Effects of Special Pelvic Floor Muscle Training on the Quality of Life in Women with Urinary Incontinence, A Clinical Trial

Background: Stress urinary incontinence (SUI) is the involuntary loss of urine which occurs with physical exertion and an increase in intra-abdominal pressure. Pelvic floor muscle training (PFMT) is generally recommended to reduce SUI. This study aimed to compare the effects of three different exercises in women with urinary incontinence by abdominal and pelvic floor muscle retraining. Methods: A total of 81 patients with urinary incontinence (UI) were randomly allocated to the pelvic muscle training by biofeedback (BF), pelvic muscle training by biofeedback plus abdominal exercise (BF+AbdExs), and only abdominal exercise (AbdExs). All participants received 12 weeks of treatment. The outcome measure was maximal vaginal squeeze pressure and Quality of life (QOL) Questionnaire. Data analysis was performed using ANOVA and Kruskal- Wallis tests. Results: The mean age of patients was 49.4±8.4 years. The scores of QOL, pelvic floor muscle strength, and endurance increased in all groups after the treatment. The mean score of QOL in group BF+Abd.Exs ranged from 65.2 to 93.6, while in groups BF and AbdExs, it ranged from 61.8 to 85.6 and 63.6 to 79.1 respectively. More aspects of QOL improved significantly in the BF+ AbdExs group than in other group. However, the difference in pelvic floor muscle strength and endurance was not statistically significant among the three groups (p>0.05) Conclusion: An increase in pelvic floor muscle strength was associated with AbdExs, which improved QOL. Thus, the AbdExs seems to induce cocontraction in pelvic floor exercise. However, AbdExs alone is not adequate for improving incontinence

The Role of Urine Polymerase Chain Reaction Test in Diagnosis of Genitourinary Tuberculosis

Abstract BACKGROUND: The genitourinary system is one of he most common sites of infection in non-pulmonary tuberculosis (TB). The clinical symptoms and radiologic findings of urinary TB are nonspecific. Current diagnostic tests are of low sensitivity and labor-intensive. Therefore, this study was aimed to evaluate diagnostic value of urine PCR in genitourinary tuberculosis (GNTB). METHODS: This was a descriptive study on 33 patients with confirmed genitourinary TB. Demographic data, clinical symptoms, laboratory and radiologic findings were collected. For each patient, three consecutive early morning urine specimens were examined by PCR. The diagnostic value of PCR in mycobacterium tuberculosis (MTB) in comparison with standard microbiological methods was assessed. FINDINGS: There were 33 patients with a mean age of 47.27 16.1 years. The most common presenting symptoms were irritative voiding symptoms (51.5%), flanks pain (27.2%), gross hematuria (9%) and suprapubic pain (9%). Laboratory findings in U/A were hematuria (75.8%) and pyuria (60.6%). IVU was abnormal in 61.5% of patients. Most common abnormalities were pyelocalyceal dilation (44%), ureteral stricture and hydroureter (37%) and multiple small calyceal deformities (25%). Of the 33 patients PCR for MTB was positive in 16 cases (48.5%). In patients with abnormal IVU, PCR was positive in 62.5%. CONCLUSION: A high index of clinical suspicion is necessary for diagnosis of GUTB. PCR is recommended for instant diagnosis and screening before further examination, it cannot be the only method in identification of GUTB

Flowmetry/pelvic floor electromyographic findings in patients with detrusor overactivity

ABSTRACTTo evaluate different flowmetry/EMG patterns in patients with proven detrusor overactivity (DO) and compare them with that of a group of patients with lower urinary tract symptoms (LUTS) but without DO.Materials and MethodsWe retrospectively evaluated the records of 100 patients with frequent urinary tract infection or any kind of storage or voiding symptoms that had undergone urodynamic testing: 50 cases with proven DO on cystometry who had a good quality flowmetry/EMG and 50 patients without DO. EMG lag time (the time distance between pelvic floor EMG inactivation and the start of urine flow) and different flow curve pattern were recorded and compared.ResultsThe age and gender distribution were not statistically significant between the two groups. A negative lag time (≤ 0 sec) and an obstructive pattern were the only parameters that were more commonly seen in the DO group. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of a lag times ConclusionsA lag time </sec

Reliability and validity of the persian language version of the female lower urinary tract symptoms' long form questionnaire

Background: Lower urinary tract symptoms (LUTS) are important and prevalent health problems that seriously affect many women and their quality of life (QOL). The female LUTS long form (FLUTS-LF) is a robust measure to assess the QOL of women. This study aimed at translating FLUTS-LF and assessing the reliability and validity of this questionnaire among Iranian patients with LUTS. Materials and Methods: Forward and backward translations of FLUTS-LF questionnaire were carried out by the research team. Data collection was conducted from November 2015 to March 2016 in Isfahan, Iran. A total of 237 women completed the Persian version of FLUTS-LF, incontinence QOL, and International Prostate Symptom Score (IPSS) questionnaires. We evaluated Cronbach's alpha coefficient, intraclass correlation coefficient (ICC), stability (reliability), and confirmatory factor analysis (CFA) of the questionnaire. Results: The mean (standard deviation) age of the participants was 45.4 (12.50) years (range 20–70 years). Face and content validities were acceptable and missing data comprise 2% of the total data. Internal consistency (Cronbach's alpha) of the urinary symptoms was 0.78. ICC of the total score in urinary symptoms section was 0.95. Indexes of factor analysis were assessed and found to be acceptable. A high correlation was observed between the total scores of FLUTS-LF and IPSS. Conclusions: It seems that FLUTS-LF questionnaire can be a suitable instrument for assessing LUTS and their impacts on Iranian women's QOL

The role of pelvic organs prolapse in the etiology of urinary incontinence in women

