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Objective Biofeedback is an effective treatment in children with standard urotherapy-resistant dysfunctional voiding (DV). However, the duration of the session intervals is not standardized. We aimed to compare the effectiveness of daily and weekly sessions of biofeedback treatments. Methods The data of children who received biofeedback due to DV between March 2018 and May 2019 were retrospectively evaluated. The children were divided into two groups, one with daily and the other with weekly sessions. The voiding patterns in uroflowmetry (UF), maximum flow rate (Qmax), electromyography activity, postvoid residual volume (PVR), the ratio of voided volume to expected bladder capacity (EBC) (%), and Dysfunctional Voiding and Incontinence Scoring System (DVISS) were compared between the two groups. Results A total of 45 children (39 girls [86.6%] and 6 boys [13.3%]) were included in the study. The daily group consisted of 27 (60%) children and the weekly group of 18 (40%). Qmax, PVR, number of abnormal UF patterns, voiding volume/EBC, and DVISS scores were similar between the two groups before treatment. Voiding parameters improved statistically significantly in both groups following biofeedback, but there was no difference between the two groups. A statistical difference was found between the results of DVISS after treatment (P = .03). Conclusion Both types of biofeedback treatment (daily and weekly) are effective methods that improve voiding parameters and DVISS values in children with DV. Therefore, the duration between sessions can be determined according to the suitability of the patient and the biofeedback unit.

Summary Introduction Dysfunctional voiding (DV) in children is a common issue, which can be found in up to 30% of children with wetting problems. Biofeedback assisted pelvic floor muscle training (PFMT) is an established nonpharmacological method to treat DV. The aim of the present study was to evaluate the efficacy of physiotherapeutic intervention with biofeedback assisted PFMT in children with DV. Study design Children referred with DV, unresponsive to standard urotherapy were included in this study. All children underwent biofeedback assisted PFMT sessions with a physiotherapist. Uroflowmetries and measurements of post-void residual (PVR) urine were performed before and after the treatment, and the following parameters were registered; daytime incontinence (DI), nocturnal enuresis (NE), constipation, faecal incontinence (FI), and recurrent urinary tract infections (UTI). Other concomitant treatments were noted. The primary outcomes were the resolution of DV evaluated by uroflow curve configuration and PVR. Secondary outcomes were the resolution of DI, NE and the reduction of recurrent UTIs. Results Forty-six children (mean age 9.6 ± 2.4 years, 38 girls) were included in the analysis. The median period of treatment was 9.0 ± 8.5 months (2–9 visits). Twenty-seven (59%) children responded to treatment according to one or both primary outcomes; uroflow configuration (50%) and PVR (28%). DI resolved in 12 (26%) children and 27 of the 32 children, who prior to the treatment had recurrent UTIs experienced no UTIs during the follow up period. The use of anticholinergics was a significant negative predictor for response to treatment. We found that almost half of the responders (48%) reached effect prior to the fourth visit. Discussion Biofeedback assisted PFMT can improve the symptoms in children with DV. When comparing to existing literature we find a less pronounced effect of the intervention. A possible explanation may be that the children enrolled in this study were recruited from a tertiary referral centre and were all refractory to standard urotherapy. Moreover, the difference in patient characteristics and treatment protocols between different studies make direct comparisons of efficacy difficult. Conclusion Physiotherapeutic intervention with biofeedback assisted PFMT seems to lead to better uroflow patterns in approximately 60% of cases in DV improving the uroflow curves and PVR, however improvement in uroflowmetry patterns is not necessarily reflected in the resolution of incontinence or UT symptoms. The use of anticholinergics seems to be a negative predictor for response to treatment. Summary table . Effect parameters evaluated. Data presented as percentages; n, number of patients. Number of children with effect Dysfunctional voiding pattern on uroflow kurves 23 (50%) Post-void residual volume (PVR) 13 (28%) Any effect of the main parameters∗ 27 (59%) Daytime incontinence (DI) 11 (24%) Recurrent urinary tract infections (n) 27 (59%) ∗Dysfunctional voiding pattern on uroflow kurves (full and partial effect) and residual urine (children with 50% or more of the uroflowmetry curves showing post-void residual volume (PVR) > 20 ml).

