Ruth Kirschner-Hermanns

Bladder Compliance What Does it Represent: Can We Measure it, and is it Clinically Relevant?

To report the conclusion of the Think Thank 8 on Compliance Discussions during the second ICI‐RS meeting in 2010.

Can incontinence be cured? A systematic review of cure rates

BackgroundIncontinence constitutes a major health problem affecting millions of people worldwide. The present study aims to assess cure rates from treating urinary (UI) or fecal incontinence (FI) and the number of people who may remain dependent on containment strategies.MethodsMedline, Embase, PsycINFO, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, and PEDro were searched from January 2005 to June 2015. Supplementary searches included conference abstracts and trials registers (2013–2015). Included studies had patientsu2009≥u200918xa0years with UI or FI, reported treatment cure or success rates, hadu2009≥u200950 patients treated with any intervention recognized in international guideline algorithms, a follow-upu2009≥u20093xa0months, and were published from 2005 onwards. Title and abstract screening, full paper screening, data extraction and risk-of-bias assessment were performed independently by two reviewers. Disagreements were resolved through discussion or referral to a third reviewer where necessary. A narrative summary of included studies is presented.ResultsMost evidence was found for UI: Surgical interventions for stress UI showed a median cure rate of 82.3% (interquartile range (IQR), 72–89.5%); people with urgency UI were mostly treated using medications (median cure rate for antimuscarinicsu2009=u200949%; IQR, 35.6–58%). Pelvic floor muscle training and bulking agents showed lower cure rates for UI. Sacral neuromodulation for FI had a median cure rate of 38.6% (IQR, 35.6–40.6%).ConclusionsMany individuals were not cured and hence may continue to rely on containment. No studies were found assessing success of containment strategies. There was a lack of data in the disabled and in those with neurological diseases, in the elderly and those with cognitive impairment. Surgical interventions were effective for stress UI. Other interventions for UI and FI showed lower cure rates. Many individuals are likely to be reliant on containment strategies.PROSPERO RegistrationPROSPERO registration number: CRD42015023763.

Fundamentals and clinical perspective of urethral sphincter instability as a contributing factor in patients with lower urinary tract dysfunction--ICI-RS 2014.

Urethral pathophysiology is often neglected in discussions of bladder dysfunction. It has been debated whether “urethral sphincter instability,” referred to based on observed “urethral pressure variations,” is an important aspect of overactive bladder syndrome (OAB). The purpose of this report is to summarize current urethral pathophysiology evidence and outline directions for future research based on a literature review and discussions during the ICI‐RS meeting in Bristol in 2014.

Long-term prognostic significance of rising PSA levels following radiotherapy for localized prostate cancer – focus on overall survival

BackgroundThe aim of this study was to evaluate the long-term prognostic significance of rising PSA levels, particularly focussing on overall survival.MethodsTwo hundred ninety-five patients with localized prostate cancer were either treated with low-dose-rate (LDR) brachytherapy with I-125 seeds as monotherapy (nu2009=u200994; 145Gy), high-dose-rate (HDR) brachytherapy with Ir-192 as a boost to external beam RT (nu2009=u200966; 50.4Gy in 1.8Gy fractions EBRTu2009+u200918Gy in 9Gy fractions HDR) or EBRT alone (70.2Gy in 1.8Gy fractions; nu2009=u2009135). “PSA bounce” was defined as an increase of at least 0.2xa0ng/ml followed by spontaneous return to pre-bounce level or lower, biochemical failure was defined according to the Phoenix definition.ResultsMedian follow-up after the end of radiotherapy was 108xa0months. A PSA bounce showed to be a significant factor for biochemical control (BC) and overall survival (OS) after ten years (BC10 of 83% with bounce vs. 34% without, pu2009<u20090.01; OS10 of 82% with bounce vs. 59% without bounce, pu2009<u20090.01). The occurrence of a bounce, a high nadir and the therapy modality (LDR-BT vs. EBRT and HDR-BTu2009+u2009EBRT vs. EBRT) proved to be independent factors for PSA recurrence in multivariate Cox regression analysis. A bounce was detected significantly earlier than a PSA recurrence (median 20xa0months vs. 32xa0months after RT; pu2009<u20090.01; median PSA doubling time 5.5 vs. 5.0xa0months, not significant). PSA doubling time was prognostically significant in case of PSA recurrence (OS10 of 72% vs. 36% with PSA doubling time ˃ 5xa0months vs. ≤ 5xa0months; pu2009<u20090.01).ConclusionsRising PSA levels within the first two years can usually be classified as a benign PSA bounce, with favourable recurrence-free and overall survival rates. PSA doubling time is an important predictor for overall survival following the diagnosis of a recurrence.

Telemetric monitoring of bladder function in female Göttingen minipigs

To generate real‐time radio‐telemetric urodynamic reference data of maximum detrusor pressure (Pdet max), maximum flow rate (Qmax) and estimated grade of infravesical obstruction, as well as duration of detrusor contraction (DOC), in female Göttingen minipigs and to describe translational aspects of the use of Göttingen minipigs for urological research.

