Research

9 pages, 539 KiB

Open AccessArticle

Clinical Experience with a Medical Device Containing Xyloglucan, Hibiscus, and Propolis for the Control of Acute Uncomplicated Urinary Tract Infection-like Symptoms

by Patricia Ortega, Esther Benito and Félix Berrocal

Uro 2022, 2(4), 245-253; https://doi.org/10.3390/uro2040027 - 21 Oct 2022

Cited by 2 | Viewed by 2241

Abstract

Background: The development of drug resistance among causative agents has resulted in the need to change the paradigm toward alternative therapeutic approaches for uncomplicated urinary tract infections (UTIs). The objective of the present study was to evaluate the efficacy of an oral medical [...] Read more.

Background: The development of drug resistance among causative agents has resulted in the need to change the paradigm toward alternative therapeutic approaches for uncomplicated urinary tract infections (UTIs). The objective of the present study was to evaluate the efficacy of an oral medical device containing xyloglucan, hibiscus, and propolis in clinical practice with a cohort of women from Switzerland with UTI-like symptoms and the administration of concomitant drugs. Materials and Methods: This work describes an observational, prospective, and multicenter study involving 103 women attending a primary care physician for a symptomatic episode, or recurrence, of acute uncomplicated cystitis between August 2018 and June 2019. Utipro^®Plus was administered orally, with patients being prescribed two capsules per day for 5 days to control discomfort symptoms or one capsule per day for 15 consecutive days per month (followed by a 15-day break for a 3-month cycle) to prevent recurrences. Results: A total of 84 women (81.6%) did not require an additional consultation, whereas 17 (16.5%) required a second one. Inadequate treatment response was found in 7 women out of the 19 who required a further consultation (36.8%): 3 women with no history of cystitis (out of 13, 23.1%) and 4 with recurrent cystitis (out of 6, 66.7%). None of the women from the study reported an adverse event. Conclusions: The studied product containing xyloglucan, hibiscus, and propolis is safe and effective for the treatment of a broad spectrum of women with acute uncomplicated or recurrent UTI-like symptoms. Full article

(This article belongs to the Special Issue Lower Urinary Tract Research: Rationale, Feasibility, and Design)

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Review

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10 pages, 245 KiB

Open AccessReview

Urinary Artificial Sphincter in Male Stress Urinary Incontinence: Where Are We Today? A Narrative Review

by Anna Ricapito, Matteo Rubino, Pasquale Annese, Vito Mancini, Ugo Falagario, Luigi Cormio, Giuseppe Carrieri, Gian Maria Busetto and Carlo Bettocchi

Uro 2023, 3(3), 229-238; https://doi.org/10.3390/uro3030023 - 06 Sep 2023

Viewed by 789

Abstract

Introduction: Urinary incontinence is a prevalent condition, especially in elderly men, with stress urinary incontinence (SUI) being a common cause after radical prostatectomy. The artificial urinary sphincter (AUS), particularly the AMS 800™ device, has been the gold-standard treatment for moderate-severe male SUI for [...] Read more.

Introduction: Urinary incontinence is a prevalent condition, especially in elderly men, with stress urinary incontinence (SUI) being a common cause after radical prostatectomy. The artificial urinary sphincter (AUS), particularly the AMS 800™ device, has been the gold-standard treatment for moderate-severe male SUI for decades. Despite some technical advancements and alternative devices like ZSI-375, Victo, and BR-SL-AS 904 being introduced, there is limited literature comparing their effectiveness to the AMS 800™. Methods: This literature review compares the AMS 800™ to the newer technologies in the management of SUI. We reviewed the current literature on urinary sphincter implant in male stress incontinence, including AMS 800™, ZSI-375, Victo, and BR-SL-AS 904. Findings: The AMS 800™ is a sophisticated system consisting of an inflatable cuff, a pressure-regulating balloon, and a control pump. Studies show continence rates ranging from 61% to 100% with AMS 800™ implants, with low infection rates and significant improvement in patients’ quality of life. The ZSI-375 sphincter is a unique single-piece cuff without an abdominal reservoir, simplifying implantation. Preliminary data show a social continence rate of 73% at six months, with lower complication rates than the AMS 800™. The VICTO^® device offers adjustable pressure and a stress relief mechanism, providing conditional occlusion of the urethra. Early studies report a satisfaction rate of up to 94.2% and a complication rate of 17.6%. BR-SL-AS 904 is a newly proposed urinary sphincter, but due to the limited number of cases and a single study, its efficacy and complication rates remain uncertain. Conclusions: Overall, AMS 800™ remains the gold-standard treatment for SUI after radical prostatectomy. Alternative devices like ZSI-375 and VICTO^® show promising results, but longer studies and more data are needed to establish their effectiveness and safety compared with the AMS 800™. Further research and ongoing monitoring are essential to address mechanical issues associated with AUS implants. Full article

