predictive factors in the treatment success of BT in women with UUI. For this reason, these predictive factors should be considered in determining the treatment strategy for women with UUI.

Study protocol for a parallel-group randomized controlled multi-center trial evaluating the additional effect of continuous ultrasound bladder monitoring in urotherapy for children with functional daytime urinary incontinence (SENS-U trial).

BACKGROUND: Lower urinary tract dysfunction or functional urinary incontinence is a common condition with a prevalence up to 21% between 6 and 8 year-old children. It is associated with an impaired quality of life, lower self-esteem, and social stigmatization. Urotherapy is the first treatment of choice for functional daytime urinary incontinence (DUI) in children. Alarm therapy can be a part of urotherapy as it provides the child adequate feedback on wetting accidents. Current alarm systems notify either at a set interval or give a notification when wetting has already occurred to prompt the child to go to the toilet. These alarms do not teach the child the interpretation of the bladder sensation preceding wetting accidents. A new wearable bladder sensor, the SENS-U, recently became available. This is a relative small, wireless ultrasonic sensor, which continuously monitors bladder filling. The SENS-U is able to provide an alarm at the exact moment voiding is warranted. It facilitates the child to learn the sensation of bladder filling preceding voiding in an easier way, increasing the learning curve throughout treatment. Its additional effect in urotherapy on continence and cost-effectiveness is to be determined. METHODS/DESIGN: This is a multi-center clinical superiority parallel-group randomized controlled trial including a total of 480 children. Participants between 6 and 16 years of age with functional DUI in which urotherapy is offered as the next treatment of choice are eligible. Four centers, two academic hospitals, and two general care (peripheral) centers are participating. Participants will be randomized at a 1:1:1 ratio into three groups: urotherapy (care as usual), urotherapy with the SENS-U added for 3 consecutive weeks throughout the training, or urotherapy with a SHAM device for 3 weeks. The primary outcome is number of wetting accidents per week after 3 months of training, compared between the SENS-U and the SHAM device. The magnitude of the placebo effect will be assessed by comparing the results of the SHAM group versus the control (care as usual) group. DISCUSSION: To our knowledge, this is the first trial studying not only the effect but also the cost-effectiveness of alarm interventions as commonly added in urotherapy. TRIAL REGISTRATION: ISRCTN44345202 . Registered on March 2022.

Systematic voiding programme in adults with urinary incontinence following acute stroke: the ICONS-II RCT.

BACKGROUND: Urinary incontinence affects around half of stroke survivors in the acute phase, and it often presents as a new problem after stroke or, if pre-existing, worsens significantly, adding to the disability and helplessness caused by neurological deficits. New management programmes after stroke are needed to address urinary incontinence early and effectively. OBJECTIVE: The Identifying Continence OptioNs after Stroke (ICONS)-II trial aimed to evaluate the clinical effectiveness and cost-effectiveness of a systematic voiding programme for urinary incontinence after stroke in hospital. DESIGN: This was a pragmatic, multicentre, individual-patient-randomised (1 : 1), parallel-group trial with an internal pilot. SETTING: Eighteen NHS stroke services with stroke units took part. PARTICIPANTS: Participants were adult men and women with acute stroke and urinary incontinence, including those with cognitive impairment. INTERVENTION: Participants were randomised to the intervention, a systematic voiding programme, or to usual care. The systematic voiding programme comprised assessment, behavioural interventions (bladder training or prompted voiding) and review. The assessment included evaluation of the need for and possible removal of an indwelling urinary catheter. The intervention began within 24 hours of recruitment and continued until discharge from the stroke unit. MAIN OUTCOME MEASURES: The primary outcome measure was severity of urinary incontinence (measured using the International Consultation on Incontinence Questionnaire) at 3 months post randomisation. Secondary outcome measures were taken at 3 and 6 months after randomisation and on discharge from the stroke unit. They included severity of urinary incontinence (at discharge and at 6 months), urinary symptoms, number of urinary tract infections, number of days indwelling urinary catheter was in situ, functional independence, quality of life, falls, mortality rate and costs. The trial statistician remained blinded until clinical effectiveness analysis was complete. RESULTS: The planned sample size was 1024 participants, with 512 allocated to each of the intervention and the usual-care groups. The internal pilot did not meet the target for recruitment and was extended to March 2020, with changes made to address low recruitment. The trial was paused in March 2020 because of COVID-19, and was later stopped, at which point 157 participants had been randomised (intervention, n = 79; usual care, n = 78). There were major issues with attrition, with 45% of the primary outcome data missing: 56% of the intervention group data and 35% of the usual-care group data. In terms of the primary outcome, patients allocated to the intervention group had a lower score for severity of urinary incontinence (higher scores indicate greater severity in urinary incontinence) than those allocated to the usual-care group, with means (standard deviations) of 8.1 (7.4) and 9.1 (7.8), respectively. LIMITATIONS: The trial was unable to recruit sufficient participants and had very high attrition, which resulted in seriously underpowered results. CONCLUSIONS: The internal pilot did not meet its target for recruitment and, despite recruitment subsequently being more promising, it was concluded that the trial was not feasible owing to the combined problems of poor recruitment, poor retention and COVID-19. The intervention group had a slightly lower score for severity of urinary incontinence at 3 months post randomisation, but this result should be interpreted with caution. FUTURE WORK: Further studies to assess the effectiveness of an intervention starting in or continuing into the community are required. TRIAL REGISTRATION: This trial is registered as ISRCTN14005026. FUNDING: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 31. See the NIHR Journals Library website for further project information.

