Percutaneous tibial nerve stimulation (PTNS) efficacy in the treatment of lower urinary tract dysfunctions. A systematic review

Background: Percutaneous Tibial Nerve Stimulation (PTNS) has been proposed for the treatment of overactive bladder syndrome (OAB), non-obstructive urinary retention (NOUR), neurogenic bladder, paediatric voiding dysfunction and chronic pelvic pain/painful bladder syndrome (CPP/PBS). Despite a number of publications produced in the last ten years, the role of PTNS in urinary tract dysfunctions remains unclear. A systematic review of the papers on PTNS has been performed with the aim to better clarify potentialities and limits of this technique in the treatment of OAB syndrome and in other above mentioned urological conditions. Methods. A literature search using MEDLINE and ISI web was performed. Search terms used were "tibial nerve" and each of the already mentioned conditions, with no time limits. An evaluation of level of evidence for each paper was performed. Results: PTNS was found to be effective in 37-100% of patients with OAB, in 41-100% of patients with NOUR and in up to 100% of patients with CPP/PBS, children with OAB/dysfunctional voiding and patients with neurogenic pathologies. No major complications have been reported.Randomized controlled trials are available only for OAB (4 studies) and CPP/PBS (2 studies). Level 1 evidence of PTNS efficacy for OAB is available. Promising results, to be confirmed by randomized controlled studies, have been obtained in the remaining indications considered. Conclusions: PTNS is an effective and safe option to treat OAB patients. Further studies are needed to assess the role of PTNS in the remaining indications and to evaluate the long term durability of the treatment. Further research is needed to address several unanswered questions about PTNS

Outcome and complications of adjustable continence therapy (ProACTTM ) in the treatment of urinary incontinence after transurethral resection of the prostate: A multicenter study

Aim: To evaluate the outcome of adjustable continence balloons in the treatment of stress urinary incontinence (SUI) after transurethral resection of the prostate (TURP). Methods: In two tertiary centers, adjustable continence balloons were implanted in 29 patients with post‐TURP SUI between 2007 and 2018. Endpoints of this retrospective multicenter study were patient‐reported changes in pad count and complications. Dry was defined as no pad or one securit

A 20-year study of persistence of lower urinary tract symptoms and urinary incontinence in young women treated in childhood

OBJECTIVE: To determine whether urinary incontinence (UI) and lower urinary tract symptoms (LUTS) persist over years, patients treated for UI and LUTS in childhood were re-evaluated in adulthood. MATERIALS AND METHODS: Forty-seven women (cases) treated in childhood for daytime UI/LUTS (group A) and nocturnal enuresis (group B) self-completed (average age: 24.89 ± 3.5 years) the International Consultation on Incontinence Questionnaire for Female with LUTS (ICIQ-FLUTS). ICIQ-FLUTS was self-administered to 111 healthy women (average age: 23 ± 5.1 years) from a nursing school as a control group. Data obtained from ICIQ-FLUTS and quality of life (QoL) score (0-10) were compared (Fisher's exact test) between patients and controls, and between group A (n = 28) and group B (n = 19). RESULTS: Prevalence of LUTS was higher in patients than in controls. The difference between patients and controls was statistically significant (p = 0.0001) for UI (34% vs. 7%) and feeling of incomplete bladder emptying (49% vs. 28%). QoL score was >5 in 59% of patients and 1% of controls (p = 0.0001). No significant differences were found between groups A and B. CONCLUSIONS: UI and LUTS are confirmed in young women who suffered for the same condition in childhood. Longitudinal studies are needed to assess if these symptoms persist or are newly onset

Randomised Controlled Trials Assessing the Clinical Value of Urodynamic Studies: A Systematic Review and Meta-analysis

Context: The role of urodynamic studies (UDSs) in the diagnosis of lower urinary tract symptoms (LUTS) is crucial. Although expert statements and guidelines underline their value for clinical decision-making in various clinical settings, the academic debate as to their impact on patient outcomes continues. Objective: To summarise the evidence from all randomised controlled trials assessing the clinical usefulness of UDS in the management of LUTS. Evidence acquisition: For this systematic review, searches were performed without language restrictions in three electronic databases until November 18, 2020. The inclusion criteria were randomised controlled study design and allocation to receive UDS or not prior to any clinical management. Quality assessment was performed by two reviewers independently, using the Cochrane Collaboration's tool for assessing the risk of bias. A random-effect meta-analysis was performed on the uniformly reported outcome parameters. Evidence synthesis: Eight trials were included, and all but two focused on women with pure or predominant stress urinary incontinence (SUI). A meta-analysis of six studies including 942 female patients was possible for treatment success, as defined by the authors (relative risk 1.00, 95% confidence interval: 0.93–1.07), indicating no difference in efficacy when managing women with UDS. Conclusions: Although UDSs are not replaceable in diagnostics, since there is no other equivalent method to find out exactly what the lower urinary tract problem is, there are little data supporting its impact on outcomes. Randomised controlled trials have focussed on a small group of women with uncomplicated SUI and showed no added value, but these findings cannot be extrapolated to the overall patient population with LUTS, warranting further well-designed trials. Patient summary: Despite urodynamics being the gold standard to assess lower urinary tract symptoms (LUTS), as it is the only method that can specify lower urinary tract dysfunction, more studies assessing the clinical usefulness of urodynamic studies (UDSs) in the management of LUTS are needed. UDS investigation is not increasing the probability of success in the treatment of stress urinary incontinence

