Publications by authors named "Matteo Balzarro"

45 Publications

Urodynamics criteria of detrusor underactivity in women underwent middle urethral sling for stress urinary incontinence: What is the clinical role?

Neurourol Urodyn 2021 Aug 22. Epub 2021 Aug 22.

Department of Urology, A.O.U.I. Verona University, Italy.

Aims: To assess the role of detrusor underactivity (DUA), diagnosed by different urodynamic criteria, on outcomes of women underwent middle urethral sling (MUS) for stress urinary incontinence (SUI).

Methods: In this prospective study, DUA criteria of women with SUI, naïve for SUI surgery, candidates to MUS were: I [email protected] ≤10 cm H2O and Qmax ≤12 mL/s (Jeong et al.) ii [email protected]<30 cm H2O and Qmax<10 mL/s (Abarbanel and Marcus) iii [email protected]<20 cm H2O and Qmax<15 mL/s and BVE < 90% (BVE criteria) iv [email protected]<20 cm H2O + Qmax (PIP1 Griffiths) Control group (CG) comprised non-DUA patients. Preoperative and at 2-years follow-up evaluation included physical examination, uroflowmetry, post void residual urine (PVR), ICIQ-FLUTS.

Results: 102 patients fulfilled 2-years controls. DUA rate range was 16.7% (BVE) - 53.9% (PIP1-Griffith). The POUR rate varied: 20% (PIP1-Griffith) - 35.3% (BVE), 10% in CG. Tape incision rate for POUR was 3.4% in DUA, 4.5% in CG. No patients had urinary retention at 2-years follow-up. In DUA groups, Qmax did not change significantly after surgery and PVR was low. SUI recurrence rate was 2.8% in DUA, 4.5% in CG. Preoperatively, urgency and post-micturition dribble were the most (82.4%) and the less (26.7%) reported symptoms, respectively. At follow-up, frequency was the most prevalent (56.1%), reduced sensation/bladder pain the less usual (23.1%). ICIQ-FLUTS scores were higher in DUA groups.

Conclusions: DUA did not have a negative impact on MUS outcomes in a mid-term follow-up. Early postoperative voiding complication rates changed according to the type of DUA urodynamic criteria.
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http://dx.doi.org/10.1002/nau.24773DOI Listing
August 2021

Late diagnosis of ureteral injury from anterior lumbar spine interbody fusion surgery: Case report and literature review.

Urologia 2021 Jul 12:3915603211030230. Epub 2021 Jul 12.

Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.

Background: Anterior Lumbosacral Interbody Fusion (ALIF) is a type of back surgery with the advantages of direct access to the spinal interbody space and the potential lessening morbidity related to posterior approaches.

Purpose: To describe a rare case of left ureteral lesion from ALIF surgery diagnosed 4 months after the procedure.

Case Description: A 37-year-old Caucasian man with a long history of painful post-traumatic spondylolisthesis and degenerative L5-S1 disc disease underwent a retroperitoneal anterior L5-S1 discectomy, insertion of an interbody tantallium cage, and placement of a pyramid titanium plate fixed with screws. Four months later, due to recurrent left lumbar pain and mild renal failure, a CT scan was performed showing left hydronephrosis with a homolateral urinoma of 17 cm in diameter. A left nephrostomy was placed and the nephrostography detected a filiform leakage at L5-S1 level in communication with the urinoma. The patient underwent laparoscopic urinoma drainage, distal left ureterectomy, and Casati-Boari flap ureterocystoneostomy with ureteral double J stent placement. The stent was held for six weeks and, 1 month later, the control ultrasound scan was negative for hydronephrosis, the creatinine level had normalized and the patient was asymptomatic.

Conclusion: Ureteral lesion from ALIF surgery is a very rare event. Spinal surgeons should be more awareness regarding the susceptibility of ureteral injuries along with the clinical presentation, diagnostic work-up, and management options for this kind of complication.
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http://dx.doi.org/10.1177/03915603211030230DOI Listing
July 2021

Post-void residual urine ratio: A novel clinical approach to the post-void residual urine in the assessment of males with lower urinary tract symptoms.

Investig Clin Urol 2021 Jul 24;62(4):470-476. Epub 2021 May 24.

Department of Urology, AOUI Verona, Verona, Italy.

Purpose: To assess the correlation between post-void residual urine ratio (PVR-R) and pathological bladder emptying diagnosed by pressure-flow studies (PFS) in males with lower urinary tract symptoms (LUTS).

Materials And Methods: PVR-R and PVR urine were evaluated in 410 males underwent PFS for LUTS. PVR-R was the percentage of PVR to bladder volume (voided volume+PVR). Schafer and International Continence Society (ICS) nomograms, Bladder Contractility Index (BCI) were used to diagnose bladder outlet obstruction (BOO) and detrusor underactivity (DUA). We subdivided the cohort in 4 groups: Group I, BOO+/DUA+; Group II, BOO-/DUA+; Group III, BOO+/DUA-; Group IV, BOO-/DUA- (control group). We subdivided the 4 groups according to PVR-R strata: (1) 0%-20%; (2) 21%-40%; (3) 41%-60%; (4) 61%-80%; (5) 81%-100%.

Results: Group I had a greater median PVR-R (50%) with a >40% in 61.4% of the cohort. Median PVR-R was 16.6% in Group II, 24% in Group III, and 0% in the control Group. According to ICS nomograms and BCI, median PVR-R and PVR were significantly higher (p<0.001) in obstructed and underactive males. PVR-R threshold of 20% allowed to recognize males with voiding disorders with high sensibility, specificity, PPV, and NPV. A PVR-R cut-off of 40% identified males with associated BOO and DUA and more severe voiding dysfunction.

Conclusions: A higher PVR-R is related to a more severe pathological bladder emptying, and to the association of BOO and DUA. PVR-R may have a clinical role in first assessment of males with LUTS and severe voiding dysfunction.
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http://dx.doi.org/10.4111/icu.20200560DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8246021PMC
July 2021

The Impact of Lockdown on Couples' Sex Lives.

J Clin Med 2021 Apr 1;10(7). Epub 2021 Apr 1.

