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Kreydin E, Welk B, Chung D, Clemens Q, Yang C, Danforth T, Gousse A, Kielb S, Kraus S, Mangera A, Reid S, Szell N, Cruz F, Chartier-Kastler E, Ginsberg DA. Surveillance and management of urologic complications after spinal cord injury. World J Urol 2018; 36:1545-1553. [PMID: 29845320 DOI: 10.1007/s00345-018-2345-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/17/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Neurogenic bladder due to spinal cord injury has significant consequences for patients' health and quality of life. Regular surveillance is required to assess the status of the upper and lower urinary lower urinary tracts and prevent their deterioration. In this review, we examine surveillance techniques in neurogenic bladder, describe common complications of this disease, and address strategies for their management. METHODS This work represents the efforts of SIU-ICUD joint consultation on Urologic Management of the Spinal Cord injury. For this specific topic, a workgroup was formed and comprehensive literature search of English language manuscripts regarding neurogenic bladder management was performed using key words of neurogenic bladder. Articles were compiled, and recommendations in the chapter are based on group discussion and follow the Oxford Centre for Evidence-based Medicine system for Levels of Evidence (LOEs) and Grades of Recommendation (GORs). RESULTS At a minimum, patients should undergo an annual history and physical examination, renal functional testing (e.g., serum creatinine), and upper tract imaging (e.g., renal ultrasonography). The existing evidence does not support the use of other modalities, such as cystoscopy or urodynamics, for routine surveillance. Urologic complications in neurogenic bladder patients are common and often more complex than in the general population. CONCLUSIONS There is a shortage of high-quality evidence to support any particular neurogenic bladder surveillance protocol. However, there is consensus regarding certain aspects of regular genitourinary system evaluation in these patients. Proper surveillance allows the clinician to avoid or address common urological complications, and to guide, alter, or maintain appropriate therapeutic regimens for individual patients.
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Affiliation(s)
- Evgeniy Kreydin
- USC Institute of Urology, 1441 Eastlake Avenue, suite 7414, Los Angeles, CA, 90033, USA
| | - Blayne Welk
- Division of Urology, The University of Western Ontario, London, ON, Canada
| | - Doreen Chung
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Teresa Danforth
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Angelo Gousse
- Bladder Health and Reconstructive Urology Institute, Miami, FL, USA
| | | | - Stephen Kraus
- University of Texas, San Antonio, San Antonio, TX, USA
| | - Altaf Mangera
- Department of Urology, Pitié-Salpêtrière, Paris, France
| | | | - Nicole Szell
- Bladder Health and Reconstructive Urology Institute, Miami, FL, USA
| | - Francisco Cruz
- Department of Urology, Hospital de São João, Porto, Portugal
| | | | - David A Ginsberg
- USC Institute of Urology, 1441 Eastlake Avenue, suite 7414, Los Angeles, CA, 90033, USA.
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Honore T, Le Breton F, Turmel N, Bignani B, Chesnel C, Charlanes A, Amarenco G. [Efficacy of botulinum toxin A injections in the urethral sphincter in patients with difficulties to perform self-intermittent catherization]. Prog Urol 2018; 28:370-376. [PMID: 29776876 DOI: 10.1016/j.purol.2018.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 03/23/2018] [Accepted: 04/04/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate safety and efficacy of botulinum toxin A injections in the urethral striated sphincter in patients with difficulties to perform self-intermittent catherization. METHODS In this prospective study, 12 patients suffering from upper motor neuron diseases (8 multiple sclerosis, 2 myelitis, 1 brain injury, 1 multi system atrophy) and with difficulties to perform self-intermittent catherization, defined by a ICDQ score>1 (Intermittent Catheterization Difficulty Questionnaire) have had injections of 100U BOTOX® under EMG guidance in the urethral striated sphincter, for a total of 15 injections. Evaluations consisted of two questionnaires (ICDQ and PGI-A, Patient Global Improvement) 30 days after the injection. RESULTS 30 days after the injection, ICDQ was improved with a mean decrease of the total score of 7.8 (SD=5.9, P<0,001). In the same manner, all the patients were improved with a mean PGI-A score of 2.3. In 73.3 % of cases, the PGI-A score was equal to 2 (improvement=much better), and in 20 % it was equal to 3 (improvement=a little better). CONCLUSIONS Botulinum toxin A injections in the urethral striated sphincter in patients with difficulties to perform self-intermittent catherization seem to safe and effective. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- T Honore
- Service MPR, hôpital Pontchaillou, 2, rue Henri-le-Guilloux, 35000 Rennes, France.
