II.

Based on observational data, SNS appears effective for treatment of OAB in women. Adverse event rates with tined leads are lower than previously published estimates using non-tined leads. High-quality studies are needed to confirm our findings and to provide additional data regarding reprogramming, quality of life, and efficacy when compared to other therapies.

Background: Although the vaginal and urinary microbiomes have been increasingly wellcharacterized in health and disease, few have described the relationship between these neighboring environments. Elucidating this relationship has implications for understanding how manipulation of the vaginal microbiome may affect the urinary microbiome and treatment of common urinary conditions.Objective: To describe the relationship between urinary and vaginal microbiomes using 16S rRNA gene sequencing. We hypothesized that the composition of the urinary and vaginal microbiomes would be significantly associated, with similarities in predominant taxa.Study Design: This multicenter study collected vaginal swabs and catheterized urine samples from 186 women with mixed urinary incontinence (MUI) enrolled in a parent study and 84 similarly aged controls. Investigators decided a priori that if vaginal and/or urinary microbiomes differed between continent and incontinent women, the groups would be analyzed separately; if similar, samples from continent and incontinent women would be pooled and analyzed together. A central laboratory sequenced variable regions 1-3 (v1-3) and characterized bacteria to the genus level. Operational taxonomic unit (OTU) abundance was described for paired vaginal and urine samples. Pearson's correlation characterized the relationship between individual OTUs of paired samples. Canonical Correlation Analysis (CCA) evaluated the association between clinical variables (including MUI and control status) and vaginal and urinary OTUs, using the CCA function in the Vegan package (R version 3.5). Linear discriminant analysis effect size (LEfSe) was used to find taxa that discriminated between vaginal and urinary samples.Results: Urinary and vaginal samples were collected from 212 women [mean age 53 (±11 years)] and results from 197-paired samples were available for analysis. As OTUs in MUI and control samples were related in CCA and since taxa did not discriminate between MUI or controls in either vagina or urine, MUI and control samples were pooled for further analysis. CCA of vaginal and urinary samples indicated that that 60 of the 100 most abundant OTUs in the samples largely overlapped. Lactobacillus was the most abundant genus in both urine and vagina (contributing on average 53% to an individual's urine sample and 64% to an individual's vaginal sample) (Pearson correlation r=0.53). Though less abundant than Lactobacillus, other bacteria with high Pearson correlation coefficients also commonly found in vagina and urine included: Gardnerella (r=0.70), Prevotella (r=0.64), and Ureaplasma (r=0.50). LEfSe analysis identified Tepidomonas and Flavobacterium as bacteria that distinguished the urinary environment for both MUI and controls as these bacteria were absent in the vagina (Tepidimonas effect size 2.38, p<0.001, Flavobacterium effect size 2.15, p<0.001). Though Lactobacillus was the most abundant bacteria in both urine and vagina, it was more abundant in the vagina (LEfSe effect size 2.72, p<0.001).Conclusion...

Purpose To describe and compare the frequency and type of lower urinary tract symptoms (LUTS) reported by men and women at the time they were recruited from urology and urogynecology clinics into the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) multi-center, prospective, observational cohort study. Materials and Methods Six research sites enrolled treatment-seeking men and women who reported any LUTS at a frequency more than “rarely” during the past month on the LUTS tool. At baseline, study participants underwent a standardized clinical evaluation and completed validated questionnaires; urological tests were performed, including pelvic/rectal examination, post-void residual, and urinalysis. Results A total of 545 women and 519 men were enrolled. The mean age was 58.8 ± 14.1 years. At baseline, nocturia, frequency, and a sensation of incomplete emptying were similar between men and women, whereas men experienced more voiding symptoms (90% vs. 85%, p=0.007), and women reported more urgency (85% vs. 66%, p<0.001). Women also reported more urinary incontinence (any type) than men (82% vs. 51% p<0.001), which was predominantly mixed incontinence (57%). Men rarely reported stress incontinence (1%), but did have other urinary incontinence (44% post-void dribbling) or urgency incontinence (46%). Older participants had higher odds of reporting symptoms of nocturia and urgency. Conclusion In this large treatment-seeking cohort of men and women, LUTS varied widely by sex and age. Men reported more voiding symptoms and non-stress or urgency urinary incontinence, whereas women reported more incontinence overall and urgency. Older participants had greater odds of urgency and nocturia.