Department of Surgical and Biomedical Science, Andrological and Urogynecological Clinic, Santa Maria Terni Hospital, University of Perugia, 05100 Terni, Italy.

Background: the aim of this study was to perform an Italian telematics survey analysis on the changes in couples' sex lives during the coronavirus disease 2019 (COVID-19) lockdown.

Methods: a multicenter cross sectional study was conducted on people sexually active and in stable relationships for at least 6 months. To evaluate male and female sexual dysfunctions, we used the international index of erectile function (IIEF-15) and the female sexual function index (FSFI), respectively; marital quality and stability were evaluated by the marital adjustment test (items 10-15); to evaluate the severity of anxiety symptoms, we used the Hamilton Anxiety Rating Scale. The effects of the quarantine on couples' relationships was assessed with questions created in-house.

Results: we included 2149 participants. The sex lives improved for 49% of participants, particularly those in cohabitation; for 29% it deteriorated, while for 22% of participants it did not change. Women who responded that their sex lives deteriorated had no sexual dysfunction, but they had anxiety, tension, fear, and insomnia. Contrarily, men who reported deteriorating sex lives had erectile dysfunctions and orgasmic disorders. In both genders, being unemployed or smart working, or having sons were risk factors for worsening the couples' sex lives.

Conclusion: this study should encourage evaluation of the long-term effects of COVID-19 on the sex lives of couples.
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http://dx.doi.org/10.3390/jcm10071414DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037775PMC
April 2021

A challenging surgery repair of a rare case of lateral vaginal wall defect.

Int Urogynecol J 2021 Aug 28;32(8):2301-2303. Epub 2021 Apr 28.

Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, 37100, Verona, Italy.

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http://dx.doi.org/10.1007/s00192-021-04807-wDOI Listing
August 2021

Telemedicine follow-up is safe and efficacious for synthetic midurethral slings: a randomized, multi-institutional control trial.

Int Urogynecol J 2021 Apr 20. Epub 2021 Apr 20.

Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.

Introduction And Hypothesis: The objective was to assess whether telemedicine-based follow-up is equivalent to office-based follow-up in the early postoperative period after routine synthetic midurethral sling placement.

Methods: This is a prospective, international, multi-institutional, randomized controlled trial. Patients undergoing synthetic midurethral sling placement were randomized to 3-week postoperative telemedicine versus office-based follow-up. The primary outcome was the rate of unplanned events. Secondary outcomes included patient satisfaction, crossover from telemedicine to office-based follow-up, and compliance with 3- to 5-month office follow-up.

Results: We included 238 patients (telemedicine: 121 vs office: 117). No differences in demographics or medical comorbidities were noted between the study groups (p = 0.09-1.0). No differences were noted in unplanned events: hospital admission, emergency department visit, or unplanned office visit or call (14% vs 12.9%, p = 0.85) or complications (9.9% vs 8.6%, p = 0.82). Both groups were equally "very satisfied" with their surgical outcomes (71.1% vs 69%, p = 0.2). Telemedicine patients were more compliant with 3- to 5-month office follow-up (90.1% vs 79.3%, p = 0.04).

Conclusions: After synthetic midurethral sling placement, telemedicine follow-up is a safe patient communication option in the early postoperative period. Telemedicine patients reported no difference in satisfaction compared with office-based follow-up but had greater compliance with 3- to 5-month follow-up.
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http://dx.doi.org/10.1007/s00192-021-04767-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056194PMC
April 2021

IncobotulinumtoxinA versus OnabotulinumtoxinA intradetrusor injections in patients with neurogenic detrusor overactivity incontinence: a double-blind, randomized, non-inferiority trial.

Minerva Urol Nephrol 2021 Mar 26. Epub 2021 Mar 26.

Department of Medicine, University of Perugia, Perugia, Italy.

Background: A randomized, double-blind, non-inferiority clinical study was performed on the efficacy and tolerability of IncobotulinumtoxinA vs OnabotulinumtoxinA intradetrusor injections in patients with refractory neurogenic detrusor overactivity incontinence performing intermittent catheterization.

Methods: Sixty-four patients with Spinal Cord Injury or Multiple Sclerosis were randomized to receive 30 intradetrusor injections of IncobotulinumtoxinA or OnabotulinumtoxinA 200 U; 28 patients in IncobotulinumtoxinA group and 29 in OnabotulinumtoxinA group completed the study. Primary outcome measure was the noninferior variation from baseline in daily urinary incontinence episodes (week 12), with a non-inferiority margin of one episode/day. Secondary outcomes measures were changes in Incontinence- Quality of Life questionnaire, Visual Analog Scale score (bother of symptoms on Quality of Life), urodynamic parameters, occurrence of adverse effects and related costs (week 12).

Results: At week 12, mean value of difference in urinary incontinence episodes/day between the two groups was -0.2 (95% two-sided CI: -1; 0.7); the difference in incontinence episodes/day between the two groups was -0.4 with a higher limit of one-sided 95% CI of 0.2 episodes/day which was much lower than the non-inferiority margin of one episode/day. Total score and subscores of Incontinence- Quality of Life questionnaire, Visual Analog Scale Scores and urodynamics did not show differences between the two groups. Adverse effects were similar for both treatments, with urinary tract infection being the most frequent, localised effect. Minor costs were observed following IncobotulinumtoxinA.

Conclusions: In patients with refractory neurogenic incontinence due to Spinal Cord Injury or Multiple Sclerosis, IncobotulinumtoxinA was not inferior to OnabotulinumtoxinA in improving clinical and urodynamic findings in the short-term follow-up, with comparable adverse effects but minor costs.
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http://dx.doi.org/10.23736/S2724-6051.21.04227-2DOI Listing
March 2021

Resilience in the face of pelvic pain: A pilot study in males and females affected by urologic chronic pelvic pain.

Neurourol Urodyn 2021 04 25;40(4):1011-1020. Epub 2021 Mar 25.

Department of Urology, A.O.U.I. Verona University, Verona, Italy.

Aims: Resilience represents a fundamental element in the experience of pain, as it allows adaptation to suffering and increases psychological social well-being and quality of life (QoL). We investigated resilience in patients affected by urologic chronic pelvic pain (UCPP) and the relationships with pain severity and distribution, catastrophizing and psychological distress.

