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MP65-18 FEMALE URETHRAL DIVERTICULA: CORRELATION OF MRI FINDINGS WITH PRE-OPERATIVE SIGNS AND SYMPTOMS OR POST-OPERATIVE OUTCOMES
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
treatment cost may be prohibitive for patients. As a convenient method, we focused on transcutaneous electrical nerve stimulation (TENS). Although TENS of somatic afferents in foot has reportedly inhibited reflex micturition and increased bladder capacity in anesthetized cats as well as healthy humans, its effect in OAB patients is still unknown. The purpose of this study is to reveal the efficacy of TENS of foot in patients with refractory OAB. METHODS: The protocol of this study was approved by the institutional review board, and registered at the Clinical Trials Registry of University hospital Medical Information Network in Japan. Nineteen patients (16 women and 3 men) with refractory OAB symptoms were enrolled in this study. Using a stimulator (Pulsecure-PRO KR-7, OG Wellness, Japan) and skin surface electrodes, patients continued 30-minute unilateral foot stimulation once a day for 12 weeks. Stimulation parameters were 5 Hz frequency and 0.05 milliseconds width biphasic rectangular waveform pulse with maximal stimulation intensity without causing discomfort or pain. Urodynamic study findings (uroflowmetry and cystometry) and frequency-volume chart (FVC) were compared before and after the 12-week treatment. Changes in the King0 s health questionnaire (KHQ), overactive bladder symptom score (OABSS) and QOL index were evaluated every 4 weeks. All values were indicated as mean standard error. RESULTS: Eighteen patients (mean age 70.6 4.2, range 2692 years old) were eligible for evaluation. Treatment-related adverse event was not found. Maximum cystometric bladder capacity was significantly increased from 180.6 22.3 ml to 228.8 28.7 ml (P < 0.05). FVC revealed significant increase in mean voided-volume per micturition at daytime (from 127.9 15.8 to 148.6 20.5 ml, P < 0.05). Regarding KHQ, incontinence impact and severity measures domains were consistently improved after the time point of 4 weeks. OABSS and QOL index were significantly improved simultaneously. No statistically significant change was seen in post-void residual volume or urinary flow rate. In accordance with the Japanese clinical research guideline, TENS achieved an efficacy of 64.7%. CONCLUSIONS: TENS of foot increased bladder capacity and improved subjective symptoms in refractory OAB patients. Because TENS can be performed safely at home, it can provide several potential advantages over the ordinary PTNS. Source of Funding: none
MP65-18 FEMALE URETHRAL DIVERTICULA: CORRELATION OF MRI FINDINGS WITH PRE-OPERATIVE SIGNS AND SYMPTOMS OR POST-OPERATIVE OUTCOMES Nima Baradaran*, Leah Chiles, Drew Freilich, William Rawls, Lindsey Cox, Ross Rames, Eric Rovner, Charleston, SC INTRODUCTION AND OBJECTIVES: Pelvic MRI (pMRI) provides excellent anatomic delineation of urethral diverticula (UD) and is routinely utilized for preoperative planning and patient counselling. Determining whether preoperative pMRI findings are correlated with severity of the condition or postoperative success is the objective of this study. METHODS: After IRB approval, records of adult females who underwent transvaginal excision of UD (TVUD) at our institution between 2004 and 2014 were retrospectively reviewed. Clinical characteristics before and after TVUD including lower urinary tract symptoms, incontinence status, dyspareunia, postvoid dribbling, and urinary tract infections were reviewed and correlated with preoperative pMRI findings. MRI characteristics included UD configuration (simple, saddlebag, or circumferential), size, location (proximal, mid, or distal urethra), and number of UD. An autologous fascia pubovaginal sling was placed at the time of UD excision if stress urinary incontinence was present preoperatively. RESULTS: 58 patients underwent TVUD of which 49 patients had available data on preoperative pMRI. Three patients had a previous
e871
TVUD at other institutions. UD was located in the proximal urethra in 36%, midurethra in 43%, and distal urethra in 6%. Four (8%) patients had panurethral involvement. Median (range) size of the UD on largest dimension was 2.5cm (0.5-6.7). UD configuration was simple in 37%, saddlebag in 37%, and circumferential in 24% of cases. Size, configuration, and location of UD on pMRI were not predictive of symptoms at presentation or symptom severity. However, distal and pan-urethral UD were correlated with presence of vaginal mass on physical examination (p¼0.04). Larger UD size (>3 cm) was associated with higher intraoperative blood loss (450cc vs. 200cc, p<0.001) as was placement of a concomitant sling at the time of TVUD (275cc vs. 200cc, p¼0.03). Complete resolution of UD on voiding cystourethrogram was achieved postoperatively in 65% of patients however only 3 (5%) patients required subsequent surgical intervention for persistent UD. There was no correlation with preoperative pMRI characteristics and resolution of UD on postoperative imaging. CONCLUSIONS: Although pMRI provides valuable anatomical information for surgical planning, preoperative pMRI findings are not correlated with patients’ presenting symptoms, signs, or postoperative outcomes. Source of Funding: none
