Clinical outcomes of conservative and surgical treatments in functional urology

The field of functional urology deals with functional disorders of the lower urinary tract, which consists of the urinary bladder and its sphincters, and the pelvic floor. Symptoms of lower urinary tract and pelvic floor disorders can have a negative impact on the quality of life. This thesis aims to evaluate effectiveness of conservative and surgical treatment in functional urology, reflected by traditional and patient reported outcome measures. A distinction is made between neurogenic and non-neurogenic patients. The effectiveness of conservative therapy in non-neurogenic children, two surgical interventions in children with a neurogenic condition and one surgical intervention in two different groups of non-neurogenic men are evaluated. To establish an optimal practice, the outcomes of different surgical interventions in a neurogenic population are assessed. Additionally, focus is placed on providing validated Dutch versions of patient reported outcome measures that evaluate sexual function in neurogenic adults and urinary and anorectal symptoms in non-neurogenic children

Tien jaar expertise met aanpasbare continentietherapie voor post-prostatectomie urine-incontinentie

Doel van het onderzoek was de evaluatie van de resultaten van ProACT™-ballonnen voor de behandeling van post-prostatectomie urine-incontinentie (PPI). Tussen 2007 en 2016 werden bij 143 niet-bestraalde patiënten ProACT™-ballonnen geïmplanteerd. De mate van urine-incontinentie is bepaald, waarbij geen inlegger of één dunne inlegger voor de zekerheid werd gedefinieerd als succesvol. De preoperatieve mate van urine-incontinentie was mild (1–2 inleggers) bij 25%, matig (3–4 inleggers) bij 40% en ernstig (≥5 inleggers) bij 35% van de patiënten. Na een mediane follow-up van 56 maanden bleek de behandeling succesvol bij 46% van de patiënten en ervoer 64% van de patiënten een verbetering van het inleggThis study aimed to evaluate outcomes of ProACT™ balloons for the treatment of male stress urinary incontinence after radical prostatectomy. Included were 143 patients without a history of radiotherapy in whom these balloons were implanted between 2007 and 2016. Outcome was urinary continence: no pad or just one security pad per day was defined as successful. Preoperative incontinence was mild in 25%, moderate in 40%, and severe in 35% of patients. The Clavien-Dindo classification <30 days were: 6% grade I, 2% grade II, 2% grade IIIb. 90% of patients had no complication. After median 56 months of follow-up, 64% of patients were improved, including the 46% who were successfully treated. The ProACT™ device showed a clear beneficial continence outcome in patients with stress urinary incontinence after radical prostatectomy. The majority of patients was satisfied and perceived improvement ≥50% on daily pad use on the long term

Outcome and complications of adjustable continence therapy (ProACT™) after radical prostatectomy: 10 years’ experience in 143 patients

Aims: To evaluate our outcomes of the adjustable continence balloons ProACT™ for the treatment of male stress urinary incontinence after radical prostatectomy. Methods: Between May 2007-August 2016 the ProACT™ was implanted in 143 patients without a history of radiotherapy. Endpoints were patient-reported changes in pad counts and complications. Treatment was considered successful if no pad or just one “security” pad per day sufficed, and improved if daily pad use was reduced by ≥50%. Results: Incontinence before implantation was mild in 36 (25%), moderate in 57 (40%), and severe in 50 (35%) patients. Complications within 30 days were classified by the Clavien-Dindo classification; eight (5.6%) grade I, three (2.1%) grade II, three (2.1%) grade IIIb, and 129 (90.2%) patients had no complication. Revision was done in 43 (30%) patients. The IPSS quality of life item improved significantly from 5.0 (IQR 4.0-5.0) preoperative to 2.0 (IQR 1.0-4.0) and 1.0 (IQR 0.0-3.0) 6 and 12 months after implantation, respectively. After a median follow up of 56 months (range 28 to 79, n = 112), 72 (64%) patients were improved, including 51 (45%) patients were successful. Daily pad use decreased from 3.0 to 1.0 (67% reduction). The median outcome on the Patient Global Impression of Improvement scale was “much better,” and 97 (87%) patients perceived improvement. Conclusions: The minimally invasive ProACT™ device showed a clear beneficial continence outcome in patients with stress urinary incontinence after radical prostatectomy. The majority of the patients were satisfied and perceived improvement ≥50% on daily pad use on the long term

The validation of the Dutch OAB-q SF: An overactive bladder symptom bother and health-related quality of life short-form questionnaire

Aims: The overactive bladder quality of life short-form questionnaire (OAB-q SF) evaluates both symptom bother and health-related quality of life in patients with OAB, a highly prevalent disease. The objective of this study was to translate and validate a Dutch version of the OAB-q SF. Methods: The translation into Dutch and validation process of the OAB-q SF was performed according to standardized guidelines. Patients with OAB who visited the department of Urology outpatient clinic completed the questionnaires OAB-q SF, European Quality of life 5-Dimension 5-Level questionnaire (EQ-5D-5L), Urogenital Distress Inventory 6 (UDI-6), and the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) at baseline (test) and 2 weeks later (retest). A reference group from the department of Allergology outpatient clinic completed the same questionnaires once. The evaluated measurement properties included content validity, internal consistency, reproducibility, criterion validity, and construct validity. Results: Fifty-two patients were included in the study group and 51 references were included. The content validity was adequate and the internal consistency was excellent (Cronbach's α > 0.80). The reproducibility was good with intraclass correlation coefficients higher than 0.70. Patient'

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

The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15): Validation of the Dutch version in patients with multiple sclerosis and spinal cord injury

Aims: The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15) evaluates symptoms of sexual dysfunction in patients with multiple sclerosis (MS). The objective of this study was to provide and validate a Dutch version of the MSISQ-15 in patients with neurological disease such as MS and spinal cord injury (SCI). Methods: The linguistic validation process of the original English MSISQ-15 into Dutch was performed according to standardized guidelines. Sexually active patients with MS or spinal cord disorders, includin

Urotherapy in children with dysfunctional voiding and the responsiveness of two condition-specific questionnaires

Aims: We sought to establish the responsiveness of the Dutch Vancouver Symptom Score for Dysfunctional Elimination Syndrome (VSSDES) and Pediatric urinary incontinence Quality of life (PinQ) questionnaires. Secondary, we evaluated the outcome of urotherapy extended for children with dysfunctional voiding (DV). Methods: This cross-sectional multicenter study was done in one tertiary and two community hospitals. Children with DV were included, also when refractory to previous urotherapeutic treatment. The questionnaires were completed before and after urotherapy. The primary outcome measure was the responsiveness of the Dutch VSDESS and PinQ. Secondary outcome was the initial success (defined by the International Children's Continence Society) of extended urotherapy. Results: Between June 2014 and May 2016, 64 children (median age 7 years, IQR 6-10) received urotherapy (median 18 weeks, IQR 11-28). In contrast to the VSSDES, the PinQ showed good responsiveness. For children and parents, respectively, the area under the ROC-curve was 0.79 (P = 0.01) and 0.72 (P = 0.03) for the PinQ and 0.50 (P = 0.98) and 0.55 (P = 0.62) for the VSSDES. Fifty children received extended urotherapy, 27 had complete, and 14 had partial response. Sixteen children had been refractory to previous treatment; four showed complete, and six showed partial response. Conclusion: The PinQ is able to detect clinically important changes in continence-specific quality of life after treatment. We support the use of the VSSDES questionnaire in addition to the current diagnostics for the diagnosis of DV. Extended urotherapy showed to be a successful treatment for children with DV, also for those who had received previous unsuccessful treatment