Increased Afferent Nerve Firing Is Correlated With the Detection of Bladder Wall Micromotion in a Perfused Ex-Vivo Porcine Model.

Introduction And Objective: Observable autonomous rhythmic changes in intravesical pressure, termed bladder wall micromotion, is a phenomenon that has been linked to urinary urgency, the key symptom in overactive bladder (OAB). However, the mechanism through which micromotion drives urinary urgency is poorly understood. In addition, micromotion is inherently difficult to study in human urodynamics due to challenges distinguishing it from normal cyclic physiologic processes such as pulse rate, breathing, rectal contractions, and ureteral jetting.

Sacral Neuromodulation Reprogramming Rates: Understanding Office-Based Requirement.

Importance: Sacral neuromodulation (SNM) is a procedure with the advantage of reprogramming for discomfort or inadequate symptom control.

Objectives: The aims of this study were to investigate the rates of office-based SNM programming in a large multisite cohort and to examine differences based on implantation indication.

Study Design: The TriNetX database was utilized for retrospective cohort comparison using International Classification of Diseases, Tenth Revision, and Current Procedural Terminology (CPT) codes.

Comparative Neuroexcitation Patterns Using fNIRS in Women With Overactive Bladder.

Importance: Functional near-infrared spectroscopy (fNIRS) is a noninvasive technique used to quantify prefrontal cortex (PFC) neuroexcitation. The PFC is involved in the decision to void, and dysfunction in the region has been associated with overactive bladder (OAB). This study demonstrates neuroexcitation differences in the brain region associated with the decision to void (prefrontal cortex) using noninvasive fNIRS.

A Review for Clinical Practice in the Treatment and Prevention of Recurrent Urinary Tract Infections in Women over Age 65.

Urinary tract infection (UTI) is a pervasive, costly, and dangerous cause of morbidity and mortality worldwide, which can lead to further complications if they become recurrent or progress to urosepsis. Recurrent UTI is a particular concern among postmenopausal females because of increased risk factors and decreased estrogen levels, leading to changes in the urogenital epithelium and subsequently causing alterations in the urogenital microbiome. Prevention strategies for recurrent UTIs are often incorporated into patient-centered care plans, but finding the right management can be difficult for older women since many of the common treatment options have contraindications and adverse side effects.

Steps toward identification of a novel cue-positive overactive bladder phenotype in women with high-bother urinary urgency.

Objective: The objective of this study was to investigate the relationship between situational cues (running water, stress, cold, etc.) and overactive bladder (OAB) symptoms.

Methods: Women scheduled for urodynamic studies for clinical indications completed surveys to characterize OAB (ICIQ-OAB and OAB-V3) and responses to situational cues (validated long-form cues survey and a novel short-form cues survey).

Ultrasound Urodynamics: A Review of Ultrasound Imaging Techniques for Enhanced Bladder Functional Diagnostics.

Purpose Of Review: Invasive urodynamics are currently used to diagnose disorders of bladder function. However, due to patient discomfort as well as artifacts induced by catheters and non-physiologic filling, less invasive screening tools that can improve diagnostic information, such as ultrasound are required. The purpose of this review is to assess different modalities of ultrasound as applied to functional bladder imaging.

A stepwise approach for functional near infrared spectroscopy measurement during natural bladder filling.

Background: Functional near infrared spectroscopy (fNIRS) is a versatile, noninvasive, and inexpensive tool that can be used to measure oxyhemoglobin (OHb) changes in the cortical brain caused by increasing bladder sensation during filling in upright posture. This study's purpose is to provide a rigorous methodologic template that can be implemented for comparative studies of fNIRS in the diagnosis and management of lower urinary tract symptoms including overactive bladder (OAB) and other forms of lower urinary tract dysfunction.

Methods: Participants without any urologic conditions completed a validated oral hydration protocol facilitating and equilibrating natural bladder filling.

A porcine bladder model of pre-clinical urodynamics demonstrates increased afferent nerve activity during filling.

Introduction And Objectives: Urodynamics are the accepted gold standard for the evaluation of multiple forms of voiding dysfunction. However, the tests are expensive, invasive, poorly reproducible, and often prone to artifacts. Therefore, there is a pressing need to develop next-generation urodynamics.

Reducing pelvic floor injury by induction of labor.

Introduction And Hypothesis: We hypothesized that elective induction of labor (eIOL) at 39 weeks is protective of levator ani muscle injury (LAMI) and is associated with decreased pelvic symptoms at 6 weeks postpartum compared to expectant management of labor.

