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Aldridge JHR. Botulinum neurotoxin: A therapeutic powerhouse with broad clinical implications. JAAPA 2023; 36:39-41. [PMID: 36976032 DOI: 10.1097/01.jaa.0000921280.56648.da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
ABSTRACT Clostridium botulinum is a Gram-positive bacterium that produces one of the most deadly chemodenervating toxins in the world. To date, six distinct neurotoxins are available for prescription use in the United States. Decades of data across aesthetic therapeutic areas and therapeutic disease states support the safety and efficacy of C. botulinum, providing good symptom management and improved quality of life in appropriately chosen patients. Unfortunately, many clinicians are slow to progress patients to toxin therapy from more conservative measures, and others wrongly interchange the products despite characteristics unique to each. Commensurate with an improved understanding of the complex pharmacology and clinical implications of botulinum neurotoxins is the importance for clinicians to appropriately identify, educate, refer, and/or treat candidate patients. This article provides an overview of the history, mechanism of action, differentiation, indications, and uses for botulinum neurotoxins.
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Affiliation(s)
- Jamie H R Aldridge
- Jamie H. R. Aldridge is a medical science liaison for argenx USA, Inc., in Boston, Mass., and practices at Moses H. Cone Memorial Hospital in Greensboro, N.C. The author has disclosed no potential conflicts of interest, financial or otherwise
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Li J, Wang J, Hu Y, Jian R, Zhao Y, Li D, Wan T, Jike W, Xu F, Huang M. Effects of repetitive functional magnetic stimulation in the sacral nerve in patients with neurogenic detrusor overactivity after suprasacral spinal cord injury: a study protocol for a randomized controlled trial. Trials 2023; 24:199. [PMID: 36932375 PMCID: PMC10022156 DOI: 10.1186/s13063-023-07207-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/28/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Neurogenic detrusor overactivity (NDO) is a serious and common complication after spinal cord injury, affecting patients' quality of life seriously. Therefore, we developed this research protocol to evaluate the efficacy of repetitive functional magnetic stimulation (rFMS) in the sacral nerve in patients with neurogenic detrusor overactivity (NDO) after suprasacral spinal cord injury (SCI) and provide more options for rFMS in treating NDO after suprasacral SCI. METHODS This study is a single-center, randomized, parallel-group clinical trial. We will recruit the patients with NDO after suprasacral SCI in the Rehabilitation Department of the Affiliated Hospital of Southwest Medical University from September 2022 to August 2023. They will be assigned to the rFMS group and the sham stimulation group randomly. The sample size is 66, with 33 patients in each group. The rFMS group will receive real rFMS treatment of the sacral nerve (100% stimulation intensity, 5 Hz, 20 min each time, five times a week), and the sham group will receive sham stimulation. Both groups will receive similar treatment strategies, including medication, standard urine management, acupuncture treatment, and health education. The bladder compliance (bladder capacity/detrusor pressure) and pudendal nerve electromyography will be evaluated at baseline, 8th week of treatment. The residual volume of the bladder and bladder diary will be recorded once a week during 8 weeks of treatments. SCI-QOL and NBSS will be evaluated at baseline, the 4th and 8th week of treatment. In addition, the above assessments will be followed up at 8 weeks after the end of treatment. DISCUSSION It is expected that the bladder function, symptoms, and quality of life might be significantly improved after rFMS of the sacral nerve. TRIAL REGISTRATION The China Clinical Trials Registry has approved this study, registration number: ChiCTR2100045148. Registered on April 7, 2021.
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Affiliation(s)
- Jiyang Li
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Jianxiong Wang
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Yue Hu
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Rui Jian
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Yulu Zhao
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Dan Li
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Tenggang Wan
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Wuga Jike
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Fangyuan Xu
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
| | - Maomao Huang
- grid.488387.8Rehabilitation Medicine Department, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan People’s Republic of China
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A cost-effectiveness analysis of bladder management strategies in neurogenic lower urinary tract dysfunction after spinal cord injury: A publicly funded health care perspective. Spinal Cord 2023; 61:269-275. [PMID: 36894764 DOI: 10.1038/s41393-023-00883-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 01/22/2023] [Accepted: 02/23/2023] [Indexed: 03/11/2023]
Abstract
STUDY DESIGN Economic evaluation study. OBJECTIVES To investigate the long-term cost-effectiveness of clean intermittent catheterization (CIC) compared with suprapubic catheters (SPC) and indwelling urethral catheters (UC) among individuals with neurogenic lower urinary tract dysfunction (NLUTD) related to spinal cord injury (SCI) from a public healthcare perspective. SETTING University affiliated hospital in Montreal, Canada. METHODS A Markov model with Monte Carlo simulation was developed with a cycle length of 1 year and lifetime horizon to estimate the incremental cost per quality-adjusted life years (QALYs). Participants were assigned to treatment with either CIC or SPC or UC. Transition probabilities, efficacy data, and utility values were derived from literature and expert opinion. Costs were obtained from provincial health system and hospital data in Canadian Dollars. The primary outcome was cost per QALY. Probabilistic and one-way deterministic sensitivity analyses were performed. RESULTS CIC had a lifetime mean total cost of $ 29,161 for 20.91 QALYs. The model predicted that a 40-year-old person with SCI would gain an additional 1.77 QALYs and 1.72 discounted life-years gained if CIC were utilized instead of SPC at an incremental cost savings of $330. CIC confer 1.96 QALYs and 3 discounted life-years gained compared to UC with an incremental cost savings of $2496. A limitation of our analysis is the lack of direct long-term comparisons between different catheter modalities. CONCLUSIONS CIC appears to be a dominant and more economically attractive bladder management strategy for NLUTD compared with SPC and/or UC from the public payer perspective over a lifetime horizon.
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Ong HL, Chiang IN, Hsu LN, Chin CW, Shao IH, Jang MY, Juan YS, Wang CC, Kuo HC. Conservative Bladder Management and Medical Treatment in Chronic Spinal Cord Injury Patients. J Clin Med 2023; 12:2021. [PMID: 36902808 PMCID: PMC10003947 DOI: 10.3390/jcm12052021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
To review the available data on non-surgical management for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI) and provide the most updated knowledge for readers. We categorized the bladder management approaches into storage and voiding dysfunction separately; both are minimally invasive, safe, and efficacious procedures. The main goals for NLUTD management are to achieve urinary continence; improve quality of life; prevent urinary tract infections and, last but not least, preserve upper urinary tract function. Annual renal sonography workups and regular video urodynamics examinations are crucial for early detection and further urological management. Despite the extensive data on NLUTD, there are still relatively few novel publications and there is a lack of high-quality evidence. There is a paucity of new minimally invasive and prolonged efficacy treatments for NLUTD, and a partnership between urologists, nephrologists and physiatrists is required to promote and ensure the health of SCI patients in the future.
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Affiliation(s)
- Hueih Ling Ong
- Department of Urology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi 622, Taiwan
| | - I-Ni Chiang
- Department of Urology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 110, Taiwan
| | - Lin-Nei Hsu
- Department of Urology, An Nan Hospital, China Medical University, Tainan City 833, Taiwan
| | - Cheih-Wen Chin
- Feng Shan Lee Chia Wen Urologic Clinic, Kaohsiung 800, Taiwan
| | - I-Hung Shao
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
| | - Mei-Yu Jang
- Department of Urology, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan
| | - Yung-Shun Juan
- Department of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung 813031, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chung-Cheng Wang
- Department of Urology, En Chu Kong Hospital, New Taipei City 237, Taiwan
- Department of Biomedical Engineering, Chung Yuan Christian University, Chungli 320, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Buddhist Tzu Chi University, Hualien 970, Taiwan
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Calën L, Mesnard B, Hedhli O, Broudeur L, Reiss B, Loubersac T, Branchereau J, Baron M, Rigaud J, Le Fort M, Perrouin-Verbe B, Le Normand L, Lefevre C, Perrouin-Verbe MA. Robot-assisted laparoscopic cystectomy with non-continent urinary diversion for neurogenic lower urinary tract dysfunction: Midterm outcomes. Neurourol Urodyn 2023; 42:586-596. [PMID: 36695768 DOI: 10.1002/nau.25134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/21/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES The aim of this study was to assess midterm functional outcomes and complications of robot-assisted laparoscopic cystectomy with non-continent urinary diversion in patients with neurogenic lower urinary tract dysfunction. MATERIALS AND METHODS We performed a retrospective single center study including all patients who underwent robot-assisted laparoscopic cystectomy with non-continent urinary diversion between January 2008 and December 2018 for neurogenic lower urinary tract dysfunction. Perioperative data, early and late complications, reoperation rate, renal function, and patient satisfaction (PGI-I) were evaluated. RESULTS One hundred and forty patients were included (70 multiple sclerosis, 37 spinal cord injuries, 33 others) with a median follow-up of 29 months (12-49). The main indication for surgery was an inability to perform intermittent self-catheterization (n = 125, 89%). The early complication rate (<30 days) was 41% (n = 58), including 72% (n = 45) minor complications (Clavien I-II) and 29% (n = 17) major complications (Clavien III-V). Three patients died in the early postoperative period. Late complications appear in 41% (n = 57), with 9% (n = 13) being ureteroileal anastomotic stricture. The overall reintervention rate was 19% (n = 27), mainly for lithiasis surgery. Pre- and postoperative renal function were comparable. Most of patients reported an improvement in their quality of life following their surgery (PGI-I 1-2). CONCLUSION Robot-assisted laparoscopic cystectomy with non-continent urinary diversion may be of particular interest in patients with neurogenic lower urinary tract dysfunction who are unable to benefit from conservative treatment, as it provides midterm protection of the upper urinary tract and an improvement in quality of life.
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Affiliation(s)
- Laura Calën
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Benoît Mesnard
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Oussama Hedhli
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Lucas Broudeur
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Bénédicte Reiss
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Thomas Loubersac
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | | | - Maximilien Baron
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Jérôme Rigaud
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Marc Le Fort
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Brigitte Perrouin-Verbe
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
| | - Loïc Le Normand
- Department of Urology, CHU Nantes, Nantes Université, Nantes, France
| | - Chloé Lefevre
- Department of Physical Medicine and Rehabilitation, CHU Nantes, Nantes Université, Nantes, France
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Manunta A, Peyronnet B, Olivari-Philiponnet C, Chartier-Kastler E, Saussine C, Phé V, Robain G, Denys P, Even A, Samson E, Grise P, Karsenty G, Hascoet J, Castel-Lacanal E, Charvier K, Guinet-Lacoste A, Chesnel C, Amarenco G, Haffner F, Haddad M, Le Normand L, Perrouin-Verbe MA, Perrouin-Verbe B, De Seze M, Ruffion A, Gamé X. [Guidelines on the urological management of the adult patient with spinal dysraphism (spina bifida)]. Prog Urol 2023; 33:178-197. [PMID: 36609138 DOI: 10.1016/j.purol.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 12/10/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Improved life expectancy and prenatal screening have changed the demographics of spina bifida (spinal dysraphism) which has presently become a disease of adulthood. Urinary disorders affect almost all patients with spinal dysraphism and are still the leading cause of mortality in these patients. The aim of this work was to establish recommendations for urological management that take into account the specificities of the spina bifida population. MATERIALS AND METHODS National Diagnosis and Management Guidelines (PNDS) were drafted within the framework of the French Rare Diseases Plan at the initiative of the Centre de Référence Maladies Rares Spina Bifida - Dysraphismes of Rennes University Hospital. It is a collaborative work involving experts from different specialties, mainly urologists and rehabilitation physicians. We conducted a systematic search of the literature in French and English in the various fields covered by these recommendations in the MEDLINE database. In accordance with the methodology recommended by the authorities (Guide_methodologique_pnds.pdf, 2006), proposed recommendations were drafted on the basis of this literature review and then submitted to a review group until a consensus was reached. RESULTS Bladder dysfunctions induced by spinal dysraphism are multiple and varied and evolve over time. Management must be individually adapted and take into account all the patient's problems, and is therefore necessarily multi-disciplinary. Self-catheterisation is the appropriate micturition method for more than half of the patients and must sometimes be combined with treatments aimed at suppressing any neurogenic detrusor overactivity (NDO) or compliance alteration (anticholinergics, intra-detrusor botulinum toxin). Resort to surgery is sometimes necessary either after failure of non-invasive treatments (e.g. bladder augmentation in case of NDO resistant to pharmacological treatment), or as a first line treatment in the absence of other non-invasive alternatives (e.g. aponeurotic suburethral tape or artificial urinary sphincter for sphincter insufficiency; urinary diversion by ileal conduit if self-catheterisation is impossible). CONCLUSION Spinal dysraphism is a complex pathology with multiple neurological, orthopedic, gastrointestinal and urological involvement. The management of bladder and bowel dysfunctions must continue throughout the life of these patients and must be integrated into a multidisciplinary context.
