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Clinical Factors Associated with Low Valsalva Leak Point Pressure Among Women with Stress Urinary Incontinence.

Sun Ouck KIM ; Young Jung KIM ; Dong Hoon YOO ; In Sang HWANG ; Eu Chang HWANG ; Seung Il JUNG ; Taek Won KANG ; Dongdeuk KWON ; Kwangsung PARK

International Neurourology Journal.2011;15(4):211-215.

PURPOSE: The purpose of this study is to determine the predictive factors that are associated with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) in women. METHODS: Between January 2008 and December 2009, 185 women with urodynamically proven SUI were included in this study and retrospectively reviewed the medical record. Preoperative SUI symptoms were classified by Stamey grade. Valsalva leak point pressure (VLPP) determination series was repeated two times in each subject after finishing one series of VLPP measurement. The patients were classified into three groups according to VLPP; 1) ISD: VLPP< or =60 cm H2O, 2) equivocal: 6090 cm H2O. Chi-square test and multivariate (logistic regression test) analyses were performed to determine the factors associated with ISD. RESULTS: The mean patient age was 54.2 years (range, 44.5 to 68.4 years). Seventy-one women (38.3%) were in the ISD group and 70 (37.8%) in the AI group. The results of univariate and multivariate analyses found that women with ISD had a higher symptom grade than women with AI (P=0.001 and 0.0001, respectively). The number of patients in the ISD and AI group in accordance with the symptom grade were 7 (10%) and 44 (62%) in grade I, 50 (54%) and 23 (25%) in grade II, and 14 (63%) and 3 (14%) in grade III respectively. There was no correlation between VLPP and other clinical factors. CONCLUSIONS: High symptom grade was the only independent clinical factor that predicted the presence of ISD. This should be considered when counseling the patients with SUI.
Counseling ; Female ; Humans ; Medical Records ; Multivariate Analysis ; Retrospective Studies ; Urinary Incontinence

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The Prevalence and Therapeutic Effect of Constipation in Pediatric Overactive Bladder.

Ji Hyun KIM ; Ji Hyun LEE ; A Young JUNG ; Jung Won LEE

International Neurourology Journal.2011;15(4):206-210.

PURPOSE: Overactive bladder (OAB) is a manifestation of urgency, regardless of urge incontinence, due to involuntary bladder contraction during the storage period. There is a close association between constipation and OAB, but constipation cannot be readily diagnosed. The aims of this study were to evaluate the prevalence of constipation in OAB and the consequent therapeutic effects according to the diagnostic criteria for constipation. METHODS: We collected clinical data from 40 children (mean age, 71+/-22 months) with chief complaints of urgency, frequency, and incontinence. A voiding questionnaire and a 2-day voiding diary were collected, and urinalysis, the Bristol stool scale, and plain abdominal radiography were performed. Constipation was defined as conditions satisfying at least one of the following criteria: Rome III diagnostic criteria, Bristol stool scale types I/II, or a Leech score higher than 8 points as determined by plain radiography. Lower urinary tract symptoms, defecation symptoms, and the bladder volume of patients were examined, and the therapeutic outcomes by constipation diagnostic criteria were evaluated. RESULTS: Of the 40 OAB patients, 25 had constipation. Among them, 6 had reduced functional bladder capacity (24%; P>0.05). Regarding treatment, in patients who satisfied only one diagnostic criterion, the symptoms improved in 76.9%, 76.9%, and 69.6% of patients meeting the Rome III criteria, Bristol stool scale, and Leech score, respectively (P<0.05). Among the 8 patients satisfying all three criteria, 75% responded to treatment (P<0.05). CONCLUSIONS: The prevalence of constipation in OAB is high. Constipated patients recruited by use of the Rome III criteria, Bristol scale, and Leech score alone and together showed similar outcomes on OAB improvement after the treatment of constipation, which implies that each criterion has the same strength and can be applied comprehensively and generally.
Child ; Constipation ; Contracts ; Defecation ; Humans ; Lower Urinary Tract Symptoms ; Pediatrics ; Prevalence ; Radiography, Abdominal ; Rome ; Urinalysis ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Incontinence, Urge

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Effects of Spinal and Peripheral Injection of alpha1A or alpha1D Adrenoceptor Antagonists on Bladder Activity in Rat Models with or without Bladder Outlet Obstruction.

Jae Heon KIM ; Ji Sung SHIM ; Seung Chul KANG ; Kang Soo SHIM ; Jae Young PARK ; Du Geon MOON ; Jeong Gu LEE ; Jae Hyun BAE

International Neurourology Journal.2011;15(4):199-205.

