Morphometry of the aging female rat urethra

Muscles in the limbs change with age, but the aging process of urethral muscles is unknown. Therefore, we compared smooth and striated muscle content in the female rat urethra in young (12 month) and old (32 month) animals, using immunochemical techniques. All the striated skeletal fibers at both ages contain slow myosin. Urethral diameter does not change with age (young, 1.44±0.08 mm; old, 1.46±0.10 mm,n=5), nor does the external sphincter width (young, 0.088±0.016 mm; old, 0.080±0.017 mm,n=5). Neither smooth nor skeletal muscle volume in the urethra is changed with age (skeletal: young, 20.72±2.94%; old, 19.95±2.35%. Smooth: young, 22.26±2.98%; old, 26.75±2.35%,n=5). The external striated sphincter is separate and distinct from the pubococcygeal region of the levator ani muscle, but is closely apposed to another layer of longitudinally oriented fibers into the vaginal musculature. The morphometric analysis shows no difference in urethral architecture in aging female rats.EDITORIAL COMMENT: This paper presents a well planned experimental animal model looking specifically at the morphologic characteristics of the aging female rat urethra. Although this information cannot be directly transferred and applied to our knowledge of the aging human female urethra, such research is extremely important. Hopefully, understanding the structure and function of the urethra in other animals will clarify the same in humans. This type of research is critical in finding an appropriate animal model for basic science research in female urology.     

A study of female urinary tract infection caused by urodynamic investigation

OBJECTIVE: The purpose of this study was to assess the prevalence of female urinary tract infection before and after urodynamic investigation and to identify the risk factors for urinary tract infection after urodynamic investigation. STUDY DESIGN: Eight hundred twenty-two consecutive incontinent women were recruited. All women were "double-screened" and treated for urinary tract infection before urodynamic investigation: first by mid stream urine culture 4 to 6 weeks before investigation and then by reagent strips for urine leukocytes and nitrites at the time of investigation. The investigation was postponed until the urinary tract infection had been treated. All women then received a standard urodynamic investigation. RESULTS: The prevalence of urinary tract infection before urodynamic investigation was 5.1% (95% CI, 3.6-6.6), and the prevalence after the investigation was 8.4% (95% CI, 6.5-10.3). Three independent risk factors were identified: age >or=70 years (odds ratio, 1.99; 95% CI, 1.14-3.48), previous continence surgery (odds ratio, 1.90; 95% CI, 1.05-3.43), and urinary tract infection before urodynamic investigation (odds ratio, 3.13; 95% CI, 1.43-6.83). The 3 most common uropathogens in the urinary tract infections after the urodynamic investigation were Escherichia coli (46.3%), Enterococcus spp (16.4%), and Enterococcus faecalis (11.9%). CONCLUSION: Despite a stringent screen-and-treat protocol before urodynamic investigation, patients still experienced urinary tract infection.     

A randomized, double-blind, placebo-controlled comparison of the effect of nitrofurantoin monohydrate macrocrystals on the development of urinary tract infections after surgery for pelvic organ prolapse and/or stress urinary incontinence with suprapubic catheterization

OBJECTIVE: The purpose of this study was to determine if antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals (study drug) after pelvic organ prolapse and/or urinary incontinence surgery with suprapubic catheterization (SPC) decreases urinary tract infection (uti) compared with placebo in a randomized, double-blind, multicenter trial. STUDY DESIGN: Six centers participated in this study. After a negative preoperative urine culture, history, surgical and postoperative course, urine culture and symptoms at SPC removal, and at 6 to 8 weeks postoperative, any other UTI and adherence were recorded. To demonstrate a 50% decrease in the bacteruria rate from 20%, with 80% power and alpha of 0.05, 438 patients were required. Data were evaluated with Student t test and Fisher exact test. RESULTS: Of 449 patients enrolled, 211 randomized to study drug, and 224 randomized to placebo. No pre- or perioperative differences existed between groups (all P>.05). Antibiotic prophylaxis decreased positive urine cultures compared with placebo (46% vs 61%, P=.002), symptomatic UTI at SPC removal (7.2% vs 19.8%, P=.001), and any other symptomatic UTI 6 to 8 weeks postoperatively (18.9% vs 32.6%, P=.002). Antibiotic prophylaxis did not decrease symptomatic UTI at the 6- to 8-week postoperative visit (1.8% vs 5.4%, P=.10). CONCLUSION: Antibiotic prophylaxis with nitrofurantoin monohydrate macrocrystals decreases UTI compared with placebo after pelvic organ prolapse and/or urinary incontinence surgery with suprapubic catheterization.     