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Affiliation(s)
- A Manunta
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - B Peyronnet
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France.
| | | | - E Chartier-Kastler
- Service d'Urologie, GH Pitié-Salpétrière, APHP, Paris, France; Sorbonne Université, Paris, France; Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France
| | - C Saussine
- Service d'urologie, les hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - V Phé
- Service d'urologie, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - G Robain
- Service de médecine physique et réadaptation, Hôpital Rotschild, APHP, Paris, France
| | - P Denys
- Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France; Faculté de médecine Paris Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - A Even
- Service de médecine physique et réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France; Faculté de médecine Paris Ouest, Université de Versailles-Saint-Quentin-en-Yvelines, Garches, France
| | - E Samson
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - P Grise
- Service d'urologie, CHU Rouen, Rouen, France
| | - G Karsenty
- Aix-Marseille Université, urologie et transplantation rénale, Hôpital La Conception, AP-HM, Marseille, France
| | - J Hascoet
- Centre de référence Spina Bifida-Dysraphismes, CHU Pontchaillou, Rennes, France
| | - E Castel-Lacanal
- CHU Toulouse, service de médecine physique et de réadaptation et ToNIC, Toulouse NeuroImaging Center, Université de Toulouse, Inserm, UPS, Toulouse, France
| | - K Charvier
- Service de médecine physique et réadaptation, Hôpital Henry-Gabrielle, Hospices civils de Lyon, Saint-Genis-Laval, France
| | - A Guinet-Lacoste
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France
| | - C Chesnel
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, Hôpital Tenon, AP-HP, Paris, France
| | - G Amarenco
- Sorbonne Université, GRC 001, GREEN Groupe de recherche clinique en neuro-urologie, AP-HP, Hôpital Tenon, 75020 Paris, France; Service de neuro-urologie et explorations périnéales, Hôpital Tenon, AP-HP, Paris, France
| | - F Haffner
- ASBH, Association nationale Spina Bifida et Handicaps associés, 94420 Le Plessis Trevise, France
| | - M Haddad
- Service de chirurgie viscérale et urologie pédiatrique, AP-HM, Marseille, France
| | - L Le Normand
- Service d'urologie, CHU de Nantes, Nantes, France
| | | | - B Perrouin-Verbe
- Service de médecine physique et réadaptation, CHU de Nantes, Nantes, France
| | - M De Seze
- Spécialiste en médecine physique et de réadaptation, Clinique St.-Augustin, Bordeaux, France
| | - A Ruffion
- Service d'urologie, Hospices civils de Lyon, Lyon, France
| | - X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, Université Paul-Sabatier, Toulouse, France
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Zhao P, Zhang G, Shen Y, Wang Y, Shi L, Wang Z, Wei C, Zhai W, Sun L. Urinary dysfunction in patients with vascular cognitive impairment. Front Aging Neurosci 2023; 14:1017449. [PMID: 36742205 PMCID: PMC9889668 DOI: 10.3389/fnagi.2022.1017449] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
Vascular cognitive impairment (VCI) is caused by vascular pathologies, with the spectrum of cognitive disorders ranging from subjective cognitive dysfunction to dementia. Particularly among older adults, cognitive impairment is often complicated with urinary dysfunction (UD); some patients may present with UD before cognitive impairment owing to stroke or even when there are white matter hyperintensities on imaging studies. Patients with cognitive impairment often have both language and movement dysfunction, and thus, UD in patients with VCI can often be underdiagnosed and remain untreated. UD has an impact on the quality of life of patients and caregivers, often leading to poor outcomes. Medical history is an important aspect and should be taken from both patients and their caregivers. Clinical assessment including urinalysis, voiding diary, scales on UD and cognitive impairment, post-void residual volume measurement, uroflowmetry, and (video-) urodynamics should be performed according to indication. Although studies on UD with VCI are few, most of them show that an overactive bladder (OAB) is the most common UD type, and urinary incontinence is the most common symptom. Normal urine storage and micturition in a specific environment are complex processes that require a sophisticated neural network. Although there are many studies on the brain-urinary circuit, the specific circuit involving VCI and UD remains unclear. Currently, there is no disease-modifying pharmacological treatment for cognitive impairment, and anti-acetylcholine drugs, which are commonly used to treat OAB, may cause cognitive impairment, leading to a vicious circle. Therefore, it is important to understand the complex interaction between UD and VCI and formulate individualized treatment plans. This review provides an overview of research advances in clinical features, imaging and pathological characteristics, and treatment options of UD in patients with VCI to increase subject awareness, facilitate research, and improve diagnosis and treatment rates.
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van Veen FEE, Scheepe JR, Blok BFM. Regional variation in urinary catheter use in the Netherlands from 2012 to 2021: a population-based cohort. Ther Adv Urol 2023; 15:17562872231215181. [PMID: 38046940 PMCID: PMC10691317 DOI: 10.1177/17562872231215181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives Our aim was to evaluate trends and regional differences in the use of indwelling and intermittent urinary catheters in the community setting in the Netherlands from 2012 to 2021. Design and methods For this population-based cohort study, data on catheter use was collected from the Drug and Medical Devices Information System of the National Healthcare Institute of the Netherlands. This database contains information on the Dutch insured population, which was 100% of the total population in 2018. Users were divided into 12 provinces according to the Nomenclature of Territorial Units for Statistics codes. The number of catheter users was adjusted for the total population of the provinces by sex and age, and was expressed by users per 100,000 people. Negative binomial regression (NBR) was used to test for differences in clean intermittent catheter (CIC) and indwelling catheter (IDC) users across Dutch provinces. Results Between 2012 and 2021, IDC users increased by 44.6% from 41,619 to 60,172, and CIC users increased by 27.3% from 34,204 to 43,528. The greatest increases were mainly observed among IDC users over 85 years old and male CIC users over 65 years old. NBR showed significant differences for IDC and CIC users between the 12 provinces. CIC incidence was higher in Drenthe and Groningen (Northern Netherlands) compared to Zuid-Holland (Southern Netherlands). IDC incidence was higher in seven provinces dispersed throughout the Netherlands compared to Noord-Holland. Conclusion CIC and IDC users have continued to increase in recent years; this was especially observed among older men. In addition, there were regional differences in the number of CIC and IDC users; CIC was more prominent in the northern region of the Netherlands, and IDC varied between multiple provinces. Practice variation in urinary catheterization may result from patient population differences or healthcare provider preferences and their alignment with guidelines.
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Affiliation(s)
- Felice E. E. van Veen
- Department of Urology, Erasmus Medical Center, Room Na-1524, Dr. Molewaterplein 40, Rotterdam 3013 GD, The Netherlands
| | - Jeroen R. Scheepe
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bertil F. M. Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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Hao F, Jia F, Hao P, Duan H, Wang Z, Fan Y, Zhao W, Gao Y, Fan OR, Xu F, Yang Z, Sun YE, Li X. Proper wiring of newborn neurons to control bladder function after complete spinal cord injury. Biomaterials 2023; 292:121919. [PMID: 36455486 DOI: 10.1016/j.biomaterials.2022.121919] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 10/14/2022] [Accepted: 11/18/2022] [Indexed: 11/26/2022]
Abstract
Activation of endogenous neurogenesis by bioactive materials enables restoration of sensory/motor function after complete spinal cord injury (SCI) via formation of new relay neural circuits. The underlying wiring logic of newborn neurons in adult central nervous system (CNS) is unknown. Here, we report neurotrophin3-loaded chitosan biomaterial substantially recovered bladder function after SCI. Multiple neuro-circuitry tracing technologies using pseudorabies virus (PRV), rabies virus (RV), and anterograde adeno-associated virus (AAV), demonstrated that newborn neurons were integrated into the micturition neural circuits and reconnected higher brain centers and lower spinal cord centers to control voiding, and participated in the restoration of the lower urinary tract function, even in the absence of long-distance axonal regeneration. Opto- and chemo-genetic studies further supported the notion that the supraspinal control of the lower urinary tract function was partially recovered. Our data demonstrated that regenerated relay neurons could be properly integrated into disrupted long-range neural circuits to restore function of adult CNS.
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Affiliation(s)
- Fei Hao
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Engineering Medicine, Beihang University, Beijing, 100191, China
| | - Fan Jia
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute (BCBDI), Translational Research Center for the Nervous System (TRCNS), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences; Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, 518055, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Peng Hao
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Hongmei Duan
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Zijue Wang
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Yubo Fan
- Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, Beijing Advanced Innovation Centre for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191, China; School of Engineering Medicine, Beihang University, Beijing, 100191, China
| | - Wen Zhao
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Yudan Gao
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China
| | - Orion R Fan
- Department of Evolution and Ecology, University of California, Davis, CA, 90007, USA
| | - Fuqiang Xu
- Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Key Laboratory of Brain Connectome and Manipulation, The Brain Cognition and Brain Disease Institute (BCBDI), Translational Research Center for the Nervous System (TRCNS), Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences; Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen, 518055, China; University of Chinese Academy of Sciences, Beijing, 100049, China; State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Key Laboratory of Magnetic Resonance in Biological Systems, Wuhan Center for Magnetic Resonance, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences, Wuhan, 430071, China.
| | - Zhaoyang Yang
- Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China.
| | - Yi E Sun
- Key Laboratory of Spine and Spinal Cord Injury Repair and Regeneration (Tongji University), Ministry of Education, Shanghai, 200065, China; Shanghai Institute of Stem Cell Research and Clinical Translation, Shanghai East Hospital, Tongji University, School of Medicine, Shanghai, 200120, China.
| | - Xiaoguang Li
- Beijing Key Laboratory for Biomaterials and Neural Regeneration, School of Engineering Medicine, Beihang University, Beijing, 100191, China; Department of Neurobiology, School of Basic Medical Sciences, Capital Medical University, Beijing, 100069, China.
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Zhong P, Zeng H, Huang M, Chen L, Fu W. Combined acupuncture and moxibustion therapy for the treatment of neurogenic bladder and bowel dysfunction following traumatic spinal cord injury: A case report. Explore (NY) 2023; 19:136-140. [PMID: 34933828 DOI: 10.1016/j.explore.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/21/2021] [Indexed: 01/25/2023]
Abstract
Neurogenic bladder and bowel are two critical autonomic complications following traumatic spinal cord injury (TSCI). Chronic lower urinary tract and bowel dysfunctions can lead to secondary complications, drastically affect the quality of life and significantly increase the risk of hospital readmission and mortality. Other than symptomatic treatments, a few effective therapies are available. Combined acupuncture and moxibustion therapy has positive effects on improving nerve repair and functional recovery in the early phases following TSCI. However, whether it is effective for TSCI-related chronic urinary and bowel dysfunctions remains unknown. This report presents the case of a 26-year-old male patient who experienced neurogenic bladder and bowel dysfunction following TSCI due to an accidental fall from height for more than 10 months and visited our department for combined acupuncture and moxibustion therapy. After 48 treatment sessions, he regained voluntary urination and defecation to a large extent. Urodynamic testing showed recovered bladder compliance and improved detrusor contractility. Symptom assessment with the Qualiveen Short-Form and neurogenic bowel dysfunction scores demonstrated reduced symptom severity. This case suggests that combined acupuncture and moxibustion therapy might help to restore the physiological functions of the lower urinary and digestive tracts following TSCI and might be a promising alternative for the treatment of neurogenic bladder and bowel dysfunction in patients with TSCI.
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Affiliation(s)
- Ping Zhong
- Department of Acupuncture and Moxibustion, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hai Zeng
- College of Traditional Chinese Medicine, Jinan University, Guangzhou, China
| | - Miaochun Huang
- Department of Emergency, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Ling Chen
- Department of Acupuncture and Moxibustion, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenbin Fu
- Department of Acupuncture and Moxibustion, The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China; Innovative research team of acupuncture for depression and related disorders, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China.
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Rietchel L, Ramirez AL, Hocaloski S, Elliott S, Walter M, Krassioukov AV. Characterization of heart rate changes associated with autonomic dysreflexia during penile vibrostimulation and urodynamics. Spinal Cord 2023; 61:8-14. [PMID: 35941361 DOI: 10.1038/s41393-022-00843-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 01/17/2023]
Abstract
STUDY DESIGN Secondary data analysis. OBJECTIVES To characterize autonomic dysreflexia (AD) associated heart rate (HR) changes during penile vibrostimulation (PVS) and urodynamic studies (UDS). SETTING University-based laboratory. METHODS We analyzed blood pressure (BP) and HR data, recorded continuously, from 21 individuals (4 females; median age 41 years [lower and upper quartile, 37; 47]; median time post-injury 18 years [7; 27]; all motor-complete spinal cord injury (SCI) except one; cervical SCI = 15, thoracic [T1-T6] SCI = 6), who underwent PVS (11/21) or UDS (10/21). RESULTS Overall, 47 AD episodes were recorded (i.e. PVS = 37, UDS = 10), with at least one AD episode in each participant. At AD threshold, bradycardia was observed during PVS and UDS in 43% and 30%, respectively. At AD peak (i.e., maximum increase in systolic BP from baseline), bradycardia was observed during PVS and UDS in 65% and 50%, respectively. Tachycardia was detected at AD peak only once during UDS. Our study was limited by a small cohort of participants and the distribution of sex and injury characteristics. CONCLUSIONS Our findings reveal that AD-associated HR changes during PVS and UDS appear to be related to the magnitude of systolic BP increases. Highly elevated systolic BP associated with bradycardia suggests the presence of severe AD. Therefore, we recommend cardiovascular monitoring (preferably with continuous beat-to-beat recordings) during PVS and UDS to detect AD early. Stopping assessments before systolic BP reaches dangerously elevated levels, could reduce the risk of life-threatening complications in this cohort.
