Effectiveness of Short Term Percutaneous Tibial Nerve Stimulation for Non-neurogenic Overactive Bladder Syndrome in Adults: A Meta-analysis

Aim: to evaluate the effectiveness of short-term PTNS for non-neurogenic OAB in adults systematically by comparing with sham procedure and other treatments. Methods: we performed a systematic review of cohort study. Data sources were MEDLINE, EMBASE, CINAHL, National Library for Health, Cochrane, and google scholar from 2005 through 2015. Meta-analysis was performed using the random effects model. Heterogeneity of effects was assessed by calculating I2 statistic. Statistical analysis was performed using Review Manager 5.3 for RCT meta-analysis. Results: we analized 11 randomised controlled trial (RCT) and five prospective non-comparative studies with variable success rate. Based on percentage of responders, the results were 37.3% - 81.8% in PTNS group, 0% - 20.9% in sham group, 54.8% in anti-muscarinic group, and 89.7% in multimodal group. The decrease of voiding symptoms episodes per day was found in PTNS (0.7-4.5), sham (0.3-1.5), and anti-muscarinic (0.6-2.9) groups. In meta-analysis of four RCTs, the results favour PTNS over sham procedure with overall risk ratio of 7.32(95% CI of 1.69-32.16), p=0.09, I2=54%. Conclusion: there is an evidence of effectiveness of short term PTNS in treatment of non-neurogenic OAB. PTNS is proven significantly better than sham procedure.Key words: overactive bladder, percutaneous tibial nerve stimulation, sham, anti-muscarinic, voiding symptoms

The Effectiveness of a Three Day Course Antibiotic Post-urodynamic Study in Preventing Lower Urinary Tract Infection

Aim: to evaluate the effect of a 3-day course antibiotic post-urodynamic study (UDS) to prevent urinary tract infection (UTI). Methods: this was a randomized double blind clinical trial on the proportion of UTI in patients who received levofloxacin 500 mg once a day for 3 days after UDS compared to nontreated patients. The outcome of this study was the incidence of lower UTI in levofloxacin group and placebo group. Lower UTI was defined as patient with one or more clinical symptoms of lower UTI and one or more urinalysis parameter of UTI. Chi-square was used to evaluate the association between the lower UTI and treatment group. Results: a total of 126 patients were enrolled in this study from two outpatient urology clinics in Jakarta: Cipto Mangunkusumo Hospital and Asri Hospital. Overall, 26 patients (20.6%) had UTI post UDS (8 out of 63 patients from levofloxacin arm (12.7%) and 18 out of 63 patients from placebo arm (28.6%); p=0.028). The most common isolate found was E. coli (n=18 patients; 69.2%). The most common indications to perform UDS were Lower Urinary Tract Symptoms (LUTS) with failure of therapy (n=43 patients; 25%), LUTS after invasive treatment (n=29 patients; 16.9%), and overactive bladder with failure of therapy (n=22 patients; 12.7%). Conclusion: the use of antibiotic post-UDS can prevent incidence of lower UTI

Prevalence of Urinary Incontinence, Risk Factors and Its Impact: Multivariate Analysis from Indonesian Nationwide Survey

Aim: to describe the profile of urinary infection (UI) and to analyze its risk factors and impacts. Methods: subjects were enrolled consecutively from pediatric, urology, obstetrics & gynecology, and geriatric outpatient clinics at six teaching hospitals in various regions of Indonesia. Those with urinary tract infection and diabetes mellitus were excluded. The UI questionnaire was adapted from the 3 Incontinence Questions (3IQ). Written informed consent was obtained prior to the interview. Results: about 2765 completed questionnaires were obtained. The overall UI prevalence was 13.0%, which consisted of prevalence of stress UI (4.0%), urgency UI/wet OAB (4.1%), dry OAB (1.6%), mixed UI (1.6%), overflow UI (0.4%), enuresis (0.4%), other UI (0.7%). The prevalence of UI was significantly higher (p0.05) between male and female subjects. Enuresis and urgency UI/wet OAB were the most common UI in pediatric population. The prevalence was 2.3% and 2.1% respectively. Urgency UI and stress UI were the two most common type in adult and geriatric population. Both have an equal prevalence of 4.6%. The multivariate analysis showed that the prevalence of UI increased with LUTS (PR 4.22, 95%CI 2.98-5.97), chronic cough (PR 2.08, 95% CI 1.32-3.28), and fecal incontinence (PR 1.85, 95% CI 1.03-3.32). We found that UI impaired family life (25.3%), sexual relationship (13.6%), and job/school performance (23.7%). Frequent toilet use and reducing fluid intake were the two most common behavior changes. Conclusion: the prevalence of UI in Indonesia is nearly similar to other Asian countries. It increases with age and is not affected by gender. LUTS, chronic cough, and fecal incontinence may have significant effects on the prevalence. UI seems to impact daily life and behavior. Key words: urinary incontinence, daily life, LUTS, prevalence, age