(This article belongs to the Special Issue Lower Urinary Tract Research: Rationale, Feasibility, and Design)

12 pages, 1530 KiB

Open AccessFeature PaperReview

Evaluation Methods of Detrusor Sphincter Dyssynergia in Spinal Cord Injury Patients: A Literature Review

by José Alexandre Pereira and Thierry Debugne

Uro 2022, 2(2), 122-133; https://doi.org/10.3390/uro2020015 - 01 Jun 2022

Cited by 4 | Viewed by 4288

Abstract

Detrusor sphincter dyssynergia (DSD) is defined as an external urethral sphincter anomalous contraction concomitant to detrusor contraction during voiding, due to a neurological disease. It commonly occurs in suprasacral spinal cord-injured (SCI) patients and can be associated with autonomic dysreflexia. DSD generates risks [...] Read more.

Detrusor sphincter dyssynergia (DSD) is defined as an external urethral sphincter anomalous contraction concomitant to detrusor contraction during voiding, due to a neurological disease. It commonly occurs in suprasacral spinal cord-injured (SCI) patients and can be associated with autonomic dysreflexia. DSD generates risks to the urinary system and overall health; hence, it should be promptly diagnosed and managed. Bladder neck dyssynergia is a condition that should be integrated in DSD assessment. We reviewed the literature indexed in PubMed/Medline on the evaluation methods of DSD in SCI patients. Urodynamics is the mainstay evaluation method and has a prognostic value for the progression of upper urinary tract structural degradation and renal function decline. We found a lack of consensus on the optimal urodynamics configuration when evaluating DSD, especially in obtaining and measuring the signal from external urethral sphincter (EUS) activity. It appears that a combination of recordings of voiding cystourethrography and EUS electromyography, either with or without EUS pressure measurement, is the most accurate method available for evaluating DSD. While gathering articles, we came across an interesting approach in evaluating DSD in the past: urodynamics coupled with ultrasound imaging. Despite being considered valuable from a diagnostic standpoint by some prominent authors, it is no longer represented in the current literature. In addition to the instrumental diagnosis, health professionals should consider additional clinical features when evaluating and managing DSD in SCI patients, to design a customized plan to achieve the best compromise between quality of life and urinary system protection. Full article

(This article belongs to the Special Issue Lower Urinary Tract Research: Rationale, Feasibility, and Design)

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Other

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6 pages, 195 KiB

Open AccessCase Report

Ureteral Complications during Surgery

by Raymond A. Dieter, Jr., George B. Kuzycz and William Jacob Dieter

Uro 2023, 3(1), 48-53; https://doi.org/10.3390/uro3010007 - 01 Feb 2023

Viewed by 1366

Abstract

Historically, ureteral complications during surgery have been occurring since the earliest performances of major abdominal or pelvic surgery. In the early 1960s, few diagnostic techniques were available to diagnose ureteral injury and determine the subsequent timely treatment required. Illustrations from two different time [...] Read more.

Historically, ureteral complications during surgery have been occurring since the earliest performances of major abdominal or pelvic surgery. In the early 1960s, few diagnostic techniques were available to diagnose ureteral injury and determine the subsequent timely treatment required. Illustrations from two different time periods of possible operative ureteral injury, ligation, or transection following major complicated surgical procedures are presented, along with the diagnostic and therapeutic approach currently followed. The first individual had apparently sustained a ureteral injury during a prior surgical procedure, which, with limited diagnostic options, was not recognized until she visited us years later—as was the case for many early ureteral injuries. Major abdominal or pelvic surgery may be extensive and complicated, especially when dense fibrosis, scarring, and benign or malignant mass formation are present. Unfortunately, surgical complications, including bleeding and ureteral concerns, may develop during these extensive procedures. A more recent patient underwent major, life-threatening retroperitoneal surgery due to a chronic aortoenteric fistula (17 months total preoperative hospitalization elsewhere), during which the left ureter was transected. In our second patient, recognition and correction of the ureteral transection during the aortic surgery, upon completion of the aortic repair, prevented a potential major renal complication. The timely diagnosis of the operative ureteral injury and the repair prior to wound closure prevented major postoperative complications. As some physicians believe that surgically induced ureteral injuries are increasing in frequency, we present this report to enhance awareness of the possibility of injury and the potential value of recognition prior to abdominal closure. In addition, current operative and postoperative strategies available to identify and reduce potential ureteral injury complications when they occur are discussed. Full article

