VOIDING FUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY
Re: Female Urinary Incontinence: Patient-Reported Outcomes 1 Year after Midurethral Sling Operations € fgren and A. Lalos M. Nilsson, O. Lalos, H. Lindkvist, M. Lo Department of Clinical Sciences, Obstetrics and Gynecology, Umea˚ University, Umea˚, Sweden Int Urogynecol J 2012; 23: 1353e1359.
Abstract available at http://jurology.com/ Editorial Comment: This article ends with the statement that “the challenge for the profession is to adequately inform patients about what surgery can accomplish in order to give them realistic expectations.” This study tries to do just that by analyzing preoperative and 12-month postoperative data from 3,334 women in the Swedish National Register for Gynecological Surgery. Three procedures were compared: tension-free vaginal tape, tension-free vaginal tape-obturator (inside out) and transobturator tape (outside in). The rates of urinary leakage postoperatively in the 3 groups were 27%, 33% and 34%. However, of these half were satisfied with the result of the operation. Of the ones who had leakage 61% had both stress and urgency incontinence, 23% had only urgency incontinence and only 8% had stress incontinence. Eight percent did not specify the type. The percentage rating themselves “much improved” with respect to their incontinence in the 3 groups were 76%, 72% and 70%. Those rating themselves “improved” were 16%, 20% and 21%. Those who were “very satisfied” with the results of the operation were 67%, 61% and 62%. Those rating themselves “satisfied” were 20%, 21% and 22%. Those who were dissatisfied or very dissatisfied totaled 5%, 8% and 7%; 8%, 10% and 9% rated themselves neither satisfied nor dissatisfied. The odds of having urinary leakage 1 year postoperatively increased 19% for every 10 years of age increase and increased 30% for each increase of 5 kg/m2 body mass index. The risk also increased with the preoperative diagnosis of mixed urinary incontinence and urgency urinary incontinence. The glass can be looked at half full or half empty but the results are well characterized and seem realistic. Alan J. Wein, MD, PhD (hon)
Re: The New England Research Institutes, Inc. (NERI) Nocturia Advisory Conference 2012: Focus on Outcomes of Therapy J. P. Weiss, J. G. Blaivas, M. H. Blanker, D. L. Bliwise, R. R. Dmochowski, M. Drake, C. E. DuBeau, A. Hijaz, R. C. Rosen, P. E. Van Kerrebroeck and A. J. Wein Department of Urology, SUNY Downstate College of Medicine, Brooklyn, New York BJU Int 2013; 111: 700e716.
Abstract available at http://jurology.com/ Editorial Comment: Nocturia is a condition that has a multifactorial etiology and at a frequency of 2 times or greater is associated with detrimental effects on sleep quality, mood, depression, overall quality of life and perhaps even mortality. This article is a summation of a conference focused on updating recent outcome studies related to this area. The article provides a useful review. Key conclusions include the following: 1) questionnaires such as the Prostate Symptom Score do not adequately estimate the frequency or prevalence of nocturiadthis is best done by the use of frequency-volume charts; 2) the observed detrimental effects of nocturia follow a dose response pattern; 3) there is a causative relationship between sleep disorder breathing (primarily obstructive sleep apnea) and nocturia, and excellent results are generally achieved in such cases when sleep apnea is successfully managed; 4) the evidence base for determinations of efficacy of various treatments is weak; 5) multicomponent behavioral interventions may be attractive but the limited evidence base limits definite conclusions regarding this; 6) antimuscarinics as stand-alone therapy rarely offer clinically significant benefit over placebo, although they may be useful as part of multimodality therapy in patients with severe nocturnal urgency; 7) some therapies for prostatic obstruction may reduce nocturia in certain circumstances where obstruction is clear and residual urine or nocturia detrusor overactivity can be decreased by outlet reduction; 8) antidiuretic therapy
1053
Re: Female Urinary Incontinence: Patient-Reported Outcomes 1 Year after Midurethral Sling Operations € fgren and A. Lalos M. Nilsson, O. Lalos, H. Lindkvist, M. Lo Department of Clinical Sciences, Obstetrics and Gynecology, Umea˚ University, Umea˚, Sweden Int Urogynecol J 2012; 23: 1353e1359.
Abstract available at http://jurology.com/ Editorial Comment: This article ends with the statement that “the challenge for the profession is to adequately inform patients about what surgery can accomplish in order to give them realistic expectations.” This study tries to do just that by analyzing preoperative and 12-month postoperative data from 3,334 women in the Swedish National Register for Gynecological Surgery. Three procedures were compared: tension-free vaginal tape, tension-free vaginal tape-obturator (inside out) and transobturator tape (outside in). The rates of urinary leakage postoperatively in the 3 groups were 27%, 33% and 34%. However, of these half were satisfied with the result of the operation. Of the ones who had leakage 61% had both stress and urgency incontinence, 23% had only urgency incontinence and only 8% had stress incontinence. Eight percent did not specify the type. The percentage rating themselves “much improved” with respect to their incontinence in the 3 groups were 76%, 72% and 70%. Those rating themselves “improved” were 16%, 20% and 21%. Those who were “very satisfied” with the results of the operation were 67%, 61% and 62%. Those rating themselves “satisfied” were 20%, 21% and 22%. Those who were dissatisfied or very dissatisfied totaled 5%, 8% and 7%; 8%, 10% and 9% rated themselves neither satisfied nor dissatisfied. The odds of having urinary leakage 1 year postoperatively increased 19% for every 10 years of age increase and increased 30% for each increase of 5 kg/m2 body mass index. The risk also increased with the preoperative diagnosis of mixed urinary incontinence and urgency urinary incontinence. The glass can be looked at half full or half empty but the results are well characterized and seem realistic. Alan J. Wein, MD, PhD (hon)
Re: The New England Research Institutes, Inc. (NERI) Nocturia Advisory Conference 2012: Focus on Outcomes of Therapy J. P. Weiss, J. G. Blaivas, M. H. Blanker, D. L. Bliwise, R. R. Dmochowski, M. Drake, C. E. DuBeau, A. Hijaz, R. C. Rosen, P. E. Van Kerrebroeck and A. J. Wein Department of Urology, SUNY Downstate College of Medicine, Brooklyn, New York BJU Int 2013; 111: 700e716.
Abstract available at http://jurology.com/ Editorial Comment: Nocturia is a condition that has a multifactorial etiology and at a frequency of 2 times or greater is associated with detrimental effects on sleep quality, mood, depression, overall quality of life and perhaps even mortality. This article is a summation of a conference focused on updating recent outcome studies related to this area. The article provides a useful review. Key conclusions include the following: 1) questionnaires such as the Prostate Symptom Score do not adequately estimate the frequency or prevalence of nocturiadthis is best done by the use of frequency-volume charts; 2) the observed detrimental effects of nocturia follow a dose response pattern; 3) there is a causative relationship between sleep disorder breathing (primarily obstructive sleep apnea) and nocturia, and excellent results are generally achieved in such cases when sleep apnea is successfully managed; 4) the evidence base for determinations of efficacy of various treatments is weak; 5) multicomponent behavioral interventions may be attractive but the limited evidence base limits definite conclusions regarding this; 6) antimuscarinics as stand-alone therapy rarely offer clinically significant benefit over placebo, although they may be useful as part of multimodality therapy in patients with severe nocturnal urgency; 7) some therapies for prostatic obstruction may reduce nocturia in certain circumstances where obstruction is clear and residual urine or nocturia detrusor overactivity can be decreased by outlet reduction; 8) antidiuretic therapy
1053