| | - F Le Breton
- GRC 01, Groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, Sorbonne universités, UPMC Université-Paris-06, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - N Turmel
- GRC 01, Groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, Sorbonne universités, UPMC Université-Paris-06, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - B Bignani
- Service de MPR, hôpital Pitié-Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - C Chesnel
- GRC 01, Groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, Sorbonne universités, UPMC Université-Paris-06, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - A Charlanes
- GRC 01, Groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, Sorbonne universités, UPMC Université-Paris-06, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - G Amarenco
- GRC 01, Groupe de recherche clinique en neuro-urologie (GREEN), service de neuro-urologie, hôpital Tenon, Sorbonne universités, UPMC Université-Paris-06, AP-HP, 4, rue de la Chine, 75020 Paris, France.
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Sun X, Guan W, Liu H, Tang K, Yan L, Zhang Y, Zeng J, Chen Z, Xu H, Ye Z. Efficacy and safety of PDE5-Is and α-1 blockers for treating lower ureteric stones or LUTS: a meta-analysis of RCTs. BMC Urol 2018; 18:30. [PMID: 29724204 PMCID: PMC5934901 DOI: 10.1186/s12894-018-0345-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 04/23/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Lower ureteric stones and lower urinary tract symptoms are common in urology.Drug treatment is one of standard therapy,but the efficacy was controversial.Thus we aimed to investigate the efficacy and safety of monotherapy or combination therapy of adrenoceptor1 blockers and phosphodiesterase5 inhibitors for treatment. METHODS Randomized controlled trials up to November 2016 were retrieved from PubMed, the Cochrane Library, Web of Science and Embase. A total of 17 studies were included. We analyzed data through random or fixed effect models. The heterogeneity between studies was assessed by the I2 test statistic. RESULTS As for lower ureter stones, our analysis demonstrated tadalafil had a significantly lower incidence of abnormal ejaculation than adrenoceptor1 blockers (2.31 95%CI 0.22to0.84, P = 0.01),while combination therapy had a higher expulsion rate (2.49 95%CI 1.44to4.29, P = 0.001) and shorter expulsion time (- 1.98 95%CI -3.08to0.88, P = 0.0004) than tamsulosin. As for lower urinary tract symptoms, our analysis indicated adrenoceptor1 blockers was more effective than phosphodiesterase5 inhibitors on decreasing International Prostate Symptom Score (1.96 95%CI 0.03to3.89, P = 0.05) and Post-Void Residual (9.41 95%CI 1.40to14.41, P = 0.02) and phosphodiesterase5 inhibitors showed a greater effect than adrenoceptor1 blockers on improving Erectile Dysfunction (2.23 95%CI 1.24to3.22, P<0.0001).Combination therapy had a significantly better effect on International Prostate Symptom Score (1.47 95%CI 1.25to1.69, P<0.0001), Maximum flow rate (0.87 95%CI 0.71to1.04, P<0.0001), Post-Void Residual (10.74 95%CI 3.53to17.96,P = 0.004) and Quality of life (0.59 95%CI 0.22to0.97, P = 0.002) but was associated with higher incidences of adverse events (3.40 95%CI 1.82to6.36, P = 0.0001) than adrenoceptor1 blockers. Combination therapy had a significantly better effect on International Prostate Symptom Score (4.19 95%CI 3.34to5.04, P<0.0001), Maximum flow rate (1.86 95%CI 1.32to2.39, P<0.0001), Post-Void Residual (22.58 95%CI 9.13to36.04, P = 0.001) and Quality of life (0.68 95%CI 0.37to1.00, P<0.0001) without higher incidences of adverse events than PDE5-Is. CONCLUSIONS In conclusion, this meta-analysis suggested combination therapy had a best efficacy of therapy for lower ureteric stones or lower urinary tract symptoms correlated with benign prostatic hyperplasia than monotherapy. Adrenoceptor1 blockers was more effective than phosphodiesterase5 inhibitors on International Prostate Symptom Score and Post-Void Residual. Both monotherapy and combination therapy were safe.