Association of age, race, and obstetric history with urinary symptoms among women in the Nurses' Health Study

OBJECTIVE: The purpose of this study was to better understand associations among age, race, obstetric history, and urinary incontinence in women. STUDY DESIGN: Race and obstetric history were assessed through the use of biennial mailed questionnaires from 1976 to 1996 among participants of the Nurses' Health Study. In 1996, 83,168 women aged 50 to 75 years reported their frequency of leaking urine and quantity leaked. We used logistic regression to calculate multivariate-adjusted odds ratios and 95% CIs for the relation of risk factors to leaking urine. RESULTS: Overall, 34.1% of the women reported leaking urine at least once per month during the previous 12 months; this prevalence was lowest in the black women (21.2%). After potential confounders were controlled, there were strong trends of increasing prevalence of occasional and frequent leaking with increasing age (P trend <.0001). There was also increasing prevalence of leaking urine with increasing parity; for example, compared with nulliparous women, the odds ratio for frequent leaking was 1.72 (95% CI, 1.55-1.90) among those with >/=5 births. Odds ratios that were associated with parity were higher in women aged <60 years than in women aged >/=60 years. Age at first birth of >35 years was associated with a slight elevation in frequent leaking compared with women with age at first birth from 21 to 25 years but was stronger for women with age at first birth of <21 years (OR, 1.27; 95% CI, 1.13-1.42). CONCLUSION: In these women, leaking urine is common; this condition is most prevalent in white women, in older women, in parous women, and in women with a younger age at first birth.     

Revision anorectoplasty in the management of anorectal anomalies

Twelve patients who had a revision posterior sagittal anorectoplasty (PSARP) were evaluated by questionnaire. They were 11 months to 15 years old (median 5 years) at the time of revision surgery. All were born with an intermediate to high anorectal anomaly (ARM) and had ongoing problems of rectal prolapse (3), stenosis (1), faecal incontinence (9), or severe constipation (4). All but 1 had a huge megarectum with a poor anorectal angle and stool impaction, causing overflow incontinence. After revision surgery, marked improvement occurred in 7 and at least some improvement was achieved in the remaining 5. Previous severe constipation resolved in 2 and improved in another 2 children. The number of soiling episodes significantly decreased in 8 patients: while before surgery 8 had been wearing nappies all the time, only 2 use them postoperatively. The anorectal prolapse has resolved in 3 and sensation improved in 5, and as a group, there has been a reduced need for laxatives and rectal washouts. The favourable outcome of our patients confirms that PSARP is an excellent technique for revision surgery, and tapering of a secondary megarectum plus the formation of an anorectal angle can produce clinical improvement, even in more severe forms of ARM. Accepted: 7 February 2001     

Single-center experience with botulinum toxin endoscopic detrusor injection for the treatment of congenital neuropathic bladder in children: Effect of dose adjustment,multiple injections,and avoidance of reconstructive procedures

ObjectiveSince 2007, intra-detrusor OnabotulinumtoxinA (OnabotA) injections have been selectively offered at our institution for cases in which maximal anticholinergic therapy failed or was not tolerated. Herein we present our experience with this approach.Materials and methodsWe prospectively obtained data on 17 patients who underwent OnabotA injections over a 4-year period. Demographic information, number of injections, and dose delivered were captured. Children were monitored with baseline and post-injection renal ultrasound, urodynamics, and assessed for side effects, satisfaction, and symptom improvement.ResultsForty-three sessions were performed with injections given every ∼6 months. Mean patient age was 10.7 years (range, 3–17). Compared with baseline, after the first injection, mean bladder capacity adjusted for age and compliance improved by 27% (p = 0.039) and 45.2% (p = 0.041), respectively. After subsequent injections, these values increased to 35.7% (p = 0.043) and 55.1% (p = 0.091), respectively. Out of 13 symptomatic patients, ≥ 50% improvement was reported in ten (76.9%) and complete resolution in seven (53.8%). However, all three patients in whom the maximum dose of OnabotA was reduced from 300 to 200 units complained of recurrent symptoms. Fourteen children avoided surgical reconstruction as a second line of treatment. Overall patient/parental reported satisfaction rate was 70.6% (12/17).ConclusionsIntra-detrusor OnabotA injection is a promising intervention for management of neuropathic bladder in selected patients. Our data demonstrate improvement in symptoms and urodynamic parameters. Although an optimal dose has not been determined for children, we found optimal response with a maximum administration of OnabotA up to 300 units.     

The impact of surgical treatment on the mental health of women with obstetric fistula

Obstetric fistula is estimated to affect 2 million women worldwide and has considerable social and psychological effects on affected individuals. In this prospective study, 51 consecutive women with obstetric fistula admitted to the Barhirdar Hamlin Fistula Centre in the north of Ethiopia were screened using the General Health Questionnaire (GHQ-28) for potential mental health disorder before and 2 weeks after fistula surgery. Prior to surgery, all women screened positive. By 2 weeks after, this had dropped to 36% ( P = 0.005). 27% of the 45 women who were cured of their incontinence screened positive, while all 6 of those with severe residual incontinence continued to screen positive. We conclude that surgical treatment of obstetric fistula results in marked improvements in mental heath.     