PURPOSE: Antagonists of alpha1-adrenergic receptors (alpha1ARs) relax prostate smooth muscle and relieve voiding and storage symptoms. Recently, increased expression of alpha1ARs with change of its subtype expression has been proved in bladder outlet obstruction (BOO). To search for the evidence of changes in alpha1ARs subtype expression and activity in the peripheral and spinal routes, the effects of spinal and peripheral administration of tamsulosin (an alpha1A/D-selective AR), naftopidil (an alpha1A/D-selective AR), and doxazosin (non-selective AR) on bladder activity were investigated in a rat model with or without BOO. METHODS: A total of 65 female Sprague-Dawley rats were divided into the BOO surgery group (n=47) and the sham surgery group (n=18). After 6 weeks, cystometry was assessed before and after intrathecal and intra-arterial administrations of tamsulosin, naftopidil, and doxazosin. RESULTS: After intra-arterial administrations of all three drugs, bladder capacity (BC) was increased and maximal intravesical pressure (Pmax) was decreased in both BOO and the sham rat models (P<0.05). After intrathecal administration of all three drugs, BC was increased and Pmax was decreased in only the BOO group. The episodes of involuntary contraction in the BOO rat models were decreased by intra-arterial administration (P=0.031). The increase of BC after intrathercal and intra-arterial administrations of alpha1ARs was significantly greater in the BOO group than in the sham group (P=0.023, P=0.041). In the BOO group, the increase of BC and decrease in Pmax were greater by intra-arterial administration than by intrathecal administration (P=0.035). There were no significant differences of the degrees of changes in the cystometric parameters among the three different alpha1ARs. CONCLUSIONS: Up-regulations of the alpha1ARs in BOO were observed by the greater increases of BC after alpha1AR antagonist administrations in the BOO group than in the sham group. However, there were no subtype differences of the alpha1ARs in functional parameters of bladder activity. In addition, alpha1ARs also act on the lumbosacral cord which implies that the sensitivity of alpha1ARs is increased in pathologic models such as BOO. Further evaluation including differential expression of alpha1ARs in BOO models are need.
Adrenergic alpha-Antagonists ; Animals ; Contracts ; Doxazosin ; Female ; Humans ; Muscle, Smooth ; Naphthalenes ; Piperazines ; Prostate ; Rats ; Rats, Sprague-Dawley ; Salicylamides ; Sulfonamides ; Urinary Bladder ; Urinary Bladder Neck Obstruction

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Development and Changes with Age of Detrusor Overactivity in Spontaneous Hypertensive Rats as Observed by Simultaneous Registrations of Intravesical and Intraabdominal Pressures.

Long Hu JIN ; Hun Jae LEE ; Hwa Yoan SHIN ; Bo Hwa CHOI ; Sang Min YOON ; Chang Shin PARK ; Tack LEE

International Neurourology Journal.2011;15(4):192-198.

PURPOSE: Overactive bladder is especially common in the elderly, although it is not regarded as a normal part of aging. Thus, we investigated how aging alters the cystometric and detrusor overactivity (DO) parameters and the density of nerve growth factor (NGF) in awake spontaneous hypertensive rats (SHRs) of different ages. METHODS: Three age groups of 12- (n=5), 17- (n=6), and 21- (n=6) week-old SHRs (Oriental Bio Inc.) were used. A catheter was implanted into the bladder to record the intravesical pressure (IVP), and a balloon-fitted catheter was positioned in the abdominal cavity to record the intraabdominal pressure (IAP). Of the IVP elevations above 2 cm H2O, DO was defined as a rise in IVP without a simultaneous change in IAP and was counted during the filling phase. We measured the expression of NGF in the bladders by enzyme-linked immunosorbent assay. RESULTS: Both the body and bladder weights significantly increased with age, but the normalized ratio between those was not changed. As for DO, none of the12-week-old rats showed DO, whereas the other groups did. DO increased significantly with age (P=0.0045 by Mantel-Haenszel trend test), although no significant differences were found in DO frequency or pressure between the 17- and 21-week-old age groups. NGF did not show any significant differences among the three groups. CONCLUSIONS: Our results showed that SHRs begin to shows DO after a certain age, such as 12 weeks of age, and that the occurrence of DO has a close relationship with aging. However, NGF, which is known to be increased in the bladder wall of patients with overactive bladder, did not show any relationship with aging in this study.
Abdominal Cavity ; Aged ; Aging ; Animals ; Catheters ; Humans ; Nerve Growth Factor ; Rats ; Rats, Inbred SHR ; Urinary Bladder ; Urinary Bladder, Overactive ; Urodynamics ; Weights and Measures

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Antiproliferative Factor Signaling and Interstitial Cystitis/Painful Bladder Syndrome.