Pelo mar escuro e ondeante da dúvida: a questão indígena no 'Sermão de Santo Antonio aos peixes'

No célebre sermão dito de "Santo António aos peixes"- pregado noMaranhão a 13 de junho de 1654 - Antonio Vieira tece o elogio dosilêncio. A mudez é, de fato, o tema dominante de uma fa la em que sereafirma o poder enredante do texto-tecido discursivo, da trama lógicoverbale da substância vocal que atrai e prende os seus leitores/ouvintes:eles são os peixes e o autor (e agente) do discurso é, sem o confessar demodo claro, o pescador, tornando-se logo, evangelicamente, "pescadorde homens". Ele é, finalm ente, aquele que confia no poder sedutor nãotanto da Voz, quanto sobretudo do Silêncio, entremeado e implícitonela e em que parece ecoar a mudez indígena, tomada como modelo deuma sa ntidade que só na abolição da palavra pode ser virtualmentealcançada

Il Comune e/o l'Estraneo

This volume aims at discussing aspects of discontinuity, fragmentation, instability which disrupt the apparent homogeneity of a world too often described as homogeneous, global, and substantially uniform, but which, on the contrary, often proves highly heterogeneous and complex in terms of language and social demands. Specific attention will be given to all artistic, philosophical, linguistic and literary expressions which, since last century, have questioned or contested, both in Europe and the Americas, the notions of hegemony and subordination, of common nationality and difference, of unlimited dilation of sense and cultural homologation. Tracing non rigid borders and porous thresholds creates a number of transitory places which are in open conflict with all-comprehensive cultural itineraries. Just like in the classical case of Northern and Southern metropolitan areas of the Americas, the phenomenon of cultural hybridization appears today evident in European societies as well. The volume, which is thematically organized around a socio-cultural Lexicon, intends to decipher and study this different topology of cultural space, as it appears in the artistic production of international writers and intellectuals

Il condono del mondo. Modelli del dono e del perdono nella cultura europea e in quella brasiliana

Ripercorrere a ritroso, fino a portarne alla luce le radici, il fondo più arcaico di alcune parole di uso comune, può rivelarsi, spesso, un esercizio fondamentale per cogliere il senso profondo di termini che ci paiono possedere un significato stabile, ma che, nel corso della loro evoluzione, hanno invece subito trasformazioni o deviazioni semantiche che ci interrogano e che dovremmo cercare, a nostra volta, di interrogare per cogliere la complessità di ciò che, oggi, pare ridursi ad un senso comune che attraversa e sembra rendere omogenee le culture. Di tale significato semplice e apparentemente universale sembrano godere anche termini ampiamente usati e in parte usurati come i tre che vorrei sottoporre in questa sede alla vostra attenzione e che, come si può immediatamente capire, discendono dalla stessa origine. Di fatto, le nozioni relative al perdono e al condono rinviano immediatamente al concetto di dono che ha goduto, com’è noto, dell’attenzione e dell’analisi attenta di studiosi del calibro di Marcel Mauss, sul piano antropologico, e dopo di lui di Émile Benveniste, sul piano storico-linguistico. Basterebbero le considerazioni e le conclusioni che entrambi ci hanno lasciato per annettere il dono alla sfera del già detto e del già noto, senza necessità di tornarvi, se non per constatare come i loro studi siano ancor’oggi oggetto di articolate deduzioni proprio per la natura complessa dell’atto e della pratica del donare, che si associa alle nozioni di sacrificio, di vittima, di largesse e dispendio ma anche di ospitalità e ostilità o di veleno. Se poi a tale intricata complessità semantica si accosta il termine latino munus – con tutti i suoi possibili derivati nelle lingue romanze – che, nella nostra attuale penuria lessicale, siamo costretti a tradurre ancora con “dono”, avremo un rizoma altamente diversificato e labirintico ad indicare un’istituzione, connessa al dare e al ricevere, che accoglie significati plurimi e difficili da percepire, nella loro diversità, da parte delle culture contemporanee. Una breve esemplificazione di tale polivalenza implicita nelle forme del dono, del perdono e del condono, nell’ambito in una società regolata da norme arcaiche, la si ricaverà dall’analisi di alcune opere dello scrittore brasiliano João Guimarães Rosa