Significant improvement in the quality of life in women treated with a novel disposable intravaginal device for stress urinary incontinence

Introduction and hypothesis  The aim of the study was to assess the quality of life (QoL) in women with stress urinary incontinence (SUI) while using a novel disposable intravaginal device. Methods  Fifty women with severe SUI who completed a 7-day control period followed by a 28-day device usage period underwent QoL assessments based on two validated questionnaires, the Incontinence Impact Questionnaire (IIQ-7) and the Urogenital Distress Inventory (UDI-6). Results  Mean total score for the IIQ-7 decreased from 41.8 ± 24.1 to 4.4 ± 8.7 at the pre- and poststudy visits, respectively (P < 0.001). The mean total score for the UDI-6 decreased from 48.2 ± 16.1 to 11.5 ± 11.9 at the pre- and poststudy visits, respectively (P < 0.001). Statistically significant decreases in most subscale scores were observed by the end of the study for both questionnaires (all P values <0.001). Conclusion  The novel disposable intravaginal device significantly improved QoL in women with SUI.     

Phenotype pharmacology of lower urinary tract α(1)-adrenoceptors

α(1)-Adrenoceptors are involved in numerous physiological functions, including micturition. However, the pharmacological profile of the α(1)-adrenoceptor subtypes remains controversial. Here, we review the literature regarding α(1)-adrenoceptors in the lower urinary tract from the standpoint of α(1L) phenotype pharmacology. Among three α(1)-adrenoceptor subtypes (α(1A), α(1B) and α(1D)), α(1a)-adrenoceptor mRNA is the most abundantly transcribed in the prostate, urethra and bladder neck of many species, including humans. In prostate homogenates or membrane preparations, α(1A)-adrenoceptors with high affinity for prazosin have been detected as radioligand binding sites. Functional α(1)-adrenoceptors in the prostate, urethra and bladder neck have low affinity for prazosin, suggesting the presence of an atypical α(1)-adrenoceptor phenotype (designated as α(1L)). The α(1L)-adrenoceptor occurs as a distinct binding entity from the α(1A)-adrenoceptor in intact segments of variety of tissues including prostate. Both the α(1L)- and α(1A)-adrenoceptors are specifically absent from Adra1A (α(1a)) gene-knockout mice. Transfection of α(1a)-adrenoceptor cDNA predominantly expresses α(1A)-phenotype in several cultured cell lines. However, in CHO cells, such transfection expresses α(1L)- and α(1A)-phenotypes. Under intact cell conditions, the α(1L)-phenotype is predominant when co-expressed with the receptor interacting protein, CRELD1α. In summary, recent pharmacological studies reveal that two distinct α(1)-adrenoceptor phenotypes (α(1A) and α(1L)) originate from a single Adra1A (α(1a)-adrenoceptor) gene, but adrenergic contractions in the lower urinary tract are predominantly mediated via the α(1L)-adrenoceptor. From the standpoint of phenotype pharmacology, it is likely that phenotype-based subtypes such as the α(1L)-adrenoceptor will become new targets for drug development and pharmacotherapy.     

盆底肌肉锻炼对产后盆底功能的影响

目的探讨盆底肌肉锻炼（pelvic floor muscle training,PFMT）对产后盆底功能的影响。方法选取154例孕妇随机分为训练组和对照组,分别于产前、产后6～8周及产后3个月对压力性尿失禁（stress urinary incontinence,SUI）的发生率进行研究。结果训练组产后6～8周与产后3个月SUI发病率比较,差异有统计学意义（P〈0.05）;产后3个月训练组较对照组SUI发病率低,有显著差异（P〈0.01）。结论妊娠和分娩对盆底功能有一定的损伤,产后盆底功能有一定的康复趋势,产后进行PFMT可以有效防治妇女产后SUI的发生及发展。     

Physical and sexual abuse in patients with overactive bladder: is there an association?

The known sequelae of sexual abuse include acute and chronic injury. The purpose of this study was to evaluate the association of overactive bladder symptoms (OABs) with a history of physical or sexual abuse. Two hundred and forty-three women who attended the gynaecological out-patient clinic or the urogynaecological clinic were recruited for our study. Based on their clinical examination, they were assigned to three groups of patients with either OAB or with stress urinary incontinence (SUI) without concomitant urgency symptoms (SUI), or without history of incontinence (control group). Afterwards, they completed an anonymous questionnaire about bladder function and physical/sexual violence. Significantly more women (30.6%, 26/85) with OAB had previously been physically or sexually abused than women with SUI (17.8%, 18/101) and of the control group (17.5%, 10/57). Our study showed that significantly more women with OAB report physical and sexual abuse than subjects with stress incontinence or no urinary complaints. Women with stress incontinence had the same rate of self-reported physical/sexual abuse as continent controls.     