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Affiliation(s)
- Xifeng Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
| | - Wei Guan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Haoran Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
| | - Kun Tang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
| | - Libin Yan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
| | - Yangjun Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
| | - Jin Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China. .,Institute of Urology of Hubei Province, Wuhan, 430030, China.
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Institute of Urology of Hubei Province, Wuhan, 430030, China
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Pakkasjärvi N, Taskinen S. Does intraoperative success predict outcome in the treatment of urethral sphincter insufficiency with bulking agent? J Pediatr Urol 2018; 14:173.e1-173.e5. [PMID: 29398585 DOI: 10.1016/j.jpurol.2017.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/22/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Sphincter insufficiency is mostly associated with neurogenic and some structural abnormalities in the pediatric population. As a mini-invasive treatment, urethral bulking agents have been used to treat this problem. OBJECTIVE The aim was to evaluate if technical success, defined as intraoperative increase in abdominal leak point pressure (ALPP), predicts the outcome of the treatment of sphincter insufficiency with urethral bulking agent. STUDY DESIGN We reviewed all children treated first time with dextranomer/hyaluronic acid (Dx/HA) copolymer (Deflux) for urethral sphincter insufficiency and who intraoperatively had ALPPs measured during 2004-2014. Patient characteristics, change in urinary continence and the duration of the possible response were evaluated in neurogenic and non-neurogenic cases. RESULTS The median age of the patients was 7.8 years (range 4.1-14.5) at initial treatment and median volume of Dx/HA instilled was 3.5 mL (IQR 2-5). Twelve patients had neurogenic disease and 15 had non-neurogenic disease. Median ALPPs before and after the injections were 19 cmH2O (IQR 14-28) and 70 cmH2O (IQR 48-80), p < 0.001. Increases in ALPPs were similar in both patient groups (p = 0.661) and in 17 patients with any response and 10 patients with no response (p = 0.267). In patients with any response the median duration of the response was only 0.8 years (IQR 0.09-2.0). During a median follow-up of 4.9 years (range 1.7-11.8), 15 patients received one to three repeat injections and eight patients went through sling or bladder neck operation (Summary table). During repeat injections, the preoperative ALPPs had returned to the original levels. Currently, 20% are continent or almost continent with one or more Dx/HA injections. In half of the patients with neurogenic bladder, compliance or volume deteriorated slightly in follow-up. Five out of 15 patients who reached puberty become continent spontaneously after failed bladder neck injection. DISCUSSION Intraoperative ALPPs increased significantly in most patients during the procedure. However, only 52% of the patients experienced more than 1 month of success after the procedure, and even in those the effect lasted mostly under a year. With one to four injections one-fifth seem to have had a good long-term result. Although the long-term success rate is limited, bulking agent injection allowed the patients with spontaneous voiding to continue it and the injection did not prevent future treatments. CONCLUSION Intraoperative increased ALPP does not predict a good long-term outcome after Dx/HA injection. At the end, only a fifth of our patients had good result with one or more Dx/HA injections. A change in bladder behavior is possible after treatment.
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Affiliation(s)
- Niklas Pakkasjärvi
- Department of Pediatric Surgery, Children's Hospital, University of Helsinki, Helsinki, Finland
| | - Seppo Taskinen
- Department of Pediatric Surgery, Children's Hospital, University of Helsinki, Helsinki, Finland.
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105
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Intermittent Self-catheterization in Older Adults: Predictors of Success for Technique Learning. Int Neurourol J 2018; 22:65-71. [PMID: 29609423 PMCID: PMC5885133 DOI: 10.5213/inj.1835008.504] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/01/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose The main goal of this retrospective study is to explore the predictors of success in learning clean intermittent self-catheterization (CISC) in patients over 65 years of age. The secondary goal is to assess whether in this population, the risk of failure to perform CISC is greater, compared with patients under 65 with similar pathologies. Methods All patients older than 65 consulting between January 2011 and January 2016 for learning CISC were included. A control population younger than 65 matching with sex, body mass index, and pathology was selected. Results One hundred sixty-nine of the 202 patients (83.7%) over 65 succeeded in learning CISC. Obesity (P<0.05), low pencil and paper test (PP test) (P<0.01) and low functional independence measure (FIM) (P<0.01) scores were risk factors of failure. No significant differences were found with sex or pathology. In multivariate analysis, low PP test perineum access (odds ratio [95% confidence interval], 2.30 [1.32–4.42]), low FIM motor (1.04 [1.01–1.08]), and FIM cognition (1.18 [1.03–1.37]) scores were independent factors of learning failure. Compared to control group, age over 65 was not predictive of failure (P=0.15). Conclusions Our study shows that success in learning CISC does not depend on age but on difficulties in mobility, access to perineum and probably cognitive disorders.