Methods: Forty-eight consecutive UCPP patients were classified on a pain body map as being affected by pelvic pain only or widespread pain (WP), and underwent the evaluation of resilience with the 14-item Resilience Scale (RS-14), with higher scores indicating high resilience levels; scores < 56 denote very poor resilience. Pelvic and nonpelvic pain intensity and the bother of urinary symptoms on QoL were measured by means of Pain Numerical Rating Scale (PNRS) and Visual Analog Scale (VAS). Pain Catastrophizing Scale (PCS) and Depression Anxiety Stress Scales (DASS-21) investigated catastrophizing and psychological conditions.

Results: Overall, RS-14 mean ± SD total score was 50.2 ± 12.5 in patients with pelvic pain only and 40.2 ± 10.2 in those with WP. Significant relationships were observed between low resilience levels and high scores of pelvic and nonpelvic PNRS, VAS, pain catastrophizing scale and depression and anxiety, stress scale (for all: p < 0.001). Significantly lower RS-14 scores were detected in females and in patients with WP.

Conclusions: A very poor resilience has been identified in UCPP patients, particularly in those with greater catastrophizing and mood alterations. WP and female gender were mostly affected. In UCPP patients, low resilience appears as a crucial factor in pain experience.
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http://dx.doi.org/10.1002/nau.24659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252554PMC
April 2021

AUTHOR REPLY.

Urology 2021 Feb;148:46

Department of Urology, San Donato Hospital, Arezzo, Italy.

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http://dx.doi.org/10.1016/j.urology.2020.10.048DOI Listing
February 2021

The Role of Emotional Condition in Patients With Lower Urinary Tract Symptoms Performing Uroflowmetry.

Urology 2021 Feb 17;148:37-46. Epub 2020 Nov 17.

Department of Urology, San Donato Hospital, Arezzo, Italy; Serafico Institute of Assisi, Research Centre "InVita", Assisi, Italy.

Objective: To evaluate the prevalence of the general and uroflowmetry (UF)-related anxiety in patients performing UF, and to assess whether anxiety may affect patient's micturition at UF.

Materials And Methods: This prospective study recruited candidates to UF. Recorded data were: demographics, lower urinary tract symptoms (LUTS) and anxiety questionnaires (IPSS, ICIQ-FLUTS, GAD-7, APAIS-M), UF parameters, linker-type scale for UF satisfaction/reproducibility and discomfort.

Results: We enrolled 167 patients (non-naïve 59.3%). One hundred twenty-five were men. General anxiety was found in 55.3% of patients (63.2% naïve), and UF-related anxiety in 41.3% (46.5% non-naïve). No significantly different rate of anxiety was found between naïve and non-naïve patients. A significant difference was found between IPSS total score in patients without anxiety (10.9 ± 6.4) and subjects with anxiety (16.9 ± 7.3; P < 0001). According to the ICIQ-FLUTS questionnaire, only the subscore F was significantly greater in women with a high level of general and UF-related anxiety (7.8 ± 6.1 vs 12 ± 4.9; P < .001). A low UF satisfaction/reproducibility was reported by 27.5% of patients, in 21.7% of subjects with general anxiety, and 36.6% of patients with UF-related anxiety. High discomfort was recorded in 58.1% of patients. Anxiety affected women twice more than men, and patients with high anxiety had worse urinary symptoms. Non-naïve anxious patients had lower reproducibility of micturition and higher discomfort than naïve anxious candidates to UF.

Conclusion: Several patients showed high general and UF-related anxiety at UF, had worse subjective feelings about the reproducibility of their habitual micturition patterns. In anxious patients, knowledge of UF did not avoid a lower reproducibility of micturition, nor a more considerable discomfort.
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http://dx.doi.org/10.1016/j.urology.2020.10.045DOI Listing
February 2021

Continuing care for patients affected by urologic chronic pelvic pain in the era of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic.

Neurourol Urodyn 2021 01 16;40(1):397-403. Epub 2020 Nov 16.

Pelvic Unit, Department of Urology, San Donato Hospital, Arezzo, Italy.

Aims: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic poses a challenge to treatment of patients with urologic chronic pelvic pain (UCPP), who are at risk to be postponed in the priority of care. We investigated pain, catastrophizing, and psychological status in UCPP patients during SARS-CoV-2 by means of Skype telephone calls.

Methods: A total of 28 UCPP patients underwent Skype video consultations. Pain intensity was assessed with Pain Numerical Rating Scale (PNRS). Pain Catastrophizing Scale (PCS) and Depression Anxiety Stress Scales (DASS-21) were used to assess catastrophizing and psychological status.

Results: During SARS-CoV-2, UCPP patients showed higher intensity of pain than before (mean ± SD PNRS score: 7.25 ± 0.9 vs. 5.4 ± 0.7; p < .0001), with pain exacerbation in 75%; they showed higher PCS and DASS-21 scores as compared to before the pandemic (mean ± SD PCS total score: 32.4 ± 1.2 vs. 23.7 ± 3.5; mean ± SD DASS-21 total score: 42.03 ± 4.5 vs. 34.4 ± 2.2; p < .001 and p < .001, respectively).

Conclusion: During SARS-CoV-2 pandemic UCPP patients presented with high intensity of pain, marked catastrophizing thoughts and severe alteration of the psychological status. These observations impose the need not to postpone assessment and treatment of these patients during the pandemic. Remote visits with video telephone calls are a simple way of continuing care in UCPP patients.
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http://dx.doi.org/10.1002/nau.24574DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7753755PMC
January 2021

Cystocele Repair by a Modified Surgical Technique of Bilateral Pubococcygeus Plication: Long-Term Surgical and Functional Results.

J Clin Med 2020 Oct 16;9(10). Epub 2020 Oct 16.

Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1, 37100 Verona, Italy.

