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Designing for Lower Torso and Leg Anatomy
Published in Karen L. LaBat, Karen S. Ryan, Human Body, 2019
Prostate volume changes are the largest single cause of urinary retention, the inability to fully empty urine from the bladder. Abnormal bladder sensation, bladder wall muscle weakness, as well as other obstructions also cause urinary retention (Selius & Subedi, 2008). Urinary retention is seldom a complete inability to void; a person may pass a moderate volume of urine but retain up to several hundred ml of urine in the bladder. Consistently retaining more than 100 ml (3.4 oz) of urine after voiding or being unable to void large amounts of urine—i.e. over 1500 ml (50.7 oz)—are both considered significant retention needing treatment.
An update on research and outcomes in surgical management of vaginal mesh complications
Published in Expert Review of Medical Devices, 2019
Dominic Lee, Philippe E. Zimmern
Transvaginal mesh (TVM) related complications are seldom solitary in the presentation. The categories of clinical presentations are varied at evaluation (Figure 1). From our recent publication, mesh extrusion and pain were the most frequently reported symptoms accounting for 74% and 72% of the presentations, respectively. Pain symptoms included dyspareunia in the majority of women but almost half of the women (44.8%) reported chronic pelvic pain and/or buttock pain, either in isolation or in combination. Urinary symptoms were frequently reported amongst women with concomitant mid-urethral sling placement at the time of prolapse surgery. Those symptoms included mixed urinary incontinence (MUI) 29%, urge urinary incontinence (UUI) 19%, voiding dysfunction (acute urinary retention) 15.5%, recurrent urinary tract infection (UTI) 15.5% and stress urinary incontinence (SUI) 9%, respectively. There were five cases of mesh-related infection and one case of vesicovaginal fistula [20].
High-intensity focused ultrasound for prostate cancer
Published in Expert Review of Medical Devices, 2020
Alessandro Napoli, Giulia Alfieri, Roberto Scipione, Andrea Leonardi, Davide Fierro, Valeria Panebianco, Cosimo De Nunzio, Costantino Leonardo, Carlo Catalano
In this category of patients, the reported rate of side events is variable among the different reports, ranging 3.7–46% for urinary incontinence, 3–54% of bladder neck contracture/urethral stricture, and 0–16% of rectal fistula. However, compared to salvage cryotherapy, HIFU seems to have a better safety profile, with lower rates of both mild-to-moderate urinary incontinence and urinary retention [74].
Axonics® system for treatment of overactive bladder syndrome and urinary urgency incontinence
Published in Expert Review of Medical Devices, 2021
Alice Wang, Elizabeth Rourke, Elisabeth Sebesta, Roger Dmochowski
Not only has SNM been found to benefit a variety of urinary or bowel disorders, SNM is a minimally invasive technique that has been found to benefit both the elderly and pediatric populations. Physiologic changes that occur with aging lead the geriatric population to suffer from urinary symptoms [26]. Aside from obstructive voiding in men, OAB syndrome and UUI are among the most prevalent conditions in this population. Though the geriatric population is often higher-risk surgical candidates, several studies have shown clinical utility of SNM in older patients with >50% reduction in symptoms with comparable rates of adverse advents to younger patients [27–29]. In terms of the pediatric population, the International Continence Society states that SNM may be considered in children who have failed an extended period of behavioral modification, biofeedback, and pharmacologic therapy and should be considered before irreversible surgery [30]. Though the safety and effectiveness has not been established for pediatric indications there have been several single center pilot studies in children that reported benefit. In one study looking at 23 patients ranging from 6 to 15 years old, SNM for dysfunctional voiding, enuresis, incontinence, urinary tract infections, bladder pain, urinary retention, urgency, frequency, constipation, and/or fecal soiling resulted in overall patient satisfaction rate of 64%, while that of the caregiver was 67% at mean 13.3 months follow up [31]. A study with longer follow-up in children after SNM also showed that nearly all children (99/105) experienced improvement in at least one symptom. Though explantation was high at 35%, most were removed due to complete resolution [32]. Mason et al. followed 30 patients over 45 months (median age 8.3 years) and demonstrated improvement in quality of life and symptom severity in children with bowel-bladder dysfunction. Children with pre-operative urodynamics demonstrating detrusor overactivity showed even greater benefit in symptom relief. Complications were noted in 23% of patients with the most common being lead breakage which can be attributed to lower body mass index and trauma [33].