BACKGROUND Overactive bladder is a chronic condition affecting lower urinary tract function that has a significant negative impact on QoL. OBJECTIVE Evaluation of the BlueWind implantable tibial nerve system performance and safety in refractory OAB. DESIGN, SETTING, AND PARTICIPANTS INTERVENTION A 6-month multi-center prospective intervention study. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Objective assessment was done by voiding diary parameters including voids/day, volume voided/day, urgency assessment, leaking episodes/day, pads used/day, leak severity, and clinical success defined as a ≥50% reduction in the number of leaks/day or number of voids/day or number of episodes with degree of urgency >2 or a return to

INTRODUCTION: The terminology for anorectal dysfunction in women has long been in need of a specific clinically-based Consensus Report. METHODS: This Report combines the input of members of the Standardization and Terminology Committees of two International Organizations, the International Urogynecological Association (IUGA) and the International Continence Society (ICS), assisted on Committee by experts in their fields to form a Joint IUGA/ICS Working Group on Female Anorectal Terminology. Appropriate core clinical categories and sub classifications were developed to give an alphanumeric coding to each definition. An extensive process of twenty rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS: A Terminology Report for anorectal dysfunction, encompassing over 130 separate definitions, has been developed. It is clinically based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in female pelvic floor dysfunction. Female-specific anorectal investigations and imaging (ultrasound, radiology and MRI) has been included whilst appropriate figures have been included to supplement and help clarify the text. Interval review (5-10 years) is anticipated to keep the document updated and as widely acceptable as possible. CONCLUSION: A consensus-based Terminology Report for female anorectal dysfunction terminology has been produced aimed at being a significant aid to clinical practice and a stimulus for research. Neurourol. Urodynam. 36:10-34, 2017. © 2016 Wiley Periodicals, Inc., and The International Urogynecological Association.

PURPOSE OF REVIEW: To assess current pharmacological principles used for treatment of nocturia/nocturnal polyuria.RECENT FINDINGS: The pathophysiology of nocturia is often multifactorial, but two main mechanisms have been identified, occurring alone or in combination: low functional bladder capacity and nocturnal polyuria. The multifactorial pathophysiology not only implies several possible targets for therapeutic intervention but also means that it is unlikely that one treatment modality including drugs will be successful in all patients. Drugs approved for the treatment of male LUTS and male and female OAB are known to be far more effective for treatment of the daytime symptoms than for nocturia. Several pharmacological principles have been tested with varying success. The treatment of choice should depend upon the main underlying cause, thus aiming primarily to increase bladder capacity by counteracting detrusor overactivity and/or reducing nocturnal polyuria. Using current available agents, effective, personalized treatment should be designed taking into account gender, co-morbidities, and identified etiological factors. However, there is a medical need for new, approved drugs for treatments for patients with nocturia.

Purpose of Review To assess current pharmacological principles used for treatment of nocturia/nocturnal polyuria. Recent Findings The pathophysiology of nocturia is often multifactorial, but two main mechanisms have been identified, occurring alone or in combination: low functional bladder capacity and nocturnal polyuria. The multifactorial pathophysiology not only implies several possible targets for therapeutic intervention but also means that it is unlikely that one treatment modality including drugs will be successful in all patients. Drugs approved for the treatment of male LUTS and male and female OAB are known to be far more effective for treatment of the daytime symptoms than for nocturia. Summary Several pharmacological principles have been tested with varying success. The treatment of choice should depend upon the main underlying cause, thus aiming primarily to increase bladder capacity by counteracting detrusor overactivity and/or reducing nocturnal polyuria. Using current available agents, effective, personalized treatment should be designed taking into account gender, co-morbidities, and identified etiological factors. However, there is a medical need for new, approved drugs for treatments for patients with nocturia.

blacksquare, square, filled Abstract Introduction: Treatment of functional anorectal pain disorders remains a challenge. The purpose of this study is to describe a single center experience with sacral neuromodulation for the treatment of chronic functional anorectal pain. Methods: This is a retrospective study based on prospectively collected data of patients treated with sacral neuromodulation for functional anorectal pain from April 2005 to August 2008. Symptoms were analyzed using a visual analog scale pain score (0 to 10). A 7-point Likert scale was used to rate global perceived effect. All patients had a percutaneous nerve evaluation and subsequent test stimulation to assess sacral neuromodulation outcome prior to permanent implantation. Patients were eligible for permanent sacral neuromodulation in case of a pain score 50% decrease in the pain score compared to baseline. Results: Nine patients (2 males) were included in this study. Mean age was 53.8 years (27.6 to 74.0). Four patients (1 male) had successful test stimulation and were eligible for permanent implantation. Median pain score decreased from 8.0 (6.0 to 9.0) to 1.0 (0 to 2.0). All patients experienced a lasting improvement during the follow-up till 24 months. Global perceived effect in successful patient was 1 (completely recovered) in one patient and 2 (much improved) in three patients. Conclusion: This study showed that sacral neuromodulation can be a successful treatment for functional anorectal pain not responding to other treatments. Improvement obtained during test stimulation is a good predictor (diagnostic) for sustained success of permanent sacral neuromodulation. blacksquare, square, filled.