Urinary incontinence affects around half of stroke survivors. It causes embarrassment and distress, affecting patients' ability to take part in rehabilitation. It also has a major impact on families and may determine whether or not patients are able to return home. Finding the underlying cause and addressing it can prevent, cure or reduce problems. Doing this in a systematic way for everyone with incontinence problems as early as possible after the stroke, while they are still in hospital, may work best. We also wanted to avoid using catheters in the bladder to drain the urine away, as these are often unnecessary and can cause urinary tract infections. This study aimed to test whether or not continence problems and the use of urinary catheters could be reduced if everyone with incontinence was fully assessed and given the right management and support early after hospital admission. We also wanted to find out if the benefits outweighed the costs. We planned to involve 1024 men and women with incontinence from 18 stroke units in the study, with 512 people receiving the intervention and 512 receiving usual care. However, the trial was paused because of COVID-19, at which time only 157 participants had been recruited. When we were thinking about restarting the study and looked at its progress, we found that not enough people had agreed to take part and, of those who had agreed, many had not returned their outcome questionnaires. This indicated that the trial was not feasible and should not restart. We could not make any firm conclusions about whether or not the intervention worked, as not enough people were involved. We found that stays in hospital after stroke are shorter than they were in the past. This suggests that future studies investigating ways of treating incontinence should consider interventions with management and support for incontinence that continue after patients leave the hospital.

Short-term effect of magnetic stimulation added to bladder training in women with idiopathic overactive bladder: A prospective randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of magnetic stimulation (MStim) added to bladder training (BT) on incontinence-related quality of life (QoL) and clinical parameters in women with idiopathic overactive bladder (OAB). MATERIAL AND METHODS: Seventy-six women with idiopathic OAB were randomized into two groups using the random numbers generator as follows: Group 1 received BT alone (n: 38), and Group 2 received BT + MStim (n: 38). MStim was performed with MStim therapy armchair (Novamag NT60), 2 days a week, 20 min a day, a total of 12 sessions for 6 weeks. Women were evaluated in terms of incontinence severity (24-h pad test), 3-day voiding diary (frequency of voiding, incontinence episodes, nocturia, and number of pads), symptom severity (OAB-V8), QoL (IIQ-7), positive response and cure-improvement rates, and treatment satisfaction (Likert scale) at the baseline and the end of treatment (sixth week). RESULTS: A statistically significant improvement was found in incontinence severity, frequency of voiding, incontinence episodes, nocturia, number of pads, symptom severity, and QoL parameters for two groups at the end of the treatment compared to the baseline values (p < 0.05). At the end of treatment; incontinence severity, incontinence episodes, nocturia, number of pads, symptom severity, and QoL were significantly improved in Group 2 compared to Group 1 (p < 0.05). No difference was found between the two groups in terms of frequency of voiding (p > 0.05). The positive response and cure-improvement rates, and treatment satisfaction were significantly higher in Group 2 than in Group 1 (p < 0.05). CONCLUSION: MStim added to BT is more effective than BT alone in women with idiopathic OAB.

