Miyabi Inoue

Extracorporeal magnetic innervation treatment for urinary incontinence

Abstract  Background:  Extracorporeal magnetic innervation (ExMI) is a new technology used for pelvic muscle strengthening for the treatment of stress urinary incontinence. We explored whether this new technology is effective for patients with urge incontinence, as well as those with stress urinary incontinence.

Impact of overactive bladder and lower urinary tract symptoms on sexual health in Japanese women

Introduction and hypothesisThis study aims to assess whether lower urinary tract symptoms (LUTS) affect sexual function in Japanese females.MethodsA multi-component questionnaire was mailed to 576 female hospital workers. It contained the Female Sexual Function Index (FSFI) and a self-administered questionnaire pertaining to LUTS.ResultsOf the 276 responses (overall response rate, 47.9%), 146 questionnaires were evaluable. LUTS had been experienced by 72 (49.3%) of the respondents, 17 (11.6%) had urge urinary incontinence, and 35 (24.0%) had stress urinary incontinence (SUI). The mean overall FSFI score was 22.4 ± 9.0. The mean FSFI score was not significantly different between women with LUTS and women without LUTS (23.2 ± 9.3 and 21.6 ± 8.8, respectively; P = 0.057). However, the mean FSFI score of women with SUI was significantly lower than that of women without it (P = 0.04). No other symptoms showed significant differences in FSFI scores.ConclusionsOur results suggest that sexual dysfunction is related to SUI.

Preliminary Results of the Effect of Extracorporeal Magnetic Stimulation on Urinary Incontinence after Radical Prostatectomy: A Pilot Study

Introduction: Radical prostatectomy is a common procedure for the treatment of clinically localized prostate cancer. However, urinary incontinence is a significant potential source of morbidity following surgery. Extracorporeal magnetic stimulation (ExMS) is a new technology used for pelvic muscle strengthening in the treatment of stress urinary incontinence. We investigated the clinical effects of ExMS on urinary incontinence after retropubic radical prostatectomy. Patients and Methods: Ten patients who had suffered from urinary incontinence for more than 12 months following radical prostatectomy were enrolled in this study. The Neocontrol system was used. Treatment sessions were for 20 min, twice a week for 2 months. The frequency of the pulse field was 10 Hz for 10 min, followed by a second treatment at 50 Hz for 10 min. Objective and subjective measures included voiding diaries, 1-hour pad weight testing, and a quality of life survey at 1, 2, 3, and 6 months after starting the treatment. Urodynamic studies were performed before and after treatment. Results: Three patients became dry (30%), 3 patients improved (30%), and 4 patients showed stationary symptoms (40%). In the 1-hour pad weight testing, the mean pad weight decreased from 25 to 10.3 g, and the quality of life scores had improved from 70.5 to 84.9 2 months after treatment. The frequency of leak episodes per day was reduced from 5.0 times before to 1.9 times after treatment. In the urodynamic study, mean maximum cystometric capacity and Valsalva leak point pressure increased from 197 ± 53.2 to 309 ± 85.3 ml and from 67.3 ± 22.6 to 97.1 ± 22.7 cm H2O after treatment, respectively (p < 0.05). 3 of 6 patients who showed improvement returned to the baseline values within 12 months after treatment and requested maintenance ExMS therapy. No side effects were observed. Conclusions: ExMS therapy offered a new option for urinary incontinence treatment after radical prostatectomy. Further studies are required to determine how long the benefits of treatment last and whether maintenance therapy is necessary.

Use of Doppler ultrasound for non-invasive urodynamic diagnosis

Objectives: A totally non-invasive transperineal urodynamic technique using Doppler ultrasonography has been developed. Methods: Since normal urine does not have blood cells, urine was thought not to produce the Doppler effects. However, basic studies confirmed that the decrease of pressure at high velocity (Bernouilli effect) caused dissolved gas to form microbubbles, which are detected by Doppler ultrasonography. Subjects sat and the probe was advanced via remote control to achieve gentle contact with the perineal skin. The digital uroflow data signals and the color Doppler ultrasound video images were processed on a personal computer. The flow-velocity curves from two sites; the distal prostatic urethra just above the external sphincter (V1) and the sphincteric urethra (V2) were plotted against time. The parameters of both the pressure-flow studies and the Doppler ultrasound urodynamic studies were compared in men who had various degrees of obstruction. Results: Functional cross-sectional area at prostatic urethra (A1), calculated by Qmax/V1, was lower in the group of bladder outlet obstruction (BOO) vs. control group. Velocity ratio (VR), which was calculated by V1/V2, was the parameter having the best correlation with BOO index, though A1 had a similar correlation. This method is viable to diagnose the degree of BOO. Conclusions: The development of non-invasive Doppler ultrasound videourodynamics (Doppler UDS) will dramatically expand the information on voiding function.