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Surgical Management of Anatomic Bladder Outlet Obstruction in Males with Neurogenic Bladder Dysfunction: A Systematic Review. Eur Urol Focus 2018; 5:875-886. [PMID: 29551557 DOI: 10.1016/j.euf.2018.02.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/24/2018] [Accepted: 02/20/2018] [Indexed: 11/22/2022]
Abstract
CONTEXT Surgical treatment of anatomic bladder outlet obstruction (BOO) may be indicated in males with neurogenic bladder dysfunction. A bothersome complication after surgery is urinary incontinence. OBJECTIVE To identify the optimal practice in the surgical treatment of anatomic BOO in males with neurogenic bladder dysfunction, due to multiple sclerosis, Parkinson disease, spinal cord injury (SCI), spina bifida, or cerebrovascular accident (CVA). EVIDENCE ACQUISITION A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Medline, Embase, Cochrane controlled trial databases, Web of Science, and Google Scholar were searched for publications until January 2017. EVIDENCE SYNTHESIS A total of 930 abstracts were screened. Eight studies were included. The types of anatomic BOO discussed were benign prostate obstruction, urethral stricture, and bladder neck sclerosis. The identified surgical treatments were transurethral resection of the prostate (TURP) in patients with Parkinson, CVA or SCI, endoscopic treatment of urethral stricture by laser ablation or urethrotomy (mainly in SCI patients), and bladder neck resection (BNR) in SCI patients. The outcome of TURP may be highly variable, and includes persistent or de novo urinary incontinence, regained normal micturition control, and urinary continence. Good results were seen in BNR and endoscopic urethrotomy studies. Laser ablation and cold knife urethrotomy resulted in restarting intermittent catheterization or adequate voiding. Overall, a high risk of bias was found. CONCLUSIONS This systematic review provides an overview of the current literature on the outcome of several surgical approaches of different types of anatomic BOO in males with neurogenic bladder dysfunction. Identifying the optimal practice was impossible due to limited availability of high-quality studies. PATIENT SUMMARY The outcome of several surgical approaches in males with neurogenic bladder dysfunction with benign prostate obstruction, urethral stricture, or bladder neck sclerosis is overviewed. The optimal practice could not be identified.
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Use of onabotulinum toxin A in patients with idiopathic overactive bladder and a lack of efficacy, intolerance or contraindication with anticholinergics. UROLOGÍA COLOMBIANA 2018. [DOI: 10.1016/j.uroco.2015.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the efficacy and safety of onabotulinum toxin A in patients with idiopathic overactive bladder inadequately managed with anticholinergics.Materials and Methods A prospective, open-label, single centre, and interventional study was conducted, from 2008 to 2013, on consecutive patients with idiophatic overactive bladder that showed lack of efficacy or intolerance to anticholinergic agents.Results The study included 73 female patients aged 58.9 ± 12.9 years. A dose of 100 and 200 units of toxin were administered in 89 and 5 cases, respectively. Nineteen patients received a second injection, 8 patients received 3, and one patient was treated 4 times. Clinically, it was observed that 98% patients had urge urinary incontinence at baseline, as compared with 42% under treatment. Similar results were obtained regarding the number of pads used per day, from 2.8 at baseline to 0.5 after treatment as regards the urodynamic parameters, the first desire to void volume improved from 97 ± 63 mL to 139 ± 81 mL. Similar results were obtained as regards cystometric capacity and the volume of the first involuntary detrusor contraction. One patient had a positive urine culture resolved using a conventional oral antibiotic regimen. Intermittent catheterisation was required in 5 patients during the first week.Conclusions Onabotulinum toxin A injections significantly improved, not only the clinical symptoms, but also the urodynamic parameters in patients with idiopathic overactive bladder inadequately managed with anticholinergic drugs. This is a simple technique with minimal adverse effects and generally well tolerated.