Context: These guidelines were prepared on behalf of the European Association of Urology (EAU) to help urologists assess the evidence-based management of chronic pelvic pain (CPP) and to incorporate the recommendations into their clinical practice.Objective: To revise guidelines for the diagnosis, therapy, and follow-up of CPP patients.Evidence acquisition: Guidelines were compiled by a working group and based on a systematic review of current literature using the PubMed database, with important papers reviewed for the 2003 EAU guidelines as a background. A panel of experts weighted the references.Evidence synthesis: The full text of the guidelines is available through the EAU Central Office and the EAU Web site (www.uroweb.org). This article is a short version of the full guidelines text and summarises the main conclusions from the guidelines on the management of CPP.Conclusions: A guidelines text is presented including chapters on chronic prostate pain and bladder pain syndromes, urethral pain, scrotal pain, pelvic pain in gynaecologic practice, neurogenic dysfunctions, the role of the pelvic floor and pudendal nerve, psychological factors, general treatment of CPP, nerve blocks, and neuromodulation. These guidelines have been drawn up to provide support in the management of the large and difficult group of patients suffering from CPP. (C) 2009 European Association of Urology. Published by Elsevier B.V. All rights reserved.

The medial preoptic area (MPO) plays an important role in many behavioral, autonomic and endocrine functions, including micturition and genital responses. Although afferents of the MPO have been studied extensively, it is unknown whether direct lumbosacral-MPO projections exist that could convey afferent information from the pelvic organs. We hypothesized that, if such direct projections exist, MPO projecting cells would be located in the lateral part of the sacral cord, where primary afferents from pelvic and pudendal nerves terminate. We used retro- and anterograde tracing techniques in cat and guinea pig to study this. In cats; injections in the MPO resulted in labeled cells throughout the spinal cord, but with the highest density in the S1-S2 segments. In guinea pigs, labeled cells were found exclusively in the S1-S3 segments after MPO injections. Labeled cells in the sacral segments were not located in the lateral parts of the gray matter, but were found in the medial laminae VI-VII and dorsal lamina VIII in cats, and mainly in lamina X in guinea pigs. Anterograde tracing results after injections in the sacral cord in cats or guinea pigs showed labeled fibers in the MPO, just ventral to the anterior commissure. The central location of the cells of origin within the sacral cord, together with the termination pattern of the spino-MPO projections, strongly suggest a role for the spino-MPO pathway in the sensory relay of pelvic viscera, important for micturition and genital responses. (C) 2009 IBRO. Published by Elsevier Ltd. All rights reserved.

Contains fulltext : 97923.pdf (Publisher’s version ) (Closed access) Results from previous studies investigating the association between fluid intake and urothelial cell carcinomas (UCC) are inconsistent. We evaluated this association among 233,236 subjects in the European Prospective Investigation into Cancer and Nutrition (EPIC), who had adequate baseline information on water and total fluid intake. During a mean follow-up of 9.3 years, 513 first primary UCC occurred. At recruitment, habitual fluid intake was assessed by a food frequency questionnaire. Multivariable hazard ratios were estimated using Cox regression stratified by age, sex and center and adjusted for energy intake, smoking status, duration of smoking and lifetime intensity of smoking. When using the lowest tertile of intake as reference, total fluid intake was not associated with risk of all UCC (HR 1.12; 95%CI 0.86-1.45, p-trend = 0.42) or with risk of prognostically high-risk UCC (HR 1.28; 95%CI 0.85-1.93, p-trend = 0.27) or prognostically low-risk UCC (HR 0.93; 95%CI 0.65-1.33, p-trend = 0.74). No associations were observed between risk of UCC and intake of water, coffee, tea and herbal tea and milk and other dairy beverages. For prognostically low-risk UCC suggestions of an inverse association with alcoholic beverages and of a positive association with soft drinks were seen. Increased risks were found for all UCC and prognostically low-risk UCC with higher intake of fruit and vegetable juices. In conclusion, total usual fluid intake is not associated with UCC risk in EPIC. The relationships observed for some fluids may be due to chance, but further investigation of the role of all types of fluid is warranted.