Here we describe our modified surgical technique of bilateral pubococcygeus plication (BPCP) for cystocele repair and assess its safety and long-term outcomes. This is a prospective study of 147 consecutive women who underwent BPCP for cystocele between January 2010 to January 2018. Inclusion criteria was naïve women with symptomatic cystocele ≥ POP-Q 2nd stage. Exclusion criteria: stress urinary incontinence (SUI), urgency urinary incontinence, other associated vaginal wall prolapses ≥ stage 2, neurological diseases, previous SUI surgeries, and previous radiation/surgery of the pelvic area. BPCP was performed by obtaining the medialization of the pubococcygeus muscle fibers of the right and left sides. Statistical analysis was performed. Objective cure was POP-Q < 2nd stage. Subjective cure and functional outcomes were evaluated by validated questionnaires. Patient's satisfaction was assessed by a Likert-type scale. Mean operative time was 64 min. At a mean follow-up of 82.4 months, objective and subjective success rates were 89.8% and 92.2% respectively. De novo urgency was 3.2%. Surgery did not alter sexual function. Complications occurred in 4.8%, and were: wrong dissection plane, hematoma, and pain lasting between 24-72 h. BPCP for correction of cystocele is safe and effective, with limited risk of complication and good long-term results.
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http://dx.doi.org/10.3390/jcm9103318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602712PMC
October 2020

An innovative device in the management of female urodynamic stress incontinence: a perception survey.

Minerva Ginecol 2020 Aug 1;72(4):219-228. Epub 2020 Oct 1.

Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.

Background: Urinary incontinence significantly affects daily life of suffering women. Minimally invasive solutions to cope with urine leakage would be of great interest.

Methods: A survey to investigate efficacy and compliance of an innovative intravaginal device (Diveen®) to reduce the risk of urine leakage was performed in 5 Urogynecological Centers across Italy. Women with urodynamic diagnosis of stress incontinence, included mixed conditions, underwent the survey.

Results: The device was effective (60%) independently from severity of Incontinence or the presence of concomitant detrusor overactivity (mixed forms) with a positive impact on quality of life in more than half of the women. Also compliance with the device was satisfactory (up to 73%). Clinically symptomatic prolapse and age >65 years are the only limiting factors in terms of efficacy and compliance, while the menopausal status would not seem to affect these aspects.

Conclusions: Despite global satisfactory outcomes, 46% of the surveyed women declare their propensity to use the device. This data deserves further investigation.
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http://dx.doi.org/10.23736/S0026-4784.20.04675-4DOI Listing
August 2020

Outcomes of transurethral resection of the prostate in unobstructed patients with concomitant detrusor underactivity.

Neurourol Urodyn 2020 11 28;39(8):2179-2185. Epub 2020 Jul 28.

Department of Urology, A.O.U.I. Verona University, Italy.

Aims: The aim of the study was to evaluate the transurethral resection of the prostate (TURP) outcomes of unobstructed patients with detrusor underactivity (DUA), comparing the surgical results between obstructed and unobstructed males with concomitant DUA, at midterm follow-up.

Methods: This was an observational, prospective, comparative, nonrandomized study. Candidates to TURP underwent preoperative urodynamics (UD), with a diagnosis of DUA, were divided in two cohorts: Group A unobstructed men, group B males with bladder outlet obstruction (BOO). Males were evaluated yearly with uroflowmetry (UF), post-void residual (PVR), and bladder voiding efficiency (BVE), International Prostate Symptom Score (IPSS) questionnaire, visual analogic scale (VAS) for subjective assessment of the quality of life. The degree of the variation of maximum flow rate (Qmax), PVR, BVE, IPSS, VAS between baseline and follow-up (Δ) was evaluated.

Results: Patients in group A were 28 and in group B 23. Overall patient's mean ± SD age was 63.37 ± 12.41 years. Preoperative urodynamics characteristics: mean bladder contractility index (BCI) of 61.15 and 76.25 in group A and B, respectively; mean bladder outlet obstruction index (BOOI) of 17.25 and 50.15 in group A and group B, respectively. After surgery, overall patient group, group A, and group B showed a statistical improvement in IPSS score (P < .0001), Qmax (P < .0001), PVR (P < .0008), BVE (P < .03) and VAS (P < .0001).

Conclusions: BOO had an important impact on the degree of improvement of Qmax and PVR/BVE, while had a poor influence on lower urinary tract symptoms amelioration. The most relevant outcomes were found when BOO was associated with DUA, which was not a contraindication to surgery.
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http://dx.doi.org/10.1002/nau.24470DOI Listing
November 2020

Is the Voided Volume at Office Uroflowmetry Physiological and Reliable? A Comparison between Voiding Diary and Uroflowmetry.

Urol Int 2020 22;104(11-12):908-913. Epub 2020 Jul 22.

Department of Urology, AOUI Verona, Verona, Italy.

Introduction: We compared voided volumes (VV) at voiding diaries (VD) and at uroflowmetry (UF) in men with lower urinary tract symptoms (LUTS).

Methods: This was a prospective, multicenter study. In a cohort of males with LUTS, VV reported in 3-day VD was compared to VV recorded at UF. Demographic data were analyzed. The patients were stratified according to VV. A sub-analysis dividing males by age strata was also performed.

Results: We enrolled 169 patients. Mean VV were higher at UF than at VD in the entire population and in each group, stratified by age. VV significantly decreased with aging. Males with the lowest threshold difference (50 mL) were 29%, with a moderate threshold difference (<100 mL) 55.6%, with an intermediate threshold difference 49.1% (51-150 mL), whereas 21.9% of men had a large threshold difference (>150 mL).

Discussion/conclusion: VV correlation between VD and UF was poor. A large part of men performed UF with VV which were poorly comparable to the habitual VV assessed by 3-day VD. Therefore, our results indicate the relevance to obtain more than 1 UF in these patients.
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http://dx.doi.org/10.1159/000509172DOI Listing
June 2021

Early and Late Efficacy on Wound Healing of Silver Nanoparticle Gel in Males after Circumcision.

J Clin Med 2020 Jun 11;9(6). Epub 2020 Jun 11.

Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy.