Efficacy of percutaneous and transcutaneous tibial nerve stimulation in women with idiopathic overactive bladder: A prospective randomised controlled trial.

BACKGROUND: Different studies have reported the efficacy of percutaneous tibial nerve stimulation (PTNS) and transcutaneous tibial nerve stimulation (TTNS) in treating idiopathic overactive bladder (OAB). However, no study has compared the effectiveness of PTNS and TTNS added to bladder training (BT) in idiopathic OAB. OBJECTIVE: To compare the efficacy of PTNS and TTNS added to BT in women with idiopathic OAB. METHODS: We randomised 60 women with idiopathic OAB into 3 groups. Group 1 (n=19) received BT, Group 2 (n=19) received PTNS in addition to BT, and Group 3 (n=20) received TTNS in addition to BT. PTNS and TTNS were performed 2 days a week, for 30min a day, for a total of 12 sessions for 6 weeks. Patients were evaluated by incontinence severity (pad test), a 3-day voiding diary (frequency of voiding, incontinence episodes, nocturia and number of pads used), symptom severity, quality of life, treatment success (positive response rate), treatment satisfaction (Likert scale), discomfort level and preparation time for stimulation (sec). RESULTS: At the end of treatment; severity of incontinence, frequency of voiding, incontinence episodes, nocturia, number of pads used, symptom severity and quality of life were significantly improved in Groups 2 and 3 versus Group 1 (P<0.0167). Treatment success and treatment satisfaction were higher in Groups 2 and 3 than Group 1 (P<0.001 and P<0.0167, respectively). Level of discomfort was lower, treatment satisfaction was higher and preparation time for stimulation was shorter in Group 3 than Group 2 (P<0.05). CONCLUSION: Both the PTNS plus BT and TTNS plus BT were more effective than BT alone in women with idiopathic OAB. These 2 tibial nerve stimulation methods had similar clinical efficacy but with slight differences: TTNS had shorter preparation time, less discomfort level and higher patient satisfaction than PTNS.

Association of acute urinary retention in postoperative patients with a urinary catheter, with and without bladder catheter clamping. / Asociación de retención urinaria aguda en pacientes postoperados con catéter urinario, con y sin pinzamiento de catéter vesical.

INTRODUCTION: The use of a temporaryor permanent catheter is very common in clinical practice. Between 15.0% and 25.0% of hospitalized patients have in-dwelling bladder catheters, the majority of which are short-term. Bladder catheter clamping before catheter removal was generally regarded as useful in the past. Today, its utility is questionable. OBJECTIVE: To determine the association between bladder catheter clamping and spontaneous micturition or acute urinary retention (AUR) in postoperative patients with short-term indwelling bladder catheter. MATERIALS AND METHODS: A descriptive, comparative,longitudinal study was conducted at a secondary care hospital center in a western Mexican state .AUR was the outcome variable. Two study groups wereformed: patients with bladder catheter clamping (n=43) and the control patients with no bladder catheter clamping (n=41). Descriptive statistical analyses were performed, and percentage comparisons were made with the chi-squaretest. Significant predictors were subsequently added to the multivariate model. RESULTS: Fourteen percent (n=12) of all the study patients, with and without bladder catheter clamping, presented with AUR and 86% (n=72) did not. In the association analysis, there was no statistically significant difference between presenting with AUR and having or not having bladder catheter clamping (p=0.59). The associations of AUR with bladder re-catheterization (p=0.001), age (p=0.01), and the presence of lower urinary symptoms (p= 0.005) were statistically significant. CONCLUSION: Postoperative bladder catheter clamping was not associated with the presence of AUR.