Background : Urinary incontinence is relatively common in women and is usually associated with pelvic organs prolapse. Our aim was to determine the relationship between type and intensity of urinary incontinence and different grades and types of pelvic organ prolapse among women. Materials and Methods: One-hundred female patients with the chief complaint of incontinence, who were diagnosed with pelvic organ prolapse participated in this study. Intensity of prolapse, stress and urge incontinence were evaluated using POP-Q (Pelvic Organ Prolapse Questionnaire), SEAPI (Stress related, Emptying ability, Anatomy, Protection, Inhibition) and Freeman criteria, respectively. Results: Patients′ mean age was 51.95 ± 12.82 years. The most common type of incontinence was stress incontinence (53%) and the most common prolapse type was cystocele (76%). Cystocele and rectocele had a significant relationship with stress (P value = 0.012) and urge incontinence (P value = 0.035), respectively; however, no relationship was observed between different grades of cystocele, rectocele and enterocele with different types of urinary incontinence (P value > 0.05). In patients with urge and mixed incontinence, prolapse grade significantly increased with age, but no such relationship was found in patients with stress incontinence. The number of vaginal deliveries had a significant relationship only with cystocele and rectocele grade; however, the relationship between other variables such as intensity of different types of urinary incontinence and enterocele grade with the number of deliveries was not significant. Conclusion: Pelvic organ prolapse had a significant relationship with urinary incontinence regardless of intensity and POP should be examined in all of these patients

The influence of ureteral orifice configuration on the success rate of endoscopic treatment of vesicoureteral reflux

Background: To investigate the effect of polyacrylate polyalcohol copolymer (Vantris) injection for the correction of VUR in children according to ureteral orifice shape and VUR grade. Materials and Methods: Forty children (29 girls and 11 boys) with 61 renal refluxing units (RRU) and primary VUR underwent endoscopic correction of their reflux, using Vantris. Under general anesthesia, routine cystoscopy was performed and ureteral orifice configuration and dynamic hydro distention grade were determined. The injection technique was STING, HIT or a combination of them. Ultrasound scan was performed one and 3 months after injection and radionuclide cystography (RNC) was performed 3 months after the operation. Results: The mean volume of injected Vantris was 0.62 cc. Reflux was corrected in 52 (85.2%) of the 61 RRU after single injection and this equates reflux correction in 37 of the 40 patients. No significant correlation was observed between ureteral orifice shape and VUR correction rate. Conclusions: Our results showed that there was no correlation between the ureteral orifice configuration and the success rate of endoscopic surgery for VUR in short term

Stress Urinary Incontinence and Pelvic Organ Prolapse Correction by Single Incision and Using Monoprosthesis: Three-year Follow-up

Background: The aim was to study the effectiveness and safety of a modified technique that employs a four-arm polypropylene (PP) mesh (NAZCA-TC) to treat pelvic organ prolapse (POP) and concurrent stress urinary incontinence (SUI) simultaneously. Materials and Methods: This prospective follow-up study was conducted on fifty SUI women with concurrent high-grade (greater than Stage 2) anterior vaginal wall and/or uterine prolapse who were referred to Al-Zahra and Noor Hospitals in Isfahan and underwent surgery using the NAZCA-TC, Promedon, Argantina kit. The POP-Quantification system was employed for staging POP before and after surgery. To evaluate lower urinary tract symptoms (LUTS) and patients' quality of life, a stress test and the short form of International Consultation on Incontinence Questionnaire of Female Lower Urinary Tract Symptom were used. Patients were followed up and assessed at 6 weeks, 6 months, and 1, 2, and 3 years after surgery. Results: The mean age of patients was 58.2 ± 10.2 years. There was a great reduction (88.6%) in POP staging after surgery. The success rate of SUI treatment was significantly high (83.5%). During 3 years of postoperative follow-up, mesh erosion occurred in 18%, 5 patients (10%) presented with mesh erosion in the first years after operation, 16% reported significant groin or pelvic pain, and 10% required sling release. Conclusion: A single vaginal incision and using two less percutaneous access sites with the PP meshes were effective for treating patients with concurrent POP and SUI but have a high rate of postsurgery erosion rate

Is there any Relationship Between Bladder Trabeculation and Efficacy and Safety of Intravesical Botulinum Toxin A Injection in Refractory Idiopathic Overactive Bladder Women?

Background: Intradetrusor injection of botulinum toxin A (BTX-A) might serve as a minimally invasive substitute in patients with refractory idiopathic overactive bladder (RIOAB). The aim of this study was to evaluate the clinical outcomes related to two different doses of abo-BTX-A (AboBTX-A) in patients with RIOAB. Materials and Methods: This prospective clinical trial was performed on 55 women with RIOAB. After determination of trabeculation grade, 300 (no or mild) or 500 (moderate or severe) unit of AboBTX-A (Dysport) was intravesicaly injected. Before 1, 3, and 6 months after intervention, lower urinary tract symptoms during 24 h were recorded. Results: Of the study population, 62% had severe bladder trabeculation. The mean duration of overactive bladder (OAB) was 1.76 versus 5.85 years, for no or mild versus severe trabeculation, respectively. After injections of 300- and 500-unit dosage, there were 19% and 26% early complications such as urinary retention. There was a statistically significant difference between the two groups in OAB score after 1 month (P < 0.001) and duration of OAB symptoms, over three follow-up times (P < 0.001). The mean preinjection OAB scores between patients with and without recurrence were statistically significant (29.36 vs. 25.07; P < 0.03). Urinary tract infection as a late complication was distinguished in four patients. Conclusion: In RIOAB, by adjusted dosage of AboBTX-A related to the grade of bladder trabeculation, in addition to maintain efficacy, consequent complications might not be affected by dosage and the drug dosage could be increased to nearly 60% with less concern associated to complicatio