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Affiliation(s)
- Lauren Rietchel
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada
| | - Andrea L Ramirez
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada
| | - Shea Hocaloski
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada.,G.F. Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Stacy Elliott
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada.,G.F. Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada.,Vancouver Coastal Health, B.C. Centre for Sexual Medicine, Vancouver, BC, Canada.,Departments of Psychiatry and Urologic Sciences, UBC, Vancouver, BC, Canada
| | - Matthias Walter
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada. .,Department of Urology, University Hospital Basel, University of Basel, Basel, Switzerland.
| | - Andrei V Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia (UBC), Vancouver, British Columbia (BC), Canada. .,G.F. Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada. .,Division of Physical Medicine and Rehabilitation, Faculty of Medicine, UBC, Vancouver, BC, Canada.
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Kostenko EV. [The use of botulinum toxin type A in symptomatic therapy and medical rehabilitation of patients with multiple sclerosis]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:17-25. [PMID: 37966435 DOI: 10.17116/jnevro202312310117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
The review of the current state of the problem of symptomatic therapy and medical rehabilitation (MR) of patients with multiple sclerosis (MS) is presented. The search was conducted in the databases Medline, Web of Science, PubMed and Scopus. Information is given about the most common symptoms of MS, among which sensory and motor disorders, bladder dysfunction, and pain have the greatest impact on the quality of life of patients, their functioning and independence in everyday life. The clinical characteristics of spasticity syndrome in MS and its relationship with quality of life indicators are considered. The features of the use of botulinum therapy (BT) in MS are considered. A high level of effectiveness of the use of BT in the treatment of neurogenic hyperactivity of detrusor and neurogenic bladder (the level of persuasiveness of recommendation A) and spasticity (the level of persuasiveness of recommendation B) is shown. Symptomatic treatment of MS and MR with the use of multidisciplinary programs helps to reduce disability, improve the quality of life of patients. When choosing symptomatic treatment and MR methods, it is customary to focus on the needs of patients.
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Affiliation(s)
- E V Kostenko
- Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
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Age-based risk of end-stage kidney disease in patients with myelomeningocele. J Pediatr Urol 2022; 19:195.e1-195.e7. [PMID: 36628830 DOI: 10.1016/j.jpurol.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE We aimed to quantify end-stage kidney disease (ESKD) risk after infancy in individuals with myelomeningocele (MMC) followed by urology in the modern medical era and to assess if ESKD risk was higher after surgery related to a hostile bladder. METHODS We retrospectively reviewed patients with MMC followed by urology at our institution born ≥ 1972 (when clean intermittent catheterization was introduced) past 1 year of age (when mortality is highest, sometimes before establishing urology care). ESKD was defined as requiring permanent peritoneal/hemodialysis or renal transplantation. Early surgery related to hostile bladder included incontinent vesicostomy, bladder augmentation, detrusor Botulinum A toxin injection, ureteral reimplantation, or nephrectomy for recurrent urinary tract infections. Survival analysis and proportional hazards regression were used. Sensitivity analyses included: risk factor analysis with only vesicostomy, timing of surgery, including the entire population without minimal follow-up (n = 1054) and only patients with ≥ 5 years of follow-up (n = 925). RESULTS Overall, 1029 patients with MMC were followed for a median of 17.0 years (49% female, 76% shunted). Seven patients (0.7%) developed ESKD at a median 24.3 years old (5 hemodialysis, 1 peritoneal dialysis, 1 transplantation). On survival analysis, the ESKD risk was 0.3% at 20 years old and 2.1% at 30 years old (Figure). This was ∼100 times higher than the general population (0.003% by 21 years old, p < 0.001). Patients who underwent early surgery for hostile bladder had higher ESKD risk (HR 8.3, p = 0.001, 6% vs. 1.5% at 30 years). On exploratory analyses, gender, birth year, shunt status and wheelchair use were not associated with ESKD risk (p ≥ 0.16). Thirty-year ESKD risk was 10% after early vesicostomy vs. 1.4% among children without one (p = 0.001). Children undergoing bladder surgery between 1.5 and 5 years old had a higher risk of ESKD. No other statistically/clinically significant differences were noted. COMMENT Patients with MMC remain at risk of progressive renal damage throughout life. We relied on the final binary ESKD outcome to quantify this risk, rather than imprecise glomerular filtration rate formulas. Analysis was limited by few people developing ESKD, inconsistent documentation of early urodynamic findings and indications for bladder-related surgery. CONCLUSIONS While ESKD is relatively uncommon in the MMC population receiving routine urological care, affecting 2.1% of individuals in the first 3 decades, it is significantly higher than the general population. Children with poor bladder function are likely at high risk, underlining the need for routine urological care, particularly in adulthood.
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User experience of a self-management WeChat applet for patients with neurogenic bladder: A qualitative approach. Int J Nurs Sci 2022; 10:89-96. [PMID: 36860717 PMCID: PMC9969162 DOI: 10.1016/j.ijnss.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/03/2022] [Accepted: 12/19/2022] [Indexed: 12/29/2022] Open
Abstract
Objectives This study aimed to determine patients' perceived benefits of a WeChat applet for self-management of patients with neurogenic bladder (NGB) and identify the key factors hindering their adoption. Methods In the qualitative study, 19 NGB patients were invited for semi-structured interviews. They were hospitalized in the rehabilitation departments of two tertiary hospitals in Shenzhen and tried out the self-management applet for two weeks. Data were analyzed using the content analysis method. Results The results indicated that the WeChat applet of self-management was helpful and embraced by the NGB patients. Three perceived benefits were identified 1) being accessible, flexible, and intuitive to users, 2) driving bladder self-management, and 3) directing the way for care partners and family members. Challenges hindering the adoption of the applet included 1) negative attitudes of patients towards bladder self-management and patient characteristics, 2) concerns about the risks of mHealth, and 3) the necessity of applet upgrading. Conclusion This study showed feasibility of the WeChat applet for self-management among NGB patients to meet their needs for access to information during hospitalization and after discharge. The study also identified facilitators and barriers to patient use, providing valuable information for healthcare providers to implement mHealth interventions to promote self-management among NGB patients.
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Spinal Cord Injury Causes Marked Tissue Rearrangement in the Urethra-Experimental Study in the Rat. Int J Mol Sci 2022; 23:ijms232415951. [PMID: 36555592 PMCID: PMC9783636 DOI: 10.3390/ijms232415951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
Traumatic spinal cord injury (SCI) results in the time-dependent development of urinary impairment due to neurogenic detrusor overactivity (NDO) and detrusor-sphincter-dyssynergia (DSD). This is known to be accompanied by massive changes in the bladder wall. It is presently less clear if the urethra wall also undergoes remodelling. To investigate this issue, female rats were submitted to complete spinal transection at the T8/T9 level and left to recover for 1 week and 4 weeks. To confirm the presence of SCI-induced NDO, bladder function was assessed by cystometry under urethane anesthesia before euthanasia. Spinal intact animals were used as controls. Urethras were collected and processed for further analysis. Following thoracic SCI, time-dependent changes in the urethra wall were observed. Histological assessment revealed marked urethral epithelium reorganization in response to SCI, as evidenced by an increase in epithelial thickness. At the muscular layer, SCI resulted in strong atrophy of the smooth muscle present in the urethral sphincter. Innervation was also affected, as evidenced by a pronounced decrease in the expression of markers of general innervation, particularly those present in sensory and sympathetic nerve fibres. The present data show an evident impact of SCI on the urethra, with significant histological rearrangement, accompanied by sensory and sympathetic denervation. It is likely that these changes will affect urethral function and contribute to SCI-induced urinary dysfunction, and they deserve further investigation.
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Tran WT, Boxley PJ, Wilcox DT, Vemulakonda VM, Wood D, Rove KO. Retrospective analysis of bladder perforation risk in patients after augmentation cystoplasty using an extraperitoneal approach. J Pediatr Urol 2022; 19:192.e1-192.e8. [PMID: 36585277 DOI: 10.1016/j.jpurol.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 11/22/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Initial management of pediatric patients with neurogenic bladder is focused on clean intermittent catheterization and medical therapies. Those with more hostile or small capacity bladders require surgical intervention including bladder augmentation that can result in significant clinical sequelae. This study examines a rarely described approach wherein the bladder reconstruction is extraperitonealized by bringing bowel segments through a peritoneal window and then closed. OBJECTIVE The aim of this study was to determine if the rate of bladder rupture and subsequent morbidity differed between patients who have undergone an intraperitoneal versus extraperitoneal bladder augmentation. We hypothesized that an extraperitoneal approach reduced the risk of intraperitoneal bladder perforation, downstream Intensive Care Unit (ICU) admission, small bowel obstruction (SBO) requiring exploratory laparotomy, and ventriculoperitoneal (VP) shunt-related difficulties as compared to the standard intraperitoneal technique. METHODS A retrospective chart review was conducted to assess surgical approach and outcomes in patients who underwent bladder augmentation performed between January 2009 and June 2021. Patients were identified through an existing database and manual chart review was conducted to extract data through imaging studies, operative notes, and clinical documentation. The primary outcome was bladder perforation. Secondary outcomes were ICU admission, exploratory laparotomy, and VP shunt externalization, infection, or revision for any cause. Nonparametric statistical analyses were performed. RESULTS A total of 111 patients underwent bladder augmentation with 37 intraperitoneal and 74 extraperitoneal procedures. Median follow up was 5.8 years [IQR 3.0-8.6 years] and did not vary between groups (P = 0.67). Only one patient was found to have a bladder perforation in the intraperitoneal group (log-rank P = 0.154). There were no significant differences in time to post-augmentation ICU admission, exploratory laparotomy, or VP shunt events between the two groups (log-rank P = 0.294, log-rank P = 0.832, and log-rank P = 0.237, respectively). Furthermore, a Kaplan-Meier analysis assessing time to composite complication demonstrated no significant difference between the two techniques (log-rank P = 0.236). DISCUSSION This study provides important data comparing the rate of bladder perforation and subsequent morbidity between intraperitoneal and extraperitoneal bladder augmentation. As expected, with a complex procedure, both groups suffered complications, but these data showed no difference between the two procedures. Rates of prior (abdominal) surgery may influence the decision to perform this procedure extraperitoneal. CONCLUSIONS Outcomes related to bladder perforation and secondary consequences do not differ significantly between patients who had bladder augmentation performed with an intraperitoneal versus extraperitoneal approach. Given the low number of adverse events in this study, larger studies are warranted.
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Affiliation(s)
- Wesley T Tran
- Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA.
| | - Peter J Boxley
- Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
| | - Duncan T Wilcox
- Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
| | - Vijaya M Vemulakonda
- Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
| | - Dan Wood
- Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
| | - Kyle O Rove
- Pediatric Urology Research Enterprise (PURE), Department of Pediatric Urology, Children's Hospital Colorado, Aurora, CO, USA; Division of Urology, Department of Surgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA; University of Colorado School of Medicine, Aurora, CO, USA
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Predictors for outcomes of noninvasive, individualized transcranial magnetic neuromodulation in multiple sclerosis women with neurogenic voiding dysfunction. CONTINENCE (AMSTERDAM, NETHERLANDS) 2022; 4:100517. [PMID: 36568960 PMCID: PMC9788803 DOI: 10.1016/j.cont.2022.100517] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Purpose Multiple sclerosis (MS) is a multifocal demyelinating disease that affects the central nervous system (CNS) and commonly leads to neurogenic lower urinary tract dysfunction (NLUTD). Proper storage and release of urine relies on synchronized activity of the LUT, which is meticulously regulated by supraspinal circuits, making it vulnerable to diseases such as MS. NLUTD, characterized by voiding dysfunction (VD), storage issues, or a combination of both is a common occurrence in MS. Unfortunately, there are limited treatment options for NLUTD, making the search for alternative treatments such as transcranial rotating permanent magnet stimulation (TRPMS) of utmost importance. To assess effectiveness of treatment we also need to understand underlying factors that may affect outcomes, which we addressed here. Methods Ten MS subjects with VD and median age of 54.5 years received daily TRPMS sessions for two weeks. Five pre-determined regions of interest (ROIs) known to be involved in the micturition cycle were modulated (stimulated or inhibited) using TRPMS. Clinical data (non-instrumented uroflow and urodynamics parameters, PVR, bladder symptom questionnaires) and neuro-imaging data were collected at baseline and following TRPMS via 7-Tesla Siemens MAGNETOM Terra magnetic resonance imaging (MRI) scanner. Each participant underwent functional MRI (fMRI) concurrently with a repeated urodynamic study (UDS). Baseline data of each arm was evaluated to determine any indicators of successful response to treatment.