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108
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Bae J, Johnston TA, Chaiittianan R, Sutthanut K, Jay M, Marson L. Characterization and in vivo efficacy of a heptapeptide ODT formulation for the treatment of neurogenic bladder dysfunction. Int J Pharm 2018; 536:397-404. [PMID: 29195918 PMCID: PMC5803421 DOI: 10.1016/j.ijpharm.2017.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 11/13/2017] [Accepted: 11/19/2017] [Indexed: 12/14/2022]
Abstract
The objective of this study was to develop oral disintegrating tablet (ODT) formulations of a heptapeptide, [Lys5,MeLeu9,Nle10]-NKA(4-10), for the treatment of neurogenic bladder dysfunction. A design of experiment approach was applied to determine the optimal ratio of chosen excipients: gelatin (X1), glycine (X2), and sorbitol (X3). These formulations were optimized for efficacy studies to produce ODTs exhibiting rapid disintegration times (Y1) and appropriate structural integrity (Y2) using JMP® 12.0.1 software. Based on theoretically predicted values from 12 experimental runs, the optimal ODT formulation was determined to be 3% (w/v) gelatin, 2% (w/v) glycine, and 1% (w/v) sorbitol in deionized water. Using this formulation, blank and drug-loaded ODTs containing 1.5 mg or 5 mg of [Lys5,MeLeu9,Nle10]-NKA(4-10) were manufactured by a lyophilization process. The peptide-loaded tablets disintegrated in less than 30 s and released 97% of the peptide within 15 min. The peptide was stable for 90 days under 25 °C/60% relative humidity (RH) and 40 °C/75% RH. In vivo efficacy of the peptide-loaded ODTs was confirmed in a rat acute spinal cord injury model under isovolumetric bladder pressure recording conditions, concluding that sublingual administration of peptide-containing ODTs evoke a rapid dose-related neurokinin 2-mediated increase in bladder pressure.
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Affiliation(s)
- Jungeun Bae
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Thomas A Johnston
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Rungsiri Chaiittianan
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Khaetthareeya Sutthanut
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Khon Kaen University, Khon Kaen, 40002, Thailand
| | - Michael Jay
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Lesley Marson
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA; Dignify Therapeutics, Research Triangle Park, NC, 27709, USA; Department of Urology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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109
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Neurogenic Bladder and Its Management. PHYSICIAN ASSISTANT CLINICS 2018. [DOI: 10.1016/j.cpha.2017.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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A systematic review of the diagnosis and treatment of patients with neurogenic hyperactivity of the detrusor muscle. Actas Urol Esp 2018; 42:5-16. [PMID: 28413135 DOI: 10.1016/j.acuro.2017.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 01/20/2017] [Accepted: 01/23/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Neurogenic detrusor hyperactivity (NDH) is a urodynamic observation characterised by involuntary detrusor contractions during the filling phase that are caused by an underlying neurological disease. The common and severe complications that can result from NDH warrant the preparation of healthcare protocols for the proper management of patients with NDH. OBJECTIVE The aim of this study is to standardise the criteria for the decision-making process in the management of patients with diagnosed or suspected NDH, providing personalised medical care. ACQUISITION OF EVIDENCE We performed a systematic noncomprehensive literature review on the aspects of the diagnosis and treatment of NDH. Based on the review, recommendations were issued by nominal consensus of a group of urology specialists. SYNTHESIS OF THE EVIDENCE In general, the diagnosis of NDH is arrived at by a proper review of the medical history, physical examination and voiding diary before performing any diagnostic study. The main treatment objectives are to protect the upper urinary tract, restore function of the lower tract and improve these patients' continence and quality of life. The treatment consists of several steps aimed at obtaining proper bladder storage that allows for sufficiently spaced voidings. The follow-up should be personalised based on each patient's needs. CONCLUSIONS The identification and management of NDH is important for positively redirecting the function of the lower urinary tract, in terms of filling and voiding, thereby improving the patients' quality of life.
