Effectiveness of percutaneous tibial nerve stimulation in the treatment of overactive bladder syndrome

Contains fulltext : 177718.pdf (publisher's version ) (Open Access)Overactive bladder syndrome (OAB) is a common condition affecting adults and children worldwide, resulting in a substantial economic and psychological burden. Percutaneous tibial nerve stimulation (PTNS) is derived from acupuncture used in Chinese traditional medicine and was first described in the early 1980s. It is a neuromodulation technique used to modulate bladder function and facilitate storage. Being a minimally invasive, easily applicable, but time-consuming treatment, future developments with implantable devices might be the solution for the logistical problems and economic burden associated with PTNS on the long term. This nonsystematic review provides a current overview on PTNS and its effectiveness in the treatment of OAB for both adults and children

Which procedure for stress urinary incontinence? Synthetic slings

Contains fulltext : 219922.pdf (Publisher’s version ) (Closed access

Words of wisdom. Re: An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) and grafts in female pelvic floor surgery. Haylen BT, Freeman RM, Swift SE, et al.

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Alterations of the myovesical plexus of the human overactive detrusor

Contains fulltext : 137486.pdf (publisher's version ) (Open Access)OBJECTIVES: The human bladder shows spontaneous autonomous activity. Detrusor overactivity could be seen as a consequence of exaggerated autonomous activity. Interstitial cells (ICs) play a potential role in coordination of autonomous activity. As it is suggested that changes in ICs coexist with detrusor overactivity (DO), we investigated possible alterations to human bladder ICs. METHODS: Biopsies were obtained from 23 patients and were categorized into four groups: genuine stress incontinence (without DO) (n = 5), neurogenic disease with DO (n = 6), bladder outlet obstruction with DO (n = 6), or idiopathic DO (n = 6). Specimens were processed to investigate expression of N-cadherin and PGP9.5. N-cadherin expression was semiquantitatively analyzed and correlated to PG9.5 expression and bladder wall morphology. RESULTS: The population of cells expressing N-cadherin is altered in the overactive detrusor, making no difference between the sources of DO. Punctate distribution of morphological changes was found and downregulation of PGP9.5 expression seemed to coexist with upregulation of N-cadherin expression in the detrusor layer. CONCLUSIONS: The population of N-cadherin+ cells of the interstitial compartment of the human bladder has the ability to proliferate. As this proliferation seems to coexist with denervation, it could be possible that a highly developed network of interstitial cells replaces the loss of innervation in overactive detrusor

The role of urodynamics in the treatment of lower urinary tract symptoms in women.

Item does not contain fulltextPURPOSE OF REVIEW: Urodynamic investigation was developed as an extension of patient history and physical examination in order to reveal the pathology of a patient's complaints. Much progress in standardizing definitions and procedures has been made in recent years. In particular, stress urinary incontinence and overactive bladder can be differentiated with urodynamics. The developed parameters, however, cannot distinguish the various types of stress urinary incontinence. Moreover the definition and diagnosis of voiding dysfunction is not clear. Finally our understanding of bladder sensations and the impact on voiding behaviour has only started to emerge. This review is about last year's publications that focus on urodynamics and lower urinary tract symptoms in women. RECENT FINDINGS: Defining bladder outlet obstruction is based on voiding pressure, urinary flow speed and residual urine but standardization is lacking. Urodynamics to reveal occult stress urinary incontinence in patients with pelvic organ prolapse needs standardization of the reducing manoeuvres. The quest for urodynamic tools for distinguishing intrinsic sphincter deficiency from urethral hypermobility continues. Urodynamics are still not good enough to discriminate between treatment options for stress urinary incontinence. The use of urodynamics in overactive bladder is developing and has elicited new findings. Voiding habit seems to be independent from bladder sensations. Also bladder sensations appear to be imperfectly correlated with bladder filling. Even bladder volumes do not predict entirely bladder fullness sensations. SUMMARY: In order to use urodynamics as a proper clinical tool, defining subtypes of stress urinary incontinence and standardization of urodynamics in pelvic organ prolapse and bladder outlet obstruction in women is needed

Clinical and socioeconomic relevance of overactive bladder.

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Open to debate. The motion: tapes and not bulking agents/drugs are first-line treatment of SUI.

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Urinary incontinence: sphincter functioning from a urological perspective.

Item does not contain fulltextStress urinary incontinence (SUI) is a debilitating disorder caused by malfunctioning of the urethral sphincter. Anatomical and histological properties of the sphincter, its innervation and supporting structures are explained in relation to the closing mechanism of the bladder outlet. Urethral sphincter function is discussed from the passive concept of urethral pressure transmission to the 'hammock theory' and the role of the pubococcygeus muscles. SUI is caused by a combination of intrinsic sphincter deficiency and urethral hypermobility. The difficult interpretation of the parameters in urodynamic investigation to assess intrinsic sphincter deficiency (ISD) and/or urethral hypermobility is discussed. Electromyography (EMG) is valuable in the assessment of the overall urethral sphincter in relation to maneuvers (kinesiological EMG) and at the level of the muscle fiber (needle EMG). The diagnostic potential of circumferential surface EMG in the urethral sphincter is reviewed in relation to the EMG features of ISD