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Marzouk MH, Darwish MH, El-Tamawy MS, Morsy S, Abbas RL, Ali AS. Posterior tibial nerve stimulation as a neuromodulation therapy in treatment of neurogenic overactive bladder in multiple sclerosis: A prospective randomized controlled study. Mult Scler Relat Disord 2022; 68:104252. [PMID: 36274285 DOI: 10.1016/j.msard.2022.104252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 10/08/2022] [Accepted: 10/16/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND one of the major annoying disorders occurring in people with multiple sclerosis is lower urinary tract disorders (LUT). Urgency is considered the main one seriously influencing the quality of life. Neurogenic detrusor over activity (DOAB) is characterized by a hyperreflexic, overactive detrusor that responds quickly to low-intensity sensory input from general visceral afferent fibers. Overactivity has been claimed to induce random, uncontrolled contractions of the detrusor muscle, leading to intravesicular pressure rise, producing urgency, frequency, and consequently incontinence AIM: To demonstrate the therapeutic efficacy for posterior tibial nerve stimulation (PTNS) in neurogenic over active bladder (NOAB) in people with multiple sclerosis METHODS: The current trial is a prospective, randomized controlled study. Forty remitting relapsing males with MS with moderate NOAB symptoms were randomly assigned into two equal groups; control group (C) treated by selected therapeutic exercises program for strengthening pelvic floor muscles and an intervention group (ES) receiving an additional posterior tibial nerve electrical stimulation. Each session ranged from 45- 50 minutes, three days weekly for a month. Outcome measures were recorded before starting the treatment and after termination of the study intervention and included over active bladder symptoms score (OVBS) score, urodynamic parameters (uroflow, filling and voiding cystometry), and post voiding residual volume by abdominal ultrasound RESULTS: There was a significant improvement of all voiding parameters compared to baseline and the group C except frequency of urgency incontinence. A significant decrease was detected in post-treatment mean episodes number of nighttime frequency, urgency, urgency incontinence (1.65 ± 0.93, 1.2 ± 0.52 and 1.5 ± 0.76) respectively of the ES group compared to that of group C (3.05 ± 1.09, 2.25 ± 0.71 and 2.25 ± 1.06) (P < 0.01). There was a significant decrease in median post-treatment OVBS score 3 (3-3) compared to group C median score 5 (6-4). A statistically significant improvement was observed of all urodynamic parameters (bladder capacity and compliance, Detrusor overactivity (DO), maximum flow rate and post voidal residual volume in the ES group compared to the group C CONCLUSION: PTNS is a promising and potentially beneficial treatment option for NOAB symptoms in males with MS and superior to pelvic floor muscle training alone.
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Affiliation(s)
- Mohamed H Marzouk
- Department of Neurology, Faculty of Physical Therapy, Cairo University.
| | - Moshera H Darwish
- Department of Neurology, Faculty of Physical Therapy, Cairo University.
| | | | - Samer Morsy
- Department of Urology, Faculty of Medicine, Cairo University.
| | - Rami L Abbas
- Physical Therapy Department, Beirut Arab University.
| | - Ahmed S Ali
- Department of Neurology, Faculty of Physical Therapy, Cairo University.
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Zhao C, Hu Y, Wang X, Hao F, Wang Y, Chen L, Cai WZ. Clinical practice guidelines for the management of adult patients with neurogenic lower urinary tract dysfunction: a systematic review protocol. BMJ Open 2022; 12:e064978. [PMID: 36418139 PMCID: PMC9685182 DOI: 10.1136/bmjopen-2022-064978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Neurogenic lower urinary tract dysfunction (NLUTD) both threatens the health of affected patients long-term and also has a significantly negative impact on the patients' quality of life. present, many clinical practice guidelines (CPGs) have been developed for NLUTD patients, but these CPGs may confuse healthcare professionals and patients due to their great difference in terms of scope, quality and content. This review aims to identify the CPGs for NLUTD patients published from 2012 to 2022, assess their quality and then analyse them in an integrated manner. METHODS AND ANALYSIS We will systematically search electronic healthcare databases (English databases including PubMed, EMBASE, OVID, Scopus, Web of Science, Cochrane Library, CINAHL, UpToDate, and Best Practice and Chinese databases including China National Knowledge Infrastructure, Wanfang Database, VIP Periodical Resource Integration Service Platform and SinoMed), online CPG repositories and relevant professional association websites to identify eligible CPGs. The CPGs published in English and Chinese with full texts available within the period from January 2012 to March 2022 will be included in this study. The Appraisal of Guidelines for Research and Evaluation (AGREE) II will be used to assess the quality of included CPGs. According to the predesigned data table, the general characteristics of these CPGs, proposed recommendations and their quality of evidence, strength of recommendation and other information will be extracted. Qualitative thematic analysis will be applied to the extracted recommendations. A summary of the proposed recommendations, their quality of evidence, strength of recommendation and other information will eventually be described in a table. This review is expected to identify knowledge gaps in current CPGs and to identify the areas of the proposed recommendations derived from low-level evidence. ETHICS AND DISSEMINATION : This systematic review does not involve the participation of any subjects, and therefore no ethical approval is required. The findings of this review will be published in a peer-reviewed journal and disseminated via conference presentations. PROSPERO REGISTRATION NUMBER CRD42022318180.
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Affiliation(s)
- Chun Zhao
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - YingJie Hu
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaojiao Wang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Fengming Hao
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Ying Wang
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
- School of Nursing, Southern Medical University, Guangzhou, Guangdong, China
| | - Ling Chen
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
| | - Wen Zhi Cai
- Department of Nursing, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China
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Andretta E, Pagliacci MC, Zuliani C, Filocamo MT, Losavio E, Krassioukov A. A survey of clinical practice concerning long-term follow-up of neurogenic lower urinary tract dysfunction due to spinal cord injury in Italy. J Spinal Cord Med 2022; 45:907-915. [PMID: 33848215 PMCID: PMC9662064 DOI: 10.1080/10790268.2020.1863899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CONTEXT/OBJECTIVE This study aimed to assess the clinical practice for long-term follow-up (FU) of neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) in Italy and compare this practice with the clinical practice in other countries and with the international guidelines. DESIGN Data concerning the long-term urological FU of individuals with SCI were collected using a questionnaire and analyzed by means of descriptive and inferential statistics. SETTING Twenty-one Italian centers following SCI patients. PARTICIPANTS One physician at each center (either a permanent staff member or chief). OUTCOME MEASURES Questions addressed the treatment of urinary tract infections (UTI), frequency of visits, urinary tract imaging examinations and urodynamic tests (UD), distinguishing between suprasacral and sacral SCI. RESULTS Nineteen out of 21 centers completed the survey. In most centers, patients were recommended to undergo a visit and an ultrasound examination of urinary tract (UT) at least once a year. While the median interval between FU visits was identical (12 months) for individuals with suprasacral and sacral SCI, the two interval distributions were significantly different (suprasacral SCI: min-max 4-18, IQR = 6; sacral SCI: min-max 6-24; IQR = 8.5; P = 0.02), showing people with suprasacral SCI are followed up more often. Approximately 80% of the surveyed centers performed scheduled UD, with a yearly median frequency of 12 months (range 6-36) for patients with suprasacral SCI, as compared to a median frequency of 18 months for sacral SCI (range 0-36, P = 0.04). VideoUD and antibiotic prophylaxis for recurrent UTIs are carried out only by urologists in 63% and 47.4% of the centers, respectively. Overall, Italian centers share common strategies that compare to standards, including yearly visits, yearly UT examinations and stricter follow-up of people with suprasacral SCI, but may not have standard protocols for antibiotic prophylaxis of UTI, and in few cases control visits and UD are carried out too often. CONCLUSIONS Even though most Italian centers follow up patients with NLUTD secondary to SCI according to international guidelines, heterogeneity in frequency of FU examinations still exists. A tailored approach to the SCI patient that minimizes unnecessary examinations and groups different tests in a single access could improve patients' compliance with FU and reduce costs for the Health system.
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Affiliation(s)
- Elena Andretta
- Urology Department, Dolo General Hospital, Venice, Italy,Correspondence to: Elena Andretta, Urology Department, Dolo General Hospital, Riviera XXIX Aprile, 2, 30031, Dolo, Venice, Italy; Phone: +39 041 5133652; +39 041 5133481.
| | | | | | | | | | - Andrei Krassioukov
- International Collaboration on Repair Discoveries, Vancouver, BC, Canada,Spinal Cord Program, GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, BC, Canada,Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON, Canada
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Effects of Deep Brain Stimulation on Lower Urinary Tract Function in Neurological Patients. Eur Urol Focus 2022; 8:1775-1782. [PMID: 35662503 DOI: 10.1016/j.euf.2022.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/26/2022] [Accepted: 05/19/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) has clear beneficial effects on motor signs in movement disorders, but much less is known about its impact on lower urinary tract (LUT) function. OBJECTIVE To evaluate the effects of DBS on LUT function in patients affected by movement disorders. DESIGN, SETTING, AND PARTICIPANTS We prospectively enrolled 58 neurological patients affected by movement disorders, who were planned to receive DBS. INTERVENTION DBS in the globus pallidus internus, ventral intermediate nucleus of the thalamus, or subthalamic nucleus. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Subjective symptom questionnaires (International Prostate Symptom Score) and objective urodynamic studies were carried out before implantation of the DBS leads and several months after surgery. After DBS surgery, urodynamic investigations were performed with DBS ON as well as DBS OFF. RESULTS AND LIMITATIONS We enrolled patients suffering from Parkinson's disease (n = 39), dystonia (n = 11), essential tremor (n = 5), Holmes tremor (n = 2), and multiple sclerosis with tremor (n = 1). DBS of the globus pallidus internus resulted in worsening of LUT symptoms in 25% (four of 16) of the cases. DBS of the subthalamic nucleus in patients with Parkinson's disease led to normalization of LUT function in almost 20% (six of 31 patients), while a deterioration was seen in only one (3%) patient. DBS of the ventral intermediate nucleus of the thalamus improved LUT function in two (18%) and deteriorated it in one (9%) patient with tremor. CONCLUSIONS DBS effects on LUT varied with stimulation location, highly warranting patient counseling prior to DBS surgery. However, more well-designed, large-volume studies are needed to confirm our findings. PATIENT SUMMARY In this report, we looked at outcomes of deep brain stimulation on lower urinary tract function. We found that outcomes varied with stimulation location, concluding that counseling of patients about the effects on lower urinary tract function is highly recommended prior to surgery.
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72
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Xu R, Yang TX, Fang KW, Wang G, Li P. Efficacy, according to urodynamics, of OnabotulinumtoxinA compared with antimuscarinic drugs, for neurogenic detrusor overactivity: a systematic review and network meta-analysis. Sci Rep 2022; 12:17905. [PMID: 36289427 PMCID: PMC9606369 DOI: 10.1038/s41598-022-22765-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/19/2022] [Indexed: 01/20/2023] Open
Abstract
To summarize the differences in urodynamic outcomes between oral antimuscarinic drugs and OnabotulinumtoxinA, and finding a therapy that maintains good urodynamics in neurogenic detrusor overactivity (NDO). We conducted a literature search of EMBASE and PubMed, with the language limited to English. In the analysis, all of the published randomized trials of OnabotulinumtoxinA or antimuscarinic drugs used to treat NDO were found and the results were finally obtained through Bayesian model analysis. A total of 12 RCTs and 2208 patients were included. OnabotulinumtoxinA 300U was superior to other drugs in terms of MCC, volume at IDC, and Pdetmax endpoints. OnabotulinumtoxinA 200U was more effective on the urodynamic endpoint of BC than other drugs or doses of OnabotulinumtoxinA. According to the MCC urodynamic results, oxybutynin, solifenacin 10 mg, and tolterodine 4 mg also had positive effects. OnabotulinumtoxinA 300U, 200U and 100U were better in improving the urodynamic results of NDO, and the current evidence also shows that selective injection of onabotulinumtoxinA can effectively improve the urodynamic results.
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Affiliation(s)
- Rui Xu
- grid.415444.40000 0004 1800 0367The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan People’s Republic of China
| | - Tong-Xin Yang
- grid.415444.40000 0004 1800 0367The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan People’s Republic of China
| | - Ke-Wei Fang
- grid.415444.40000 0004 1800 0367The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan People’s Republic of China
| | - Guang Wang
- grid.415444.40000 0004 1800 0367The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan People’s Republic of China
| | - Pei Li
- grid.415444.40000 0004 1800 0367The Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan People’s Republic of China
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73
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Robotic versus open cystectomy with ileal conduit for the management of neurogenic bladder: a comparative study. World J Urol 2022; 40:2963-2970. [DOI: 10.1007/s00345-022-04190-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/06/2022] [Indexed: 12/01/2022] Open
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74
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Hofer AS, Scheuber MI, Sartori AM, Good N, Stalder SA, Hammer N, Fricke K, Schalbetter SM, Engmann AK, Weber RZ, Rust R, Schneider MP, Russi N, Favre G, Schwab ME. Stimulation of the cuneiform nucleus enables training and boosts recovery after spinal cord injury. Brain 2022; 145:3681-3697. [PMID: 35583160 PMCID: PMC9586551 DOI: 10.1093/brain/awac184] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 04/07/2022] [Accepted: 05/04/2022] [Indexed: 11/15/2022] Open
Abstract
Severe spinal cord injuries result in permanent paraparesis in spite of the frequent sparing of small portions of white matter. Spared fibre tracts are often incapable of maintaining and modulating the activity of lower spinal motor centres. Effects of rehabilitative training thus remain limited. Here, we activated spared descending brainstem fibres by electrical deep brain stimulation of the cuneiform nucleus of the mesencephalic locomotor region, the main control centre for locomotion in the brainstem, in adult female Lewis rats. We show that deep brain stimulation of the cuneiform nucleus enhances the weak remaining motor drive in highly paraparetic rats with severe, incomplete spinal cord injuries and enables high-intensity locomotor training. Stimulation of the cuneiform nucleus during rehabilitative aquatraining after subchronic (n = 8 stimulated versus n = 7 unstimulated versus n = 7 untrained rats) and chronic (n = 14 stimulated versus n = 9 unstimulated versus n = 9 untrained rats) spinal cord injury re-established substantial locomotion and improved long-term recovery of motor function. We additionally identified a safety window of stimulation parameters ensuring context-specific locomotor control in intact rats (n = 18) and illustrate the importance of timing of treatment initiation after spinal cord injury (n = 14). This study highlights stimulation of the cuneiform nucleus as a highly promising therapeutic strategy to enhance motor recovery after subchronic and chronic incomplete spinal cord injury with direct clinical applicability.
