Ahmed S. El-Azab

Arabic validation of the Urogenital Distress Inventory and Adapted Incontinence Impact Questionnaires—short forms†‡

The purpose of this study was to adapt the IIQ‐7 to suit the Egyptian culture and then to assess validity and reliability of the adapted and translated IIQ‐7 and UDI‐6.

Patient reported and anatomical outcomes after surgery for pelvic organ prolapse

Primary aim was to modify Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) to assess pelvic organ prolapse (POP) in Arabic Muslim women. Secondary aim was to compare functional and anatomical outcomes of POP repair.

The satisfaction of patients with refractory idiopathic overactive bladder with onabotulinumtoxinA and augmentation cystoplasty

Abstract Objective: To assess the satisfaction of patients with refractory idiopathic overactive bladder (OAB) with two treatment methods, onabotulinumtoxinA (oBTX) and augmentation ileocystoplasty (AC). Patients and methods: This prospective study included patients with refractory idiopathic OAB for >6 months and a urodynamic diagnosis of OAB. Oral pharmacotherapy had failed in all patients. Patients with any suspected neurological disorder were excluded. Before the procedure, patients completed the Urogenital Distress Inventory (UDI-6) and modified Incontinence Impact Questionnaire (IIQ-7), a neurological evaluation, a urodynamic study and their postvoid residual urine volume was measured. Patients were assigned to receive oBTX or AC, depending on patient’s preference. Follow-up visits were at 6 weeks and 3 and 6 months after the procedure. The OAB Satisfaction questionnaire (OAB-SAT-q) was used to assess satisfaction after the procedure. Results: In all, 31 patients with refractory OAB were included, 16 in the oBTX group and 15 in the AC group. There was no significant difference between the groups in mean age, baseline OAB symptoms and urodynamic values. There were significant improvements in urinary symptoms (UDI-6) and quality of life (IIQ-7) after both procedures (except in the domain enquiring about difficulty, which significantly worsened after AC). Of the 16 patients, 15/16 and seven of 15 were completely dry after AC and oBTX, respectively. The overall and individual scores of the OAB-SAT-q were significantly higher among patients treated with AC than with oBTX. The incidence of the de novo need to use clean intermittent catheterisation after oBTX and AC was two of 16 and four of 15, respectively. Conclusions: Both procedures are effective in improving the symptoms of OAB and of quality of life, but patients were more satisfied with AC than oBTX therapy.

Quality of Life in Bladder Cancer Patients Treated with Radical Cystectomy and Orthotopic Bladder Reconstruction versus Bladder Preservation Protocol

Background: Tri-modality bladder sparing therapy in selected bladder cancer patients may be an alternatives treatment option to immediate radical cystectomy as it may result in satisfactory Quality Of Life (QOL). The present study evaluated the effects of this conservative approach versus surgical approach, i.e. Radical Cystectomy (RC) and orthotopic neobladder, on QOL of patients. Patients and methods: This is a prospective study of patients with bladder cancer in group I (using tri-modality bladder sparing therapy) and group II (using RC and orthotopic neobladder). Patients in both groups were subjected to interview NCCN-FACT FBlSI18 questionnaire, inquiring about physical and emotional disease related symptoms, treatment side effects and function and well being. SPSS version18 software was used for statistical analysis. Results: Internal consistency of the 18 items in both groups was assessed by Cronbach’s α which was adequate at 0.89 at Group I and 0.84 at Group II. Univariate analysis showed that there were statistically significant difference (p<0.05) in favor of group I patients compared to those in group II, regarding bladder function, potency and bowel symptoms. Multivariate analysis revealed that only T stage significantly affected physical and emotional disease related symptoms, and treatment side effects subscales in favor of bladder preservation group. Conclusions: Tri-modality bladder sparing therapy resulted in well-functioning bladders, mild bowel symptoms, and satisfactory sexual functioning in contrast to the surgical approach in bladder cancer patients and should be considered as a reasonable option for these patients.

Developing a treatment for neurogenic bladder dysfunction using Model Predictive Control (MPC)

Abstract Neurogenic Lower Urinary Tract Dysfunction (NLUTD) which is usually called neurogenic bladder, is a dysfunction of the urinary bladder due to malfunction in the central nervous system or peripheral nerves which involved in the control of micturition (urination). Current treatments vary between medications, surgery and open loop Electrical-stimulatory therapy. This paper presents new a treatment approach for this disease using totally a new approach namely the control engineering. A nonlinear model for the LUTD is developed and controller using the Model Predictive Control (MPC) is designed to compensate for the faulty, weak, or absent control signals while considering the constraints in the nerve control signals. The MPC controller shows a significant ability in controlling the micturition process and bringing the bladder behavior to its normal function pattern while satisfying the nerve signal constraints. Meanwhile, the MPC shows significant robustness and excellent ability to deal with wide range of model uncertainties.