We evaluate the early and late safety and efficacy of silver nanoparticle (AgNPs) in wound healing after circumcision. This multicenter prospective comparative non-randomized observational study compares wound dressing with AgNPs (group A) vs. gentamicin cream (group B). Follow-up included objective evaluation at 10 and 30 days by the Southampton Scoring System (SSS) and Stony Brook Scar Evaluation Scale (SBSES). We enrolled 392 males: 194 in group A, and 198 in group B. At 10 days follow-up, in group A, the SSS scale was grade 1 in 49.5% and grade 2 in the remaining; meanwhile, in group B, grade 1 was in 58%, grade 2 in 34.3%, and grade 4 in 7.6%. At 30 days follow-up, grade 1 healing was 97.4% and 98.4% in group A and B, respectively. At 10 days follow-up, the mean SBSES score was 3.58 and 3.69 in group A and B, respectively; while at 30 days follow-up, 4.81 and 4.76 in group A and B, respectively. Only in group B did 7.6% of males have antibiotic therapy due to pus discharge. No patients needed surgical wound revision. AgNPs led to a late but safer healing, they were non-inferior to the antibiotic cream wound dressing efficacy, and they avoided pus discharge and the need for oral antibiotics due to their polymer material.
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http://dx.doi.org/10.3390/jcm9061822DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356923PMC
June 2020

Impact of urodynamic evaluation on the treatment of women with idiopathic overactive bladder: a systematic review.

Minerva Urol Nefrol 2020 Aug 30;72(4):420-426. Epub 2020 Jan 30.

Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Rome, Italy.

Introduction: Overactive bladder (OAB) is a common clinical condition affecting women. The impact of urodynamics (UDS) on the management of idiopathic OAB in women is highly debated. This systematic review analyzes the impact of UDS on the choice and on the outcomes of treatment of female idiopathic OAB.

Evidence Acquisition: A systematic literature search in the PubMed/Medline, Web of Science, Scopus and Cochrane databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement to identify clinical trials, randomized controlled trials, meta-analyses, and guidelines on female OAB and UDS published from 2000. A total of 1554 records were initially identified and 12 articles were included in the final qualitative synthesis.

Evidence Synthesis: UDS represents the main tool to diagnose detrusor overactivity (DO) in OAB female patients which is considered one of the major OAB underlying pathophysiology factor. UDS can underline the presence of voiding dysfunction that could be considered as another underlying cause of uncomplicated female OAB. On the basis of this urodynamic findings, we can better define different aspects of OAB syndrome leading to a more tailored and proper treatment.

Conclusions: UDS can have a useful role in the diagnosis of idiopathic OAB in women given the possibility to gain a precise diagnosis and, therefore, a tailored treatment based on the underlying cause. The integration of clinics with UDS and all the other diagnostic available tools is desirable.
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http://dx.doi.org/10.23736/S0393-2249.20.03685-1DOI Listing
August 2020

Urethral bulking agents for the treatment of female stress urinary incontinence.

Int Urogynecol J 2020 08;31(8):1493-1494

Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.

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http://dx.doi.org/10.1007/s00192-019-04221-3DOI Listing
August 2020

Possible role of 5-alpha reductase inhibitors in non-invasive bladder urothelial neoplasm: multicentre study.

Minerva Urol Nefrol 2019 Dec 12. Epub 2019 Dec 12.

Urology Unit, Department of Medico- Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Latina, Italy.

Background: About 75% of urothelial bladder cancers are non-muscle invasive (NMIBC), and limited to mucosa (Ta or CIS) or sub-mucosa (T1). An increase of androgen expression and androgen receptors has a positive effect on oncogenic expression. We aimed to evaluate whether 5-alpha reductase inhibitors (5-ARI) have a role in NMIBC.

Methods: We retrospectively evaluated the clinical and pathological data of 423 patients with NMIBC who underwent transurethral bladder resection. We analysed the number of resections, number of total recurrences, time of recurrences, and histopathology details. The population was classified into two groups: treated and untreated with 5-ARIs. The enrolled patients were in treatment with 5ARIs for symptomatic prostatic hyperplasia for at least 12 months. Mean follow-up time was 30.43 months.

Results: Patients treated with 5-ARIs had a lower rate of recurrence (14%) than the untreated group (37%). There was a significant difference in the mean number of recurrences between the untreated and the treated group (p value: 0.006). Furthermore, the treated group showed a significantly greater number of low than high grade tumours, compared to the untreated group (p value ≤ 0.05). There was a significant decrease in the number of muscle invasive tumours in treated patients (p value = 0.032). The recurrence- free survival rate of patients treated with 5-ARIs was significantly higher (p value: 0.0001).

Conclusions: Long-term treatment with 5- ARIs might reduce the risk of bladder tumour recurrence, extension of lesions and increase the recurrence-free survival rate. A long-term, randomized prospective study could definitively assess the possible role of these drugs.
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http://dx.doi.org/10.23736/S0393-2249.19.03563-XDOI Listing
December 2019

The bladder is an unreliable witness: The case for urodynamic investigations in female stress urinary incontinence.

Eur J Obstet Gynecol Reprod Biol 2020 Jan 7;244:35-37. Epub 2019 Nov 7.

Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.

For some years, the role of urodynamics (UDS) in female stress urinary incontinence (SUI) has been a topic of intense debate. The findings of the VaLUE and VUSIS-II randomised clinical trials (RCTs) published in 2012 appeared to suggest that UDS is not useful in women with uncomplicated SUI, with the result that several authoritative guidelines were amended and the routine use of UDS in this setting fell sharply. However, many experts have raised concerns about the design of these two RCTs and their subsequent interpretation - including the inappropriate generalisation of the findings beyond uncomplicated cases, which represent only a small minority of the overall patient population. In this paper, we consider a range of issues and confounding factors which raise doubts about how influential these RCTs should have been and reflect on the potential value of UDS both for objective diagnosis and patient counselling in female SUI.
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http://dx.doi.org/10.1016/j.ejogrb.2019.10.046DOI Listing
January 2020

A Prospective Comparative Study of the Feasibility and Reliability of Telephone Follow-Up in Female Urology: The Patient Home Office Novel Evaluation (PHONE) Study.

Urology 2020 Feb 11;136:82-87. Epub 2019 Nov 11.

Dept. of Urology Azienda Ospedaliera Universitaria Integrata, Verona, Italy.

Objective: To determinate the feasibility, reliability, and patient satisfaction of telephonic follow-up in women treated for stress urinary incontinence (SUI) or pelvic organ prolapse (POP): Patient-Home-Office-Novel-Evaluation (PHONE) study.