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Affiliation(s)
- Anna-Sophie Hofer
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland
- Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Myriam I Scheuber
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland
- Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Andrea M Sartori
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland
- Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Nicolas Good
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland
- Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Stephanie A Stalder
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Nicole Hammer
- Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Kai Fricke
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Sina M Schalbetter
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland
- Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Anne K Engmann
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Rebecca Z Weber
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland
- Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Ruslan Rust
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland
- Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Marc P Schneider
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Natalie Russi
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
| | - Giacomin Favre
- Department of Economics, University of Zurich, 8032 Zurich, Switzerland
| | - Martin E Schwab
- Brain Research Institute, University of Zurich, 8057 Zurich, Switzerland
- Institute for Regenerative Medicine, University of Zurich, 8952 Schlieren, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland
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75
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Lauridsen SV, Averbeck MA, Krassioukov A, Vaabengaard R, Athanasiadou S. UTI assessment tool for intermittent catheter users: a way to include user perspectives and enhance quality of UTI management. BMC Nurs 2022; 21:272. [PMID: 36199133 PMCID: PMC9535847 DOI: 10.1186/s12912-022-01033-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urinary Tract Infections (UTIs) are among the most severe complications for users of intermittent catheterisation (IC), with numerous risk factors contributing to their occurrence. The aim of this study was to develop a tool to assess UTI risk factors among IC users in a systematic way that considers the perspective of the individual user. METHODS The Design Thinking Process was used to guide the development of the content and format of the tool. The UTI Risk Factors model by Kennelly et al. was used as a basis for developing the content. Insights on the appropriate content and format were collected via the Coloplast Nurse Advisory Boards and by conducting a qualitative evidence synthesis on user perspectives and practices in relation to UTIs. RESULTS The literature search identified a total of 3544 articles, out of which 22 met the inclusion criteria. Additionally, three rounds of meetings were conducted with approximately 90 nurses from the Nurse Advisory Boards across Europe. The qualitative evidence synthesis showed that users describe their UTI symptoms in different terms and that personal needs and priorities impact their adherence and catheter selection. Furthermore, some users lack relevant and updated knowledge about IC and UTIs. The nurses described that correct UTI diagnosis is essential. They pointed that they would assess the user's general condition, adherence, technique, and catheter type as potential areas of risk factors and emphasised the importance of adequate support for users. The study resulted in the development of the UTI assessment tool for intermittent catheter users, which comprises three elements: a guide for healthcare professionals, a dialogue board, and a notepad. The tool starts with a confirmation of the UTI incidence, and then assesses risk factors via questions on health, adherence, technique, and catheter, and concludes with a support section. CONCLUSIONS The UTI assessment tool for intermittent catheter users is designed to help healthcare professionals assess UTI risk factors in a systematic way, while engaging users and taking their perspective into account. By identifying the relevant risk factors, the use of this tool has the potential to reduce the occurrence of UTIs for the individual IC user.
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Affiliation(s)
- S V Lauridsen
- Department of Urology, Copenhagen University Hospital, Copenhagen, Denmark. .,WHO-CC, Parker Institute, Copenhagen University Hospital, Frederiksberg and Bispebjerg Hospital, Frederiksberg, Denmark.
| | | | - A Krassioukov
- International Collaboration on Repair Discoveries (ICORD), Division of Physical Medicine and Rehabilitation, Department of Medicine, Faculty of Medicine, International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Endowment Lands, Canada.,G.F. Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
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76
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Chen SF, Lee YK, Kuo HC. Satisfaction with Urinary Incontinence Treatments in Patients with Chronic Spinal Cord Injury. J Clin Med 2022; 11:jcm11195864. [PMID: 36233731 PMCID: PMC9571409 DOI: 10.3390/jcm11195864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/12/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2022] Open
Abstract
Purpose: To investigate the long-term satisfaction and complications in chronic spinal cord injury (SCI) patients after various bladder management strategies and surgical procedures for the treatment of urinary incontinence. Methods: Patients at a single institution with chronic SCI who received bladder management treatment or surgical procedure to improve urinary continence were retrospectively assessed. Thorough urological examinations and videourodynamic studies were performed. Patients were treated either through conservative approaches including medical treatment, clean intermittent catheterization (CIC), cystostomy, and indwelling urethral catheter, or through surgical procedures including detrusor botulinum toxin (Botox) injections, augmentation, ileal conduit, Kock pouch diversion, continent cystostomy, suburethral sling, and artificial urethral sphincter (AUS) implantation. The patients’ satisfaction with urinary continence improvement, causes of dissatisfaction, long-term complications, and overall satisfaction with bladder and voiding condition were assessed. Results: A total of 700 consecutive patients were enrolled in this study. High satisfaction rates were noted after detrusor Botox injection (81.1%), augmentation enterocystoplasty (91.4%), autoaugmentation (80%), Kock pouch diversion, and continent cystostomy (all 100%). Fair satisfaction rates were noted after ileal conduit diversion (66.7%), suburethral sling (64.3%), and AUS implantation (66.7%). Patients who received conservative treatment with medicines, CIC, cystostomy, or an indwelling urethral catheter all had less-satisfactory outcomes (all < 40%). Conclusion: Overall satisfaction with surgical procedures aimed to improve urinary continence in chronic SCI patients was higher than with conservative bladder management (35.4%). Appropriate surgical procedures for chronic SCI patients with neurogenic lower urinary tract dysfunction (NLUTD) and urological complications yielded satisfaction with both urinary continence improvement and with overall bladder and voiding condition.
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Affiliation(s)
| | | | - Hann-Chorng Kuo
- Correspondence: ; Tel.: +886-3-8561825 (ext. 2117); Fax: +886-3-8560794
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77
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Long-term outcomes of augmentation cystoplasty: A retrospective view of 54 children. Actas Urol Esp 2022; 46:487-493. [PMID: 35780052 DOI: 10.1016/j.acuroe.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/19/2021] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND OBJECTIVES Throughout the years, clinicians dealing with pediatric urology disorders have resorted to bladder augmentation (BA), a demanding surgical procedure, to preserve renal functions in sundry congenital urinary tract defects. This study aimed to reveal the very long-term outcomes of BA in a large sample of pediatric patients and the role of underlying disease on renal prognosis after BA. MATERIALS AND METHODS A retrospective cross-sectional study was conducted on 54 children with congenital urinary defects who underwent BA. The utilized augmentation technique, the location of ureter implantation, complications, and ultrasonography findings were analyzed. Data on serum creatinine levels were collected from preoperative records and anniversaries following BA. RESULTS Among 54 children, 33 (61.1%) were boys. Diagnoses were spinal dysraphism (SD) (n = 13), posterior urethral valve (PUV) (n = 8), bladder exstrophy (n = 32) and trauma (n = 1). The median follow-up duration was 18 (3-31) years. The comparisons of serum creatinine levels between groups revealed that, despite no meaningful difference was present between bladder exstrophy and PUV group in the preoperative period and postoperative 1st year, cases with PUV had significantly higher levels of serum creatinine levels in the following postoperative years. Therewithal compared with the SD group, subjects with PUV had significantly higher levels at the postoperative 2nd year (P = .035) and 10th year (P = .006). CONCLUSIONS In our study, significantly long-term follow-up outcomes could facilitate the pre- and postoperative approach for enterocystoplasty in children. According to our results, it is noteworthy that kidney functions are at high risk of worsening in subjects with PUV and underwent BA.
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78
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Abou Chaaya C, Neuville P, Ruffion A, Arber T. [Isolated continent urinary diversion: An interesting or often regretted indication?]. Prog Urol 2022; 32:1498-1504. [PMID: 36068151 DOI: 10.1016/j.purol.2022.07.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The aim of this study is to evaluate the percentage of patients developing vesical overactivity after the realization of a continent stoma without bladder enlargement. MATERIAL AND METHOD This is a retrospective monocentric study between January 2007 and April 2021. Patients undergoing an isolated continent urinary diversion for neurological or non-neurological reasons were included. The data collected concerned the clinical symptoms of bladder overactivity and their treatment as well as the pre- and postoperative urodynamic information. RESULTS During the period, 9 patients were included. The main indications for continent urinary diversion were patients with spinal cord injury. Clinical bladder overactivity was found postoperatively in 78% (7) of the patients, and detrusor overactivity in 57% (4) of them. The main symptoms were urinary incontinence (67%) and pollakiuria (56%, 5 patients). Most of the patients benefited from associated treatments (78% pre- and postoperative), mainly anticholinergic drugs. No patient required botulinum toxin injections preoperatively, compared with 6 (67%) postoperatively. The time of initiation of these injections varied between 3 and 8 months postoperatively. CONCLUSION Isolated continent urinary diversion seems to induce or increase bladder overactivity. A larger multicentric study is necessary to validate our hypothesis. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- C Abou Chaaya
- Service d'urologie du Pr. Ruffion, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Benite, France.
| | - P Neuville
- Service d'urologie du Pr. Ruffion, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Benite, France
| | - A Ruffion
- Service d'urologie du Pr. Ruffion, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Benite, France
| | - T Arber
- Service d'urologie du Pr. Ruffion, centre hospitalier Lyon sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Benite, France
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79
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Patient Support Program and Healthcare Resource Utilization in Patients Using Clean Intermittent Catheterization for Bladder Management. J Wound Ostomy Continence Nurs 2022; 49:470-480. [PMID: 36108231 PMCID: PMC9481293 DOI: 10.1097/won.0000000000000901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The primary purpose of this study was to evaluate the impact of a patient-centered, chronic care self-management support program of clean intermittent catheterization (CIC) on emergency department (ED) visits and hospitalizations within the first 30 days of starting CIC. Secondary research objectives were to compare reuse of catheters, adherence to healthcare provider–instructed frequency of CIC, and reasons for nonadherence.
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80
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Zhou Z, Gao Y, Li X, Wang X, Liao L. Diagnosis and treatment of neurogenic bladder secondary to aortic dissection: A 8-year retrospective study at a single center. Neurourol Urodyn 2022; 41:1844-1852. [PMID: 36000463 DOI: 10.1002/nau.25033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/26/2022] [Accepted: 08/14/2022] [Indexed: 11/10/2022]
Abstract
PURPOSE To review the characteristics of the neurogenic lower urinary tract dysfunction (NLUTD) secondary to aortic dissection (AD), analyze the clinical features, and discuss the treatment options. METHODS Ten individuals complaining of lower urinary tract syndrome following AD were enrolled in this study. Clinical characteristics, urological and neurological symptoms/signs, imaging examination, and intervention were reviewed. Liao's comprehensive classification system was used to precisely assess the lower and upper urinary dysfunction. RESULTS The urinary symptoms can be varied, including dysuria, incontinence, and frequency. Individuals were divided into the detrusor overactivity (DO) and detrusor underactivity (DU) subgroups. Continence, impaired upper urinary tract functions (renal insufficiency, vesicoureteral reflux, upper urinary tract dilatation, and lower urinary tract functions (DO and/or detrusor external sphincter dyssynergia/detrusor bladder neck dyssynergia, DU, low bladder capacity, and compliance) were examined using video-urodynamics. The principle of treatment is "low-pressure bladder storage with complete bladder emptying," and close follow-up was recommended due to the volatile course of NLUTD. CONCLUSIONS Both cardiovascular surgeons and urologists should pay attention to the occurrence of NLUTD following AD, and determine the most appropriate therapeutic option.