MP65-19 TRANSLATING UNIQUE LEARNING FOR INCONTINENCE PREVENTION, THE TULIP PROJECT: COMPARATIVE EFFECTIVENESS STUDY OF A DIVERSE POPULATION OF ADULT WOMEN RECEIVING BLADDER HEALTH EDUCATION. Diane Newman*, Philadelphia, PA; Carolyn Sampselle, Trivellore Raghunathan, Janis Miller, Keri Kirk, Ann Arbor, MI; Rebecca Kimmel, Maryann DiCamillo, Philadelphia, PA INTRODUCTION AND OBJECTIVES: The Translating Unique Learning for Incontinence Prevention study enrolled women, 55 years or older from diverse backgrounds who reported no to slight urinary incontinence (UI) to determine whether a group class or a take-home DVD of behavioral techniques for bladder health is more effective in primary prevention of UI. METHODS: 647 participants were enrolled between University of Pennsylvania (UP n¼320) and University of Michigan (UM n¼327). Of those enrolled, 332 participants were randomized to a 2-hour face-toface Bladder Health Class (BHC) that reviewed three primary selfmanagement practices, while the remaining 315 participants were randomized to view a 15-minute instructional DVD on practices for Bladder Health. Participants were followed for 24-months (3 months, 12-months, 24-months) post-intervention to assess the long-term outcomes and sustainability. Intent-to-treat analysis was performed to compare the effect of each intervention group across time and also with each other. Missing values were multiply imputed and all comparisons were adjusted for covariates using a regression analysis. RESULTS: This study was able to recruit and retain a population where one-fourth were African-American (UP n¼105, UM n¼76). Primary outcome was self-reported UI, as measured by the International Consultation on Incontinence-Short Form (ICIQ-SF)(score of < 5 on Questions 1 + 2). There were no differences in the ICIQ-SF between the two groups over the 24 months of the study controlling for BMI at baseline, age, race/ethnicity, education, employment status, income, and marital status (See Table 1). Retention was achieved in 89% (UP n¼ 269, UM n¼275) of participants and variables such as race, age, BMI, education, and socio-economic status did not predict dropouts. CONCLUSIONS: Although no significant difference in ICIQ-SF scores was demonstrated between the two interventions, mean scores at 12/24 months were consistently lower than baseline regardless of the intervention received. Results indicate that the DVD is a sustainable source of Bladder Health information that can be provided at the point of well-women care (annual visit).
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
treatment cost may be prohibitive for patients. As a convenient method, we focused on transcutaneous electrical nerve stimulation (TENS). Although TENS of somatic afferents in foot has reportedly inhibited reflex micturition and increased bladder capacity in anesthetized cats as well as healthy humans, its effect in OAB patients is still unknown. The purpose of this study is to reveal the efficacy of TENS of foot in patients with refractory OAB. METHODS: The protocol of this study was approved by the institutional review board, and registered at the Clinical Trials Registry of University hospital Medical Information Network in Japan. Nineteen patients (16 women and 3 men) with refractory OAB symptoms were enrolled in this study. Using a stimulator (Pulsecure-PRO KR-7, OG Wellness, Japan) and skin surface electrodes, patients continued 30-minute unilateral foot stimulation once a day for 12 weeks. Stimulation parameters were 5 Hz frequency and 0.05 milliseconds width biphasic rectangular waveform pulse with maximal stimulation intensity without causing discomfort or pain. Urodynamic study findings (uroflowmetry and cystometry) and frequency-volume chart (FVC) were compared before and after the 12-week treatment. Changes in the King0 s health questionnaire (KHQ), overactive bladder symptom score (OABSS) and QOL index were evaluated every 4 weeks. All values were indicated as mean standard error. RESULTS: Eighteen patients (mean age 70.6 4.2, range 2692 years old) were eligible for evaluation. Treatment-related adverse event was not found. Maximum cystometric bladder capacity was significantly increased from 180.6 22.3 ml to 228.8 28.7 ml (P < 0.05). FVC revealed significant increase in mean voided-volume per micturition at daytime (from 127.9 15.8 to 148.6 20.5 ml, P < 0.05). Regarding KHQ, incontinence impact and severity measures domains were consistently improved after the time point of 4 weeks. OABSS and QOL index were significantly improved simultaneously. No statistically significant change was seen in post-void residual volume or urinary flow rate. In accordance with the Japanese clinical research guideline, TENS achieved an efficacy of 64.7%. CONCLUSIONS: TENS of foot increased bladder capacity and improved subjective symptoms in refractory OAB patients. Because TENS can be performed safely at home, it can provide several potential advantages over the ordinary PTNS. Source of Funding: none