Primary versus secondary ureteroscopy for pediatric ureteral stones

OBJECTIVE To evaluate the outcome of primary versus secondary ureteroscopy for pediatric ureteral stones. PATIENTS AND METHODS A retrospective chart review study that included 66 children aged less than 12 years, who were subdivided into two groups: Group A, which included 42 children who had undergone primary ureteroscopy without pre-stenting; and Group B, which included 24 children who had undergone ureteroscopy after ureteric stenting. Kidneys, ureters and bladder radiographs were done on the first postoperative day to assess the degree of stone clearance and stent position. RESULTS Age, gender, stone location and stone size were not significantly different between both groups. In Group A, 31 (73.8%) children required ureteric dilation, 13 (31%) had a tight ureter that failed to respond to dilation, 25 (59.5%) displayed complete stone clearance, and of these, 13 (52%) needed postoperative stenting. One child experienced ureteric injury during stone disintegration and was stented for two weeks. Children in Group B experienced a 95.8% complete stone clearance rate, with no ureteric injury reported; postoperative stenting was performed in three (12.5%) children.. CONCLUSION Secondary ureteroscopy is preferable over primary ureteroscopy in pediatric populations because of a significantly lower need for ureteric dilation, shorter procedure time and better stone clearance rate..

Development of mathematical model for lower urinary tract dysfunctions

The main objective of this paper is to simulate different types of diseases that cause deformities which occur in the lower urinary tract system together with abnormal micturition , which results from these diseases. To achieve this a modified version of the normal micturition process model proposed by William Fletcher (1) was developed and simulated using MATLAB. The new model is assuming abnormal nerve signals and bladder, ureteral muscles disorders The newly developed model allows to simulate six types of lower urinary tract system (LUTS) disorders caused by dysfunctions in bladder, urethral muscles and nerves control system and gives mathematical representation for abnormal micturition process. Moreover, the simulation developed has got a wide number of advantages in the medical sector such as design intelligent control scheme to correct any deformations that occur in lower urinary tract system, and can be allowed to test the system safely before trial with humans.

Parasympathetic Nervous Signal Damping Using the Adaptive Neuro-Fuzzy Inference System Method to Control Overactive Bladder

Overactive bladder is a sudden bladder contraction without the patient’s control despite the bladder may contain only a small amount of urine. The overactive bladder is a chronic dysfunction caused primarily by a problem in the nerves that causes an increasing discomfort and burden on the patient. Therefore, the management of overactive bladder is crucial for the health. This study investigated a new controller approach based on Adaptive Neuro-Fuzzy Inference System to damp the parasympathetic nervous signal and furthermore to stimulate the stimulation locations such as the tibial nerve and dorsal penile nerve to enhance the bladder stability of the control continence. The complete simulations are performed in the MATLAB Simulink to provide comprehensive understanding of the issue. Simulation results demonstrated that the developed Adaptive Neuro-Fuzzy Inference System–based controller would be more effective in damping signal oscillations.

2265 URODYNAMIC PREDICTORS OF DE NOVO CLEAN INTERMITTENT CATHETERIZATION AFTER AUGMENTATION CYSTOPLASTY FOR REFRACTORY OVERACTIVE BLADDER

INTRODUCTION AND OBJECTIVES: In developed countries, numerous minimally invasive procedures are available for refractory Overactive bladder (OAB). Augmentation ileocystoplat (AC) remains an option for cultural and economic reasons in other countries. This study aimed to evaluate preoperative urodynamic variables that may predict subjects with refractory idiopathic OAB who may need CIC after AC. METHODS: Patients with refractory idiopathic urodynamically proven OAB completed UDI-6 and IIQ-7 questionnaires, urodynamics and post-void residual urine assessment before and 6 months after AC. Excluded from our study are subjects with suspected neurological deficit. RESULTS: 13 patients underwent augmentation cystoplasty for refractory OAB. Rate of De novo CIC after augmentation is 30% (n 4). Peak flow rate (Qmax) and detrusor pressure at Qmax were significantly higher among subjects who did not need CIC compared to those who needed CIC after augmentation (see table). In addition, the Qmax occurs during the down limb of the Pdet curve during voiding (see Figure). CONCLUSIONS: Qmax, Pdet at the Qmax and flow rate at the maximum detrusor pressure may ai to predict subjects who might require De novo CIC after AC for refractory idiopathic OAB.