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Borau A, Adot J, Allué M, Arlandis S, Castro D, Esteban M, Salinas J. A systematic review of the diagnosis and treatment of patients with neurogenic hyperactivity of the detrusor muscle. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.acuroe.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Faleiros F, Pelosi G, Warschausky S, Tate D, Käppler C, Thomas E. Factors Influencing the Use of Intermittent Bladder Catheterization by Individuals With Spina Bifida in Brazil and Germany. Rehabil Nurs 2018; 43:46-51. [DOI: 10.1002/rnj.302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Ladi-Seyedian SS, Nabavizadeh B, Sharifi-Rad L, Kajbafzadeh AM. Pharmacological treatments available for the management of underactive bladder in neurological conditions. Expert Rev Clin Pharmacol 2017; 11:193-204. [DOI: 10.1080/17512433.2018.1411801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Seyedeh-Sanam Ladi-Seyedian
- Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Nabavizadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Lida Sharifi-Rad
- Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Physical Therapy, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology and Regenerative Medicine Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
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Scott KA, Tonzi M, Nikolavsky D. Use of Artificial Urinary Sphincter and Slings to Manage Neurogenic Bladder Following Spinal Cord Injury—Is It Safe? CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0449-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vigneswaran H, Abhyankar N, Kocjancic E. Using Advanced Imaging Including MRI to Detect Voiding Dysfunction in Neurogenic Bladder and Fowler Syndrome. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0453-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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116
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Zlatev DV, Shem K, Elliott CS. Predictors of long-term bladder management in spinal cord injury patients-Upper extremity function may matter most. Neurourol Urodyn 2017; 37:1106-1112. [PMID: 29044679 DOI: 10.1002/nau.23430] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 09/16/2017] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Clean intermittent catheterization (CIC) is the gold standard for neurogenic bladder management in most patients with spinal cord injury (SCI). There is nonetheless a lack of long-term adherence to CIC, with up to 50% discontinuance at 5-year follow-up. We hypothesize that limitations in upper extremity (UE) motor function represent a strong predictor for long-term CIC adoption. METHODS We assessed Forms I and II data from the 2000-2013 National SCI Database. Bladder management was determined at initial discharge and 1-year follow-up. Upper extremity (UE) motor scores were transformed using a previously published algorithm to predict a patient's ability to independently self-catheterize. Uni- and multivariable logistic regression modeling was performed to assess risk factors affecting: a) a lack of CIC adoption at rehabilitation discharge, b) CIC discontinuance by 1-year follow-up (CIC "dropout"), and c) adherence to management with an indwelling catheter rather than conversion to CIC at 1-year follow-up. RESULTS For all three modeled scenarios, UE motor function represented the most significant predictor for lack of CIC adoption (OR range 2.1-6.3, P ≤ 0.003 for all). Other predictors included increasing age (OR 1.01-1.02, P ≤ 0.001 for all models) and female gender (OR 1.6-1.7, P < 0.001 for lack of CIC adoption at discharge). CONCLUSIONS Among physically limiting factors, impairment in UE motor function appears to be the most significant predictor of a lack of long-term CIC adoption at 1-year follow-up.
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Affiliation(s)
- Dimitar V Zlatev
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Kazuko Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California
| | - Christopher S Elliott
- Department of Urology, Stanford University School of Medicine, Stanford, California.,Division of Urology, Santa Clara Valley Medical Center, San Jose, California
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117
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Sinha S. Follow-up urodynamics in patients with neurogenic bladder. Indian J Urol 2017; 33:267-275. [PMID: 29021649 PMCID: PMC5635666 DOI: 10.4103/iju.iju_358_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/24/2017] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Neurogenic bladder patients are at long-term risk of secondary upper urinary tract damage. Symptoms are unreliable and follow-up urodynamics is the only method of ascertaining safety of bladder pressures. This review examines the recommendations, shortcomings and utilization of existing guidelines. The evidence with regard to follow-up urodynamics in different settings relevant to neurogenic bladder is evaluated and an algorithm is proposed. METHODS A pubmed search was conducted for studies on follow-up urodynamics in patients with neurogenic bladder. Additional search was made of secondary sources including reviews and guidelines. RESULTS The need for follow-up urodynamics should be considered in all patients undergoing an initial assessment and weighed against the risks. Existing guidelines, while unanimous in their recommendation of its utilization, give scant details regarding its incorporation in clinical management. Follow-up urodynamics can document efficacy and identify the need for escalation of therapy in patients on intermittent catheterization and antimuscarinics. Patients with spinal injury, spinal dysraphism and anorectal malformations are at higher risk for upper tract damage. Follow-up urodynamics can help identify patients suitable for intravesical botulinum and mark those destined for failure. Patients undergoing augmentation cystoplasty may be candidates for less aggressive urodynamic follow-up. CONCLUSIONS Neurogenic bladder is managed by a broad cross-section of physicians. Clear recommendations and a management algorithm are important for improving patient care. Follow-up urodynamics can identify patients at risk, prevent renal dysfunction and improve the quality of life. There is an urgent need for more evidence on this important subject.