(This article belongs to the Special Issue Lower Urinary Tract Research: Rationale, Feasibility, and Design)

7 pages, 4533 KiB

Open AccessCase Report

Traumatic Urinary Bladder and Renal Artery Disruption with Kidney Salvage—A Case Report

by Raymond A. Dieter, Jr., George B. Kuzycz, Robert S. Dieter and Raymond A. Dieter III

Uro 2023, 3(1), 20-26; https://doi.org/10.3390/uro3010004 - 17 Jan 2023

Cited by 2 | Viewed by 1380

Abstract

Motor vehicle accidents continue to cause thousands of life threatening injuries or mortality (nearly 45,000 deaths in 2021) in the United States. A sixteen year-old young man riding a motorcycle was severely injured when struck by an automobile driven by an individual under [...] Read more.

Motor vehicle accidents continue to cause thousands of life threatening injuries or mortality (nearly 45,000 deaths in 2021) in the United States. A sixteen year-old young man riding a motorcycle was severely injured when struck by an automobile driven by an individual under the influence of alcohol. Multiple long bone fractures, the left renal artery torn off the aorta, with non-function of the left kidney, urinary bladder rupture with cystourethral injury, thoracic aortic disruption, and splenic fracture injuries were present. Emergency repair of the thoracic aorta, splenectomy, and left renal artery bypass were all completed. Absorbable suture repair of the urinary bladder and cystouretheral junction injuries followed Foley and suprapubic bladder decompression. All long bone fractures were stabilized and corrected. Normal urinary function of the left kidney returned, and urinary bladder control accompanied the four-month recuperation. Six and twelve month follow-up showed almost normal mobility with normal bilateral renal and urinary bladder function. Full article

(This article belongs to the Special Issue Lower Urinary Tract Research: Rationale, Feasibility, and Design)

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8 pages, 233 KiB

Open AccessOpinion

Urological Management of the Spinal Cord-Injured Patient: Suggestions for Improving Intermittent Catheterization and Reflex Voiding

by James Walter, John Wheeler, Raymond Dieter, Brandon Piyevsky and Aasma Khan

Uro 2022, 2(4), 254-261; https://doi.org/10.3390/uro2040028 - 11 Nov 2022

Viewed by 1890

Abstract

Spinal cord injury can either be complete with no neural communication across the injury level or incomplete with limited communication. Similarly, motor neuron injuries above the sacral spinal cord are classified as upper motor neuron injuries, while those inside the sacral cord are [...] Read more.

Spinal cord injury can either be complete with no neural communication across the injury level or incomplete with limited communication. Similarly, motor neuron injuries above the sacral spinal cord are classified as upper motor neuron injuries, while those inside the sacral cord are classified as lower motor neuron injuries. Specifically, we provide recommendations regarding the urological management of complete upper motor neuron spinal cord injuries; however, we also make limited comments related to other injuries. The individual with a complete upper motor neuron injury may encounter five lower urinary tract conditions: first, neurogenic detrusor overactivity causing urinary incontinence; second, neurogenic detrusor underactivity resulting in high post-void residual volumes; third, detrusor sphincter dyssynergia, which is contraction of striated and/or smooth muscle urethral sphincters during detrusor contractions; fourth, urinary tract infection; and fifth, autonomic dysreflexia during detrusor contractions, which produces high blood pressure as well as smooth muscle detrusor sphincter dyssynergia. Intermittent catheterization is the recommended urinary management method because it addresses the five lower urinary tract conditions and has good long-term outcomes. This method uses periodic catheterizations to drain the bladder, but also needs bladder inhibitory interventions to prevent urinary incontinence between catheterizations. Primary limitations associated with this management method include difficulties with the multiple catheterizations, side effects of bladder inhibitory medications, and urinary tract infections. Three suggestions to address these concerns include the use of low-friction catheters, wireless, genital-nerve neuromodulation for bladder inhibition, and consideration of urine egress into the urethra as a risk factor for UTI as well as egress treatment. The second management method is reflex voiding. This program uses external condoms for urine collection in males and diapers for females. Suprapubic tapping is used to promote bladder contractions. This method is not recommended because it has high rates of medical complications. In particular, it is associated with high detrusor pressure, which can lead to ureteral reflux and kidney pathology. Botulinum toxin injection into the urethral striated sphincter can manage detrusor sphincter dyssynergia, reduce voiding pressures, and risks to the kidney. We suggest a modified method for botulinum toxin injections as well as five additional methods to improve reflex voiding outcomes. Finally, the use of intermittent catheterization and reflex voiding for individuals with incomplete spinal injuries, lower motor neuron injuries and multiple scleroses are briefly discussed. Full article

(This article belongs to the Special Issue Lower Urinary Tract Research: Rationale, Feasibility, and Design)

5 pages, 641 KiB

Open AccessOpinion

Is Urine Egress into the Female Urethra a Risk Factor for UTI?

by James Walter, John Wheeler and Aasma Khan

Uro 2022, 2(4), 199-203; https://doi.org/10.3390/uro2040024 - 23 Sep 2022

Cited by 1 | Viewed by 1907

Abstract

In 50% of typical (nonneurogenic) women, at least one urinary tract infection (UTI) will occur, with cystitis being the most common UTI, with about 25% of patients experiencing recurrence. A factor not currently included in UTI risk models is egress of urine from [...] Read more.