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Affiliation(s)
- Zhonghan Zhou
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Urology, China Rehabilitation Research Center, Beijing, China.,University of Health and Rehabilitation Sciences, Qingdao, Shandong, China
| | - Yi Gao
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Urology, China Rehabilitation Research Center, Beijing, China.,School of Rehabilitation, Capital Medical University, Beijing, China
| | - Xing Li
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Urology, China Rehabilitation Research Center, Beijing, China.,School of Rehabilitation, Capital Medical University, Beijing, China
| | - Xuesheng Wang
- University of Health and Rehabilitation Sciences, Qingdao, Shandong, China.,School of Rehabilitation, Capital Medical University, Beijing, China
| | - Limin Liao
- Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.,Department of Urology, China Rehabilitation Research Center, Beijing, China.,University of Health and Rehabilitation Sciences, Qingdao, Shandong, China.,School of Rehabilitation, Capital Medical University, Beijing, China
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81
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Sadeghmousavi S, Soltani Khaboushan A, Jafarnezhad-Ansariha F, Nejad-Gashti R, Farsi M, Esmaeil-Pour R, Alijani M, Majidi Zolbin M, Niknejad H, Kajbafzadeh AM. The role of spinal cord tractography in detecting lesions following selective bladder afferent and efferent fibers: A novel method for induction of neurogenic lower urinary tract dysfunction in rabbit. Neurourol Urodyn 2022; 41:1539-1552. [PMID: 35842827 DOI: 10.1002/nau.25009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Neurogenic lower urinary tract dysfunction (NLUTD), a challenging disorder, is defined by lack of bladder control due to the abnormalities in neural pathways and can be classified based on the location of lesions within the nervous system, thus investigating the neural pathways can help us to know the site of the lesion and specify the class of the NLUTD. Diffusion Tensor Imaging (DTI) tractography, a noninvasive advanced imaging method, is capable of detecting central nervous system pathologies, even if routine magnetic resonance imaging shows no abnormality. Accordingly, tractography is an ideal technique to evaluate patients with NLUTD and visualize the pathology site within the spine. This study aimed to introduce a novel method of spinal cord injury (SCI) to establish NLUTD in the rabbit and to investigate the potential of tractography in tracing neural tracts of the spinal cord in an induced NLUTD animal model. MATERIALS AND METHODS An animal model of NLUTD was induced through cauterization of the spinal cord at the level T12-L1 in 12 rabbits. Then rabbits were assessed via DTI, urodynamic studies (UDS), voiding cystourethrogram (VCUG), and pathology assessments using antineurofilament 200 (NF200) antibody, anti-S100, anti-Smooth Muscle Actin, anti-Myogenin, and anti-MyoD1. RESULTS The tractography visualized lesions within spinal cord fibers. DTI parameters including fractional anisotropy (FA) value and tract density were significantly decreased (FA: p-value = 0.01, Tract density: p-value = 0.05) after injury. The mean diffusivity (MD) was insignificantly increased compared to before the injury. Also, the results of UDS and pathology assessments corroborated that applying SCI and the establishment of the NLUTD model was completely successful. CONCLUSION In the present study, we investigated the auxiliary role of tractography in detecting the spinal cord lesions in the novel established rabbit model of NLUTD. The introduced method of NLUTD induction was without the leg's neurological deficit, easily applicable, low-cost, and was accompanied by minimal surgical preparation and a satisfactory survival rate in comparison with other SCI animal models.
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Affiliation(s)
- Shaghayegh Sadeghmousavi
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.,School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Soltani Khaboushan
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center, Tehran University of Medical Science, Tehran, Iran
| | - Fahimeh Jafarnezhad-Ansariha
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Nejad-Gashti
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Farsi
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Esmaeil-Pour
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Alijani
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Majidi Zolbin
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Niknejad
- Department of Pharmacology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Section of Tissue Engineering and Stem Cells Therapy, Children's Hospital Medical Center, Pediatrics' Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.,Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, Childern's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Shenot PJ, Teplitsky S, Margules A, Miller A, Das AK. Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients. J Spinal Cord Med 2022; 45:614-621. [PMID: 33054669 PMCID: PMC9246097 DOI: 10.1080/10790268.2020.1829420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Context: Spinal cord injury (SCI) patients with neurogenic bladder and the inability to self-catheterize may require incontinent diversion to provide low-pressure drainage while avoiding the use of indwelling catheters. We demonstrate that in patients with significant functional improvement, the ileovesicostomy can be a reversible form of diversion, with simultaneous bladder augmentation using the same segment of ileum utilized for the ileovesicostomy. Multidisciplinary management should be utilized to assure mastery of intermittent catheterization before urinary undiversion. This technique allows for transition to a regimen of intermittent self-catheterization with excellent functional and urodynamic outcomes.Design: Case Series.Setting: Tertiary care hospital, Philadelphia, Pennsylvania.Participants: Three individuals with an SCI.Interventions: Conversion of bladder management from an incontinent ileovesicostomy to an augmentation ileocystoplasty, with intermittent catheterization.Outcome Measures: Ability to regain urinary continence with preservation of renal function as determined by serum creatinine and renal ultrasound.Results: Three SCI patients who had an incontinent ileovesicostomy developed sufficient functional improvement to intermittently self-catheterize reliably and underwent conversion of ileovesicostomy to ileocystoplasty. For each, the ileovesicostomy channel was taken down and detubularized, then used to create an ileal patch for augmentation ileocystoplasty. Intermittent catheterization was then used for periodic bladder drainage. All achieved large capacity, low-pressure bladders with complete continence and stable creatinine.Conclusion: In motivated SCI patients, it is possible to regain continence by converting the ileovesicostomy into augmentation ileocystoplasty, avoiding the disadvantages of a urostomy. A multidisciplinary collaborative approach facilitates the optimal rehabilitation of SCI individuals.
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Affiliation(s)
- Patrick J. Shenot
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA,Correspondence to: Patrick J. Shenot, Department of Urology, Thomas Jefferson University, 1025 Walnut St, Ste 1112, Philadelphia, PA19107, USA.
| | - Seth Teplitsky
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew Margules
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aaron Miller
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Akhil K. Das
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Chkir S, Michel F, Akakpo W, Chinier E, Capon G, Peyronnet B, Saussine C, Baron M, Biardeau X, Ruffion A, Gamé X, Denys P, Chartier-Kastler E, Phé V, Karsenty G. Non-continent urinary diversion (ileal conduit) as salvage therapy in patients with refractory lower urinary tract dysfunctions due to multiple sclerosis: results of a national cohort from the French Association of Urology (AFU) Neurourology Committee and the French-speaking Neurourology Study Group (GENULF). Urology 2022; 168:216-221. [PMID: 35768028 DOI: 10.1016/j.urology.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/10/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To describe the outcomes of ileal conduit as a salvage therapy for refractory lower urinary tract dysfunctions (LUTDs) due to multiple sclerosis (MS) in a national neurourology referral center network. METHODS A retrospective multicenter French study was carried out to identify MS patients who underwent non-continent urinary diversion for refractory LUTDs from January 2010 to December 2015. Multiple sclerosis status, urological history, surgical indication and technique, postoperative complications, renal anatomy and function at last follow-up as well as number of rehospitalizations for urinary tract infections (UTI) were collected. Preoperative and postoperative urinary-related quality of life (urQoL) through the QualiveenTM short-form questionnaire (QSFTM) and patient global impression of improvement (PGI-I) were collected and analyzed. RESULTS Overall, 10 centers identified 211 patients with a mean age of 54±11 and mean preoperative EDSS (expanded disability status scale) score of 7.3±0.9. The main indication for diversion was MS progression leading to impossible intermittent self-catheterization (55%). Cystectomy was performed either by open (34.6%), laparoscopic (39.3%) or robotic (21.8%) approach (unknown: 4.2%) with cystectomy in all cases. Early complications were reported in 42% of the patients, mainly Clavien I or II grades. There was no difference in GFR (glomerular filtration rate) after surgery. After diversion, patients had fewer hospitalizations for UTI and better urQoL on QSF™ confirmed by evaluation of PGI-I. CONCLUSION This study, reporting the largest series of ileal conduit in selected MS patients with end-stage LUTDs, showed significant improvement in symptomatic UTI and quality of life with a low high-grade complication rate.
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Affiliation(s)
- Sadok Chkir
- Urology and Kidney Transplantation, Aix-Marseille University, La Conception Univeristy Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
| | - Floriane Michel
- Urology and Kidney Transplantation, Aix-Marseille University, La Conception Univeristy Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
| | - William Akakpo
- Urology, Sorbonne University, Hôpital La pitié Salpétrière, Assistance-Publique Hôpitaux de Paris, Paris, France.
| | - Eva Chinier
- Neuro-Rehabilitation, University of Nantes, Hôpital Saint Jacques, Nantes, France.
| | - Gregoire Capon
- Urology, University of Bordeaux, Hôpital Pellegrin, Bordeaux France.
| | - Benoit Peyronnet
- Urology, University of Rennes, Hôpital Pontchaillou, Renne, France.
| | - Christian Saussine
- Urology, University of Strasbourg, Hôpital Hautepierre, Strasbourg, France.
| | | | | | - Alain Ruffion
- Urology, University Claude Bernard Lyon 1, Hôpital Lyon Sud, HCL, Pierre Bénite, France.
| | - Xavier Gamé
- Urology, University of Toulouse Purpan, Hôpital Rangueil, Toulouse, France.
| | - Pierre Denys
- Urology, Paris Saclay University, neuro-urology unit, Hôpital Raymond Poincaré, AP-HP, Garches, France.
| | - Emmanuel Chartier-Kastler
- Urology, Sorbonne University, Hôpital La pitié Salpétrière, Assistance-Publique Hôpitaux de Paris, Paris, France; Urology, Paris Saclay University, neuro-urology unit, Hôpital Raymond Poincaré, AP-HP, Garches, France.
| | - Véronique Phé
- Urology, Sorbonne University, Tenon Academic Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
| | - Gilles Karsenty
- Urology and Kidney Transplantation, Aix-Marseille University, La Conception Univeristy Hospital, Assistance Publique - Hôpitaux de Marseille, Marseille, France.
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84
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Blé O, Levy J, Lefèvre C, Perrouin-Verbe MA, Even A, Le Normand L, Kastler EC, Perrouin-Verbe B, Denys P, Joussain C. Neurogenic bladder in patients with paraplegia: a two-center study of the real-life experience of the patients' journey. World J Urol 2022; 40:1743-1749. [PMID: 35648199 DOI: 10.1007/s00345-022-04044-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/01/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Several patterns of urological dysfunctions have been described following spinal cord injury (SCI), depending on the level and the completeness of the injury. A better understanding of the natural history of neurogenic bladder in patients with SCI, and the description of their successive therapeutic lines based on their clinical and urodynamic pattern is needed to improve their management. This study aimed to describe the real-life successive therapeutic lines in patients with neurogenic lower urinary tract dysfunction (NLUTD) following SCI. METHODS We conducted a two-center retrospective review of medical files of patients with SCI followed in two French specialized departments of Physical Medicine and Rehabilitation between January 2000 and January 2018. All patients with SCI with a level of lesion bellow T3 and older than 18 years old were eligible. The primary outcome was the description of the natural journey of neurogenic bladder in this population, from the awakening bladder contraction to the last therapeutic line. Survival curves were calculated with a 95-confidence interval using the Kaplan-Meier method. RESULTS One hundred and five patients were included in this study. Most of the patients were young men with a complete SCI lesion. The median time of treatment introduction was 1 and 9 years for anticholinergics and intradetrusor injection of BoNT/A, respectively. Median duration of effect of treatments was 4 and 6 years post-introduction of anticholinergics and BoNT/A, respectively. CONCLUSION This study describes NLUTD journey of patients with SCI demonstrating the mid-term efficacy of the two first therapeutic lines of NDO management. An improvement of non-surgical therapeutics is needed.
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Affiliation(s)
- O Blé
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France
| | - J Levy
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France
- Medical School Paris Île-de-France Ouest, Inserm U1179, Versailles Saint-Quentin University, Versailles, France
| | - C Lefèvre
- Department of Neurological Physical Medicine and Rehabilitation, Saint-Jacques Hospital, Nantes University Hospital, Nantes, France
| | | | - A Even
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France
| | - L Le Normand
- Department of Urology, Nantes University Hospital, Nantes, France
| | - E Chartier Kastler
- Pitié-Salpêtrière Academic Hospital, Department of Urology, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - B Perrouin-Verbe
- Department of Neurological Physical Medicine and Rehabilitation, Saint-Jacques Hospital, Nantes University Hospital, Nantes, France
| | - P Denys
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France
- Medical School Paris Île-de-France Ouest, Inserm U1179, Versailles Saint-Quentin University, Versailles, France
| | - C Joussain
- Department of Physical Medicine and Rehabilitation, Hospital Raymond-Poincaré AP-HP, Garches, France.
- Medical School Paris Île-de-France Ouest, Inserm U1179, Versailles Saint-Quentin University, Versailles, France.
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85
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Urinary system complications and long-term treatment compliance in chronic traumatic spinal cord injury patients with neurogenic lower urinary tract dysfunction. Turk J Phys Med Rehabil 2022; 68:278-285. [PMID: 35989971 PMCID: PMC9366489 DOI: 10.5606/tftrd.2022.7719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives
The aim of this study was to evaluate upper and lower urinary tract complications and the compliance of long-term treatment in patients with spinal cord injury (SCI) by urodynamic examination.
Patients and methods
Between January 1997 and May 2007, a total of 89 patients with SCI (79 males, 19 females; mean age: 39.8±12.2 years; range, 19 to 72 years) who were admitted to physical medicine and rehabilitation clinic were retrospectively analyzed. Demographic, neurological, and urodynamic data of the patients with the diagnosis of neurogenic lower urinary tract dysfunction (NLUTD) in their initial urodynamic examination and without regular follow-up were recorded.