MP65-18 FEMALE URETHRAL DIVERTICULA: CORRELATION OF MRI FINDINGS WITH PRE-OPERATIVE SIGNS AND SYMPTOMS OR POST-OPERATIVE OUTCOMES Nima Baradaran*, Leah Chiles, Drew Freilich, William Rawls, Lindsey Cox, Ross Rames, Eric Rovner, Charleston, SC INTRODUCTION AND OBJECTIVES: Pelvic MRI (pMRI) provides excellent anatomic delineation of urethral diverticula (UD) and is routinely utilized for preoperative planning and patient counselling. Determining whether preoperative pMRI findings are correlated with severity of the condition or postoperative success is the objective of this study. METHODS: After IRB approval, records of adult females who underwent transvaginal excision of UD (TVUD) at our institution between 2004 and 2014 were retrospectively reviewed. Clinical characteristics before and after TVUD including lower urinary tract symptoms, incontinence status, dyspareunia, postvoid dribbling, and urinary tract infections were reviewed and correlated with preoperative pMRI findings. MRI characteristics included UD configuration (simple, saddlebag, or circumferential), size, location (proximal, mid, or distal urethra), and number of UD. An autologous fascia pubovaginal sling was placed at the time of UD excision if stress urinary incontinence was present preoperatively. RESULTS: 58 patients underwent TVUD of which 49 patients had available data on preoperative pMRI. Three patients had a previous
e871
TVUD at other institutions. UD was located in the proximal urethra in 36%, midurethra in 43%, and distal urethra in 6%. Four (8%) patients had panurethral involvement. Median (range) size of the UD on largest dimension was 2.5cm (0.5-6.7). UD configuration was simple in 37%, saddlebag in 37%, and circumferential in 24% of cases. Size, configuration, and location of UD on pMRI were not predictive of symptoms at presentation or symptom severity. However, distal and pan-urethral UD were correlated with presence of vaginal mass on physical examination (p¼0.04). Larger UD size (>3 cm) was associated with higher intraoperative blood loss (450cc vs. 200cc, p<0.001) as was placement of a concomitant sling at the time of TVUD (275cc vs. 200cc, p¼0.03). Complete resolution of UD on voiding cystourethrogram was achieved postoperatively in 65% of patients however only 3 (5%) patients required subsequent surgical intervention for persistent UD. There was no correlation with preoperative pMRI characteristics and resolution of UD on postoperative imaging. CONCLUSIONS: Although pMRI provides valuable anatomical information for surgical planning, preoperative pMRI findings are not correlated with patients’ presenting symptoms, signs, or postoperative outcomes. Source of Funding: none
MP65-19 TRANSLATING UNIQUE LEARNING FOR INCONTINENCE PREVENTION, THE TULIP PROJECT: COMPARATIVE EFFECTIVENESS STUDY OF A DIVERSE POPULATION OF ADULT WOMEN RECEIVING BLADDER HEALTH EDUCATION. Diane Newman*, Philadelphia, PA; Carolyn Sampselle, Trivellore Raghunathan, Janis Miller, Keri Kirk, Ann Arbor, MI; Rebecca Kimmel, Maryann DiCamillo, Philadelphia, PA INTRODUCTION AND OBJECTIVES: The Translating Unique Learning for Incontinence Prevention study enrolled women, 55 years or older from diverse backgrounds who reported no to slight urinary incontinence (UI) to determine whether a group class or a take-home DVD of behavioral techniques for bladder health is more effective in primary prevention of UI. METHODS: 647 participants were enrolled between University of Pennsylvania (UP n¼320) and University of Michigan (UM n¼327). Of those enrolled, 332 participants were randomized to a 2-hour face-toface Bladder Health Class (BHC) that reviewed three primary selfmanagement practices, while the remaining 315 participants were randomized to view a 15-minute instructional DVD on practices for Bladder Health. Participants were followed for 24-months (3 months, 12-months, 24-months) post-intervention to assess the long-term outcomes and sustainability. Intent-to-treat analysis was performed to compare the effect of each intervention group across time and also with each other. Missing values were multiply imputed and all comparisons were adjusted for covariates using a regression analysis. RESULTS: This study was able to recruit and retain a population where one-fourth were African-American (UP n¼105, UM n¼76). Primary outcome was self-reported UI, as measured by the International Consultation on Incontinence-Short Form (ICIQ-SF)(score of < 5 on Questions 1 + 2). There were no differences in the ICIQ-SF between the two groups over the 24 months of the study controlling for BMI at baseline, age, race/ethnicity, education, employment status, income, and marital status (See Table 1). Retention was achieved in 89% (UP n¼ 269, UM n¼275) of participants and variables such as race, age, BMI, education, and socio-economic status did not predict dropouts. CONCLUSIONS: Although no significant difference in ICIQ-SF scores was demonstrated between the two interventions, mean scores at 12/24 months were consistently lower than baseline regardless of the intervention received. Results indicate that the DVD is a sustainable source of Bladder Health information that can be provided at the point of well-women care (annual visit).