Indonesian Urologists' Current Practice on Nocturnal Enuresis

Nocturnal enuresis (NE) is a symptom and a condition of intermittent incontinence which takes place during periods of sleep. Being the most common form of incontinence in children, the prevalence of NE in Indonesia is 2.3%. The objective of the study was to review Indonesian urologists' current practice on NE. This was a descriptive cross-sectional study using a self-constructed questionnaire which was distributed during several urological scientific meetings from August 2017 until August 2018. Indonesian urologists were asked to fill out these questionnaires which contained characteristics of the respondents and NE patients they had seen in their practices, diagnostic modalities and treatment options for NE. 133 out of 400 urologists participated. Most urologists had to deal with 1-5 cases NE per month. It was most commonly seen in 5-10 age group and affecting more girls than boys (45.9% vs 27.8% respectively). Approximately only half of Indonesian urologists utilized bladder diary for NE cases. Almost 90% urologist educated and proposed lifestyle intervention to manage NE. Alarm therapy and desmopressin was chosen by 51.1% and 21.8% of urologists respectively as treatment. Desmopressin was still less commonly prescribed compared to antimuscarinic and beta 3 agonist. To conclude, diagnostic strategies for NE are mostly in accordance with available guidelines although bladder diary was only opted by approximately half of urologists. Regarding treatment, education, lifestyle intervention and alarm therapy were the most form of treatment utilized for this condition.Praktik Terkini Spesialis Urologi Indonesia dalam Menangani Enuresis Nokturnal  Enuresis nokturnal adalah bentuk inkontinensia urine intermiten yang terjadi saat tidur yang merupakan inkontinensia urine tersering pada anak dengan prevalensi di Indonesia 2,3%. Tujuan penelitian ini adalah mengetahui praktik terkini dokter spesialis urologi dalam menangani enuresis nokturnal. Studi deskriptif potong lintang ini menggunakan kuesioner yang dibagikan pada dokter spesialis urologi pada bulan Agustus 2017–Agustus 2018. Sebanyak 133 dari 400 spesialis urologi berpartisipasi dalam studi ini. Mayoritas spesialis urologi mendapat 1-5 kasus enuresis nokturnal per bulan. Usia pasien tersering adalah 5-10 tahun dan lebih banyak anak perempuan dibandingkan anak laki-laki (45,9% vs 27,8%). Setengah spesialis urologi menggunakan catatan harian berkemih untuk diagnosis enuresis nokturnal. Hampir 90% responden memilih edukasi dan intervensi gaya hidup sebagai tata laksana. Terapi alarm dan desmopressin digunakan oleh 51,1% dan 21,8% responden untuk terapi. Anti-muskarinik dan beta-3-agonis lebih sering diberikan dibandingkan desmopressin. Disimpulkan strategi diagnostik untuk enuresis nokturnal telah sesuai dengan panduan tata laksana kecuali untuk catatan harian berkemih. Terapi yang paling banyak dipilih adalah edukasi, intervensi gaya hidup, dan terapi alarm.&nbsp