INTRODUCCIÓN: El uso de un catéter urinario temporal o permanente es muy común en la práctica clínica. Entre el 15,0% y el 25,0% de los pacientes hospitalizados tienen catéteres vesicales, la mayoría a corto plazo. Durante mucho tiempo se había considerado a los ejercicios vesicales como una práctica útil antes del retiro de los mismos. En la actualidad su utilidad es muy cuestionable.OBJETIVOS: Determinar la asociación que tienen los ejercicios vesicales sobre la micción espontánea o retención aguda de orina en pacientes postoperados portadores de catéter urinario de corta duración.MATERIAL Y MÉTODOS: Se realizó un estudio comparativo, longitudinal y descriptivo en un hospital de 2º nivel de un estado de occidente de México. La variablede desenlace fue la retención aguda de orina. Se formaron dos grupos de estudio; con ejercicios vesicales y un grupo control sin ejercicios vesicales 43 sujetos vs- 41 respectivamente. Se realizaron pruebas estadísticas descriptivas y a comparación de porcentajes se realizó con la prueba Chi2. Posteriormente se agregaron predictores significativos al modelo multivariable.RESULTADOS: De los pacientes incluidos en el estudio con y sin ejercicios vesicales, 14% (12) presentaron retención aguda de orina (RAO) y 72% (86) no la presentaron. Haciendo un análisis de asociación, no hubo significancia estadística, tener RAO y hacer ejercicios vesicales o no hacerlos (p=0,59). Hubo asociación estadísticamente significativa cuando se compararon la recolocación del catéter urinario con RAO p=0,001, la edad con la RAO p=0,01 y la presencia de síntomas irritativos urinarios bajos p=0,005.CONCLUSIÓN: El realizar ejercicios vesicales en los pacientes postoperados no están asociados a la presencia de retención aguda de orina.

Asociación de retención urinaria aguda en pacientes postoperados con catéter urinario, con y sin pinzamiento de catéter vesical / Association of acute urinary retention in postoperative patients with urinary catheter, with and without bladder catheter clamping

Introducción: El uso de un catéterurinario temporal o permanente es muy común en lapráctica clínica. Entre el 15,0% y el 25,0% de los pacientes hospitalizados tienen catéteres vesicales, la mayoría a corto plazo. Durante mucho tiempo se habíaconsiderado a los ejercicios vesicales como una práctica útil antes del retiro de los mismos. En la actualidadsu utilidad es muy cuestionable. Objetivos: Determinar la asociación que tienen losejercicios vesicales sobre la micción espontánea o retención aguda de orina en pacientes postoperados portadores de catéter urinario de corta duración. MATERIAL Y MÉTODOS: Se realizó un estudio comparativo, longitudinal y descriptivo en un hospital de 2ºnivel de un estado de occidente de México. La variablede desenlace fue la retención aguda de orina. Se formaron dos grupos de estudio; con ejercicios vesicalesy un grupo control sin ejercicios vesicales 43 sujetosvs- 41 respectivamente.Se realizaron pruebas estadísticas descriptivas y a comparación de porcentajes se realizó con la prueba Chi 2.Posteriormente se agregaron predictores significativos almodelo multivariable. Resultados: De los pacientes incluidos en el estudiocon y sin ejercicios vesicales, 14% (12) presentaron retención aguda de orina (RAO) y 72% (86) no la presentaron. Haciendo un análisis de asociación, no hubosignificancia estadística, tener RAO y hacer ejerciciosvesicales o no hacerlos (p=0,59). Hubo asociación estadísticamente significativa cuando se compararon larecolocación del catéter urinario con RAO p=0,001, laedad con la RAO p=0,01 y la presencia de síntomasirritativos urinarios bajos p=0,005. Conclusion: El realizar ejercicios vesicales en lospacientes postoperados no están asociados a la presencia de retención aguda de orina.(AU)

Introduction: The use of a temporary or permanent catheter is very common in clinicalpractice. Between 15.0% and 25.0% of hospitalizedpatients have in-dwelling bladder catheters, the majorityof which are short-term. Bladder catheter clamping before catheter removal was generally regarded as usefulin the past. Today, its utility is questionable. Objetive: To determine the association between bladder catheter clamping and spontaneous micturition oracute urinary retention (AUR) in postoperative patientswith short-term indwelling bladder catheter.Materials and methods: A descriptive, comparative, longitudinal study was conducted at a secondary care hospital center in a western Mexican state.AUR was the outcome variable. Two study groups wereformed: patients with bladder catheter clamping (n=43)and the control patients with no bladder catheter clamping (n=41).Descriptive statistical analyses were performed, andpercentage comparisons were made with the chi-squaretest. Significant predictors were subsequently added tothe multivariate model. Results: Fourteen percent (n=12) of all the study patients, with and without bladder catheter clamping,presented with AUR and 86% (n=72) did not. In theassociation analysis, there was no statistically significantdifference between presenting with AUR and having ornot having bladder catheter clamping (p=0.59). Theassociations of AUR with bladder re-catheterization (p=0.001), age (p=0.01), and the presence of lower urinary symptoms (p= 0.005) were statistically significant. Conclusion: Postoperative bladder catheter clamping was not associated with the presence of AUR.(A U)

An in-home rehabilitation program for the treatment of urinary incontinence symptoms in endometrial cancer survivors: a single-case experimental design study.