Results
The mean time to the first urodynamic examination was 8.6±5.4 months. Sixty-seven patients who had neurogenic detrusor overactivity (NDO) in their first urodynamic tests were recommended anticholinergics. Clean intermittent catheterization (CIC) was recommended after initial urodynamic examination in all patients. Thirty-nine patients of 67 who had NDO were taking medications, while 28 were not. In the patients who continued anticholinergic treatment, bladder capacity was found to statistically significantly increase, compared to the initial measurement values and detrusor pressures significantly decreased (p<0.001). The compliance rate with CIC and anticholinergic treatment was 79.8% and 58.2%, respectively. Sixteen of the patients had calculus in the urinary system. Forty-two patients had infections more than once a year and used antibiotics.
Conclusion
Neurogenic bladder should be evaluated at the beginning of SCI and, then, followed on a regular basis. Urodynamic tests should be performed immediately after spinal shock and can be repeated, as indicated.
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86
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de Seze M. Surveillance urodynamique annuelle dans la SEP : Ô que oui ! Prog Urol 2022; 32:485-486. [DOI: 10.1016/j.purol.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/20/2022] [Indexed: 10/18/2022]
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87
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Kuzdan M, Demirkan H. Resultados a largo plazo de la cistoplastia de ampliación: una evaluación retrospectiva de 54 niños. Actas Urol Esp 2022. [DOI: 10.1016/j.acuro.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ghoniem G, Moskowitz D, Nguyen C. Urological Care After Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00347-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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van Doorn T, Berendsen SA, Scheepe JR, Blok BFM. Single use versus reusable catheters in intermittent catheterisation for treatment of urinary retention: a protocol for a multicentre, prospective, randomised controlled, non-inferiority trial (COMPaRE). BMJ Open 2022; 12:e056649. [PMID: 35410930 PMCID: PMC9003620 DOI: 10.1136/bmjopen-2021-056649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/22/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Chronic urinary retention is a common lower urinary tract disorder, mostly neurogenic or idiopathic in origin. The preferred treatment is clean intermittent urinary self-catheterisation (CISC) four to six times a day. In most European countries, virtually all patients use single use catheters, which is in contrast to several countries where the use of reusable catheters is more common. The available literature on the use of reusable catheters is conflicting and until now, no randomised controlled trial with sufficient power has been performed to investigate if reusable catheters for CISC is as safe as single use catheters. METHODS AND ANALYSIS We described this protocol for a prospective, randomised controlled non-inferiority trial to investigate if the use of reusable catheters is as safe as single use catheters for CISC patients, measured by symptomatic urinary tract infections (sUTIs). Secondary objectives are adverse events due to a sUTI, urethral damage, stone formation, quality of life and patient satisfaction. A cost-effectiveness analysis will also be performed. 456 Participants will be randomised into two groups stratified for age, gender, menopausal status and (non-)neurogenic underlying disorder. The intervention group will replace the reusable catheter set every 2 weeks for a new set and replace the cleaning solution every 24 hours. The control group continues to use its own catheters. The primary outcome (amount of sUTIs from baseline to 1 year) will be tested for non-inferiority. Categorical outcome measures will be analysed using χ2 tests and quantitative outcome variables by t-tests or Mann-Whitney U tests. Two-sided p values will be calculated. ETHICS AND DISSEMINATION This protocol was reviewed and approved by the Medical Ethics Committee of the Erasmus MC (MEC 2019-0134) and will be performed according to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist for non-inferiority trials. The results of this randomised controlled non-inferiority trial will be published in a peer-reviewed journal and will be publicly available. TRIAL REGISTRATION NUMBER NL8296.
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Affiliation(s)
- Tess van Doorn
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sophie A Berendsen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeroen R Scheepe
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bertil F M Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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Yuanzhuo C, Liao P, Chi Z, Boya L, Deyi L. The efficacy and safety of mirabegron for adult and child patients with neurogenic lower urinary tract dysfunction: A systematic review and meta‐analysis. Neurourol Urodyn 2022; 41:1056-1064. [PMID: 35373855 DOI: 10.1002/nau.24928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/06/2022] [Accepted: 03/07/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Chen Yuanzhuo
- Department of Urology, Institute of Urology, West China Hospital Sichuan University Chengdu Sichuan P. R. China
| | - Peng Liao
- Department of Urology, Institute of Urology, West China Hospital Sichuan University Chengdu Sichuan P. R. China
| | - Zhang Chi
- Department of Urology, Institute of Urology, West China Hospital Sichuan University Chengdu Sichuan P. R. China
| | - Li Boya
- Department of Urology, Institute of Urology, West China Hospital Sichuan University Chengdu Sichuan P. R. China
| | - Luo Deyi
- Department of Urology, Institute of Urology, West China Hospital Sichuan University Chengdu Sichuan P. R. China
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Vamour N, Dequirez PL, Seguier D, Vermersch P, De Wachter S, Biardeau X. Early interventions to prevent lower urinary tract dysfunction after spinal cord injury: a systematic review. Spinal Cord 2022; 60:382-394. [PMID: 35379959 DOI: 10.1038/s41393-022-00784-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/25/2022] [Accepted: 02/25/2022] [Indexed: 12/09/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To synthetise the available scientific literature reporting early interventions to prevent neurogenic lower urinary tract dysfunction (NLUTD) after acute supra-sacral spinal cord injury (SCI). METHODS The present systematic review is reported according to the PRISMA guidelines and identified articles published through April 2021 in the PubMed, Embase, ScienceDirect and Scopus databases with terms for early interventions to prevent NLUTD after SCI. Abstract and full-text screenings were performed by three reviewers independently, while two reviewers performed data extraction independently. An article was considered relevant if it assessed: an in-vivo model of supra-sacral SCI, including a group undergoing an early intervention compared with at least one control group, and reporting clinical, urodynamic, biological and/or histological data. RESULTS Of the 30 studies included in the final synthesis, 9 focused on neurotransmission, 2 on the inflammatory response, 10 on neurotrophicity, 9 on electrical nerve modulation and 1 on multi-system neuroprosthetic training. Overall, 29/30 studies reported significant improvement in urodynamic parameters, for both the storage and the voiding phase. These findings were often associated with substantial modifications at the bladder and spinal cord level, including up/downregulation of neurotransmitters and receptors expression, neural proliferation or axonal sprouting and a reduction of inflammatory response and apoptosis. CONCLUSIONS The present review supports the concept of early interventions to prevent NLUTD after supra-sacral SCI, allowing for the emergence of a potential preventive approach in the coming decades.
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Affiliation(s)
| | | | | | - Patrick Vermersch
- Univ. Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU Lille, FHU Precise, F-59000, Lille, France
| | - Stefan De Wachter
- Department of Urology, Antwerp University Hospital, Edegem, Belgium.,Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), Faculty of Medicine and Health Sciences, Wlrijk, Belgium
| | - Xavier Biardeau
- Univ. Lille, Inserm UMR-S1172 LilNCog, Lille Neuroscience and Cognition, CHU Lille, F-59000, Lille, France
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Anderson CE, Birkhäuser V, Jordan X, Liechti MD, Luca E, Möhr S, Pannek J, Kessler TM, Brinkhof MW. Urological Management at Discharge from Acute Spinal Cord Injury Rehabilitation: A Descriptive Analysis from a Population-based Prospective Cohort. EUR UROL SUPPL 2022; 38:1-9. [PMID: 35495286 PMCID: PMC9051958 DOI: 10.1016/j.euros.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 01/06/2023] Open
Abstract
Background There is limited epidemiological evidence describing contemporary neuro-urological management of persons with acute spinal cord injury (SCI). Objective To describe neurogenic lower urinary tract dysfunction (NLUTD) management at discharge from SCI rehabilitation. Design, setting, and participants The population-based Swiss Spinal Cord Injury (SwiSCI) cohort study prospectively collected data from 602 adults undergoing specialized postacute SCI rehabilitation from 2013 to 2020. The management strategy was based on the European Association of Urology (EAU) Guidelines on Neuro-Urology. Outcome measurements and statistical analysis Data were collected at discharge using the International SCI Lower Urinary Tract Function Basic Data Set. Multivariable logistic regression adjusting for demographics, SCI characteristics, and center, with inverse probability weighting accounting for sampling bias, was used to produce prevalence estimates and identify predictors of lower urinary tract symptoms (LUTS) and NLUTD management outcomes. Results and limitations At discharge (median time after SCI: 5.0 mo [Q1-Q3: 3.0–7.2]), the prevalence of LUTS or managed NLUTD was 82% (95% confidence interval [CI]: 79–85%). SCI completeness was the main predictor of LUTS and managed NLUTD. The risk of urinary incontinence was elevated in females (odds ratio 1.98 [95% CI: 1.18–3.32]) and with complete lesions (odds ratio 4.71 [95% CI: 2.52–8.81]). Voiding dysfunction was most commonly managed with intermittent catheterization (prevalence 39% [95% CI: 35–42%]), followed by indwelling catheterization (prevalence 22% [95% CI: 18–25%]). The prevalence of antimuscarinic or mirabegron use was 29% (95% CI: 26–33%). Urodynamic and renal function data were not collected. Conclusions Our population-based description of urological management in Swiss SCI centers utilizing the EAU Guidelines on Neuro-Urology may be used as a reference for evaluation in other settings. Data further indicate a need for sex-specific neuro-urological management research. Patient summary At discharge from spinal cord injury (SCI) rehabilitation, a majority of patients have lower urinary tract problems, especially those with complete SCI. Women have a higher risk of urinary incontinence.
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Affiliation(s)
- Collene E. Anderson
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Veronika Birkhäuser
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Martina D. Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Eugenia Luca
- Clinique Romande de Réadaptation, Sion, Switzerland
| | - Sandra Möhr
- Neuro-Urology, REHAB Basel, Basel, Switzerland
| | - Jürgen Pannek
- Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
- Department of Urology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas M. Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martin W.G. Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Corresponding author. Swiss Paraplegic Research, Guido A. Zäch Strasse 4, CH-6207 Nottwil, Switzerland. Tel. +41 41 939 65 97; Fax: +41 41 939 66 40.
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Chartier-Kastler E, Chapple C, Schurch B, Saad M. A Real-world Data Analysis of Intermittent Catheterization, Showing the Impact of Prelubricated Versus Hydrophilic Catheter Use on the Occurrence of Symptoms Suggestive of Urinary Tract Infections. EUR UROL SUPPL 2022; 38:79-87. [PMID: 35495281 PMCID: PMC9051966 DOI: 10.1016/j.euros.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Systematic reviews have highlighted the lack of evidence on choosing the type of intermittent urinary catheter (IUC) with regard to the occurrence of urinary tract infections (UTIs). Objective To describe the incidence and frequency of symptoms suggestive of UTIs (ssUTIs) for prelubricated versus hydrophilic IUCs. Design, setting, and participants An observational study of a patient database compiled by UK general practitioners was conducted. Outcome measurements and statistical analysis The primary outcome measures were the proportion of patients with at least one ssUTI (prescription of a nonspecific antibiotic with a UTI-related diagnosis, or prescription of a UTI-specific antibiotic) and the mean number of ssUTIs per affected patient in the 12 mo following the index IUC prescription. Comparable prelubricated (“PRELUBE”) and hydrophilic (“HYDRO”) catheter groups were obtained with 1:1 propensity score matching (PSM). Results and limitations A total of 5296 patients were included (prelubricated: n = 458; hydrophilic: n = 4838). After PSM, the two groups had similar proportions of patients with ssUTIs at baseline. The proportion of patients with ssUTIs during exposure was similar in the PRELUBE (36.9%) and HYDRO groups (41.5%; p = 0.155). However, among patients having used the same type of catheter throughout the exposure period, the proportion with ssUTIs was significantly lower in the PRELUBE group (44.6%, vs 55.0% for HYDRO; p = 0.015), as was the number of ssUTIs per patient (1.3 vs 1.8; p = 0.036). Conclusions When choosing a coated IUC, physicians and patients should not rule out PRELUBE IUCs for safety reasons alone. Patient summary Using real-world data compiled by UK general practitioners, we described the incidence and frequency of symptoms suggestive of urinary tract infection in people who were using various types of intermittent urinary catheters. When the same type of prelubricated catheter was used throughout the study period, the incidence of these symptoms was lower than for hydrophilic catheters.
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94
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Sampogna G, Barbosa F, Brambillasca PM, Montanari E, Rampoldi A, Spinelli M. Prostatic artery embolization in people with spinal cord injury: a safe and effective technique to ease intermittent catheterization in case of concomitant benign prostatic hyperplasia. Spinal Cord Ser Cases 2022; 8:34. [PMID: 35332117 PMCID: PMC8948271 DOI: 10.1038/s41394-022-00499-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Case series. OBJECTIVES To assess the safety and efficacy of prostatic artery embolization (PAE) to reduce prostate volume (PV) and facilitate intermittent catheterization (IC) in individuals with concurrent benign prostatic hyperplasia (BPH) and spinal cord injury (SCI). SETTING Italian tertiary referral center for people with SCI. METHODS We retrospectively collected all data of individuals undergoing PAE from 2015 to 2020 because of BPH-related problems during IC. PAE was performed under local anesthesia with superselective catheterization of the prostatic arteries. Technical success was defined as bilateral embolization. We determined pre- and post-procedural PV by magnetic resonance imaging. RESULTS We considered 10 cases with tetraplegia (n = 5) and paraplegia (n = 5). Nine (90%) procedures were technically successful, while we performed monolateral PAE in one case. The median pre-procedural PV was 61 mL. After 6 months, all patients experienced significant PV reduction (median: 19.6%), and 7/7 patients with indwelling urinary catheter started successfully IC. Neither intra- nor post-procedural complications occurred within a median follow-up of 33 months. CONCLUSIONS PAE proved to be a safe and effective treatment for BPH to facilitate IC in people with SCI. Considering the minimal morbidity of PAE, further multi-center studies are mandatory to draw definitive conclusions and warrant its widespread adoption in this population.