In 50% of typical (nonneurogenic) women, at least one urinary tract infection (UTI) will occur, with cystitis being the most common UTI, with about 25% of patients experiencing recurrence. A factor not currently included in UTI risk models is egress of urine from the bladder into the urethra during bladder filling and activities of daily living. Urinary egress, if it occurs, would shorten the distance that bacteria need to travel to gain access to the bladder. Video urodynamics with contrast medium can demonstrate urinary egress; however, the observations can be difficult to conduct. Egress can be expected to be more likely in women with lower urinary tract conditions such as urge and stress incontinence. Treatment of the incontinence also reduces UTI rates and the reduction could, in part, be due to reduced urine egress. If UTI risk remains after incontinence management, then further treatment with pelvic floor exercises and pessaries could be considered to reduce the risk from potential residual urine egress. In summary, urine egress as a risk factor for UTI needs further research and clinical consideration. Full article

(This article belongs to the Special Issue Lower Urinary Tract Research: Rationale, Feasibility, and Design)

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6 pages, 506 KiB

Open AccessOpinion

Can Wireless Transcutaneous Nerve Stimulation Applied to the Genital Nerve Manage Urinary Incontinence Following Spinal Cord Injury and Multiple Sclerosis?

by James Walter, John Wheeler and Aasma Khan

Uro 2022, 2(3), 173-178; https://doi.org/10.3390/uro2030021 - 27 Jul 2022

Cited by 1 | Viewed by 1790

Abstract

Individuals with spinal cord injury and multiple sclerosis usually use intermittent catheterization for urinary management; however, many patients will also encounter a condition of neurogenic detrusor overactivity, which causes urinary incontinence. The use of muscarinic receptor antagonists is the first-line treatment to manage [...] Read more.

Individuals with spinal cord injury and multiple sclerosis usually use intermittent catheterization for urinary management; however, many patients will also encounter a condition of neurogenic detrusor overactivity, which causes urinary incontinence. The use of muscarinic receptor antagonists is the first-line treatment to manage this condition. These drugs, however, have significant side effects. Transcutaneous electrical nerve stimulation applied to the genital nerve (GEN) is an alternative noninvasive method that produces detrusor inhibition through neuromodulation. Despite studies demonstrating bladder inhibition with GEN, more outcomes are required regarding decreased use of bladder inhibitory medications and concerns with dangling wires. It is proposed that wireless-GEN can be used in home-use studies in order to address these limitations. If needed, wireless tibial nerve stimulation could be added to improve incontinence management. Full article

(This article belongs to the Special Issue Lower Urinary Tract Research: Rationale, Feasibility, and Design)

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3 pages, 164 KiB

Open AccessOpinion

Use of Bethanechol, 50 mg/BID, for a Failed Decatheterization Test: A Position Statement

by James Walter and John Wheeler

Uro 2022, 2(2), 134-136; https://doi.org/10.3390/uro2020016 - 20 Jun 2022

Cited by 2 | Viewed by 2309

Abstract

If urinary catheters are used during surgeries, epidurals and parturition, patients and their physicians want a return to volitional voiding as soon as possible. Micturition is regained by passing a decatheterization test. Fortunately, only a small percentage of patients fail three or more [...] Read more.

If urinary catheters are used during surgeries, epidurals and parturition, patients and their physicians want a return to volitional voiding as soon as possible. Micturition is regained by passing a decatheterization test. Fortunately, only a small percentage of patients fail three or more of these tests and have to use catheters longer-term. Surprisingly, there are no approved drugs that are currently approved to assist with these tests; however, bethanechol, 50 mg/BID, should be considered further for this application. The drug is a bladder wall receptor stimulant and, at this moderate dosage, it is reasonable to expect it to help with decatheterization tests. This position statement includes several designs for future bethanechol use and research. In addition, an International Neuro-Urological Research Group is introduced that is promoting this drug. Full article

(This article belongs to the Special Issue Lower Urinary Tract Research: Rationale, Feasibility, and Design)

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