INTRODUCTION AND HYPOTHESIS: There is a high prevalence of urinary incontinence among endometrial cancer survivors. They are also known to present with pelvic floor muscle alterations. Evidence on the effects of conservative interventions for the management of UI is scarce. This study aims at verifying the effects of an in-home rehabilitation program, including the use of a mobile technology, to reduce UI severity in endometrial cancer survivors. METHODS: This study used a single-case experimental design with replications. Primary outcome for UI severity was the pad test, and secondary outcomes were the ICIQ-UI SF questionnaire and 3-day bladder diary. Pelvic floor muscle function was assessed using 2D-transperineal ultrasound and intravaginal dynamometry. Adherence was documented using mobile technology and an exercise log. Visual and non-parametric analyses of longitudinal data were conducted. RESULTS: Results show a reduction in UI severity for 87.5% of participants, with a significant relative treatment effect of moderate size (RTE: 0.30). Significant small relative treatment effects were found for the quick contraction and endurance dynamometric tests. CONCLUSION: This study provides new evidence that endometrial cancer survivors can improve the severity of their UI following an in-home rehabilitation program, including the use of a mobile technology. This mode of delivery has the potential to address a gap in access to pelvic floor physiotherapy services for survivors of EC living in rural and remote communities.

Cognitive components of behavioral therapy for overactive bladder: a systematic review.

INTRODUCTION AND HYPOTHESIS: Behavioral therapy is the first-line treatment for overactive bladder (OAB); however, the cognitive components of behavioral therapy for OAB have not been evaluated. The purposes of this systematic review were to describe the cognitive components of behavioral therapy for OAB and evaluate their effectiveness as well as to describe their rationale and origins. METHODS: Searches were conducted on the PubMed, CINAHL, Web of Science, Cochrane and PEDro databases. Inclusion criteria were single-arm or randomized controlled trials on OAB treatment that utilized behavioral therapy, with a description of a cognitive component of the behavioral therapy. Study participants were neurologically intact adults (n = 1169). Study methodological quality was assessed with the PEDro and Newcastle-Ottawa scales. RESULTS: Five studies were included, published between 2009 and 2020. Methodological quality was variable. All studies reported a reduction of symptoms in participants receiving behavioral therapy. Cognitive components of behavioral therapy were not extensively described. Distraction was the most common cognitive strategy for managing urgency. The relative impact of the cognitive aspect of behavioral therapy could not be evaluated, and the cognitive aspects of behavioral therapy appear to be accepted wisdom, traceable to several key authors, that has not been subjected to scientific investigation. CONCLUSIONS: Behavioral therapy for OAB appears useful, but its cognitive components are not well described, their relative importance has not been evaluated or ascertained, nor have they been rigorously studied.

Which combination is most effective in women with idiopathic overactive bladder, including bladder training, biofeedback, and electrical stimulation? A prospective randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of single and combined use of biofeedback (BF) and electrical stimulation (ES) added to bladder training (BT) on incontinence-related quality of life (QoL) and clinical parameters in women with idiopathic overactive bladder (OAB). MATERIAL AND METHODS: Seventy women were randomized into four groups as follows: Group 1 received BT alone (n = 18), Group 2 received BT + BF (n = 17), Group 3 received BT + ES (n = 18), and Group 4 received BT + BF + ES (n = 17). BF and ES were performed 3 days a week, 20 min a day, a total of 24 sessions for 8 weeks. All women were evaluated in terms of incontinence severity (pad test), pelvic floor muscles strength (perineometer), 3-day voiding diary (frequency of voiding, nocturia, incontinence episodes, and number of pads), QoL (incontinence impact questionnaire), treatment success (positive response rate), cure/improvement rate, treatment satisfaction (Likert scale), and discomfort level (visual analog scale). RESULTS: At the end of the treatment, severity of incontinence, frequency of voiding, incontinence episodes, and treatment satisfaction significantly improved in Group 3 and Group 4 compared with the other two groups. In Group 3 and Group 4, high statistically significant values were found in cure/improvement and positive response rates as opposed to Group 1 and Group 2. In Group 2 and Group 3, statistically significant improvements were seen in nocturia and QoL compared with Group 1. Moreover, statistically significant improvements in nocturia and QoL were found in Group 4 compared with the other three groups. There was no difference in the discomfort level of application between the groups. CONCLUSION: We conclude that in the first-line conservative treatment of women with idiopathic OAB: (i) adding BF and/or ES to BT increases treatment effectiveness, (ii) clinical efficiency is greater when the combination includes ES, (iii) BT + BF + ES (triple combination) is the most effective treatment option in reducing nocturia and improving QoL.