针灸治疗女性盆底功能障碍性疾病选穴规律分析

目的:总结近10年针灸治疗女性盆底功能障碍性疾病的选穴规律。方法:检索中国知网数据库(CNKI)、维普数据库(VIP)和万方数据库(Wanfang)中近10年针灸治疗女性盆底功能障碍性疾病(pelvic floor dysfunction,PFD)的相关临床文献,检索时间段为2009年1月至2019年12月。PFD包括压力性尿失禁(stress urinary incontinence,SUI)、盆腔器官脱垂(pelvic organ prolapse,POP)以及产后性功能障碍(postpartum female sexual disfunction,PSD)。结果:针灸治疗SUI文献126篇,涉及48个穴位,总频次580次,选穴以关元、中极、三阴交、肾俞、气海、足三里、会阳、次髎、中髎、膀胱俞、百会最多。针灸治疗POP文献45篇,共使用39个穴位,总频次323次,选穴以关元、气海、百会、三阴交、足三里、子宫、中极、维道、肾俞、大赫最多。针灸治疗PSD文献3篇。针灸治疗PFD选穴频率最高为关元,经脉以任脉、足太阳膀胱经为主,选穴主要分布在腹部,特定穴以交会穴使用最多。结论:针灸治疗PFD注重远近配合、循经取穴,对于PFD不同的症状表现,选穴侧重点略有不同。     

Patient goals after incontinence procedures: does the single-incision sling satisfy them?

Objective

This study was undertaken to describe short-term postoperative achievement of subjective preoperative goals for single-incision MiniArc slings, in comparison with tension-free vaginal tape (TVT).

Method

Patients submitted to mid-urethral sling (TVT and MiniArc) procedures for stress urinary incontinence (SUI) in two centers were included in this prospective study. Before surgery, the patients completed a preoperative open-ended questionnaire, in which they described their personal outcomes goals for SUI surgery and the degree of severity of their symptoms. At the first postoperative check, they were asked to assess the degree to which their goals had been met and the degree of postoperative incontinence symptoms; their grade of satisfaction was evaluated with IIQ-7, UDI-6 and a 0–10 visual analog scale.

Results

One hundred and eight patients (TVT n = 51, MiniArc n = 57) were included in this study. Incontinence symptom relief and improvement of quality of life were the most commonly described preoperative goals. Six to eight weeks after surgery, 47 patients (92.1%) after TVT and 53 (92.9%) women after single-incision slings were objectively cured (P = 1). After surgery, more than 90% of the patients in both groups achieved their preoperative goals. Symptom scores improved significantly and were comparable in both groups.

Conclusion

Our results show that self-reported achievement of preoperative goals of patients submitted to single-incision slings are comparable at the first follow-up with patients who have undergone the classic mid-urethral sling.     

Duloxetine for the treatment of stress urinary incontinence in women: an integrated analysis of safety

OBJECTIVE: The objective was to characterize the safety of duloxetine for treatment of stress urinary incontinence (SUI) in women, using an integrated database generated from four published placebo-controlled clinical trials. METHODS: The database included 1913 women randomized to duloxetine (N=958) or placebo (N=955), examining adverse events (AEs), serious adverse events (SAEs), vital signs, electrocardiograms, and laboratory analytes. AEs occurring initially or worsening during the double-blind treatment period were considered treatment-emergent (TEAE). Differences between duloxetine-treated and placebo-treated groups were compared statistically. RESULTS: Common TEAEs included: nausea (23.2%), dry mouth (13.4%), fatigue (12.7%), insomnia (12.6%), constipation (11.0%), headache (9.7%), dizziness (9.5%), somnolence (6.8%), and diarrhea (5.1%). Most TEAEs that emerged early were mild to moderate, rarely worsened, and resolved quickly. Overall AE discontinuation rates were 20.5% for duloxetine and 3.9% for placebo (P<.001). Most discontinuations (83%) occurred within the first month of treatment. SAEs were uncommon and did not differ between treatments. Statistically significant, but clinically unimportant mean increases in heart rate (2.4 bpm) and systolic and diastolic blood pressure (相似文献   

压力性尿失禁调查及发病机理的探讨

本文总结1464名纺织女工中559例压力性尿失禁调查结果。本病发病率较高,症状较明显的Ⅱ～Ⅳ度为15.40％,需要手术治疗Ⅲ—Ⅳ度者为4.71％。发病率与年龄及分娩次数为正相关系。对压力性尿失禁的发病机理进行初步探讨。     

经阴道无张力尿道中段吊带术的手术护理

目的 探讨无张力阴道吊带（TVT）术治疗女性压力性尿失禁（SUI）的较佳护理。方法17例女性SUI患者接受TVT，术前充分准备，术中密切配合术者。结果 17例均手术顺利，术后恢复好，效果满意。结论 TVT治疗SUI安全有效，良好的术前准备及术中护理是本手术的较佳方法。