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Affiliation(s)
- Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, Telangana, India
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118
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Zeng XT, Su XJ, Li S, Weng H, Liu TZ, Wang XH. Association between SRD5A2 rs523349 and rs9282858 Polymorphisms and Risk of Benign Prostatic Hyperplasia: A Meta-Analysis. Front Physiol 2017; 8:688. [PMID: 28955247 PMCID: PMC5600931 DOI: 10.3389/fphys.2017.00688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 08/28/2017] [Indexed: 01/25/2023] Open
Abstract
Objective: Previous studies have reported that rs523349 (V89L) and rs9282858 (A49T) polymorphisms in the gene 5α-reductase II (SRD5A2) are associated with the risk of benign prostatic hyperplasia (BPH), but different opinions have emerged. In view of distinct discrepancies among those findings, we performed this meta-analysis to ascertain a more accurate association between SRD5A2 rs523349 and rs9282858 polymorphisms and the risk of BPH. Methods: Studies investigating the association between SRD5A2 rs523349 and rs9282858 polymorphisms and susceptibility to BPH were searched from the databases of PubMed, Embase, Wanfang, and Chinese National Knowledge Infrastructure (CNKI).The strength of correlation was assessed by crude odds ratios (ORs) with their corresponding 95% confidence intervals (95% CIs). Moreover, subgroup analysis was conducted to further ascertain such relationship and investigate sources of heterogeneity. Results:SRD5A2 rs9282858 (A49T) polymorphism showed a significant correlation with increased BPH susceptibility under allele T vs.allele A genetic model (OR = 2.51, 95% CI = 1.29-4.88) in total analysis, and stratification analysis by ethnicity also revealed a similar association in Caucasian group under the same contrast. SRD5A2 rs523349 (V89L) polymorphism showed no significant role in BPH occurrence in total analysis, but its reducing and increasing effects on the disease risk were reflected in Caucasian and other-ethnicity subgroups, respectively, after stratification analysis by ethnicity. Conclusion: In conclusion, SRD5A2 rs9282858 polymorphism may elevate the susceptibility to BPH, while the polymorphism rs523349 may exert different influences on the disease in people of different ethnic lines.
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Affiliation(s)
- Xian-Tao Zeng
- Department of Urology, Zhongnan Hospital of Wuhan UniversityWuhan, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan UniversityWuhan, China
| | - Xin-Jun Su
- Department of Urology, Zhongnan Hospital of Wuhan UniversityWuhan, China
| | - Sheng Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan UniversityWuhan, China
| | - Hong Weng
- Department of Urology, Zhongnan Hospital of Wuhan UniversityWuhan, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan UniversityWuhan, China
| | - Tong-Zu Liu
- Department of Urology, Zhongnan Hospital of Wuhan UniversityWuhan, China
| | - Xing-Huan Wang
- Department of Urology, Zhongnan Hospital of Wuhan UniversityWuhan, China.,Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan UniversityWuhan, China
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119
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Fang H, Lu B, Wang X, Zheng L, Sun K, Cai W. Application of data mining techniques to explore predictors of upper urinary tract damage in patients with neurogenic bladder. Braz J Med Biol Res 2017; 50:e6638. [PMID: 28832768 PMCID: PMC5561813 DOI: 10.1590/1414-431x20176638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/29/2017] [Indexed: 11/30/2022] Open
Abstract
This study proposed a decision tree model to screen upper urinary tract damage (UUTD) for patients with neurogenic bladder (NGB). Thirty-four NGB patients with UUTD were recruited in the case group, while 78 without UUTD were included in the control group. A decision tree method, classification and regression tree (CART), was then applied to develop the model in which UUTD was used as a dependent variable and history of urinary tract infections, bladder management, conservative treatment, and urodynamic findings were used as independent variables. The urethra function factor was found to be the primary screening information of patients and treated as the root node of the tree; Pabd max (maximum abdominal pressure, >14 cmH2O), Pves max (maximum intravesical pressure, ≤89 cmH2O), and gender (female) were also variables associated with UUTD. The accuracy of the proposed model was 84.8%, and the area under curve was 0.901 (95%CI=0.844-0.958), suggesting that the decision tree model might provide a new and convenient way to screen UUTD for NGB patients in both undeveloped and developing areas.
