Benefits and Harms of Conservative, Pharmacological, and Surgical Management Options for Women with Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel

Peyronnet, B.; Lapitan, Marie Carmela; Tzelves, Lazaros; O’Connor, Eabhann; Ríogh, Aisling Nic An; Manso, Margarida; Yuan, Yuhong; Arlandis, Salvador; Bø, Kari; Costantini, Elisabetta; Farag, Fawzy; Groen, Jan; Nambiar, Arjun; Phé, Véronique; Vaart, Huub van der; Omar, Muhammad Imran; Harding, Chris

doi:10.1016/j.euf.2021.10.006

Cited by 6 publications

(10 citation statements)

References 47 publications

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“…To date, no consensus has been reached regarding the diagnosis and treatment of this complication [6][7][8][9][10]. A postoperative urodynamic study did not seem to add much benefit in the clinical evaluation and prediction of outcomes [14,15].…”

Section: Introductionmentioning

confidence: 98%

“…Moreover, the incidence is likely to be under-reported due to patient satisfaction of being dry, and most patients who need sling revision seek a different surgeon. Post-sling VD causes a spectrum of symptoms ranging from irritative voiding to voiding difficulty with or without elevated post-void residual urine volume and total urinary retention [6][7][8][9][10]. In addition to these bothersome symptoms, delayed treatment may result in irreversible bladder dysfunction [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

“…A postoperative urodynamic study did not seem to add much benefit in the clinical evaluation and prediction of outcomes [14,15]. Most surgeons rely on the temporal relationship between the operation and onset of associated symptoms to establish a diagnosis [6][7][8][9][10]. Initial conservative management includes catheterization, pharmacotherapy, and addressing circumstantial factors (e.g., pain) interfering with normal voiding [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…Most surgeons rely on the temporal relationship between the operation and onset of associated symptoms to establish a diagnosis [6][7][8][9][10]. Initial conservative management includes catheterization, pharmacotherapy, and addressing circumstantial factors (e.g., pain) interfering with normal voiding [6][7][8][9][10]. Various sling loosening procedures performed at a short interval were reported to resolve the problem, and have been associated with minimal morbidity [10,[16][17][18].…”

Section: Introductionmentioning

confidence: 99%

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Continence Is Not Affected after Sling Revision with Transvaginal Tape Elongation for Post-Sling Voiding Dysfunction

Tsai,

Liu,

Yang

et al. 2024

JCM

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Voiding dysfunction (VD) after sling operation is not uncommon. Sling revisions by incision/excision are usually effective; however, they may result in recurrent stress urinary incontinence (SUI). We aimed to evaluate continence status after an innovative sling revision procedure that preserves the integrity of the sling. Patients who underwent either a single-incision (AJUST) or a trans-obturator (TVT-O) mid-urethral sling were studied. Transvaginal tape elongation (i.e., sling midline incision and mesh interposition) was performed on patients with post-sling VD. Factors that may affect recurrent SUI were investigated by statistical analyses. Of 119 patients, 90 (75.6%) (45 AJUST and 45 TVT-O) were available for long-term (median 9; 8–10 years) follow-up. A significantly higher rate (17.2% vs. 3.3%, p = 0.014) of VD was noted after AJUST (N = 10) than after TVT-O (N = 2). After sling revision, four (33%) of the 12 cases reported recurrent SUI, which was not significantly different (p = 1.000) from the rate (37%, 29/78) of patients who did not undergo sling revision. Further statistical analyses revealed no significant predisposing factors affecting the recurrence of SUI. Surgical continence did not seem to be affected by having had sling revision with transvaginal tape elongation for post-sling VD.

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Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Continence Is Not Affected after Sling Revision with Transvaginal Tape Elongation for Post-Sling Voiding Dysfunction

Tsai,

Liu,

Yang

et al. 2024

JCM

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“…Therefore, combination therapy using pharmacotherapy and non-pharmacotherapy options provide the best clinical efficacy, as the combination of treatments target different mechanisms of action [ 6 ]. For patients with voiding dysfunction due to bladder neck dysfunction or urethral sphincter dyssynergia, an alpha-blocker with baclofen is usually prescribed [ 7 , 8 ]. The adverse events (AE) of postural hypotension after alpha-blocker administration and the general weakness and dizziness after baclofen administration should be monitored in older patients with CNS-related LUTD.…”

Section: Introductionmentioning

confidence: 99%

Real-Life Treatment Outcome of Botulinum Toxin A Injection on Overactive Bladder and Voiding Dysfunction in Patients with Central Nervous System Lesions