52 CHANGES IN CLITORIAL BLOOD FLOW FOLLOWING SURGERY WITH TENSION-FREE VAGINAL MESH FOR PELVIC ORGAN PROLAPSE

INTRODUCTION AND OBJECTIVES: In the previous study, we reported a significant improvement in sexual function outcome following the surgery with tension-free vaginal mesh (TVM) for pelvic organ prolapse (POP). We evaluated the effect of TVM procedure on clitorial blood flow and sexual function in women with POP. METHODS: The study was conducted with 30 patients who underwent TVM for surgical correction of pelvic organ prolapse. Doppler ultrasonography was performed using a commercially available color Doppler scanner (prosound -7, ALOKA, Tokyo, JAPAN) with a 12 mHz linear array transducer. The Doppler translabial probe was placed sagittally on the clitoris at an angle of less than 20°, without exerting any significant pressure on the tissues. After identifying the clitoral artery using color flow mapping, the Doppler probe was positioned over the vessel and at least three sequential Doppler waveforms were obtained. We measured the resistance index (RI), pulsatility index (PI), peak systolic velocity (PSV), and end-diastolic velocity (EDV) of the clitoral arteries, before and 1, 3, 6 months postoperatively. Female sexual function was also investigated with the Female Sexual Function Index (FSFI) which was a 19-question, self-report measure, organized in a 6-domain structure, including desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. RESULTS: One month after surgery, the mean PI and RI, which reflect blood flow impedance, increased and both parameters significantly decreased 6 months after surgery. (P 0.05). On the other hand, the mean PSV and EDV decreased one month after surgery, and then increased at 6 months after surgery. These 4 parameters recovered at 6 months after surgery. Total FSFI scores were deteriorated from 10.2 7.9 at baseline to 7.0 4.3 at 3 months, and then improved significantly to 18.2 8.9 at 6 months after surgery. As the PI and RI decreased, FSFI scores tended to increase; and they also tended to increase as the PSV and EDV increased. CONCLUSIONS: Color Doppler ultrasonography appears to be feasible and useful in measuring both baseline and post-treatment condition of clitorial blood flow in patients treated with TVM for POP. Further studies are necessary to investigate the effect of clitorial blood flow changes on female sexual function in various clinical settings.

The Effect of Hochuekkito on Female Stress Urinary Incontinence

女性腹圧性尿失禁患者に対して補中益気湯を4週間投与し，その臨床的有用性を検討した。女性腹圧性尿失禁患者13名に対し，食前に1日3回補中益気湯7.5gを4週間投与した。治療前，治療1カ月後に，VAS（visual analog scale），IQOL（Incontinence-QOL）による自覚症状の変化を観察し，また排尿日誌を用いて排尿回数，尿失禁回数の変化，パッドテストによる失禁量の変化，尿流測定による他覚的な排尿状態の変化の確認を行った。また投与終了時の患者の満足度も検討した。結果は有意差は認めなかったが，VAS，IQOLスコア，いずれも改善傾向であった。パッドテスト，失禁回数は減少傾向であった。排尿回数，最大尿流量は変化なく，患者満足度は高かった。BMI別で検討すると非肥満型では有意にVAS, IQOLの改善を認めた。補中益気湯は排尿状態に影響を及ぼさず，尿失禁の程度，証などを考慮すれば有効であることが示唆された。副作用として重篤なものは認めなかった。

RECTAL SWAB CULTURES CAN ASSESS FOR ALTERNATIONS IN MICROBIAL FLORA; RECTAL COLONIZATION OF FLUOROQUINOLONE RESISTANT ESHERICHIA COLI AMONG TRANSRECTAL ULTRASONOGRAPHY GUIDED PROSTATE BIOPSY PATIENTS

regression analysis. RESULTS: Forty-five patients were diagnosed with LS. The average age was 50.2 years (range 22.5-82.9) with an average follow-up of 44.2 months. Circumcision or meatotomy was performed in 10, and 7 were treated with clobetasol alone. Twenty-five had urethral disease necessitatinf 26 open surgical repairs. Meatoplasty was performed in 12 (46%), staged repair in 9 (35%), perineal urethrostomy in 4 (15%), and augmented repair in 1 (4%). Recurrent LS was diagnosed in 8 (32%) patients and confirmed with biopsy. Of the recurrences, 1 had undergone extended meatoplasty and 7 recurred following staged procedures: 4 after the first stage, and 3 after completion of the two-staged repair. One patient who had recurrence after a two-stage procedure, also had recurrent LS at the site of subsequent perineal urethrostomy. Younger age at time of diagnosis (p=0.044), bulbar urethra as site of LS (p=0.018), staged urethroplasty as type of intervention (p=0.003), increased number of prior endoscopic procedures (p=0.035), and increased number of prior open procedures (p=0.049) were associated with increased risk of LS recurrence. Race, circumcision status, treatment with steroid cream, and medical co-morbidities were not found to be significant. Multivariate logistic regression analysis did not find any independent risk factors for recurrent LS, though number of prior endoscopic procedures trended towards significance (p=0.12). CONCLUSIONS: Our data suggest the recurrence rate for LS is high, and that the buccal graft may not be the panacea once thought for treatment of LS. The association with previous instrumentation and lack of other associated risk factors suggest that the Koebner phenomenon may be an important factor in progression of LS.