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Affiliation(s)
- Gianluca Sampogna
- Unit of Neuro-Urology - Unipolar Spinal Unit, Niguarda Hospital, Milan, Italy
- Unit of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Fabiane Barbosa
- Unit of Interventional Radiology, Niguarda Hospital, Milan, Italy
| | | | - Emanuele Montanari
- Unit of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Antonio Rampoldi
- Unit of Interventional Radiology, Niguarda Hospital, Milan, Italy
| | - Michele Spinelli
- Unit of Neuro-Urology - Unipolar Spinal Unit, Niguarda Hospital, Milan, Italy.
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95
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Intravesical oxybutynin therapy for patients with neurogenic detrusor overactivity: a systematic review and meta-analysis. Int Urol Nephrol 2022; 54:737-747. [DOI: 10.1007/s11255-022-03129-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/10/2022] [Indexed: 12/29/2022]
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96
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Sartori AM, Salemi S, Hofer AS, Baumgartner V, Eberli D, Liechti MD, Schwab ME, Kessler TM. Early Transcutaneous Tibial Nerve Stimulation Acutely Improves Lower Urinary Tract Function in Spinal Cord Injured Rats. Neurotrauma Rep 2022; 3:15-26. [PMID: 35211695 PMCID: PMC8863914 DOI: 10.1089/neur.2021.0058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite the fact that a majority of patients with an injury to the spinal cord develop lower urinary tract dysfunction, only few treatment options are available currently once the dysfunction arises. Tibial nerve stimulation has been used in pilot clinical trials, with some promising results. Hence, we investigated whether the early application of transcutaneous tibial nerve stimulation in the animal model of spinal cord injured rats can prevent the development of detrusor overactivity and/or detrusor-sphincter-dyssynergia. Rats were implanted with a bladder catheter and external urethral sphincter electromyography electrodes. A dorsal over-hemisection, resulting in an incomplete spinal cord injury at the T8/9 spinal level, induced immediate bladder paralysis. One week later, the animals received daily tibial nerve or sham stimulation for 15 days. Effects of stimulation on the lower urinary tract function were assessed by urodynamic investigation. Measurements showed improvements of several key parameters of lower urinary tract function—in particular, non-voiding bladder contractions and intravesical pressure—immediately after the completion of the stimulation period in the stimulated animals. These differences extinguished one week later, however. In the dorsal horn of the lumbosacral spinal cord, a small significant increase of the density of C-fiber afferents layers I-II was found in the stimulated animals at four weeks after spinal cord injury. Tibial nerve stimulation applied acutely after spinal cord injury in rats had an immediate beneficial effect on lower urinary tract dysfunction; however, the effect was transitory and did not last over time. To achieve more sustainable, longer lasting effects, further studies are needed looking into different stimulation protocols using optimized stimulation parameters, timing, and treatment schedules.
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Affiliation(s)
- Andrea M. Sartori
- Institute for Regenerative Medicine, University of Zürich, and Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Souzan Salemi
- Laboratory for Tissue Engineering and Stem Cell Therapy, Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Anna-Sophie Hofer
- Institute for Regenerative Medicine, University of Zürich, and Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Valentin Baumgartner
- Laboratory for Tissue Engineering and Stem Cell Therapy, Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Daniel Eberli
- Laboratory for Tissue Engineering and Stem Cell Therapy, Department of Urology, University Hospital Zürich, Zürich, Switzerland
| | - Martina D. Liechti
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Martin E. Schwab
- Institute for Regenerative Medicine, University of Zürich, and Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Thomas M. Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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97
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The microbiological and physical properties of catheters for intermittent catheterization: a systematic review on the impact of reuse and cleaning. Spinal Cord 2022; 60:581-593. [PMID: 35066573 DOI: 10.1038/s41393-021-00740-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic Review. OBJECTIVES To review systematically the clinical evidence of the effectiveness of various intermittent catheter cleaning methods that have been proposed as methods to prepare catheters for reuse. METHODS A keyword search in Medline, Excerpta Medica dataBASE, the Cumulative Index to Nursing and Allied Health Literature, Web of Science and Cochrane Central Register of Controlled Trials, was undertaken to identify all English, Russian and German language literature evaluating the effectiveness of various intermittent catheter cleaning methods. Studies selected for review included analytical experimental, prospective cohort and cross-sectional. Cleaning methods reviewed included heat-based sterilization, chemical cleaning solutions, mechanical abrasion, photocatalytic sterilization, and combined methods. RESULTS Overall, 12 studies were included. Heat-based sterilization and mechanical abrasion methods were either not effective or damaged the physical properties of catheters. Two studies reported evidence that their chemical cleaning methods (i.e., soaked catheters in a 70% alcohol solution for 5 min or combined approach detergent wash followed by soaking in Milton sterilizing fluid also known as the Milton method) both preserved the structural integrity of their catheters and were bactericidal. CONCLUSIONS Numerous cleaning methods resulted in the destruction of catheters. However, there are two reported cleaning methods, submersion for 5 min in 70% alcohol and the "Milton method", that eliminate bacterial colonization while leaving the physical properties of the catheters unchanged. While these cleaning methods are promising, each was published in just one study, therefore higher-powered / longitudinal studies confirming the safety and efficacy of these cleaning methods must be obtained before current clinical recommendations can be modified.
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98
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Prediction of Poststroke Urinary Tract Infection Risk in Immobile Patients Using Machine Learning: a observational cohort study. J Hosp Infect 2022; 122:96-107. [PMID: 35045341 DOI: 10.1016/j.jhin.2022.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/08/2022] [Accepted: 01/08/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Urinary tract infection (UTI) is one of major nosocomial infections significantly affecting the outcomes of immobile stroke patients. Previous studies have identified several risk factors, but it's still challenging to accurately estimate personal UTI risk. OBJECTIVES We aimed to develop predictive models for UTI risk identification for immobile stroke patients. METHODS Research data were collected from our previous multi-centre study. Derivation cohort included 3982 immobile stroke patients collected from November 1, 2015 to June 30, 2016; external validation cohort included 3837 patients collected from November 1, 2016 to July 30, 2017. 6 machine learning models and an ensemble learning model were derived based on 80% of derivation cohort and effectiveness was evaluated with the remaining 20%. We used Shapley additive explanation values to determine feature importance and examine the clinical significance of prediction models. RESULTS 2.59% (103/3982) patients were diagnosed with UTI in derivation cohort, 1.38% (53/3837) in external cohort. The ensemble learning model performed the best in area under the receiver operating characteristic (ROC) curve in internal validation (82.2%); second best in external validation (80.8%). In addition, the ensemble learning model performed the best sensitivity in both internal and external validation sets (80.9% and 81.1%, respectively). We also identified seven UTI risk factors (pneumonia, glucocorticoid use, female sex, mixed cerebrovascular disease, increased age, prolonged length of stay, and duration of catheterization). CONCLUSIONS Our ensemble learning model demonstrated promising performance. Future work should continue to develop a more concise scoring tool based on machine learning models and prospectively examining the model in practical use, thus improving clinical outcomes.
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99
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Haudebert C, Hascoet J, Freton L, Khene ZE, Dosin G, Voiry C, Samson E, Richard C, Neau AC, Drouet A, Mathieu R, Bensalah K, Verhoest G, Manunta A, Peyronnet B. Cystectomy and ileal conduit for neurogenic bladder: Comparison of the open, laparoscopic and robotic approaches. Neurourol Urodyn 2021; 41:601-608. [PMID: 34962653 DOI: 10.1002/nau.24855] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/17/2021] [Accepted: 11/15/2021] [Indexed: 11/09/2022]
Abstract
AIM The objective of the present study was to compare the outcomes of open versus laparoscopic versus robotic cystectomy and ileal conduit for neurogenic lower urinary tract dysfunction (NLUTD). METHODS The charts of all patients who underwent cystectomy and ileal conduit for NLUTD between January 2004 and November 2020 in an academic center were retrospectively reviewed. The approach was either open, laparoscopic or robot-assisted depending on the period (i.e., three consecutive era). For the robotic approach, the diversion was done either intracorporeally or extracorporeally. We compared the perioperative and late postoperative outcomes between the three groups. RESULTS After exclusion of 10 patients with non-neurogenic benign conditions, 126 patients were included over the study period. The most frequent neurological conditions were multiple sclerosis (36.5%) and spinal cord injury (25.4%). The approach was open, laparoscopic or robot-assisted in 31 (24.6%), 26 (20.6%) and 69 (54.7%) cases respectively. Seventy-two patients experienced a 90-day postoperative complication (57.1%) of which 22 had a major complication (Clavien 3 or higher, 17.5%) including one death (0.8%). The rate of major postoperative complications was significantly lower in the robotic group (23% vs. 23% vs. 10%; p = 0.049) while the rate of overall complications was comparable across the three groups (58.1% vs. 53.9% vs. 60.6%; p = 0.84). After a median follow-up of 23 months, 22 patients presented a late complication (17.6%), mainly incisional hernia (5; 4%) and uretero-ileal stricture (9; 7.2%). The rate of late complications did not differ significantly between the three approaches. CONCLUSION Cystectomy and ileal conduit for neurogenic bladder is associated with a relatively high perioperative morbidity. The robot-assisted approach may decrease the risk of major postoperative complications.
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Affiliation(s)
| | | | - Lucas Freton
- Department of Urology, University of Rennes, Rennes, France
| | | | - Gilles Dosin
- Department of Urology, University of Rennes, Rennes, France
| | - Caroline Voiry
- Department of Physical Medicine and Rehabilitation, University of Rennes, Rennes, France
| | - Emmanuelle Samson
- Department of Physical Medicine and Rehabilitation, University of Rennes, Rennes, France.,Referral Center for Spina Bifida, NeuroSphinx Network, Rennes, France
| | - Claire Richard
- Department of Urology, University of Rennes, Rennes, France
| | - Anne-Cécile Neau
- Department of Anesthesiology, University of Rennes, Rennes, France
| | - Anais Drouet
- Department of Anesthesiology, University of Rennes, Rennes, France
| | - Romain Mathieu
- Department of Urology, University of Rennes, Rennes, France
| | - Karim Bensalah
- Department of Urology, University of Rennes, Rennes, France
| | | | - Andréa Manunta
- Department of Urology, University of Rennes, Rennes, France.,Referral Center for Spina Bifida, NeuroSphinx Network, Rennes, France
| | - Benoit Peyronnet
- Department of Urology, University of Rennes, Rennes, France.,Referral Center for Spina Bifida, NeuroSphinx Network, Rennes, France
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100
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Piquet V, Turmel N, Chesnel C, Haddad R, Lebreton F, Amarenco G, Hentzen C. Upper urinary tract function of patients with multiple sclerosis. Neurourol Urodyn 2021; 41:498-505. [PMID: 34931344 DOI: 10.1002/nau.24860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/04/2021] [Accepted: 11/27/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neurogenic lower urinary tract dysfunction (NLUTD) is frequent in multiple sclerosis (MS) and renal prognosis is a key point of bladder management. OBJECTIVE To assess upper urinary tract damage risk using voiding cystourethrography (VCUG) in patients with (PwMS) and NLUTD. METHODS We conducted a retrospective study between 2010 and 2020. Demographic data, urinary symptoms, urinary tract infection (UTI), renal ultrasounds findings, glomerular filtration rate (GFR), VCUG data, and urodynamic parameters were collected in PwMS with NLUTD. RESULTS Among 325 PwMS included, 67% were female, mean age was 51.6 ± 12.0 years, and mean EDSS 4.6 ± 1.8. VCUG showed vesicoureteral reflux (VUR) in 18 patients. A link was found between VUR and progressive MS course (p = 0.04), hydronephrosis (odds ratio [OR] = 17.44; 95% confidence interval [CI] = 3.46-87.87; p = 0.001), low GFR (p < 0.001), and detrusor overactivity (p = 0.04). No association with UTIs, EDSS, detrusor sphincter dyssynergia, were elicited. On multivariate analysis, alteration of GFR was independently related to the presence of VUR (OR = 0.95; 95% CI = 0.92-0.98). CONCLUSIONS VUR elicited on VCUG is associated with lower GFR and hydronephrosis. However, due to the low prevalence (5.5%) of this abnormality in PwMS, VCUG should be performed in selected cases and not in routinary practice.
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Affiliation(s)
- Violaine Piquet
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Nicolas Turmel
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France.,Service de Médecine physique et de réadaptation, Hôpital Danielle Casanova, Saint-Denis, France
| | - Camille Chesnel
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Rebecca Haddad
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Frédérique Lebreton
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Gérard Amarenco
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
| | - Claire Hentzen
- Sorbonne Université, GRC 01, GREEN Groupe de Recherche Clinique en Neuro-Urologie, AP-HP, Hôpital Tenon, Paris, France
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