Jayoung KIM ; Michael R FREEMAN

International Neurourology Journal.2011;15(4):184-191.

A unique glycopeptide, antiproliferative factor (APF), has been suggested as a urinary biomarker and potential mediator of long-term bladder disorder Interstitial Cystitis/Painful Bladder Syndrome. There is no known cause for this disease. Several mechanistic approaches have been employed to address the underlying mechanism whereby APF regulates cellular responses in the bladder epithelium. A summary of recent literature is provided, and is focused on signal transduction pathways and networks that are responsive to APF.
Cystitis, Interstitial ; Epithelium ; Signal Transduction ; Urinary Bladder

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Potential Use of Antiproliferative Factor as a Targeting Therapy in Painful Bladder Syndrome/Interstitial Cystitis.

Khae Hawn KIM

International Neurourology Journal.2011;15(4):183-183.

No abstract available.
Cystitis ; Urinary Bladder

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Development of Personalized Urination Recognition Technology Using Smart Bands.

Sung Jong EUN ; Taeg Keun WHANGBO ; Dong Kyun PARK ; Khae Hawn KIM

International Neurourology Journal.2017;21(Suppl 1):S76-S83. doi:10.5213/inj.1734886.443

PURPOSE: This study collected and analyzed activity data sensed through smart bands worn by patients in order to resolve the clinical issues posed by using voiding charts. By developing a smart band-based algorithm for recognizing urination activity in patients, this study aimed to explore the feasibility of urination monitoring systems. METHODS: This study aimed to develop an algorithm that recognizes urination based on a patient's posture and changes in posture. Motion data was obtained from a smart band on the arm. An algorithm that recognizes the 3 stages of urination (forward movement, urination, backward movement) was developed based on data collected from a 3-axis accelerometer and from tilt angle data. Real-time data were acquired from the smart band, and for data corresponding to a certain duration, the absolute value of the signals was calculated and then compared with the set threshold value to determine the occurrence of vibration signals. In feature extraction, the most essential information describing each pattern was identified after analyzing the characteristics of the data. The results of the feature extraction process were sorted using a classifier to detect urination. RESULTS: An experiment was carried out to assess the performance of the recognition technology proposed in this study. The final accuracy of the algorithm was calculated based on clinical guidelines for urologists. The experiment showed a high average accuracy of 90.4%, proving the robustness of the proposed algorithm. CONCLUSIONS: The proposed urination recognition technology draws on acceleration data and tilt angle data collected via a smart band; these data were then analyzed using a classifier after comparative analyses with standardized feature patterns.
Acceleration ; Arm ; Humans ; Posture ; Urination* ; Vibration

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Development of Decision Support Formulas for the Prediction of Bladder Outlet Obstruction and Prostatic Surgery in Patients With Lower Urinary Tract Symptom/Benign Prostatic Hyperplasia: Part II, External Validation and Usability Testing of a Smartphone A.

Min Soo CHOO ; Seong Jin JEONG ; Sung Yong CHO ; Changwon YOO ; Chang Wook JEONG ; Ja Hyeon KU ; Seung June OH

International Neurourology Journal.2017;21(Suppl 1):S66-S75. doi:10.5213/inj.1734854.427

PURPOSE: We aimed to externally validate the prediction model we developed for having bladder outlet obstruction (BOO) and requiring prostatic surgery using 2 independent data sets from tertiary referral centers, and also aimed to validate a mobile app for using this model through usability testing. METHODS: Formulas and nomograms predicting whether a subject has BOO and needs prostatic surgery were validated with an external validation cohort from Seoul National University Bundang Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center between January 2004 and April 2015. A smartphone-based app was developed, and 8 young urologists were enrolled for usability testing to identify any human factor issues of the app. RESULTS: A total of 642 patients were included in the external validation cohort. No significant differences were found in the baseline characteristics of major parameters between the original (n=1,179) and the external validation cohort, except for the maximal flow rate. Predictions of requiring prostatic surgery in the validation cohort showed a sensitivity of 80.6%, a specificity of 73.2%, a positive predictive value of 49.7%, and a negative predictive value of 92.0%, and area under receiver operating curve of 0.84. The calibration plot indicated that the predictions have good correspondence. The decision curve showed also a high net benefit. Similar evaluation results using the external validation cohort were seen in the predictions of having BOO. Overall results of the usability test demonstrated that the app was user-friendly with no major human factor issues. CONCLUSIONS: External validation of these newly developed a prediction model demonstrated a moderate level of discrimination, adequate calibration, and high net benefit gains for predicting both having BOO and requiring prostatic surgery. Also a smartphone app implementing the prediction model was user-friendly with no major human factor issue.
Calibration ; Cohort Studies ; Dataset ; Decision Support Systems, Clinical ; Discrimination (Psychology) ; Humans ; Mobile Applications ; Nomograms ; Prostatic Hyperplasia* ; Sensitivity and Specificity ; Seoul ; Smartphone* ; Tertiary Care Centers ; Urinary Bladder Neck Obstruction* ; Urinary Bladder* ; Urinary Tract*