Methods: Prospective cohort pilot study of uncomplicated, primiparous women with a singleton, vertex gestation enrolled immediately post-vaginal delivery (VD). Subjects were dichotomized into two groups based on labor management: eIOL without complication defined by the ARRIVE trial versus spontaneous VD between 39 weeks and 42 weeks or no indication for IOL prior to 40 weeks.

What Is Being Reported About Vaginal "Lasers"?: An Examination of Adverse Events Reported to the Food and Drug Administration on Energy-Based Devices.

Background: A description of energy-based genitourinary non-surgical devices (energy-based devices) safety data is outlined given their rapid adoption.

Objectives: The authors sought to describe adverse events for energy-based devices in the Manufacturer and User Facility Device Experience database and to compare with similar devices and other subspecialty applications. We hypothesized that products with genitourinary applications had similar adverse events to dermatologic or general surgery applications.

Clobetasol Compared With Fractionated Carbon Dioxide Laser for Lichen Sclerosus: A Randomized Controlled Trial.

Objective: To compare 6-month safety and efficacy outcomes of fractionated CO2 laser (laser) with topical clobetasol propionate (steroid) for treatment of symptomatic vulvar lichen sclerosus.

Methods: We conducted a single-center randomized controlled trial that compared fractionated CO2 laser with steroid treatment for patients with biopsy-proven lichen sclerosus. Randomization was stratified by prior clobetasol propionate use.

Validation of Transvaginal Hysterectomy Surgical Model - Modification of the Flowerpot Model to Improve Vesicovaginal Plane Simulation.

Study Objective: To establish face and construct validity for a novel variation of American College of Obstetrics and Gynecology "Flowerpot Model" for transvaginal hysterectomy (TVH) surgical simulation with improved vesicovaginal dissection during surgical education simulation.

Design: Cross-sectional face and construct validation study using the "Flowerpot Model." The vesicovaginal dissection plane was modified to include additional felt and balloon materials to simulate the bladder.

Impact of Menopausal Status on Uropathogen Prevalence and Antimicrobial Resistance Profiles.

Objectives: The unique factors associated with urinary tract infections (UTIs) in postmenopausal (PMP) women have been significantly less investigated as compared with premenopausal (PreMP) women. Our objective was to compare the prevalence of uropathogens and antibiotic resistance patterns between PreMP and PMP women with UTIs.

Methods: This was a cross-sectional analysis of PreMP and PMP women treated for a UTI in a urogynecologic practice between November 2016 and November 2017.

A Cost Analysis of Icon Reusable Underwear Versus Disposable Pads for Mild to Moderate Urinary Incontinence.

Objective: The objective of this study was to perform a cost analysis assessing the economic feasibility of reusable underwear as alternative for disposable pads for women with mild to moderate urinary incontinence.

Methods: A consumer-perspective cost analysis was performed with the following assumptions: (1) consumers have mild to moderate urinary incontinence and use 2 pads per day (PPD); (2) consumers have a 2-week supply of underwear; (3) there is no difference in laundering cost between 2 incontinence options; (4) there is no difference in use of labor/other accessories of care; (5) there is no difference in skin complaints/associated cost; (6) cost of products are nonfluctuant with time; and (7) all incontinence products were purchased online. Sensitivity analyses were performed varying the longevity of underwear, price of regular underwear, price of pads, pads used per day, and shipping and handling.

A hypocalcemic child with a novel activating mutation of the calcium-sensing receptor gene: successful treatment with recombinant human parathyroid hormone.

Context: Persistent hypercalciuria, with the attendant risk of nephrocalcinosis and eventual renal failure, is common in hypoparathyroid patients, especially those with activating mutations of the calcium-sensing receptor (CASR) gene, being treated with oral calcium and calcitriol. Treatment with replacement PTH may be warranted, although this has yet to be evaluated in children.

Objectives: The objectives of this study were to identify the cause of the disorder in a young hypocalcemic patient and to assess the efficacy of treatment of the patient with recombinant human PTH(1-34).

Endocrinological and auxological abnormalities in young children with optic nerve hypoplasia: a prospective study.

Objective: To determine the prevalence of endocrinopathies, neuroradiographical findings, and growth derangements in young children with optic nerve hypoplasia (ONH).

Study Design: A prospective observational study examined the prevalence of endocrinopathies at study enrollment and growth patterns in children with ONH. Subjects (n = 47, mean +/- SD 15.