Urge incontinence in postmenopausal women.

This article explores the social and physical issue of urge incontinence among postmenopausal women. This condition can severely inhibit the activities of the affected individual on a daily basis for fear of embarrassment due to its unpredictability. Urge incontinence is usually of mixed aetiology, and the symptoms are primarily the sudden onset of micturition unexpectedly in any situation. The treatments focus on the non-surgical support that can be given. Various physical therapies such as bladder training and core-stabilising exercises can be recommended, alongside counselling over the subject, and a range of medical treatments are available if non-medical treatments do not work, such as antimuscarinic drugs or as a last resort, botulinum type A injections. The psychosocial aspect is important, and the approach to care should be sensitive and empathetic. Use of 'I can't wait' cards is a helpful recommendation to those who wish to live a more active life but worry they are unable to queue in a long wait for the toilet. Review of fluid intake and existing medications, such as diuretics for use in heart failure, should also be considered, alongside lifestyle advice.

Conquering Bedwetting: Non-Pharmacologic Methods for Managing Nocturnal Enuresis.

Bedwetting, also called nocturnal enuresis, is a common developmental problem in school-aged children. In a study by Van Tijen, Messer, & Namdar (1998), children ranked it as the third most stressful life event, after parental fighting and divorce. About 15% of affected children outgrow bedwetting on their own each year without medical intervention (Kiddoo, 2015), but inadequate knowledge and lack of support and guidance from family may lead to low self-esteem and mental distress in children dealing with this situation. Nonpharmacologic interventions like bedwetting alarms have a higher success rate (75%) and lower relapse rate (41%) than pharmacologic interventions (Monda & Husmann, 1995). This article discusses nonpharmacologic interventions for nocturnal enuresis: bedwetting alarms, motivational therapy, dietary modification, behavioral modification, and pelvic floor muscle training.

The effects of bladder training on bladder functions after transurethral resection of prostate.

AIM AND OBJECTIVES: The aim of this was to examine the effect of bladder training on bladder functions. BACKGROUND: Urinary catheterization is frequently performed in order to evaluate the outcomes of the surgical procedures and to monitor the urine output after urology operations. DESIGN AND METHODS: This quasi-experimental study was conducted in the urology clinic in Istanbul, Turkey in which 50 males were nonrandomly assigned to either a bladder training (n = 28) or a control group (n =22). In the bladder training groups, the urinary catheters of the patients were clamped at 4-hr intervals and then were left open for 5 min on the second postoperative day. This study was created in accordance with TREND Statement Checklist. RESULTS: The first urgency time and the first voiding time were longer, and the prevoiding and the voiding volumes were higher following the removal of the catheter in the training group (p = 0.001). In addition, the evaluation of the patient bladder diaries in the first three days after the discharge period revealed that the daily frequencies of micturition and nocturia were lower (p = 0.04), the mean duration of intervals between the micturition was longer (p = 0.006), and the mean voided urinary volume was higher (p = 0.024) in the training group. CONCLUSION: At the end of the study, it is observed that bladder training performed by clamping the catheter on postoperative day 2 after Transurethral Resection of Prostate (TUR-P) operation is a significant positive effect on the storage symptoms of the patients. RELEVANCE TO CLINICAL PRACTICE: Before removing the urinary catheter, bladder training programme affects positively to patients, especially prevoiding and the voiding volumes, the daily frequencies of micturition and nocturia on postoperative periods.

Variations in implementation of bladder training for overactive bladder: an online international survey.