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Development of Decision Support Formulas for the Prediction of Bladder Outlet Obstruction and Prostatic Surgery in Patients With Lower Urinary Tract Symptom/Benign Prostatic Hyperplasia: Part I, Development of the Formula and its Internal Validation.

Min Soo CHOO ; Changwon YOO ; Sung Yong CHO ; Seong Jin JEONG ; Chang Wook JEONG ; Ja Hyeon KU ; Seung June OH

International Neurourology Journal.2017;21(Suppl 1):S55-S65. doi:10.5213/inj.1734852.426

PURPOSE: As the elderly population increases, a growing number of patients have lower urinary tract symptom (LUTS)/benign prostatic hyperplasia (BPH). The aim of this study was to develop decision support formulas and nomograms for the prediction of bladder outlet obstruction (BOO) and for BOO-related surgical decision-making, and to validate them in patients with LUTS/BPH. METHODS: Patient with LUTS/BPH between October 2004 and May 2014 were enrolled as a development cohort. The available variables included age, International Prostate Symptom Score, free uroflowmetry, postvoid residual volume, total prostate volume, and the results of a pressure-flow study. A causal Bayesian network analysis was used to identify relevant parameters. Using multivariate logistic regression analysis, formulas were developed to calculate the probabilities of having BOO and requiring prostatic surgery. Patients between June 2014 and December 2015 were prospectively enrolled for internal validation. Receiver operating characteristic curve analysis, calibration plots, and decision curve analysis were performed. RESULTS: A total of 1,179 male patients with LUTS/BPH, with a mean age of 66.1 years, were included as a development cohort. Another 253 patients were enrolled as an internal validation cohort. Using multivariate logistic regression analysis, 2 and 4 formulas were established to estimate the probabilities of having BOO and requiring prostatic surgery, respectively. Our analysis of the predictive accuracy of the model revealed area under the curve values of 0.82 for BOO and 0.87 for prostatic surgery. The sensitivity and specificity were 53.6% and 87.0% for BOO, and 91.6% and 50.0% for prostatic surgery, respectively. The calibration plot indicated that these prediction models showed a good correspondence. In addition, the decision curve analysis showed a high net benefit across the entire spectrum of probability thresholds. CONCLUSIONS: We established nomograms for the prediction of BOO and BOO-related prostatic surgery in patients with LUTS/BPH. Internal validation of the nomograms demonstrated that they predicted both having BOO and requiring prostatic surgery very well.
Aged ; Calibration ; Cohort Studies ; Decision Support Systems, Clinical ; Humans ; Logistic Models ; Male ; Nomograms ; Prospective Studies ; Prostate ; Prostatectomy ; Prostatic Hyperplasia* ; Residual Volume ; ROC Curve ; Sensitivity and Specificity ; Urinary Bladder Neck Obstruction* ; Urinary Bladder* ; Urinary Tract*

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Biodegradation and Biocompatibility of Poly L-lactic Acid Implantable Mesh.

Sang Don YOON ; Young Sam KWON ; Kyu Sung LEE

International Neurourology Journal.2017;21(Suppl 1):S48-S54. doi:10.5213/inj.1734882.441

PURPOSE: The purpose of this study was to evaluate the biodegradation and biocompatibility of poly L-lactic acid (PLLA) implantable mesh under in vitro and in vivo conditions. METHODS: PLLA mesh was examined for changes in weight and tensile strength. The histology of the tissue around the PLLA implant was also evaluated. RESULTS: The weight and tensile strength of the PLLA prosthesis was stable for 180 days. In addition, the surface of the PLLA mesh was not digested under in vitro or in vivo conditions as determined by scanning electron microscope. Histologically, there were no significant changes in the diameters of implanted PLLA mesh and subtype fibers over the course of 180 days. Likewise, there were no significant changes in the number of inflammatory and mast cells after 180 days, nor was there an increase in the percentage of collagen surrounding the PLLA mesh. CONCLUSIONS: The results indicate that PLLA prostheses have good rigidity and biocompatibility in vivo and in vitro.
Collagen ; In Vitro Techniques ; Lactic Acid* ; Mast Cells ; Prostheses and Implants ; Tensile Strength

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