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  • 1
    Language: English
    In: Parthasarathy, Sairam, MaryPat Fitzgerald, James L. Goodwin, Mark Unruh, Stefano Guerra, and Stuart Fun Quan. 2012. Nocturia, sleep-disordered breathing, and cardiovascular morbidity in a community-based cohort. PLoS ONE 7(2): e30969.
    Description: Background: Nocturia has been independently associated with cardiovascular morbidity and all-cause mortality, but such studies did not adjust for sleep-disordered breathing (SDB), which may have mediated such a relationship. Our aims were to determine whether an association between nocturia and cardiovascular morbidity exists that is independent of SDB. We also determined whether nocturia is independently associated with SDB. Methodology/Principal Findings: In order to accomplish these aims we performed a cross-sectional analysis of the Sleep Heart Health Study that contained information regarding SDB, nocturia, and cardiovascular morbidity in a middle-age to elderly community-based population. In 6342 participants (age 63±11 [SD] years, 53% women), after adjusting for known confounders such as age, body mass index, diuretic use, diabetes mellitus, alpha-blocker use, nocturia was independently associated with SDB (measured as Apnea Hypopnea index 〉15 per hour; OR 1.3; 95%CI, 1.2–1.5). After adjusting for SDB and other known confounders, nocturia was independently associated with prevalent hypertension (OR 1.23; 95%CI 1.08–1.40; P=0.002), cardiovascular disease (OR 1.26; 95%CI 1.05–1.52; P=0.02) and stroke (OR 1.62; 95%CI 1.14–2.30; P=0.007). Moreover, nocturia was also associated with adverse objective alterations of sleep as measured by polysomnography and self-reported excessive daytime sleepiness (P〈0.05). Conclusions/Significance: Nocturia is independently associated with sleep-disordered breathing. After adjusting for SDB, there remained an association between nocturia and cardiovascular morbidity. Such results support screening for SDB in patients with nocturia, but the mechanisms underlying the relationship between nocturia and cardiovascular morbidity requires further study.
    Keywords: Nephrology ; Urology ; Respiratory Medicine ; Neurological Disorder
    ISSN: 1932-6203
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  • 2
    Language: English
    In: Journal of Clinical Microbiology, pp. 1376-1383
    Description: Article on evidence of uncultivated bacteria in the adult female bladder.
    Keywords: Uropathogens ; Clinical Cultivation ; Uncultivated Bacteria ; Urinary Tract Conditions
    ISSN: 1098660X
    E-ISSN: 1098660X
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  • 3
    Language: English
    In: Neurourology and Urodynamics, 2011, Vol.30(5), pp.700-703
    Description: The Nocturia Think Tank (TT) met during the 2010 meeting of the International Consultation on Incontinence-Research Society to discuss present knowledge and future directions in care and research of this prominent component of the spectrum of lower urinary tract symptoms. Questions raised included whether nocturia should be re-defined as a function of its bother, effects on quality of life, and economic impact upon society. At issue is the need to delineate the determinants of successful nocturia management. The multifactorial nature of nocturia requires that progress in its treatment will be dependent upon the cooperative investigation on the part of urologists, urogynecologists, geriatricians, epidemiologists, medical economists and pharma. Areas for future avenues of research were outlined at the conclusion of the meeting.
    Keywords: Future Research ; Lower Urinary Tract Symptoms ; Nocturia ; Quality Of Life
    ISSN: 0733-2467
    ISSN: 1520-6777
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  • 4
    In: The New England Journal of Medicine, 2007, Vol.356(21), pp.2143-2155
    Description: Background Many surgical procedures are available for women with urinary stress incontinence, yet few randomized clinical trials have been conducted to provide a basis for treatment recommendations. Methods We performed a multicenter, randomized clinical trial comparing two procedures — the pubovaginal sling, using autologous rectus fascia, and the Burch colposuspension — among women with stress incontinence. Women were eligible for the study if they had predominant symptoms associated with the condition, a positive stress test, and urethral hypermobility. The primary outcomes were success in terms of overall urinary-incontinence measures, which required a negative pad test, no urinary incontinence (as recorded in a 3-day diary), a negative cough and Valsalva stress test, no self-reported symptoms, and no retreatment for the condition, and success in terms of measures of stress incontinence specifically, which required only the latter three criteria. We also assessed postoperative urge incontinence, voiding dysfunction, and adverse events. Results A total of 655 women were randomly assigned to study groups: 326 to undergo the sling procedure and 329 to undergo the Burch procedure; 520 women (79%) completed the outcome assessment. At 24 months, success rates were higher for women who underwent the sling procedure than for those who underwent the Burch procedure, for both the overall category of success (47% vs. 38%, P=0.01) and the category specific to stress incontinence (66% vs. 49%, P〈0.001). However, more women who underwent the sling procedure had urinary tract infections, difficulty voiding, and postoperative urge incontinence. Conclusions The autologous fascial sling results in a higher rate of successful treatment of stress incontinence but also greater morbidity than the Burch colposuspension. (ClinicalTrials.gov number, NCT00064662 .) This multicenter, randomized clinical trial compared two surgical procedures — the Burch colposuspension and the autologous fascial pubovaginal sling — in women with urinary stress incontinence. Success rates (in terms of overall urinary-incontinence measures and stress-incontinence measures specifically) were higher at 2 years for the sling group, but this group also had greater morbidity. These findings inform decision making with respect to surgical treatment of stress incontinence and underscore the importance of surgical randomized trials. This trial compared two surgical procedures — the Burch colposuspension and the fascial sling — in women with urinary stress incontinence. Success rates were higher at 2 years for the sling group, but this group also had greater morbidity. Urinary incontinence affects an estimated 15 to 50% of women,1,2 resulting in a significant medical, social, and economic burden.1 In 1995 dollars, the annual direct costs of incontinence in the United States were estimated to be more than $16 billion.3 Among women with incontinence, 50 to 80% are identified as having stress incontinence,4 or involuntary leakage of urine resulting from physical exertion or sneezing and coughing.5 Although the initial treatment of stress incontinence is often nonsurgical (behavioral therapy, pelvic-floor exercises, or incontinence devices), surgical treatment is considered for patients who are bothered by persistent symptoms. An estimated 4 to . . .