Elderly patients aged ≥ 75 years with locally advanced prostate cancer may benefit from local treatment: a population-based propensity score-adjusted analysis

ObjectiveTo evaluate whether elderly patients aged ≥u200975xa0years with locally advanced prostate cancer (LAPC) may benefit from local treatment (LT).MethodsElderly patients aged ≥u200975xa0years with non-metastatic cT3–4 LAPC who were treated with LT [radical prostatectomy (RP), radiation therapy (RT)] or non-LT (NLT) were identified. After propensity score matching (PSM), cancer-specific mortality (CSM) and other-cause mortality (OCM) rates were assessed. In the assessment of LT vs. NLT and RP vs. RT, multivariable competing risk regression (MVA CRR) analysis was used.Results368 and 482 paired patients were matched for LT vs. NLT and RP vs. RT, respectively. 5 and 10xa0years CSM rates were 9.4 vs. 18.5% in LT and 24.9 vs. 29.3% in NLT-treated patients, respectively (Pu2009<u20090.0001). 5 and 10xa0years CSM rates were 3.4% vs. 8.6% in RP and 6.7% vs. 15.1% in RT-treated patients, respectively (Pu2009=u20090.10). In the MVA CRR model, after PSM, NLT resulted in higher CSM rates in Gleason score 8–10 [subhazard ratio (sHR)u2009=u20092.83, Pu2009<u20090.001], cT3b/4 (sHRu2009=u20093.97/2.56, Pu2009=u20090.003/0.002), cN0 (sHRu2009=u20092.52, Pu2009<u20090.001) or PSAu2009>u200910xa0ng/ml [sHR (PSAu2009=u200910.1–20xa0ng/ml)u2009=u20094.59, Pu2009=u20090.03; sHR (PSAu2009>u200920xa0ng/ml)u2009=u20092.77, Pu2009=u20090.001] patients compared with LT. However, no statistically significant difference in CSM was observed between RP and RT, except for cT3a patients in whom higher CSM rates were noted for RT compared with RP (sHRu2009=u20093.91, Pu2009=u20090.02).ConclusionLAPC patients may benefit from local treatment despite advanced age. However, this benefit was only seen in patients with cT3b/4, Gleason score 8–10, cN0 or PSA >u200910xa0ng/ml.

Current controversies in urinary tract infections: ICI-RS 2017

The current definition of urinary tract infection (UTI) relies on laboratory and clinical findings, which may or may not be relevant, depending upon the patient group under consideration. This report considers the utility of current definitions for UTI in adults with and without underlying neurological conditions in order to identify gaps in current understanding and to recommend directions for research.

Urodynamics Useless in Female Stress Urinary Incontinence? Time for Some Sense-A European Expert Consensus

BACKGROUNDnRoutine use of urodynamics (UDS) for the assessment of female stress urinary incontinence (SUI) appears to be in decline across Europe. The reasons for this trend appear multifactorial, but the implications are of significant concern.nnnOBJECTIVESnTo achieve an expert consensus viewpoint on the value of UDS in female SUI and current barriers to its use.nnnMETHODOLOGYnA multidisciplinary group of UDS experts from six European countries was convened, and a modified version of the Delphi method was utilised to reach a consensus viewpoint structured around five key questions.nnnRESULTSnConsensus was achieved on all five questions. The group was unanimous that the decline in routine use of UDS is unjustified and misguided, driven by restrictions in funding and accelerated by the publication-and subsequent influence-of two trials that had major limitations.nnnLIMITATIONSnThe authors comprised a selected group of UDS experts and the analysis is not a formal systematic review.nnnCONCLUSIONSnExtensive experience and observational studies have demonstrated the value of UDS for the assessment of female SUI and the dangers of empiric management. This evidence base should not be eclipsed by the findings of two randomised controlled trials that had numerous shortcomings.nnnPATIENT SUMMARYnA group of experts were worried that, even though the cause of incontinence varies, doctors seem to be skipping a diagnostic test called urodynamics (UDS) in some patients and just providing treatment-even surgery-without knowing exactly what is wrong. These experts analysed the situation in detail and reached agreement that UDS testing should not be skipped.

Quality of life up to 10 years after external beam radiotherapy and/or brachytherapy for prostate cancer

PURPOSEnThe aim of this study was to evaluate quality-of-life changes up to 10xa0years following three different radiotherapy concepts.nnnMETHODS AND MATERIALSnIn the years 2000-2003, 295 patients were treated with external beam radiotherapy (EBRT; nxa0=xa0135; 70.2xa0Gy in 1.8xa0Gy fractions), low-dose-rate brachytherapy (LDR-BT with I-125; nxa0= 94; 145xa0Gy), and high-dose-rate brachytherapy (HDR-BT with Ir-192; nxa0= 66; 18xa0Gy in two fractions using 4-6 needles) as a boost to EBRT (50.4xa0Gy in 1.8xa0Gy fractions). Quality of life was assessed using the Expanded Prostate Cancer Index Composite at median time of 2, 6, and 10 years after treatment.nnnRESULTSnThe urinary function score 2xa0years after EBRT (mean 93 points) was significantly higher in comparison to HDR-BTxa0+ EBRT (80 points, higher doses to the urethra relevant) and LDR-BT (88 points). After 10 years, only HDR-BTxa0+ EBRT (75 points) remained worse (LDR-BT 92 points; EBRT 91 points). Urinary incontinence score decreased from 83 to 76 points in the HDR-BTxa0+ EBRT group. No significant differences or changes resulted in the bowel domain. The mean sexual function score (i.e., sexuality score) was significantly higher after LDR-BT versus HDR-BTxa0+ EBRT and EBRT (30 vs. 19 and 24 points after 2 years and 25 vs. 13 and 15 points after 10 years, respectively)-a lower patient age and a lower percentage with hormonal treatment need to be considered.nnnCONCLUSIONnApart from decreasing sexual function for all patients, decreasing urinary scoresxa0were found in the HDR-BTxa0+ EBRT group predominantly as a result of increasing incontinence. This study demonstrates the need for optimum BT treatment planning.

Development and initial psychometric properties of the ‘ICIQ-Cog’: a new assessment tool to measure the disease-related impact and care effort associated with incontinence in cognitively impaired adults

To develop a new assessment tool, the ICIQ‐Cog, to measure the disease‐related impact of incontinence in cognitively impaired adults and the effort associated with the care of this population, and to present the initial psychometric properties of this tool and outline the possible clinical implications.