Search

Context: Female lower urinary tract symptoms (LUTS) are a common presentation in urological practice. Thus far, only a limited number of female LUTS conditions have been included in the European Association of Urology (EAU) guidelines compendium. The new non-neurogenic female LUTS guidelines expand the remit to include these symptoms and conditions. Objective: To summarise the management of underactive bladder (UAB), bladder outlet obstruction (BOO), and nocturia in females. Evidence acquisition: The literature search was updated in September 2021 and evidence synthesis was conducted using modified GRADE approach as outlined for all EAU guidelines. A new systematic review on BOO was carried out by the panel for purposes of this guideline. Evidence synthesis: The important considerations for informing guideline recommendations are presented, along with a summary of all the guideline recommendations. Conclusions: Non-neurogenic female LUTS are an important presentation of urological dysfunction. Initial evaluation, diagnosis, and management should be carried out in a structured and logical fashion on the basis of the best available evidence. This guideline serves to present this evidence to practising urologists and other health care providers in an easily accessible and digestible format. Patient summary: This report summarises the main recommendations from the European Association of Urology guideline on symptoms and diseases of the female lower urinary tract (bladder and urethra) not associated with neurological disease. We cover recommendations related to the treatment of underactive bladder, obstruction of the bladder outlet, and nighttime urination. © 2022 European Association of Urology

Context: Female lower urinary tract symptoms (LUTS) are a common presentation in urological practice. Thus far, only a limited number of female LUTS conditions have been included in the European Association of Urology (EAU) guidelines compendium. The new non-neurogenic female LUTS guideline expands the remit to include these symptoms and conditions. Objective: To summarise the diagnostic section of the non-neurogenic female LUTS guideline and the management of female overactive bladder (OAB), stress urinary incontinence (SUI), and mixed urinary incontinence (MUI). Evidence acquisition: New literature searches were carried out in September 2021 and evidence synthesis was conducted using the modified GRADE criteria as outlined for all EAU guidelines. A new systematic review (SR) on OAB was carried out by the panel for the purposes of this guideline. Evidence synthesis: The important considerations for informing guideline recommendations are presented, along with a summary of all the guideline recommendations. Conclusions: Non-neurogenic female LUTS are an important cause of urological dysfunction. Initial evaluation, diagnosis, and management should be carried out in a structured and logical fashion based on the best available evidence. This guideline serves to present this evidence to health care providers in an easily accessible and digestible format. Patient summary: This report summarises the main recommendations from the European Association of Urology guideline on symptoms and diseases of the female lower urinary tract (bladder and urethra) not associated with neurological disease. We cover recommendations related to diagnosis of these conditions, as well as the treatment of overactive bladder, stress urinary incontinence, and mixed urinary incontinence. © 2022 European Association of Urology

Context: Female bladder outlet obstruction (fBOO) is a relatively uncommon condition compared with its male counterpart. Several criteria have been proposed to define fBOO, but the comparative diagnostic accuracy of these remains uncertain. Objective: To identify and compare different tests to diagnose fBOO through a systematic review process. Evidence acquisition: A systematic review of the literature was performed according to the Cochrane Handbook and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. The EMBASE/MEDLINE/Cochrane databases were searched up to August 4, 2020. Studies on women ≥18 yr of age with suspected bladder outlet obstruction (BOO) involving diagnostic tests were included. Pressure-flow studies or fluoroscopy was used as the reference standard where possible. Two reviewers independently screened all articles, searched reference lists of retrieved articles, and performed data extraction. The risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Evidence synthesis: Overall, 28 nonrandomised studies involving 10 248 patients were included in the qualitative analysis. There was significant heterogeneity regarding the characteristics of women included in BOO cohorts (ie, mixed cohorts including both anatomical and functional BOO). Pressure-flow studies ± fluoroscopy was evaluated in 25 studies. Transperineal Doppler ultrasound was used to evaluate bladder neck dynamics in two studies. One study tested the efficacy of transvaginal ultrasound. The urodynamic definition of fBOO also varied amongst studies with different parameters and thresholds used, which precluded a meta-analysis. Three studies derived nomograms using the maximum flow rate (Qmax) and voiding detrusor pressure at Qmax. The sensitivity, specificity, and overall accuracy ranges were 54.6–92.5%, 64.6–93.9%, and 64.1–92.2%, respectively. Conclusions: The available evidence on diagnostic tests for fBOO is limited and heterogeneous. Pressure-flow studies ± fluoroscopy remains the current standard for diagnosing fBOO. Patient summary: Evidence on tests used to diagnose female bladder outlet obstruction was reviewed. The most common test used was pressure-flow studies ± fluoroscopy, which remains the current standard for diagnosing bladder outlet obstruction in women. Take Home Message: The available evidence on diagnostic tests for female bladder outlet obstruction is limited and heterogeneous. The most common test used was video-urodynamics, which remains the current standard for diagnosing bladder outlet obstruction in women. © 2021 European Association of Urology

While the management of bladder outlet obstruction (BOO) in men has been a topic of several systematic reviews and meta-analyses, no such evidence base exists for female BOO.

Background: Azithromycin is a widely used macrolide antibiotic in cystic fibrosis (CF), but little is known about the safety of long-term use. Reported side effects only apply to short-term use. The aim of this study is to investigate possible azithromycin-induced toxicity of the kidney, liver and heart during chronic azithromycin therapy and whether long-term use can be considered safe regarding the condition of these organs. Methods: CF patients from two medical centers in the Netherlands were included in this cohort study. Data were retrospectively extracted from January 1, 2008 to December 31, 2015 from hospital electronic patient files and anonymously transferred into the database. Index group participants used azithromycin for at least three uninterrupted years, whereas control group participants did not use azithromycin for at least three uninterrupted years. To reflect renal function, the estimated glomerular filtration rate (eGFR) was used, calculated with the MDRD Equation. To monitor hepatic function, the liver function parameters alanine amino-transferase (ALAT), aspartate amino-transferase (ASAT), gamma-glutamyl transferase (GGT), alkaline phosphatase (ALP) and total bilirubin (TB) were used. The QTcinterval was used to determine the condition of the heart. The parameters to reflect renal and hepatic function were analysed with Linear Mixed Models analysis. For the QTc-interval was determined whether population means of index and control group were equal. Results: A total of 91 adult patients, 72 index patients and 19 patients in the control group, were included in the study. The health status of index patients was worse than the condition of patients in the control group, since presence of CF-related diabetes (CFRD) and population means of FEV1 and BMI differed between groups (P=0.001 for CFRD; P=0.002 for FEV1; P=0.027 for BMI). Decline in eGFR over time for the index group did not differ from the control group (P=0.763). During the whole study period the eGFR was higher for the index group (P=0.001). For the liver function parameters there was no difference in course over time between index and control group (P=0.587 for ALAT; P=0.851 for ASAT; P=0.646 for GGT; P=0.209 for ALP; P=0.268 for TB). During the whole study period the GGT was higher for the index group (P=0.005). There was no difference between population means regarding the QTc-interval (P=0.229) nor was this influenced by gender (P=0.660 for males; P=0.190 for females). Conclusion: Chronic azithromycin therapy can be considered safe regarding the risk for kidney, liver and heart. However, it cannot be ruled out that that the elevated GGT in the index group is due to azithromycininduced toxicity from use before the study period. Further research should focus on this possible azithromycin-induced liver toxicity.