Urge urinary incontinence (UUI) is one of the most troublesome complications of surgery of the prostate whether for malignancy or benign conditions. For many decades, there have been attempts to reduce the morbidity of this outcome with variable results. Since its development in the 1970s, the artificial urinary sphincter (AUS) has been the "gold standard" for treatment of the most severe cases of UUI. Other attempts including injectable bulking agents, previous sphincter designs, and slings have been developed, but largely abandoned because of poor long-term efficacy and significant complications. The AUS has had several sentinel redesigns since its first introduction to reduce erosion and infection and increase efficacy. None of these changes in the basic AUS design have occurred in the past three decades, and the AUS remains the same despite newer technology and materials that could improve its function and safety. Recently, newer compressive devices and slings to reposition the bladder neck for men with mild-to-moderate UUI have been developed with success in select patients. Similarly, the AUS has had applied antibiotic coating to all portions except the pressure-regulating balloon (PRB) to reduce infection risk. The basic AUS design, however, has not changed. With newer electronic technology, the concept of the electronic AUS or eAUS has been proposed and several possible iterations of this eAUS have been reported. While the eAUS is as yet not available, its development continues and a prototype device may be available soon. Possible design options are discussed in this review.
Humans ; Prostatectomy/adverse effects* ; Prosthesis Design ; Urinary Incontinence, Urge/surgery* ; Urinary Sphincter, Artificial

PURPOSE: To investigate the efficacy and safety of 0.4 mg of tamsulosin in patients with nocturia not responding to 0.2 mg.METHODS: Patients with intractable nocturia after treatment with 0.2 mg of tamsulosin for>1 month were included in a multicenter, prospective, observational, single-arm study. Patients were prescribed 0.4 mg of tamsulosin and followed up for 2 months to assess nocturnal voiding and nocturia-related bother. Changes in the mean number of nocturnal voids, the proportion of 50% responders, 3-day frequency-volume chart parameters, and questionnaire scores were assessed.RESULTS: Sixty-two patients were prescribed 0.2 mg of tamsulosin, of whom 56 were prescribed 0.4 mg of tamsulosin. Ten patients dropped out. A single case of orthostatic hypotension was reported. The mean age was 68 years. After 1 and 2 months of taking 0.4 mg of tamsulosin, 23.9% and 22.7% of patients demonstrated a>50% reduction of nocturia, and 16.1% and 19.4% of patients rated the treatment as “very effective,” respectively. Dose escalation to 0.4 mg of tamsulosin, compared to 0.2 mg, did not show an additional effect on reducing nocturnal urine volume. Multivariate logistic regression analysis showed that lower serum sodium levels (odds ratio [OR], 0.41, P=0.037) and the presence of urge incontinence (OR, 7.08, P=0.036) were predictors of a significant improvement of nocturia in response to 0.4 mg of tamsulosin.CONCLUSIONS: Dose escalation may yield a significant improvement of nocturia in>20% of patients, and may be especially helpful in patients with lower sodium levels and urge incontinence.
Adrenergic alpha-Antagonists ; Humans ; Hypotension, Orthostatic ; Logistic Models ; Male ; Nocturia ; Prospective Studies ; Sodium ; Urinary Incontinence, Urge

PURPOSE: The brainstem plays an important role in the control of micturition, and brainstem strokes are known to present with micturition dysfunction. Micturition dysfunction in cases of lateral medullary infarction (LMI) is uncommon, but often manifests as urinary retention. In this study, we investigated the neuro-anatomical correlates of urinary retention in patients with LMI. METHODS: This was a hospital-based retrospective study conducted in the neurology unit of a quaternary-level teaching hospital. Inpatient records from January 2008 to May 2018 were searched using a computerized database. Cases of isolated LMI were identified and those with micturition dysfunction were reviewed. MRI brain images of all patients were viewed, and individual lesions were mapped onto the Montreal Neurological Institute (MNI) space manually using MRIcron. Nonparametric mapping toolbox software was used for voxel-based lesion-symptom analysis. The Liebermeister test was used for statistical analysis, and the resultant statistical map was displayed on the MNI template using MRIcron. RESULTS: During the study period, 31 patients with isolated LMI were identified. Their mean age was 48 years and 28 (90%) were male. Six of these patients (19%) developed micturition dysfunction. All 6 patients had urinary retention and 1 patient each had urge incontinence and overflow incontinence. In patients with LMI, the lateral tegmentum of the medulla showed a significant association with urinary retention. CONCLUSIONS: In patients with isolated LMI, we postulate that disruption of the descending pathway from the pontine micturition centre to the sacral spinal cord at the level of the lateral tegmentum results in urinary retention.
Brain ; Brain Stem ; Hospitals, Teaching ; Humans ; Infarction ; Inpatients ; Magnetic Resonance Imaging ; Male ; Neurology ; Retrospective Studies ; Spinal Cord ; Stroke ; Urinary Incontinence, Urge ; Urinary Retention ; Urination

