Bladder dysfunction in human T cell lymphotropic virus infection: A prospective cohort study

Background While bladder dysfunction is observed in the majority of patients with human T cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy (HAM), it is also observed in patients who do not fulfill all diagnostic criteria for HAM. These patients are classified as having possible or probable HAM/TSP. However, it remains unclear whether the severity and progression of bladder dysfunction occurs similarly between these two groups. Objective Compare the severity and evolution of bladder dysfunction in HTLV-1-infected patients with possible and definite HAM/TSP. Methods The present prospective cohort study followed 90 HTLV-1 patients with possible HAM/TSP and 84 with definite HAM/TSP between April 2011 and February 2019. Bladder dysfunction was evaluated by bladder diary, overactive bladder symptoms scores (OABSS) and urodynamic studies. Bladder dysfunction progression was defined as the need for clean self-intermittent catheterization (CIC). Results At baseline, nocturia, urgency and OABSS scores were worse in definite compared to possible HAM/TSP patients. The main urodynamic finding was detrusor overactivity, present in 77.8% of the patients with definite HAM/TSP versus 58.7% of those with possible HAM/TSP (P = 0.05). Upon study conclusion, the cumulative frequency of patients requiring CIC increased in both groups, from 2 to 6 in possible HAM/TSP and from 28 to 44 in definite HAM/TSP patients. The estimated time to need for CIC was 6.7 years (95%CI 6.5–7.0) in the possible HAM/TSP group compared to 5.5 years (95%CI 4.8–6.1) in the definite HAM/TSP group. Conclusions Although both groups showed similarities in bladder dysfunction and tended to progress to requiring CIC over time, patients with possible HAM/TSP presented less severe manifestations at baseline and progressed more slowly than those with definite HAM/TSP.

The Impact of Catheter Removal Time on Urinary Continence and Overactive Bladder Symptoms After Robot-Assisted Radical Prostatectomy: A Retrospective Analysis of Consecutive 250 Cases From a Single Institution

Background After radical prostatectomy, the optimal length of postoperative catheterization time remains to be determined. This study investigates the impact of catheter removal time on urinary continence and overactive bladder symptoms after robot-assisted radical prostatectomy (RARP).Methods Two hundred and fifty consecutive patients underwent RARP by a single surgeon between November 2020 and May 2021. Time to catheter removal was categorized into 7, 10, and ≥ 14 days. Continence was defined as no more than 1 pad used or no more than 20 grams of urine leakage per 24 hours. The patients' continence rates and overactive bladder symptom score (OABSS) were assessed at 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks after catheter removal.Results Overall, continence rates were 36% 48 hours after catheter removal, 55.6% 1 week, 74.8% 4 weeks, 98.4% 12 weeks, and 100% 24 weeks after catheter removal. The median time to regain continence was 1 week. After stratification according to catheterization time, no significant difference in continence rates was found between different groups at each time point after catheter removal. Longer catheterization was not an independent predictor of continence recovery (10 days: OR 0.985, 95% CI 0.689-1.409, p = 0.936; ≥14 days: OR 1.194, 95% CI 0.869-1.642, p = 0.274). The presence of diabetes was associated with worse continence outcomes (OR 1.535, 95% CI 1.105-2.132, p = 0.011). The mean OABSS of patients in the continent group were significantly lower than the incontinent group at 48 hours, 1 week, and 4 weeks after catheter removal. No significant difference in OABSS was found between different catheterization time groups at each time point after catheter removal.Conclusions Our results demonstrated that different catheterization time (7 days, 10 days, ≥14 days) is not associated with short-, intermediate-, long-term continence outcomes or overactive bladder symptoms.

Autologous mid-urethral fascial sling for stress urinary incontinence: Long term outcomes

There has been an increasing interest in mesh-free surgical options for Stress Urinary Incontinence (SUI). Traditionally rectus fascia autologous slings were placed at the bladder neck but more recently they are positioned at the mid-urethra (aMUS). The long-term outcomes for these patients are described. A retrospective analysis of aMUS patients between 2009-2014 by a single surgeon for primary SUI was performed. All patients were evaluated preoperatively with urodynamics. Patient reported outcomes were collected via postal questionnaire using the ICIQ-UI short-form questionnaire, 7-point Global Impression of Improvement score, questions on pad usage, self-catheterisation, overactive bladder treatment and re-operation rates. Results included 31 patients (response rate 63.8%). The median age was 49 years and median BMI was 27. Twenty-seven per cent (27%) of patients had stress predominant mixed urinary incontinence pre-operatively. Median length of follow up was 8 years (5- 11); 60% of patients were dry and pad-free. Seventy-seven per cent (77%) found the surgery led to “much improvement” or “very much improvement” in quality of life. Thirteen per cent (13%) of patients reported a deterioration in quality of life. The median ICIQ-UI short form score was 5.5. 16.7% were taking medication and 1 patient received botulinum toxin therapy for overactive bladder symptoms. All these patients had mixed urinary incontinence on preoperative urodynamics. The re-operation rate was 13.3%. One patient was selfcatheterising. Three out of 31 (10%) had experienced pelvic pain, with 2 out of 31 (6%) experiencing dyspareunia. AMUS shows good long-term continence outcomes and is associated with low rates of de-novo overactive bladder symptoms and voiding dysfunction.

Psychiatric History and Overactive Bladder Symptom Severity in Ambulatory Urogynecological Patients

Introduction and hypothesis: A link between psychiatric comorbidities and overactive bladder symptomatology has been suggested by preclinical and clinical studies. Given this, we hypothesized that a psychiatric history and current treatment with psychotropic medications could be related to the severity of overactive bladder and incontinence symptoms in patients referred to a tertiary care urogynecological center. Methods: One hundred and twenty-seven female patients diagnosed with an overactive bladder were screened for a lifetime history of psychiatric disorders and the type and number of psychotropic medications currently taken. The overall severity of overactive bladder symptoms was assessed using the Indevus Urgency Severity Scale. The severity and impact of urinary incontinence on the quality of life were quantified with the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form. Urinary incontinence was further quantified with the aid of the Urinary Distress Inventory-6. The patients were screened for stress urinary incontinence using the Stamey Incontinence Score. Results: A psychiatric history, as well as current use of at least two psychotropic medications, was associated with increased severity of overactive bladder symptoms. A history of depression and current treatment with any selective serotonin reuptake inhibitor was associated with increased severity of stress urinary incontinence symptoms. Current treatment with other psychotropic medications, including sedative-hypnotics and drugs with anticholinergic properties was not related to the severity of overactive bladder and incontinence symptoms.