We distributed an online questionnaire to 365 health care professionals specialising in urogynaecology, using the International Urogynaecology Association (IUGA) and British Society of Urogynecolgoy (BSUG) directories to investigate how the bladder training (BT) is provided in their units. We assessed the techniques provided, who provides them, and how these techniques are implemented and taught to the patients. Two hundred and thirteen (59%) completed responses have been received. 88% of the respondents felt that BT is an important and effective tool in treating overactive bladder. 50.7% indicated those physiotherapists are the health care practitioners responsible to deliver BT in their units. 88.3% of respondents use face-to-face consultation to deliver BT, 11% only use leaflets sent to patients. 87% use bladder diaries before implementing their BT. 26.4% use anti-muscarinic medications with BT from the start.IMPACT STATEMENTWhat is already known on this subject? Bladder training (BT) is a well-established behavioural therapy used to treat overactive bladder with comparable efficacy to pharmacotherapy with less side effects. It I recommended to be offered as first line therapy for at least 6 weeks. However, there is no clarity about the techniques and the methods used to deliver it.What do the results of the study add? The current study aimed to find out how the BT programme delivered to patients using an online questionnaire directed to a mixed group of medical urogynecology practitioners in different geographical regions. It showed that there is a wide variation in how the BT is delivered and lack of consistency in the techniques used and the duration recommended.What are the implications of these findings for clinical practice and/or further research? Future well-designed research is needed to look at the best ways to give BT instructions, the frequency of supervision of patients who use BT, the appropriate time length of the BT programme, and the best strategies to control urgency.

Curative efficacy of low frequency electrical stimulation in preventing urinary retention after cervical cancer operation.

BACKGROUND: To evaluate the clinical significance of low-frequency electrical stimulation in preventing urinary retention after radical hysterectomy. METHODS: A total of 91 women with stage IA2-IB2 cervical cancer, who were treated with radical hysterectomy and lymphadenectomy from January 2009 to December 2012, were enrolled into this study and were randomly divided into two groups: trail group (48 cases) and control group (43 cases). Traditional bladder function training and low-frequency electrical stimulation were conducted in the trail group, while patients in the control group were only treated by traditional bladder training. The general condition, rate of urinary retention, and muscle strength grades of pelvic floor muscle in the perioperative period were compared between these two groups. RESULTS: The incidence of postoperative urinary retention in the electrical stimulation group was 10.41%, significantly lower than that in the control group (44.18%), and the difference was statistically significant (P < 0.01). The duration of postoperative fever and use of antibiotics were almost the same between these two groups. Eleven days after surgery, the difference in grades of the pelvic floor muscle between these two groups was not statistically significant. However, 14 days after the operation, grades of the pelvic floor muscle were significantly higher in the trail group than in the control group, and the difference was statistically significant (P < 0.01). In addition, although there was no significant difference between the two groups with different parameters (P = 0.782), the incidence of urinary retention was lower in the endorphins analgesia program group than in the neuromuscular repair program group (9.09% < 11.54%). CONCLUSION: Low-frequency electrical stimulation is more effective than conventional intervention in preventing urinary retention after radical hysterectomy. It also intensifies the recovery of pelvic muscle strength.

Feasibility of early postoperative bladder catheter removal without prior bladder-training exercises after laparoscopic nerve sparing radical hysterectomy.

The aim of the study is to evaluate the feasibility of early postoperative bladder catheter removal without prior bladder-training exercises after laparoscopic nerve sparing radical hysterectomy (LNSRH). The post-operative bladder catheterisation period of 30 patients who underwent LNSRH at two institutes in Egypt and Italy were prospectively evaluated with postoperative drainage of the bladder through a Foley catheter for two days without performing bladder-training exercise. The median duration for postoperative bladder catheterisation was 3.5 (3-5) days. Within the fifth postoperative day, 82.7% had a PVR urine volume less than 100 ml. None of the patients had PVR urine more than 100 ml more than 10 days after the operation with no need for self-catheterisation. These results support early postoperative bladder catheter removal without prior bladder-training exercises following LNSRH. IMPACT STATEMENT What is already known on this subject? Bladder-training exercise was used routinely following radical hysterectomy (RH) operations before bladder catheter removal. Only two studies reported that these exercises could be omitted, but one study was done on both laparoscopic and open RH patients and the other did not show whether the operation was nerve-sparing and whether it was done by laparoscopy or open technique. What the results of this study add? This study's results support early postoperative bladder catheter removal without prior bladder-training exercises after laparoscopic nerve sparing RH. What the implications are of these findings for clinical practice and/or further research? Excluding the unnecessary procedure of bladder training, which is time- and effort-consuming, after the operation.