Jiang,

Jhang,

Chen

et al. 2024

Toxins

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Purpose: Neurogenic lower urinary tract dysfunction (NLUTD) is common in patients with neurological lesions in the central nervous system (CNS). Medical treatment usually cannot adequately relieve NLUTD. This study reported the real-life treatment outcome of botulinum toxin A (BoNT-A) for overactive bladders (OAB) and voiding dysfunction in patients with CNS lesions. Methods: We retrospectively analyzed the first-time treatment outcome of 74 patients who received detrusor 100 U BoNT-A for OAB and 45 patients who received a urethral sphincter 100 U BoNT-A injection for voiding dysfunction. The treatment outcome, therapeutic duration, and adverse events (AE) after BoNT-A were compared among different CNS lesions and among patients with different urodynamic characteristics. Results: The study included 74 patients receiving detrusor injections for OAB (36 with cerebrovascular accidents, 13 with Parkinson’s disease, and 25 with dementia) and 45 patients receiving a urethral sphincter injection for voiding dysfunction (26 with cerebrovascular accidents, 7 with Parkinson’s disease, and 12 with dementia). After detrusor BoNT-A treatment, urinary continence was achieved in 28.4% of patients with neurogenic OAB, postoperative difficult urination in 59.5%, acute urinary retention (AUR) in 9.5%, and urinary tract infection (UTI) in 14.9%, with a therapeutic duration of 6.43 months. There were no differences among subgroups or between patients with detrusor overactivity (DO) and DO with detrusor underactivity (DU) in terms of treatment outcomes and AEs. The improvement rate of urethral sphincter BoNT-A injections was 75.6% without any difference among subgroups. After treatment, 24.4% of the patients had exacerbated urinary incontinence, 33.3% had persistent difficult urination, and 15.6% had UTI. Patients with dementia had higher rates of difficult urination and UTI, higher postvoid residual volume, and a shorter therapeutic duration. Patients with DU and those without urethral sphincter dyssynergia had less favorable outcomes after their urethral sphincter BoNT-A injection. Conclusions: The therapeutic efficacy of detrusor BoNT-A injection for OAB due to CNS lesions is limited, with high rates of difficult urination, AUR, and UTI. Although urethral sphincter BoNT-A injection is effective in treating voiding dysfunction; however, exacerbated urinary incontinence and persistent difficult urination remain a problem, particularly in patients with dementia.

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Patient Reported Outcomes Due to Bladder Neck Obstruction in Women Treated With Botulinum Toxin A Injection

Bibicheff,

Roberts,

Pettijohn

et al. 2024

Neurourology and Urodynamics

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IntroductionPrimary bladder neck obstruction (BNO) occurs when the bladder neck fails to open during voiding, causing urinary symptoms despite no anatomic obstruction. The cause of BNO is unclear but may involve neurogenic dysregulation related to the sympathic nervous system such as upper motor neuron lesion or peripheral autonomic neuropathy (small fiber neuropathy (SFN)). Another etiology can incuded increased sympathetic tone secondary to anxiety or stress conditons. Botulinum toxin A (BoNT‐A) to the bladder neck has been used in our practice to treat women with BNO who failed conventional therapies (alpha blockers, relaxation strategies). This is the first report of patient‐reported outcomes after BoNT‐A treatment in women with pelvic pain and BNO.Materials and MethodsWe included female patients with pelvic pain and BNO who received BoNT‐A to the bladder neck between January 2022 and March 2023, and mailed self‐reported outcome questionnaires. The primary outcome was the Global Response Assessment (GRA); secondary outcomes included pain scores on the Visual Analogue Scale (VAS) and symptom checklists. BNO was diagnosed using Nitti Criteria (high bladder pressure, low flow in bladder neck on video urodynamics), supplemented by additional criteria (e.g., high voiding pressure, prolonged attempts, Valsalva effort, and cystoscopic evidence or symptoms related to BNO). Urodynamic studies followed International Continence Society standards. Additionally, due to BNO's association with SFN, patient history of biopsy‐confirmed SFN was recorded.ResultsOur inclusion criteria was satisfied among 18 patietns, with 17 completing the questionnaire. Out of those, 14 patients (77%) reported improvement on the GRA, with an average VAS of 8.3 (“Very Helpful”). The most commonly improved symptoms were feeling of incomplete emptying, difficulty starting stream, urethral burning, pain with urination, and pelvic pain. Postoperative symptom flares were reported in six patients for an average of 16 days. All six patients with biopsy‐confirmed SFN showed significant improvement (VAS 8.7). Total of 14 patients (77%) indicated they would repeat the procedure.ConclusionsBoNT‐A to the bladder neck significantly improved pelvic pain and refractory hesitancy in women with bladder neck obstruction, especially in those with small fiber neuropathy. Symptom flares are common, but did not reduce interest in repeated treatments, and scheduling injections before symptom recurrence may mitigate these flares.

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Benefits and Harms of Conservative, Pharmacological, and Surgical Management Options for Women with Bladder Outlet Obstruction: A Systematic Review from the European Association of Urology Non-neurogenic Female LUTS Guidelines Panel

Cited by 6 publications

References 47 publications

Continence Is Not Affected after Sling Revision with Transvaginal Tape Elongation for Post-Sling Voiding Dysfunction

Continence Is Not Affected after Sling Revision with Transvaginal Tape Elongation for Post-Sling Voiding Dysfunction

Real-Life Treatment Outcome of Botulinum Toxin A Injection on Overactive Bladder and Voiding Dysfunction in Patients with Central Nervous System Lesions

Patient Reported Outcomes Due to Bladder Neck Obstruction in Women Treated With Botulinum Toxin A Injection

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