    Keywords: Postoperative Complications -- Epidemiology ; Urinary Incontinence, Stress -- Surgery ; Urologic Surgical Procedures -- Methods;
    ISSN: 0028-4793
    E-ISSN: 1533-4406
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  • 5
    Language: English
    In: The Journal of Urology, 2008, Vol.179(4), pp.1470-1474
    Description: We determined the prognostic value of preoperative urodynamic results in patients with stress urinary incontinence. In a 9-center surgical trial, women with stress urinary incontinence were randomized to a Burch or pubovaginal sling procedure. Women were eligible for the study if they had predominant stress urinary incontinence symptoms, a positive cough stress test, a bladder capacity more than 200 ml and urethral hypermobility. Preoperative free uroflowmetry, filling cystometry and pressure flow studies were performed in all. Overall treatment success required a negative pad test, no urinary incontinence on a 3-day diary, a negative stress test, no self-reported stress urinary incontinence symptoms and no re-treatment for stress urinary incontinence. Stress specific success required all of the last 3 criteria. We examined urodynamic measures, and whether the presence of urodynamic stress incontinence, the presence of detrusor overactivity and Valsalva leak point pressure would predict surgical success. Subjects with urodynamic stress incontinence had a 2-fold greater odds of overall success when compared with the No urodynamic stress incontinence group, but this trend did not quite reach statistical significance (OR 2.26; 95% C.I. 0.99, 5.17). Odds of stress specific success did not differ by urodynamic stress incontinence status. Subjects with detrusor overactivity did not have significantly worse success rates. Stratifying by treatment group, there was no difference in mean Valsalva leak point pressure values between surgical successes and failures. We found a nearly statistically significant trend that women with urodynamic stress incontinence are twice as likely to have a successful overall outcome from surgical management of stress urinary incontinence as women without urodynamic stress incontinence. The level of Valsalva leak point pressure and the presence of detrusor overactivity do not predict the success outcomes after the Burch or autologous fascia sling procedures in women with pure or predominant stress urinary incontinence. The impact of urodynamic studies on surgical outcomes needs further investigation.
    Keywords: Urinary Incontinence ; Stress ; Urodynamics ; Urinary Bladder ; Surgery ; Medicine
    ISSN: 0022-5347
    E-ISSN: 1527-3792
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  • 6
    Language: English
    In: International Urogynecology Journal, 2008, Vol.19(10), pp.1359-1362
    Description: The purpose of the study was to compare incontinence bother in women with mixed incontinence versus pure incontinence subtypes. This is an institutional review board-approved study comparing physical exam findings and responses to the Medical Epidemiologic and Social Aspects of Aging (MESA) questionnaire and the Urinary Distress Inventory (UDI-6). The MESA responses were used to classify women as mixed, pure stress, or pure urge incontinence. This analysis includes 551 women with a mean age of 56 ± 16 years. Most women were Caucasian (86%) with 7% African American and 5% Hispanic. UDI scores were significantly higher in women with mixed incontinence (61 ± 23) than those with pure stress incontinence (40 ± 26) or pure urge incontinence (40 ± 25; p  〈 0.0001). Women with mixed incontinence report greater incontinence bother than women with either pure stress or urge incontinence.
    Keywords: Bother ; Mixed incontinence ; Quality of life ; Stress incontinence ; Urge incontinence
    ISSN: 0937-3462
    E-ISSN: 1433-3023
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