Bladder training prior to urinary catheter removal in total joint arthroplasty. A randomized controlled trial.

BACKGROUND: Urinary catheters are commonly used in patients undergoing total hip and knee arthroplasty. Bladder training before catheter removal is reported to shorten the time to return to normal bladder function and reduce the incidence of urinary retention. OBJECTIVE: To evaluate the results of bladder training in patients with total hip and knee arthroplasty. DESIGN: Randomized controlled trial. SETTING: Orthopaedic Department of a tertiary Military Hospital. PARTICIPANTS: We enrolled consecutive patients undergoing total hip or knee arthroplasty during a period of 14 months. METHODS: We randomly allocated the participants into either a bladder training group, in which clamping was considered prior to catheter removal, or a free drainage removal group, using a computer-generated list and subsequently assessed their need for re-catheterization due to urinary retention. The primary outcome of this study was to evaluate if bladder training in patients with total hip and knee arthroplasty reduces the need for re-catheterization due to urinary retention. Multivariable logistic regression was used to model the association between postoperative urinary retention and independent variables (total hip or total knee arthroplasty, age, gender, and history of diabetes mellitus or prostatism). Secondary outcomes were the incidence of urinary tract infection, and subjective patients' symptoms. RESULTS: We included 218 patients in the study; 114 in the bladder training group and 104 in the free drainage removal group. All patients were over 50 years old with a mean age of 69.3 (SD = 8) years. We observed three cases of urinary retention in the bladder training and six in free drainage removal group, and the difference was not statistically significant (2.6% and 5.8% respectively, p = 0.316). We also observed increased odds of re-catheterization in patients with prostatism under medication (odds ratio was 26.42, p < 0.001). No infections or major subjective symptoms were noted. CONCLUSION: This trial shows that bladder training by catheter clamping offers no advantage over free draining removal of short-term urinary catheters in patients with total hip and knee arthroplasty. Therefore, we conclude that the bladder training procedure is not indicated. However, healthcare providers should monitor patients' urination after removal of the catheter.

Does a serious game increase intrinsic motivation in children receiving urotherapy?

INTRODUCTION: Urotherapy is considered the treatment of choice for children suffering daytime urinary incontinence (DUI). Urotherapy intends to improve bladder dysfunction for children with DUI. For children with refractory DUI, an intensive inpatient bladder training program exists, which focuses on relearning, concentration on, and awareness of the bladder. Children's motivation and adherence are key determinants of a successful training outcome. It is hypothesized that motivation endurance throughout the treatment process may be enhanced by a serious game training tool, which could make the training more appealing and rewarding. OBJECTIVE: The study explores intrinsic motivation in children receiving bladder training for DUI and whether using a serious game improves their intrinsic motivation. STUDY DESIGN: In this pragmatic study, 50 children were allowed to choose among receiving bladder training with (intervention group) or without the application of a serious game (control group). At 4, 8, and 12 weeks of training, children and parents were asked to complete the Intrinsic Motivation Inventory (IMI). Children also completed the Pediatric Urinary Incontinence Quality of Life Tool (PinQ) before the start of the training and 6 months thereafter. At 6-month follow-up, patients were ask to participate in two focus groups, wherein the children discussed how they used the serious game and which improvements they would prefer. RESULTS: Children who received standard bladder training with the addition of a serious game did not differ in terms of intrinsic motivation from children who underwent standard bladder training only. Training results were equal in both the groups, with 80% good or improved. Incontinence-related quality of life (QoL) improved accordingly. DISCUSSION: In contrast to the study expectations, this game did not increase intrinsic motivation. Findings on training and QoL results are consistent with those of previous studies in both interventions. Although a randomized design could have yielded more valid results than this preference-based approach, the latter is more congruent with clinical practice. In contrast to existing bladder diary apps, this game offers a combination of child-friendly instructions, explanation of bladder (dys)function, and keeping a bladder diary. Mobile devices are playing an increasingly important role in health care; therefore, an urotherapy app can be a complementary therapeutic tool. CONCLUSION: Most children find it attractive to combine bladder training with a serious game. However, no added value was found regarding intrinsic motivation and training results. All children with persistent DUI in this cohort were highly motivated to complete an intensive bladder training program.