The Management of Nocturia by Indonesian Urologist

Nocturia is defined as the number of times urine is passed during main sleep. Prevalence of nocturia is around 70% and 11-44% for age group 70-80 and 20-40 years respectively. Although, it is clearly prevalent, nocturia is just seen as a small part of lower urinary tract symptoms (LUTS). The objective of the study was to review nocturia in terms of diagnostic and management strategies among Indonesian urologists. This was a descriptive cross-sectional study. A self-constructed questionnaire was distributed to Indonesian urologists from August 2017 until August 2018 using consecutive sampling method. 124 urologists out of 400 urologists participated. in this study most of the urologists had to face 1-5 cases nocturia per month. Age of patients were mostly 50-65 years old and affecting more men than women (66.9% vs 16.9% respectively). Only 45% of urologists utilized bladder diary regularly to assess nocturia. Nearly 90% urologist opted for lifestyle intervention to manage nocturia. Desmopressin was used by only 20.2% urologists to treat nocturia. Anti-muscarinic and beta-3 agonist were used more often than desmopressin to treat nocturia. To conclude, diagnostic strategies for nocturia are mostly in line with available guidelines except for bladder diary which was only used routinely by 45% of urologists. As for treatment, desmopressin was still prescribed less frequently than OAB drugs for nocturia

Endoscopic incision of protruding right ureterocele in a single collecting system: a case report

Protruding ureterocele is a very rare case found in the literature. We are reporting a 21 year-old female with an intermittent protruding mass from urethra, accompanied by dysuria, hematuria, and recurrent urinary tract infection. Inspection of the external genitalia revealed a protruding mass from the urethra which could be reduced manually. Excretory urography showed bilateral single collecting systems, grade II hydronephrosis of the right kidney, and a cobra head appearance of the lower right pelvis. The patient was diagnosed with a protruding right ureterocele in a single collecting system, and thus, endoscopic incision of a ureterocele was performed. Ultrasonography which was carried out three weeks after the procedure confirmed no residual hydronephrosis or ureterocele in the bladder. Voiding cystourethrography (VCUG) underwent at a three-month-follow up revealed a grade 5 vesico-ureteral reflux (VUR) on the right side. Surgical reimplantation was then considered. In conclusion, endoscopic incision was safe and yielded good result for protruding ureteroceles, but the need for secondary surgery in several conditions should be considered

Management of overactive bladder review: the role of percutaneous tibial nerve stimulation

Overactive bladder (OAB) is a common condition that is experienced by around 455 million people (11% of the world population) and associated with significant impact in patients’ quality of life. The first line treatments of OAB are conservative treatment and anti-muscarinic medication. For the refractory OAB patients, the treatment options available are surgical therapy, electrical stimulation, and botulinum toxin injection. Among them, percutaneous tibial nerve stimulation (PTNS) is a minimally invasive option that aims to stimulate sacral nerve plexus, a group of nerve that is responsible for regulation of bladder function. After its approval by food and drug administration (FDA) in 2007, PTNS revealed considerable promise in OAB management. In this review, several non-comparative and comparative studies comparing PTNS with sham procedure, anti-muscarinic therapy, and multimodal therapy combining PTNS and anti-muscarinic had supportive data to this consideration

Effectiveness of Short Term Percutaneous Tibial Nerve Stimulation for Non-neurogenic Overactive Bladder Syndrome in Adults: A Meta-analysis

Aim: to evaluate the effectiveness of short-term PTNS for non-neurogenic OAB in adults systematically by comparing with sham procedure and other treatments. Methods: we performed a systematic review of cohort study. Data sources were MEDLINE, EMBASE, CINAHL, National Library for Health, Cochrane, and google scholar from 2005 through 2015. Meta-analysis was performed using the random effects model. Heterogeneity of effects was assessed by calculating I2 statistic. Statistical analysis was performed using Review Manager 5.3 for RCT meta-analysis. Results: we analized 11 randomised controlled trial (RCT) and five prospective non-comparative studies with variable success rate. Based on percentage of responders, the results were 37.3% - 81.8% in PTNS group, 0% - 20.9% in sham group, 54.8% in anti-muscarinic group, and 89.7% in multimodal group. The decrease of voiding symptoms episodes per day was found in PTNS (0.7-4.5), sham (0.3-1.5), and anti-muscarinic (0.6-2.9) groups. In meta-analysis of four RCTs, the results favour PTNS over sham procedure with overall risk ratio of 7.32(95% CI of 1.69-32.16), p=0.09, I2=54%. Conclusion: there is an evidence of effectiveness of short term PTNS in treatment of non-neurogenic OAB. PTNS is proven significantly better than sham procedure. Key words: overactive bladder, percutaneous tibial nerve stimulation, sham, anti-muscarinic, voiding symptoms

