Jan Krhut

Pad weight testing in the evaluation of urinary incontinence.

To present the teaching module “Pad Weight Testing in the Evaluation of Urinary Incontinence.” This teaching module embodies a presentation, in combination with this manuscript. This manuscript serves as a scientific background review; the evidence base made available on ICS website to summarize current knowledge and recommendations.

Persistence with first line anticholinergic medication in treatment-naïve overactive bladder patients

Abstract Objective. The aim of this study was to evaluate the persistence of first line anticholinergic medication use by patients with overactive bladder (OAB). Data from a hospital outpatient database were matched with information obtained by a telephone survey of patients to determine which patients discontinued use of anticholinergic medication and to identify the reasons underlying discontinuation. Material and methods. The study group included 377 OAB patients (52 men, 325 women) with a mean age of 60.29 ± 13.84 years. In total, 189 patients (50.1%) were treated with trospium (median dose 27.86 ± 12.73 mg), 41 patients (10.9%) with propiverine (28.17 ± 4.97 mg), nine patients (2.4%) with extended-release tolterodine (4.0 ± 0 mg), 48 patients (12.7%) with solifenacin (5.94 ± 1.97 mg) and 90 patients (23.9%) with fesoterodine (6.09 ± 2.01 mg). Results. The median time for persistence with the first line anticholinergic treatment was 6.53 ± 3.84 months. Persistence was significantly higher in patients treated with anticholinergic medication with an extended-release formulation than in patients treated with immediate-release anticholinergics. The most common reasons for termination of treatment were healing/resolution of symptoms (35.9%), low effectiveness (30.9%) and side-effects (23.7%). Conclusions. More than half of the OAB patients were not satisfied with their first line treatment. Other treatment options should be sought, such as changing the medication or dosage, or possibly combining treatments.

A Preliminary Report on the Use of Functional Magnetic Resonance Imaging with Simultaneous Urodynamics to Record Brain Activity During Micturition

PURPOSE We mapped brain activity during micturition using functional magnetic resonance imaging with simultaneous recording of urodynamic properties during slow bladder filling and micturition. MATERIALS AND METHODS We evaluated 12 healthy female volunteers 20 to 68 years old. Eight subjects could urinate while supine. Meaningful data were obtained on 6 of these subjects. Brain activity was recorded continuously during bladder filling and micturition. Functional magnetic resonance imaging measurements made during the micturition phase were used for the final analysis. RESULTS Using group statistics we identified clusters of brain activity in the parahippocampal gyrus, anterior cingulate gyrus, inferior temporal gyrus and inferior frontal gyrus during micturition. At the individual level we also observed activation in the upper pontine region, thalamus and posterior cingulum. In subjects unable to void brain activation was documented in the frontal lobe and posterior cingulate gyrus but not in the pons, thalamus or anterior cingulate gyrus. In 5 subjects we identified a relevant pattern of brain activity during the terminal portion of the filling phase when the patient reported a strong desire to urinate. CONCLUSIONS This new protocol allows for the localization of brain structures that are active during micturition. Data suggest that additional validation studies are needed. Future studies will test modifications that include more detailed monitoring of bladder sensation, stratifying subjects based on age and gender, and increasing the number of data points by adding subjects and the number of micturitions recorded in a single subject.

Brain activity during bladder filling and pelvic floor muscle contractions: a study using functional magnetic resonance imaging and synchronous urodynamics.

To map the brain activity during bladder filling by functional magnetic resonance imaging using a refined scanning protocol including synchronous urodynamics and pelvic floor muscle contractions.

Analysis of the upper urinary tract function in multiple sclerosis patients

Aims –  The objective of this study was to analyse the upper urinary tract (UT) function in a group of consecutive multiple sclerosis (MS) patients, who had not previously been treated by urologist.

Persistence in the treatment of overactive bladder syndrome (OAB) with mirabegron in a multicenter clinical study

OBJECTIVE The objective of this project was to evaluate treatment persistence in patients being treated for overactive bladder syndrome (OAB) with mirabegron, employing clinical follow-up in a prospective, multicenter study. STUDY DESIGN This is an analysis of patients who started treatment with mirabegron between May and September 2014 and were evaluated 1year after treatment commenced. During this evaluation we determined how many patients stopped treatment and established their reasons for discontinuation. RESULTS 206 patients being treated for OAB with mirabegron were evaluated a year after starting treatment. It emerged that 60 patients (29.1%) had discontinued the treatment, citing the following reasons: 24/60 insufficient treatment efficacy, 26/60 other reasons, while 10 members of the group discontinued treatment because of side effects. 75 out of 206 patients were ≤60 years old and 28% terminated the study prematurely: 131 out of 206 were >60years old and 29.2% terminated the study prematurely. In the group of patients without previous OAB treatment 35.7% discontinued treatment with mirabegron, while 28.1% of patients with previous anticholinergic treatment discontinued treatment. CONCLUSION In our clinical prospective multicenter study, persistence in treatment with mirabegron reached a figure of 71%.

Brain activity on fMRI associated with urinary bladder filling in patients with a complete spinal cord injury

Patients with complete spinal cord injury (SCI) may maintain some perception of bladder fullness. The aim of the study was to evaluate brain activation arising from anticipated extraspinal sensory pathways.

Lower urinary tract functions in a series of Charcot–Marie–Tooth neuropathy patients

To evaluate lower urinary tract (LUT), bowel, and sexual dysfunctions in a series of patients with Charcot–Marie–Tooth disease (CMT).

Impact of clean intermittent catheterization on quality adjusted life years (QALYs) in spinal cord injury patients with neurogenic urinary incontinence

The impact of clean intermittent catheterization (CIC) on quality adjusted life years (QALYs) gained in adults’ spinal cord injury population with neurogenic urinary incontinence (UI).

Intravesical instillation of onabotulinum toxin A embedded in inert hydrogel in the treatment of idiopathic overactive bladder: A double-blind randomized pilot study

Abstract Objective. It was hypothesized that increasing the time for which onabotulinum toxin A (OnabotA) is exposed to the urothelium following intravesical instillation will augment its effect. TC-3 is an inert heat-sensitive hydrogel, which creates an intravesical bulk providing a slow release of the embedded drug after instillation. The aim of this study was to evaluate the effect of OnabotA, embedded in inert TC-3 hydrogel, in patients with idiopathic overactive bladder (OAB). Methods. In total, 39 female patients (age 30–65, average 53.8 years) with OAB symptoms were randomized for the study into four groups, each receiving 50 ml of the following intravesical instillations: Group A, 0.9% NaCl (placebo, n = 11); Group B, TC-3 gel + 200 U OnabotA (n = 9); Group C, TC-3 gel + 200 U OnabotA + dimethyl sulfoxide (DMSO) (n = 10); and Group D, DMSO (n = 9). The parameters were compared before and 1 month after treatment. Results. When comparing parameters using conventional statistical methods (Kruskal–Wallis test), no statistically significant changes were observed within the groups. Comparison of the medians using an analysis based on the mathematical gnostics showed the superiority of the method used in Group B over the other groups in the following parameters: number of urgency grade 3 + 4 episodes/72 h, number of leakage episodes/72 h, Overactive Bladder Questionnaire total score and Patient Perception of Bladder Condition total score. Group D showed its superiority over the other groups in respect to the number of nocturia episodes/72 h. Conclusions. The results indicate that intravesical instillation of OnabotA, embedded in TC-3 gel, could become an alternative to intramural injection for a well-selected subgroup of patients.