Voiding Function and Dysfunction, Bladder Physiology and Pharmacology, and Female Urology.

Abstract

available at http://www.ncbi.nlm.nih.gov/pubmed/30644584 Editorial Comment: The Working Group was formed by the ICS Standardisation Steering Committee, a process that consisted of 16 rounds of internal and external reviews with decision making by consensus. The principal differences in the terminology are as follows. The main sleep period is now defined as the period from the time of falling asleep to the time of intending to rise for the next day. Nighttime is defined as commencing at the time of going to bed with the intention of sleeping and ending when the individual decides they will no longer attempt to sleep and rises for the next day. Thus, nighttime is defined as the individual sleep cycle rather than the solar cycle. Nighttime frequency is defined as the number of voids recorded from the time the individual goes to bed with the intention of going to sleep to the time they end their main sleep with the intention of rising. Nocturia is now differentiated from nighttime frequency and is defined as the number of times urine is passed during the main sleep period. Having woken to pass urine for the first time, each urination must be followed by sleep or the intention to sleep. This should be quantified using a bladder diary. The sign of nocturia is the number of times an individual passes urine during their main sleep period from the time they have fallen asleep up to their intention to rise. This is derived from a bladder diary. The symptom of nocturnal polyuria is defined as passing large volumes of urine during the main sleep period, while the sign is excessive production of urine during the main sleep period, both quantified with a bladder diary. Nocturnal urine volume is the total volume of urine produced during the individual’s main sleep period, including the first void after the main sleep period, quantified using a bladder diary. It would be interesting to see whether those writing about various management strategies for nocturia use the new definition of nocturia or nighttime frequency. The latter may indeed be different (larger). The definition used previously seems to correspond to the current definition of nocturia, although nighttime frequency may actually be a more practical metric to measure. It would also be interesting to see whether assessing this metric would significantly change the statistics in existing studies on management of the disruption of the sleep cycle by having to urinate when someone goes to bed with the intention of going to sleep. Alan J. Wein, MD, PhD (hon) Re: Improvement in Lower Urinary Tract Symptoms across Multiple Domains following Ventriculoperitoneal Shunting for Idiopathic Normal Pressure Hydrocephalus S. C. Krzastek, S. P. Robinson, H. F. Young and A. P. Klausner Division of Urology and Department of Neurosurgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia Neurourol Urodyn 2017; 36: 2056e2063. doi: 10.1002/nau.23235 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/28185313 VOIDING FUNCTION AND DYSFUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY 665available at http://www.ncbi.nlm.nih.gov/pubmed/28185313 VOIDING FUNCTION AND DYSFUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY 665 Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited. Editorial Comment: Idiopathic normal pressure hydrocephalus is characterized by the triad of dementia, gait disturbances and urinary incontinence in the setting of radiographically enlarged lateral ventricles. This condition occurs independently of central nervous system insults and is typically seen in the 8th to 9th decades of life, with the prevalence increasing with age. The authors cite prior series showing that in a newly diagnosed cohort of 55 patients 91% admitted experiencing some degree of urinary incontinence at least once a day, mostly urge predominant. Rates of stress and urge incontinence were higher in women. Younger patients reported greater quality of life impact. Urodynamics testing in this group revealed that 100% of patients had detrusor overactivity. Ventriculoperitoneal shunting is the treatment of choice but it is not an entirely benign procedure and can be associated with significant complications. For that reason not all patients for whom this procedure is prescribed choose to undergo the intervention. This article describes evaluation of patients with idiopathic normal pressure hydrocephalus who underwent ventriculoperitoneal shunting with respect to the effects of the procedure on lower urinary tract symptoms. A total of 55 patients were initially identified, and following full informed consent 16 men and 7 women chose ventriculoperitoneal shunting. Overall, based on the International Consultation on Incontinence Questionnaire (ICIQ) on overactive bladder, postoperatively patients reported significant improvement in amount of urinary urgency, bother from urinary urgency and amount of urgency incontinence. Nocturia did not improve. The ICIQ Urinary Incontinence Short Form was used to evaluate urinary incontinence. Although the domains of leakage frequency, volume and bother, and total score demonstrated improvement, none of these values reached statistical significance. The ICIQ Lower Urinary Tract Symptoms Quality of Life Form showed improved symptoms and bother across all domains, with significant improvement in symptoms in terms of physical activities and global quality of life. The AUA Symptom Score bother scale was improved but not to statistical significance. Women reported statistically more improvement in symptoms across more domains than men but nocturia was changed in neither men nor women. In looking at the bar graphs there were improvements, not necessarily statistically significant, in every domain, although, oddly, the percentage of patients who leaked all the time was reportedly greater after the shunt procedure than before. With this exception, which I really cannot explain, it seems apparent that there is improvement, although not quantum, that one can predict for these patients. Alan J. Wein, MD, PhD (hon) Re: The Fragility of Statistically Significant Findings from Randomized Controlled Trials in the Urological Literature V. M. Narayan, S. Gandhi, K. Chrouser, N. Evaniew and P. Dahm Department of Urology, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, Minnesota, and Division of Orthopaedics, Department of Surgery, McMaster University College of Medicine, Hamilton, Ontario, Canada BJU Int 2018; 122: 160e166. doi: 10.1111/bju.14210 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/29569390available at http://www.ncbi.nlm.nih.gov/pubmed/29569390 Editorial Comment: This is an exceptionally clever and important article. The Fragility Index is defined as the minimum number of patients in a trial arm whose status would have to change from “event” to “nonevent” such that a statistically significant result would become nonsignificant. This index was developed as a novel metric to assess the robustness of statistically significant results and to complement p values and confidence intervals. The Fragility Index could be calculated only in randomized controlled trials with event or nonevent outcomes. These authors assessed fragility in randomized controlled trials published in the urological literature, where this metric has not been used, during a 5-year period. They examined 41 eligible studies. The median Fragility Index was 3, indicating that the addition of only 3 alternate events to an average trial arm would have eliminated the statistical significance. Nine outcomes had a Fragility Index of 0 because they lost their statistical significance when the p values were recalculated using a 666 VOIDING FUNCTION AND DYSFUNCTION, BLADDER PHYSIOLOGY AND PHARMACOLOGY, AND FEMALE UROLOGY Copyright © 2019 American Urological Association Education and Research, Inc. Unauthorized reproduction of this article is prohibited.