Methods: This is a prospective comparative study in women following surgery for SUI underwent middle urethral sling (MUS) (Group A), or symptomatic anterior vaginal wall (AVW) defect underwent AVW repair (fascial/mesh/biomesh) (Group B). The 1-year follow-up included a telephonic interview using a checklist and validated questionnaires followed by a standard outpatient clinic visit 7-12 days later including: an interview, validated questionnaires, objective examination, and score satisfaction with the telephone follow-up.

Results: We enrolled 420 pts: 215 for SUI in Group A, and 205 for POP in Group B. SUI recurrence was 19.1% and 11.6% at the telephone and office follow-up, respectively. De-novo urgency urinary incontinence rate was 7.5%. Telephone follow-up was able to detect POP recurrence and related symptoms. Tape and mesh extrusions were detected only at the objective evaluation: 1.9% and 4.4% respectively. No difference was found at the questionnaires. Satisfaction with the telephone follow-up was high.

Conclusion: Due to the wrongly interpretation of de-novo urge urinary incontinence as a recurrence of SUI, a telephone interview may lose reliability in case of reported incontinence. Thus, telephone follow-up was feasible and reliable in women not reporting incontinence. In patients treated for POP the phone interview was a valid tool only in case of no-prosthetic surgery due to the absence of extrusion in these cases.
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http://dx.doi.org/10.1016/j.urology.2019.10.021DOI Listing
February 2020

Lower urinary tract and gastrointestinal dysfunction in sportswomen: a systematic review and meta-analysis of observational studies.

Minerva Urol Nefrol 2020 Dec 4;72(6):698-711. Epub 2019 Nov 4.

Department of Obstetrics and Gynecology, F. Del Ponte Hospital, University of Insubria, Varese, Italy.

Introduction: The aim of this review was to assess the prevalence of gastrointestinal (GI) and lower urinary tract symptoms (LUTS) in sportswomen having high intensity training and to determine whether the type of sport might also affect LUTS and GI symptoms.

Evidence Acquisition: A systematic review of the literature was performed by searching PubMed, CINAHL, Cochrane Library and Web of Science up to November 2018. The search strategy included several keywords concerning pelvic floor disorders, urinary dysfunction, bowel dysfunction, sportswomen, and elite sports. Inclusion criteria were studies of women who performed any kind of sport with a prevalence of LUTS and/or bowel symptoms without any restriction for age, sport modality or frequency of training. Outcomes were prevalence of LUTS and GI symptoms and meta-analyses and moderator analyses to identify risk factors for the occurrence of these symptoms in female athletes.

Evidence Synthesis: During the search, 1263 records were screened, 31 of which met the methodological criteria for qualitative analysis and 5 for meta-analysis. Sportswomen during daily activity showed a threefold higher risk to develop urinary incontinence (UI) than controls (OR 3.13; 95% CI: 2.39-4.00). No differences were found stratifying data for UI types. Cumulative prevalence rates were: 58.7% of all kinds of UI (daily life together with sport time), 32.8% at rest (during daily life out of sport time), 36.3% during sport time; 23% of stress urinary incontinence (SUI) during sport time versus 38.6% at rest; 11% of urge urinary incontinence (UUI) during sport time versus 17.8% at rest; 11.9% of mixed urinary incontinence (MUI) during sport time versus 20.7% at rest. Prevalence rates of GI symptoms before sport time were 57.6%, during sport competition 35.2% and 58.2% after competition.

Conclusions: All the analyzed studies showed bias. This meta-analysis indicated that competitive sport activities represent a risk factor for urinary incontinence and gastrointestinal disorders. To prevent urinary leakage athletes should be instructed to strengthen the pelvic floor muscles.
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http://dx.doi.org/10.23736/S0393-2249.19.03582-3DOI Listing
December 2020

Impact of Overactive Bladder-Wet Syndrome on Female Sexual Function: A Systematic Review and Meta-Analysis.

Sex Med Rev 2019 10 17;7(4):565-574. Epub 2019 Jul 17.

Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.

Introduction: Overactive bladder (OAB) is subtyped into OAB-wet and OAB-dry, based on the presence or absence, respectively, of urgency incontinence. Although women with OAB frequently have a higher risk for sexual dysfunction, a systematic review on the impact of OAB-wet on female sexuality is lacking. This may be evaluated by measuring the effect of the bladder condition on sexuality per se, or by the effect of OAB treatment on female sexual dysfunction.

Aim: To assess the role of OAB-wet on female sexual function.

Methods: A systematic review of the literature was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Research on PubMed, EMBASE, and SCOPUS was performed and concluded on October 15, 2018. A systematic computerized search was conducted on published literature from January 1, 2000-2018. Meta-analysis was performed with a meta-analysis program.

Main Outcomes Measures: The following search terms were used: ((("female sexual function") OR ("female sexual dysfunction") OR ("female sexuality") OR ("dyspareunia")) AND (("overactive bladder") OR ("coital incontinence") OR ("detrusor instability") OR ("detrusor overactivity") OR ("urge urinary incontinence") OR (onabotulinumtoxinA) OR ("botulinum") OR ("sacral neuromodulation") OR (SNM) OR (PTNS) OR ("stoller afferent neuro-stimulation") OR ("SANS") OR ("antimuscarinic drugs") OR ("anticholinergic") OR ("peripheral neuromodulation") OR (beta-agonist))).

Results: 1,033 references were reviewed for inclusion and exclusion criteria. Final analysis identified 12 articles for systematic review. OAB-wet was reported as the most affecting factor on sexuality. OAB treatments showed improvement of both the OAB-wet and the sexual function. Results of the meta-analysis suggested that OAB therapies improving OAB-wet significantly reduced female sexual dysfunction (odds ratio 0.19; 95% CI 0.26-0.45).

Conclusion: OAB-wet represents a risk for sexual dysfunction; however, data available show low-quality evidence of the impact of OAB-wet on sexual dysfunction. Balzarro M, Rubilotta E, Mancini V, et al. Impact of Overactive Bladder-Wet Syndrome on Female Sexual Function: A Systematic Review and Meta-Analysis. Sex Med Rev 2019;7:565-574.
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http://dx.doi.org/10.1016/j.sxmr.2019.05.002DOI Listing
October 2019

Pure stress urinary incontinence: analysis of prevalence, estimation of costs, and financial impact.