Pilihan Terapi pada Overactive Bladder Refrakter

AbstrakOveractive bladder (OAB) merupakan suatu kondisi yang berkaitan dengan gangguan proses berkemih. International Continence Society menetapkan OAB sebagai suatu gangguan berkemih yang terdiri dari gejala desakan, dengan atau tanpa inkontinensia, umumnya disertai dengan sering berkemih dan nokturia, tanpa suatu bukti infeksi atau proses patologis lainnya. Saat ini, terapi lini pertama OAB meliputi perubahan gaya hidup, terapi fisik dan/atau perilaku, pengaturan jadwal berkemih, hingga pemberian obat golongan antimuskarinik. Ada beberapa kasus OAB yang memiliki respon kurang baik terhadap terapi lini pertama. Pasien dengan OAB yang tidak menunjukkan respon positif setelah menjalani terapi lini pertama selama tiga bulan harus menjalani pemeriksaan urodinamik dan sistoskopi untuk mengevaluasi penyebab lain dari gejala berkemih yang dialami. Untuk kasus refrakter, harus dipertimbangkan penggunaan terapi lini kedua yang bersifat lebih invasif. Injeksi botulinum toxin intravesika, neuromodulasi sakral, dan sistoplasti merupakan pilihan terapi lini kedua bagi OAB yang refrakter terhadap terapi konservatif lini pertama. Ketiga terapi lini kedua tersebut cukup invasif, sehingga terapi alternatif seperti stimulasi N. Tibialis posterior, Mirabegron, serta kombinasi dual antimuskarinik dapat menjadi pilihan.Kata kunci: OAB refrakter, overactive bladder, botox, neuromodulasi, sistoplasti, mirabegron AbstractOveractive bladder (OAB) is a condition related to voiding dysfunction. The International Continence Society defined OAB as a urinary urgency, with or without incontinence, usually with frequent voiding and nocturia, without evidence of infection or other pathological process. At the moment, the first line therapy for OAB includes lifestyle modification, physical and/or behavioral therapy, timed voiding, and antimuscarinic drugs. There are some cases of OAB that do not respond to first line therapy. Patients who do not respond positively to first line therapy within three months should undergo urodynamic andcystoscopic examination to evaluate other causes of the voiding dysfunction. For such refractory cases, a more invasive second line therapy should be considered. Intravesical botulinum toxin injection, sacral neuromodulation, and cystoplasty are considered second line therapy for OAB refractory to conservative first line therapy. However, these therapies are considered invasive; therefore, before deciding to use them, posterior tibial nerve stimulation, Mirabegron, and dual antimuscarinic drugs can be considered as less invasive alternatives.Keywords: refractory OAB, overactive bladder, botox, neuromodulation, cystoplasty, mirabegro

A survey on the management of overactive bladder by Indonesian urologists

Background: Overactive bladder (OAB) is a clinical syndrome consisting of symptom complex of urgency, with or without incontinence which has significant effects on quality of life and has to be managed properly. The aim of this study was to review the management of OAB by Indonesian urologists.Methods: A self-constructed questionnaires containing diagnostic and treatment options of OAB patients were distributed to Indonesian urologists. This was a cross-sectional study and descriptive analysis method was used to analyze the data.Results: 129 Indonesian urologists participated in this study. Most of them faced more than 20 OAB cases per year with the most common type was OAB without incontinence or dry OAB (57.4%). Most urologists (34.1%) ordered at least three diagnostic tools to determine OAB. They were bladder diary, urinalysis and scoring system. The most used scoring system (48.9%) was the overactive bladder symptoms score (OABSS). Thirty-five point seven percents (35.7%) of urologists used antimuscarinic and behavioral therapy as initial therapy. Solifenacin 5 mg/day was the most common antimuscarinic prescribed as the first line therapy (48%). Most common items commonly evaluated for follow-up: symptoms (96.9%), bladder diary (72.9%); and drug’s side effect (58.1%). When initial therapy had failed, most of the urologists (54.3%) chose to increase the dose of antimuscarinic. None of them chose bladder botulinum toxin injection as their additional therapy.Conclusion: OAB is a frequent disorder which remains a challenge for urologists. The management of patients with OAB by Indonesian urologists has been suitable with the previous studies and guidelines.</p