Introduction & Hypothesis Previous studies have suggested that women with urinary incontinence have an altered urinary microbiome. We hypothesized that the microbiome in women with mixed urinary incontinence (MUI) differed from controls and tested this hypothesis using bacterial gene sequencing techniques. Methods This multicenter study compared the urinary microbiome in women with MUI and similarly aged controls. Catheterized urine samples were obtained; v4–6 regions of the 16S rRNA gene were sequenced to identify bacteria. Bacterial predominance (> 50% of an individual’s genera) was compared between MUI and controls. Bacterial sequences were categorized into “community-types” using Dirichlet multinomial mixture (DMM) methods. Generalized linear mixed models predicted MUI/control status based on clinical characteristics and community-type. Post-hoc analyses were performed in women <51 and ≥51 years. Sample size estimates required 200 samples to detect a 20% difference in Lactobacillus predominance with P<.05. Results Of 212 samples, 97.6% were analyzed (123 MUI/84 controls, mean age 53±11 years). Overall Lactobacillus predominance did not differ between MUI and controls (45/123=36.6% vs. 36/84=42.9%, P=0.36). DMM analyses revealed six community-types; communities differed by age (P=0.001). A High-Lactobacillus (89.2% Lactobacillus) community had a greater proportion of controls (19/84=22.6%, MUI 11/123=8.9%). Overall, bacterial community-types did not differ in MUI and controls. However, post-hoc analysis of women <51 years found that bacterial community-types distinguished MUI from controls (P=0.041); Moderate-Lactobacillus (aOR 7.78, CI 1.85–32.62) and Mixed (aOR 7.10, CI 1.32–38.10) community-types were associated with MUI. Community-types did not differentiate MUI and controls in women ≥51 years (P=0.94). Conclusions Women with MUI and controls did not differ in overall Lactobacillus predominance. In younger women, urinary bacterial community-types differentiated MUI from controls.

Objective To compare the effectiveness of non-surgical abnormal uterine bleeding (AUB) treatments for bleeding control, quality of life, pain, sexual health, patient satisfaction, additional treatments needed, and adverse events. Data Sources MEDLINE and Cochrane databases from inception to May 2012. We included randomized controlled trials of non-surgical treatments for AUB. Interventions included the levonorgestrel intrauterine system, combined oral contraceptives, progestins, nonsteroidal anti-inflammatory drugs, and antifibrinolytics. Gonadotropin releasing hormone agonists, danazol, and placebo were allowed as comparators. Study selection Two reviewers independently screened the 5846 citations and extracted eligible trials. Studies were assessed for quality and strength of evidence. Tabulation, Integration, and Results Twenty-six trials of eight different interventions met inclusion criteria. For the reduction of menstrual bleeding in women with AUB-E, the levonorgestrel intrauterine system, combined oral contraceptives, extended cycle oral progestins, tranexamic acid, and nonsteroidal anti-inflammatory drugs were all effective treatments. The levonorgestrel intrauterine system, combined oral contraceptives, and antifibrinolytics were all superior to luteal phase progestins. The levonorgestrel intrauterine system was superior to combined oral contraceptives and nonsteroidal anti-inflammatory drugs. Antifibrinolytics were superior to nonsteroidal anti-inflammatory drugs for menstrual bleeding reduction. Data were limited on other important outcomes for women with AUB-E and on women with AUB-O. Conclusion Many non-surgical treatments for AUB are effective for reducing menstrual bleeding in women with AUB-E. Additional research is necessary to determine the effectiveness of treatments for other essential quality of life outcomes, and for other populations, including women with AUB-O.

Objective To systematically review outcomes after mesh sacrocolpopexy compared with native tissue vaginal repairs in women with apical prolapse. Data Sources We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov through June 4, 2012. Methods of Study Selection For anatomic and functional analyses, we included studies comparing mesh sacrocolpopexy compared with native tissue vaginal repairs with at least 6 months follow-up. The primary outcome was anatomic “success” after surgery. Secondary outcomes were reoperation and symptom outcomes. We included large case series and comparative studies with shorter follow-up to increase power for adverse event analyses. Tabulation, Integration, and Results Evidence quality was assessed with the Grades for Recommendation, Assessment, Development and Evaluation system. Meta-analyses were performed when at least three studies reported the same outcome. We included 13 comparative studies for anatomic success, reoperation, and symptom outcomes. Moderate-quality evidence supports improved anatomic outcomes after mesh sacrocolpopexy; very low–quality evidence shows no differences in reoperation between sacrocolpopexy and native tissue vaginal repairs. Evidence was insufficient regarding which procedures result in improved bladder or bowel symptoms. Low-quality evidence showed no differences in postoperative sexual function. Adverse event data were compiled and meta-analyzed from 79 studies. When including larger noncomparative studies, ileus or small bowel obstruction (2.7% vs. 0.2%, p < 0.01), mesh or suture complications (4.2% vs. 0.4%, p < 0.01), and thromboembolic phenomena (0.6% vs. 0.1%, p = 0.03) were more common after mesh sacrocolpopexy compared to native tissue vaginal repairs. Conclusion When anatomic durability is a priority, we suggest that mesh sacrocolpopexy may be the preferred surgical option. When minimizing adverse events or reoperation is the priority, there is no strong evidence supporting one approach over the other.

Women across different racial and ethnic groups share similar UI management strategies and UI experiences. However, perceptions about UI may differ in certain populations. These findings could be useful when considering future educational strategies regarding UI in women.