PURPOSE: To compare the clinical efficacy of anticholinergics for managing diabetes mellitus-associated overactive bladder (DM OAB) versus idiopathic overactive bladder (OAB) in Korean women. METHODS: We conducted a multicenter, prospective, parallel-group, open-label, 12-week study. Women (20–65 years old) with OAB symptoms for over 3 months were assigned to the DM OAB and idiopathic OAB groups. Changes in the Overactive Bladder Symptom Score (OABSS), urgency, urinary urgency incontinence, nocturia, daytime frequency according to a voiding diary, uroflowmetry, and postvoid residual urine volume (PVR) at the first visit (V1), week 4 (V2), and week 12 (V3) were compared. RESULTS: No significant difference was found between the baseline patient characteristics of the DM OAB and idiopathic OAB groups. Treatment with solifenacin was associated with improvements in urgency, urinary urgency incontinence, nocturia, frequency according to a voiding diary, and the total OABSS between V1 and V2 and between V1 and V3. Moreover, a significant improvement in urgency and urge incontinence was found between V2 and V3 in the DM OAB group. However, no significant changes were found in any other parameters. There were no significant differences between the DM OAB group and the idiopathic OAB group except for urgency and urge incontinence at V2 (3.71 vs. 2.28 and 0.47 vs. 0.32, respectively). CONCLUSIONS: The patients who received solifenacin demonstrated improved urgency, urinary urgency incontinence, nocturia, frequency according to a voiding diary, and total OABSS. Management with solifenacin was equally effective for both DM-related OAB and idiopathic OAB.
Cholinergic Antagonists ; Diabetes Mellitus ; Female ; Humans ; Nocturia ; Prospective Studies* ; Solifenacin Succinate* ; Treatment Outcome* ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge

PURPOSE: The aim of this study was to describe lower urinary tract symptoms in neuromyelitis optica (NMO), and to compare these data with urinary disorders observed in multiple sclerosis (MS) patients. METHODS: Retrospective study of data collected from January 1997 to July 2017 using the database from a Neuro-Urology Department of a university hospital. NMO and MS patients were matched for sex, age, and Expanded Disability Status Scale (EDSS) RESULTS: Twenty-six patients with NMO were included and compared with 33 MS patients. Mean age was 41.6 years (standard deviation [SD], 14,8), mostly female patients (24 vs. 2 males). Mean EDSS was 4.6 (SD, 1.8) in the 2 groups. In NMO group, 57% of the patients (n=15) had overactive bladder with urgency and urge incontinence and 38.5% (n=10) of them had nocturia. Voiding symptoms was observed in 69.2% of the patients (n=18); 42.3% of NMO patients performed self-intermittent catheterization versus 12.1% in MS patients (P=0.012). Low bladder compliance and severe urinary tract infections (pyelonephritis) were more frequent in NMO than in MS patients (respectively 15% vs. 0%, P=0.016 and 42% vs. 12%, P=0.024). CONCLUSIONS: Lower urinary tract symptoms, especially overactive bladder and urinary retention, are frequent in NMO. Low bladder compliance, serious urinary infections, and high prevalence of urinary retention requiring self-intermittent catheterization are the main symptoms significantly more frequent than in MS.
Catheterization ; Catheters ; Compliance ; Female ; Humans ; Lower Urinary Tract Symptoms* ; Multiple Sclerosis* ; Neuromyelitis Optica* ; Nocturia ; Prevalence ; Retrospective Studies ; Sensitivity and Specificity* ; Urinary Bladder ; Urinary Bladder, Overactive ; Urinary Incontinence, Urge ; Urinary Retention ; Urinary Tract Infections

BACKGROUNDSacral neuromodulation (SNM) has become an effective method for treating lower urinary tract voiding dysfunction during the past 20 years. Because of the expensive cost, the number of implantable pulse generator (IPG) implantations per year in China is far lower than that in Western developed countries since 2012. This study was to summarize the effects of the appropriate prolonged SNM testing time in improving the implantation rate of a permanent IPG in patients with refractory lower urinary tract symptoms (LUTS) in mainland China.