TVT-O和TVT治疗单纯女性压力性尿失禁的疗效对比:立足随机对照试验的Meta分析

目的:系统评价经阴道无张力尿道中段悬吊带术(闭孔路径)(TVT-O)和经阴道无张力尿道中段悬吊带术(TVT)治疗女性压力性尿失禁的客观成功率和并发症发生率。方法:计算机配合手工检索1994年1月~2007年6月各数据库和灰色文献中TVT-O和TVT疗效的随机对照试验(RCT),用Revman4.2.2软件,对两种术式的客观成功率、并发症发生率进行Meta分析。结果:共纳入10个随机对照试验。TVT-O组553例,TVT组575例。Meta分析显示,TVT-O客观成功率、主观成功率均与TVT相似[P>0.05,OR 0.78,95%可信区间(CI):0.47~1.30;P>0.05,OR 0.93,95%CI:0.51~1.68)],TVT-O的"膀胱损伤"发生率低于TVT(P<0.01,OR 0.16,95%CI:0.05~0.49),TVT-O的"尿路症状"发生率与TVT相似(P>0.05,OR 0.90,95%CI:0.61~1.34)。因文献的异质性和结论的高敏感性,不能确定TVT-O"术后疼痛"发生率是否增高。结论:TVT-O术是一种疗效确切的无张力阴道吊带术,与TVT术的成功率、尿路症状相似而膀胱损伤的风险减少。但须进一步研究确证"术后疼痛"发生率是否增加。     

Analysis of Hospital Readmissions After Prosthetic Urologic Surgery in the United States: Nationally Representative Estimates of Causes,Costs, and Predictive Factors

BackgroundThe surgical treatment of urinary incontinence and erectile dysfunction by prosthetic devices has become part of urologic practice, although sparse data exist at a national level on readmissions and hospital costs.AimTo assess causes and costs of early (≤30 days) and late (31–90 days) readmissions after implantation of penile prostheses (PPs), artificial urinary sphincters (AUSs), or PP + AUS.MethodsUsing the 2013 and 2014 US Nationwide Readmission Databases, sociodemographic characteristics, hospital costs, and causes of readmission were compared among PP, AUS and AUS + PP surgeries. Multivariable logistic regression models tested possible predictors of hospital readmission (early, late, and 90 days), increased hospital costs, and prolonged length of stay at initial hospitalization and readmission.OutcomeOutcomes were rates, causes, hospital costs, and predictive factors of early, late, and any 90-day readmissions.ResultsOf 3,620 patients, 2,626 (73%) had PP implantation, 920 (25%) had AUS implantation, and 74 (2%) underwent PP + AUS placement. In patients undergoing PP, AUS, or PP + AUS placement, 30-day (6.3% vs 7.9% vs <15.0%, P = .5) and 90-day (11.6% vs 12.8% vs <15.0%, P = .8) readmission rates were comparable. Early readmissions were more frequently caused by wound complications compared with late readmissions (10.9% vs <4%, P = .03). Multivariable models identified longer length of stay, Charlson Comorbidity Index score higher than 0, complicated diabetes, and discharge not to home as predictors of 90-day readmissions. Notably, hospital volume was not a predictor of early, late, or any 90-day readmissions. However, within the subset of high-volume hospitals, each additional procedure was associated with increased risk of late (odds ratio = 1.06, 95% CI = 1.03–1.09, P < .001) and 90-day (odds ratio = 1.03 95% CI = 1.02–1.05, P < .001) readmissions. AUS and PP + AUS surgeries had higher initial hospitalization costs (P < .001). A high hospital prosthetic volume decreased costs at initial hospitalization. Mechanical complications led to readmission of all patients receiving PP + AUS.Clinical ImplicationsHigh-volume hospitals showed a weaker association with increased initial hospitalization costs. Charlson Comorbidity Index, diabetes, and length of stay were predictors of 90-day readmission, showing that comorbidity status is important for surgical candidacy.Strengths and LimitationsThis is the first study focusing on readmissions and costs after PP, AUS, and PP + AUS surgeries using a national database, which allows ascertainment of readmissions to hospitals that did not perform the initial surgery. Limitations are related to the limited geographic coverage of the database and lack of surgery- and surgeon-specific variables.ConclusionsAnalysis of readmissions can provide better care for urologic prosthetic surgeries through better preoperative optimization, counseling, and resource allocation.Pederzoli F, Chappidi MR, Collica S, et al. Analysis of Hospital Readmissions After Prosthetic Urologic Surgery in the United States: Nationally Representative Estimates of Causes, Costs, and Predictive Factors. J Sex Med 2017;14:1059–1065.