BMC Urol 2019 Jun 4;19(1):44. Epub 2019 Jun 4.

Department of Experimental Medicine and Surgery, Urology Unit, Tor Vergata University, Rome, Italy.

Background: The prevalence of pure stress urinary incontinence (P-SUI) and the role of urodynamic investigation (UDI) prior to surgery for stress urinary incontinence (SUI) is debated. Since the exact prevalence of P-SUI is not clear, its clinical and economic impact is not well defined. The aims of this study were to evaluate the prevalence of P-SUI in a population of women who underwent UDI for urinary incontinence (UI), also assessing: 1) the correspondence between clinical diagnosis of P-SUI and urodynamic findings; 2) the analysis of costs in terms of UDI and eventually post-UDI avoided surgical procedures.

Methods: A single cohort of women who underwent UDI for UI between January 2012 and July 2016 was prospectively collected and retrospectively analyzed. Clinical P-SUI was defined by the strict criteria of the International Continence Society. For each patient, history, physical examination and UDI were collected. The correspondence between clinical and urodynamic findings of P-SUI was analyzed. The rate of clinical P-SUI changed after performing UDI and the number of unnecessary intervention after UDI were reported. A wide cost analysis of UDIs, and the amount of surgical procedures that were believed unnecessary after UDI was reported.

Results: Stress urinary incontinence was present in 323/544 (59.4%) patients. The prevalence of clinical P-SUI was 20.7% (67/323), while the prevalence of complicated SUI (C-SUI) was 79.3% (256/323). After UDI, diagnosis of P-SUI decreased to 18.3% (59/232). In 10.2% of cases (6/59) the scheduled middle urethral sling (MUS) was suppressed after the UDI results because 3/6 cases had detrusor overactivity and urge incontinence, in 2/6 cases SUI was treated with a conservative management, in 1/6 case an important voiding dysfunction was detected. Considering the national reimbursement in our country, the cost of each UDI was 296.5 euros and the total amount was 17,493.5 euros. So far the surgery-related savings covered 61.7-105.0% of the costs of total number of UDIs performed in the uncomplicated patients.

Conclusions: The prevalence of clinical P-SUI is relevant, involving about 20% of women with clinical SUI. Although the correspondence between clinical and urodynamic diagnosis was high, we demonstrated that UDI may help in some cases to avoid an inappropriate surgical treatment. Therefore, UDI prior to SUI surgery should be considered to achieve a correct diagnosis and a proper therapeutic strategy.
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http://dx.doi.org/10.1186/s12894-019-0468-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549321PMC
June 2019

Assessment of Overactive Bladder after Laparoscopic Lateral Suspension for Pelvic Organ Prolapse.

Biomed Res Int 2019 4;2019:9051963. Epub 2019 Apr 4.

Department of Urology, Azienda Ospedaliera Universitaria Integrata of Verona, 37121 Verona, Italy.

Background: Pelvic organ prolapses (POP) and overactive bladder (OAB) may coexist and both negatively impact quality of life in women. The correlation between POP and OAB remains unclear, but these patients may have the OAB resolution after the surgical treatment of POP. Aim of our study was to assess the anatomical results and the effect on OAB symptoms in women who underwent laparoscopic lateral suspension for POP.

Materials And Methods: This prospective study included all women with apical POP who underwent surgical repair with laparoscopic uterine lateral suspension from January 2016 to December 2017. The baseline and the 1-year follow-up included post-void residual measurement, urinalysis, vaginal examination, OAB symptoms evaluation, and administration of questionnaires (PFDI-20, UDI 6).

Results: 64 women underwent laparoscopic lateral suspension for uterine prolapse and 78.1% had concomitant anterior vaginal wall defect. At 1-year follow-up the anatomic success rates were 84.4% for the apical and 76.2% for the anterior compartment. The comparison between OAB symptoms before and after the surgical procedure showed the resolution of OAB in 76% of the women, while de novo OAB was present in 2.6%. With the questionnaires 95.3% (61/64) of our patients were satisfied after the POP repair. We documented a trend in ameliorating of OAB regardless of the POP-Q stage. However, the Pearson test showed this correlation as statistically significant only in women with anterior vaginal wall defect stage III and apical stage II. No patient had vaginal exposure of the polypropylene mesh.

Conclusion: Our data show how laparoscopic lateral suspension is an effective procedure for apical and anterior vaginal wall defects. This study provides further evidence for the concept that OAB in women with POP >II stage improves after a successful POP surgery. These women may benefit from a resolution of OAB and POP symptoms with the improvement of patient's quality of life.
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http://dx.doi.org/10.1155/2019/9051963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6475562PMC
August 2019

Transobturator mid-urethral sling in females with stress urinary incontinence and detrusor underactivity: effect on voiding phase.

Int Urogynecol J 2019 09 4;30(9):1519-1525. Epub 2019 Feb 4.

Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Perugia, Italy.

Introduction And Hypothesis: To assess whether detrusor underactivity (DU) is a risk factor for voiding dysfunction (VD) after transobturator tape (TOT) and if a detrusor pressure at maximum flow (PdetQmax) value predicts postoperative VD in DU patients. Also, we examined uncomplicated patients for postoperative VD.

Methods: This is a prospective long-term study on SUI patients who underwent TOT. Exclusion criteria were preoperative POP stage ≥ 2, previous anti-incontinence surgery and comorbidities. Patients were grouped by detrusor contractility using the projected isovolumetric pressure (PIP) index (PdetQmax + maximum flow rate) with values of 30-75 cmHO indicating normal contractility. Follow-up was at 1, 3, 6 and 12 months, and then annually. All patients underwent a stress test and responded to the Urogenital Distress Inventory questionnaire and to the King's Health Questionnaire. The subjective cure was evaluated using the Patient Global Impression of Improvement. We determined the diagnostic accuracy of PdetQmax levels using ROC curve analysis, with a cut-off point calculated for optimal sensitivity and specificity.

Results: In 2007-2013, 118 patients underwent TOT. We included 50 in the undercontractility group (G1) and 50 in the normocontractility group (G2). Continence rates were 82% in G1 and 84% in G2 (mean follow-up 76 months). VD increased from 18 to 36% (p < 0.05) in G1 and from 14 to 16% (p = 0.198) in G2. De novo VD was 28% in G1 and 2% in G2. In the G1 group PdetQmax ≤ 12 cmHO predicted postoperative VD with 71.4% specificity and 80.0% sensitivity.

Conclusions: DU adversely affects the voiding phase of micturition after TOT. In DU patients, PdetQmax ≤ 12 cmHO predicts postoperative VD.
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http://dx.doi.org/10.1007/s00192-019-03871-7DOI Listing
September 2019

Urodynamic findings and functional outcomes after laparoscopic sacrocolpopexy for symptomatic pelvic organ prolapse.

Int Urogynecol J 2019 04 2;30(4):589-594. Epub 2019 Feb 2.

Andrology and Urogynecological Clinic, Santa Maria Hospital Terni, University of Perugia, Piazzale Tristano di Joanuccio, Terni, Italy.

Introduction And Hypothesis: The aim of this study was to evaluate the functional outcomes and urodynamic findings after laparoscopic sacrocolpopexy (LSC) in patients with stages II-IV pelvic organ prolapse (POP).

Methods: In this single-center prospective study, we evaluated 63 women (mean age 62.5 ± 7.5 years) women with symptomatic and advanced POP (stage II-IV) who underwent LSC without concomitant anti-incontinence surgery. The preoperative evaluation incuded history, clinical examination, and urodynamic testing. Women were followed up at 1, 3, 6, and 12 months after surgery and then annually using history, examination, and uroflowmetry. At 6 months, we performed urodynamic testing. To evaluate urinary symptoms, we used the Urogenital Distress Inventory (UDI)-6 questionnaire before and 6 months after surgery.

Results: Median follow- up was 22 months (range 8-48). After surgery, maximum flow (Q) significantly improved compared with baseline (14.17 ± 2.3 vs 27 ± 8.4 ml/s; p = 0.02), and the percentage of patients with elevated postvoid residual (PVR) significantly decreased (33.3% vs 11.1%; p = 0.001). Detrusor overactivity and bladder outlet obstruction disappeared in 73.6% and 85.7% of patients, respectively, while detrusor underactivity persisted in 66.6% of women. Twenty women (31.7%) reported stress urinary incontinence (SUI) before surgery (14 clinically evident and 6 as occult form), which persisted in only 7/20 (11%) patients following LSC, with no de novo cases. The most common preoperative symptoms were voiding symptoms, present in 42/63 (66.6%) patients, which resolved in 36 (85.7%). The overactive bladder syndrome disappeared in 60% of women, with no de novo cases. Results were reflected by a significant decrease in UDI-6 score from a median of 16 (0-45) at baseline to 5.5 (0-17) at the final follow-up (p = 0.001). The domain on storage symptoms (median 3 vs 1) and voiding symptoms (median 3 vs 1) of UDI-6 showed an improvement after surgery (p = 0.001).

Conclusions: The urodynamic finding showed that LSC in women with advanced POP provides good functional outcomes.
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http://dx.doi.org/10.1007/s00192-019-03874-4DOI Listing
April 2019

Counseling in urogynecology: A difficult task, or simply good surgeon-patient communication?

Int Urogynecol J 2018 07 29;29(7):943-948. Epub 2018 May 29.

University of Chicago, Chicago, IL, USA.

Surgical treatments for pelvic organ prolapse (POP) and urinary incontinence (UI) have greatly changed in recent years. Prompted by increases in reports of adverse outcomes in relation to such treatments, several scientific societies and researchers have emphasized providing patients with thorough counseling before treating them. Patient-centered communication has become the gold standard for excellence in clinical care. This challenges clinicians to be cognizant of their patients' perspectives, motivations, expectations, fears, concerns, and social contexts to enable them to reach a shared understanding with patients. Considering this, urogynecology counseling represents a crucial process through which women can gain a clear understanding of their clinical condition and the risks and benefits of potential treatment options. However, many urogynecologists believe that proposing a treatment and providing only enough detail to secure informed consent constitutes counseling. This article is intended to describe good counseling for women undergoing urogynecological surgery and to suggest optimal methodologies for implementation.
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http://dx.doi.org/10.1007/s00192-018-3673-8DOI Listing
July 2018

OnabotulinumtoxinA detrusor injection improves female sexual function in women with overactive bladder wet syndrome.

Eur J Obstet Gynecol Reprod Biol 2018 Jun 5;225:228-231. Epub 2018 May 5.

Dept. of Obstetrics and Gynecology, University of Insubria, via Ravasi 2, Varese, 21100, Italy.

Objectives: The correlation between changes in sexual function and improvements in LUTD in patients treated with OnabotulinumtoxinA (onaBoNT-A) detrusor injection is unclear and limited only to women with neurogenic OAB. The aim of this study was to evaluate the impact of OnabotulinumtoxinA (onaBoNT-A) injection on sexual function in women undergoing this treatment for idiopathic wet overactive bladder (OAB).

Study Design: This is a pilot three-center observational study including women affected by idiopathic wet overactive bladder refractory to standard conservative treatments and underwent onaBoNT-A injection. Sexuality was assessed using the Female Sexual Function Index (FSFI). A 3-day voiding diary, OAB screener questionnaire (OAB-S), and the international consultation on incontinence questionnaire short form (ICIQ-sf) were completed before and 3 months after onaBoNT-A injection to evaluate OAB symptoms.

Results: All the 32 enrolled patients were included for statistical analysis. These patients received 100U of onaBoNT-A. Significant improvement of many FSFI domains was found. Only desire and pain domains had no significant improvements. The FSFI total score showed a significant improvement (P 0.0008). Clinical efficacy has been documented by voiding diaries, OAB-S scores, and ICIQ-sf scores. Correlation between UUI episodes and FSFI total score was statistically significant (r = -0.73; p = 0.04) while no significant correlation was found between the number of micturition and FSFI total score.

Conclusion: Women who underwent successful OnaBoNT-A detrusor injection to treat wet OAB, showed an improvement in sexual function due to the significant correlation between the improvement of urinary urge incontinence and a better gratification of sexuality.
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June 2018
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