METHODSFrom January 2013 to June 2016, 51 patients with refractory LUTS received SNM therapy. In this study, we compared the conversion rate 2 weeks after the Stage I test and final actual conversion rate. We also observed the complications (such as pain, infection, and electrode displacement) and effectiveness. We tried to improve an appropriate prolonged test time which was favorable for improving the SNM conversion rate while ensuring safety and effectiveness.

RESULTSAmong 51 patients receiving SNM therapy, 19 patients (mean age 45.0 ± 16.9 years) had poor Stage I test results, and on an average, the electrode was removed 27.4 ± 9.6 days after the surgery. In one patient, the electrode was removed within 2 weeks; when the remaining 18 patients were questioned 2 weeks after testing, none of the patients wanted to terminate the test, and all the 18 patients desired to prolong the testing time to further observe the treatment effect. The remaining 32 patients (mean age 46.7 ± 15.3 years) received Stage II permanent implantation at 19.6 ± 10.4 days after the surgery. The overall Stage I-II conversion was 62.7% (32/51) in this study. Within 2 weeks after the surgery, only eight patients received Stage II permanent implantation, and the conversion rate was only 15.7% (8/51), which was much lower than the overall conversion rate of 62.7%. Nearly 84.4% (27/32) of the patients received Stage II implantation within 4 weeks. None of the patients had incision infections. In one patient, the entire system was removed 1 month after Stage II implantation due to pain in the implantation site.

CONCLUSIONSAppropriate extension of the Stage I testing time of an SNM-barbed electrode could significantly improve the Stage II permanent implantation rate in Chinese refractory LUTS patients; there were no wound infections, and the postoperative complication rate was low. This study recommended that Stage I period of SNM therapy should be 4 weeks according to safety and successful conversion rate.

Adult ; China ; Electric Stimulation Therapy ; methods ; Female ; Humans ; Lower Urinary Tract Symptoms ; therapy ; Male ; Middle Aged ; Retrospective Studies ; Sacrum ; innervation ; Urinary Incontinence, Urge ; therapy

PURPOSE: Overactive bladder (OAB) is characterized by urinary urgency with or without urge incontinence, accompanied by frequency and nocturia. It affects individuals of all ages and can predispose affected individuals to depression and anxiety. However, few studies have been conducted on this topic. The objective of this study was to perform a systematic review and meta-analysis assessing the symptoms of depression, anxiety, and OAB using validated instruments. METHODS: The search for articles was based on the following descriptors: overactive bladder, depression, and anxiety (“Urinary bladder, Overactive AND Depression and Anxiety”) OR (“Urinary bladder, Overactive AND Depression” OR “Urinary bladder, Overactive AND Anxiety”). The databases searched included PubMed, MEDLINE, and SciELO. RESULTS: Initially, 111 articles were identified, but only 11 articles, containing 11,784 participants with depression and 10,436 with anxiety, specifically addressed depression or anxiety and were included in this systematic review. Ten articles incorporated a quantitative analysis, with cohort, series, population-based, and cross-sectional designs. One qualitative study was also included. Three articles were included in the meta-analysis, resulting in a total of 7,468 participants in whom depression was evaluated and 8,030 participants in whom anxiety was analyzed. Depression and anxiety were positively correlated with OAB. Men with OAB were considerably more likely than women to have anxiety (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.40–1.73) but there was no sex-related difference in depression (OR, 0.96; 95% CI, 0.77–1.21). CONCLUSIONS: This study showed a positive correlation between OAB and anxiety and depression. Men were considerably more likely than women to have anxiety related to OAB, but depression levels in OAB patients were not sex-related. This review highlights the need to investigate depression and anxiety in patients with OAB.
Anxiety* ; Cohort Studies ; Depression* ; Female ; Humans ; Male ; Nocturia ; Quality of Life ; Subject Headings ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge

Urinary incontinence (UI) has been a serious health problem which can significantly affect quality of life. UI may occur at any age but more common in the elderly population. Many conditions may leak to UI and differential diagnosis is critical to guide appropriate manage strategy. After a brief description of the pathophysiology, classification, and diagnostic evaluation of UI, this review highlights oral pharmacological therapy mainly in clinical point of view. For urge UI, antimuscarinic are the most commonly used medication supported with high level of evidence. Antimuscarinics competitively block muscarinic receptors with variations in selectivity for the different subtypes. Common adverse effects are dry mouth, constipation, and blurred vision. High caution for cognitive function should be applied in the use of antimuscarinics in the elderly. Mirabegron, a beta3-agonist, is a new class of drug targeting urge UI, which reported similar efficacy with antimuscarinics and favorable adverse effect profile. For stress UI, various type of medications have been clinically investigated but so far none showed satisfactory resolution of stress UI. Duloxetine is the only medication approved for stress UI in European countries but not in US Food and Drug Administration and Korean Food and Drug Administration due to low benefit-risk profile for UI. Conclusively, pharmacological therapy should be tailored to the type of UI. Recent options of medications may give further treatment possibilities for the optimal treatment for each patient.
Aged ; Classification ; Constipation ; Diagnosis, Differential ; Drug Delivery Systems ; Duloxetine Hydrochloride ; Humans ; Medication Therapy Management ; Mouth ; Muscarinic Antagonists ; Quality of Life ; Receptors, Muscarinic ; United States Food and Drug Administration ; Urinary Incontinence* ; Urinary Incontinence, Stress ; Urinary Incontinence, Urge

The efficacy of intravesical onabotulinumtoxinA (BTXA) in the treatment of overactive bladder (OAB) has been well documented. The use of BTXA injection in orthotopic neobladders is yet to be studied. We present 4 cases of patients injected with intravesical BTXA for overactive orthotopic ileal neobladder. We recorded patient demographics, presenting and follow-up symptoms, urodynamic profiles, and Patient Global Impression of Improvement (PGI-I) scores. The 4 patients reported varying degrees of subjective improvements in the symptoms, including urgency, urge incontinence, and pad usage. Mean follow-up duration was 8.3 months (range, 5-14 months). Average PGI-I score was 3 ("a little better") (range, 2-4). To our knowledge, the current study is the first case series examining BTXA injection for orthotopic neobladder overactivity. BTXA injection yielded varying degrees of objective and subjective improvements, without significant complications. Intravesical BTXA injection is feasible and may be considered as a potential treatment alternative for OAB in orthotopic neobladders, although further study is warranted.
Administration, Intravesical ; Demography ; Follow-Up Studies ; Humans ; Urinary Bladder, Overactive ; Urinary Diversion ; Urinary Incontinence, Urge ; Urinary Reservoirs, Continent ; Urodynamics

OBJECTIVE: The purpose of this study was to evaluate the impact of pelvic organ prolapse (POP) repair on overactive bladder (OAB) symptoms in women with POP and the effect of baseline POP severity on improvement in OAB after surgical repair of POP. And we also tried to identify any preoperative factors for persistent postoperative OAB symptoms. METHODS: A total of 87 patients with coexisting POP and OAB who underwent surgical correction of POP were included and retrospectively analyzed and postoperative data was obtained by telephone interview. OAB was defined as an affirmative response to item no. 15 (urinary frequency) and item no. 16 (urge incontinence) of the Pelvic Floor Distress Inventory. POP severity was dichotomized by Pelvic Organ Prolapse Quantification stage 1 to 2 (n=22) versus stage 3 to 4 (n=65). RESULTS: OAB symptoms were significantly improved after surgical treatment (P<0.001). But there was no significant differences in postoperative improvement of frequency and urge incontinence between stage 1 to 2 group versus stage 3 to 4 group. Preoperative demographic factors (age, parity, and POP stage) were not significantly related to persistent postoperative OAB symptoms. CONCLUSION: Women with coexisting POP and OAB who undergo surgical repair experience significant improvement in OAB symptoms after surgery, but severity of POP had no significant difference in improvement of OAB symptoms. Postoperative persistent OAB symptoms were not related to age, parity, body mass index, and POP stage.
Body Mass Index ; Demography ; Female ; Humans ; Interviews as Topic ; Parity ; Pelvic Floor ; Pelvic Organ Prolapse* ; Retrospective Studies ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge