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Weight Loss and Overactive Bladder
AbstractPurpose of ReviewWe sought to explore the relationship between obesity and overactive bladder (OAB) and to review the available literature that supports weight loss as a means to alter OAB severity and bother.Recent FindingsOver the past 15  years, several population-based human studies and animal models have identified obesity as a risk factor for the development of OAB. The bariatric surgery literature demonstrates that substantial weight loss following some form of gastric bypass can lead to at least subjective improvement in OAB s ymptoms. Ongoing research seeks to further elucidate the role of anti-inflammato...
Source: Current Bladder Dysfunction Reports - September 14, 2018 Category: Urology & Nephrology Source Type: research

So the First Pelvic Organ Prolapse Repair Failed …Now What?
AbstractPurpose of ReviewSurgical repair of pelvic organ prolapse (POP) is common and a significant number of women will experience POP recurrence. This paper provides a summary of management options for recurrent POP.Recent FindingsVaginal and abdominal approaches to recurrent POP utilizing native tissues, previously placed mesh, or a new mesh implant are all reasonable options for repair. Choice of surgical approach should be individualized to the patient.SummaryWithout evidence from randomized controlled studies to help clinicians delineate the appropriate repair for each patient, there is still no perfect answer as to ...
Source: Current Bladder Dysfunction Reports - September 4, 2018 Category: Urology & Nephrology Source Type: research

Stress Urinary Incontinence Management in the Patient With Overactive Bladder
AbstractPurpose of the ReviewMixed urinary incontinence is a common diagnosis that has significant impact on patient quality of life and can be more bothersome to patients compared to pure stress incontinence. Given the complexity of concomitant stress incontinence and overactive bladder symptoms, mixed urinary incontinence can often present as a clinically challenging scenario for treating physicians across different subspecialties and primary care medicine. In this review, we discuss the importance of a judicious evaluation and the utility of deciphering stress-predominant versus urge-predominant urinary incontinence in ...
Source: Current Bladder Dysfunction Reports - September 1, 2018 Category: Urology & Nephrology Source Type: research

Post-Implant Management of Sacral Neuromodulation
AbstractPurpose of ReviewPost-implant management of sacral neuromodulation is crucial in ensuring the success of therapy. Common management dilemmas include various follow-up schedules, circumstances related to pregnancy, and the possible need for magnetic resonance imaging. Moreover, complications such as lack of or declining efficacy over time, painful stimulation, pain at the implantable pulse generator site, and wound complications need to properly be handled.Recent FindingsIn this chapter, each of these above-mentioned scenarios is explored, and the literature concerning them is reviewed. Tips regarding dealing with m...
Source: Current Bladder Dysfunction Reports - September 1, 2018 Category: Urology & Nephrology Source Type: research

Management of Recurrent Stress Urinary Incontinence After Failed Mid-Urethral Sling Placement
AbstractPurpose of ReviewOur objective is to review the current literature on recurrent stress urinary incontinence after mid-urethral sling placement, focusing on evidence-based management considerations for this complex clinical problem.Recent FindingsConservative, minimally invasive surgical therapies are currently available for management of persistent or recurrent SUI after a previous mid-urethral sling (MUS).SummaryOur review of the literature does not show a clear benefit of one approach over others and emphasizes that the ideal management for these complex patients should be determined using an individualized appro...
Source: Current Bladder Dysfunction Reports - September 1, 2018 Category: Urology & Nephrology Source Type: research

Managing of Lower Urinary Tract Dysfunction Following Stroke
AbstractPurpose of ReviewThis comprehensive up-to-date review will synthesise relevant available literature on the topic of post-stroke lower urinary tract dysfunction (LUTD). Topics include epidemiology of LUTD, LUTD as a prognostic indicator for stroke recovery, urinary incontinence and retention, correlations between brain lesion localisation and LUTD, causes of LUTD, medical complications due to LUTD, diagnostics and contemporary management of LUTD in stroke patients.Recent FindingsLUTD frequently occurs after a stroke and is associated with poor overall functional outcome, increased institutionalisation and mortality ...
Source: Current Bladder Dysfunction Reports - September 1, 2018 Category: Urology & Nephrology Source Type: research

Cost-Effectiveness of Third-Line Therapies for Overactive Bladder
AbstractPurpose of ReviewWhile third-line therapies for overactive bladder and urgency urinary incontinence are well-described in guideline statements, there is little offered in guidance when it comes to selecting a particular intervention amongst these therapies for patients. Data regarding efficacy has a body of literature that takes sides on all fronts, making efficacy of these interventions a topic of continued debate. An ever-present factor for consideration also remains —cost of therapy. This review examines current data available for cost of third-line therapies.Recent FindingsIn this body of literature regarding...
Source: Current Bladder Dysfunction Reports - September 1, 2018 Category: Urology & Nephrology Source Type: research

New Concepts in Bladder Sensation and Urinary Urgency
AbstractPurpose of ReviewThe purpose of this review is to summarize the current state of knowledge regarding the evaluation and measurement of urinary urgency and bladder sensation.Recent FindingsNew technologies have been developed to improve our diagnostic capabilities in urinary urgency and bladder sensation. Recent developments include MRI-based neuroimaging and novel tablet-based sensation meters that can be used during urodynamics as well as during oral hydration.SummaryCommonly used metrics for urinary urgency and bladder sensation include the use of validated surveys/void diaries and standardized verbal sensory thr...
Source: Current Bladder Dysfunction Reports - September 1, 2018 Category: Urology & Nephrology Source Type: research

AUA Guidelines on Stress Urinary Incontinence: What Is New in the Guidelines?
AbstractPurpose of the ReviewStress urinary incontinence is a prevalent condition that can have a detrimental impact on the quality of life of affected individuals. Once judicious assessment of degree of bother the symptoms are causing a patient is performed, it is crucial to incorporate appropriate counseling and patient education as part of symptom management. Treatment modalities have evolved over the last several decades, and both nonsurgical and surgical treatment options should be discussed. This review highlights the recently published guidelines update from the American Urological Association (AUA) and the Society ...
Source: Current Bladder Dysfunction Reports - September 1, 2018 Category: Urology & Nephrology Source Type: research

Does Urodynamics Impact the Outcomes of Third-line Therapy of Refractory OAB (or Refractory Urgency Urinary Incontinence)?
AbstractPurpose of ReviewOveractive bladder (OAB) is highly prevalent with increasing age. Conservative management including lifestyle adaptation, controlled fluid intake, and bladder training are considered first-line therapeutic options. Second-line options are medication such as antimuscarinics or beta-3 adrenergic receptor agonists. Therapy refractory patients should be referred to a specialist for further evaluation.Recent FindingsIt currently remains unclear if patients should undergo routine urodynamic investigation (UDI) before offering third-line therapies like sacral neuromodulation (SNM) or intradetrusor injecti...
Source: Current Bladder Dysfunction Reports - September 1, 2018 Category: Urology & Nephrology Source Type: research

The Role of Chemical Sphincterotomy with Urethral Botulinum Toxin Injection in Patients with Neurogenic and Non-neurogenic Failure to Empty
AbstractPurpose of ReviewThis review focuses on the evidence for injection of botulinum A toxin (BTX) to the external urinary sphincter for management of impaired bladder emptying secondary to neurogenic conditions such as detrusor sphincter dyssynergia (DSD) and non-neurogenic conditions such as dysfunctional voiding (DV). The application of urethral BTX for patients with impaired emptying secondary to detrusor underactivity will also be discussed. The goal of the review is to comprehensively analyze the evidence surrounding urethral BTX in this context and help guide decision-making.Recent FindingsA robust body of litera...
Source: Current Bladder Dysfunction Reports - September 1, 2018 Category: Urology & Nephrology Source Type: research

Effects of Pelvic Organ Prolapse on the Bladder
AbstractPurpose of ReviewTo assess how pelvic organ prolapse (POP) and treatment affect bladder function.Recent FindingsThere is significant overlap between POP and bladder symptoms, including urinary incontinence and overactive bladder. POP may result in bladder outlet obstruction (BOO) secondary to urethral kinking, which may result in overactive bladder (OAB), dysfunctional voiding, and occult or de novo stress urinary incontinence (SUI). Improvements in obstructive symptoms and dysfunctional voiding after POP surgery suggest that pelvic floor reconstruction restores pelvic floor anatomic structure and function. Further...
Source: Current Bladder Dysfunction Reports - September 1, 2018 Category: Urology & Nephrology Source Type: research