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Affiliation(s)
- H Fang
- Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - B Lu
- Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - X Wang
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - L Zheng
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - K Sun
- The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - W Cai
- Shenzhen Hospital, Southern Medical University, Shenzhen, China
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120
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Vince RA, Klausner AP. Surveillance Strategies for Neurogenic Lower Urinary Tract Dysfunction. Urol Clin North Am 2017; 44:367-375. [DOI: 10.1016/j.ucl.2017.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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121
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Gor RA, Elliott SP. Surgical Management of Neurogenic Lower Urinary Tract Dysfunction. Urol Clin North Am 2017; 44:475-490. [DOI: 10.1016/j.ucl.2017.04.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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122
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Abstract
Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions can include non-surgical options (such as lifestyle modifications, pelvic floor muscle training and drugs) and surgical options to support the urethra or increase bladder capacity. Future directions in research may increasingly target primary prevention through understanding of environmental and genetic risks for incontinence.
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Affiliation(s)
- Yoshitaka Aoki
- Department of Urology, University of Fukui Faculty of Medical Sciences, Fukui, Japan
| | - Heidi W Brown
- Departments of Obstetrics and Gynecology &Urology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Linda Brubaker
- Department of Reproductive Medicine, University of California San Diego, San Diego, California, USA
| | - Jean Nicolas Cornu
- Department of Urology, Charles Nicolle Hospital, University of Rouen Normandy, Rouen, France
| | - J Oliver Daly
- Department of Obstetrics and Gynaecology, Western Health, Victoria, Australia
| | - Rufus Cartwright
- Department of Urogynaecology, St Mary's Hospital, London, UK
- Department of Epidemiology and Biostatistics, Imperial College London, Norfolk Place, London W2 1PG, UK
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123
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Madec FX, Hedhli O, Perrouin-Verbe MA, Levesque A, Le Normand L, Rigaud J. Feasibility, Morbidity, and Functional Results of Supratrigonal Cystectomy with Augmentation Ileocystoplasty by Combined Robot-Assisted Laparoscopy and Mini-Laparotomy Approach. J Endourol 2017; 31:655-660. [PMID: 28467725 DOI: 10.1089/end.2017.0107] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Evaluation of the feasibility, morbidity, learning curve, and functional results of robotic supratrigonal cystectomy with augmentation ileocystoplasty (RSCAI). MATERIALS AND METHODS RSCAI was performed in 19 patients between 2012 and 2016. Thirteen patients (66.4%) presented refractory detrusor overactivity or impaired compliance and 6 patients (31.6%) had painful bladder syndrome. A combined robot-assisted laparoscopy and mini-laparotomy approach was performed. Early (<30 days) and late (>30 days) complications were reported according to the Clavien-Dindo classification. Functional results were analyzed according to the surgical indication. RESULTS Mean total operating time was 288.7 ± 92.1 minutes. Mean intraoperative blood loss was 147.4 ± 144.8 mL. Mean length of hospital stay in the surgical ward was 9.4 ± 3.7 days. Mean duration of bladder drainage was 23.3 ± 4.1 days. For surgeons who regularly performed robot-assisted laparoscopy, the learning curve of this technique, as assessed by the operating time, required almost five operations. No major (Clavien-Dindo >2) early (0%) or late (0%) postoperative complication was observed. Early minor complications were observed in 47.4% of cases, usually consisting of pyelonephritis (21.1%). Late minor complications (10.5%) were Clavien-Dindo grade I. Mean follow-up was 13.6 ± 10.1 months. The majority of patients (94.7%) obtained functional improvement of their disease in terms of pain, functional bladder capacity, or bladder compliance. CONCLUSION Our RSCAI technique is a reliable technique with no early or late major postoperative complications reported in this series. This technique allows patients to be operated by minimally invasive surgery with very satisfactory long-term functional results.
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Affiliation(s)
| | - Oussama Hedhli
- Department of Urology, Nantes University Hospital , Nantes, France
| | | | - Amélie Levesque
- Department of Urology, Nantes University Hospital , Nantes, France
| | - Loïc Le Normand
- Department of Urology, Nantes University Hospital , Nantes, France
| | - Jérôme Rigaud
- Department of Urology, Nantes University Hospital , Nantes, France
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124
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Gao Y, Danforth T, Ginsberg DA. Urologic Management and Complications in Spinal Cord Injury Patients: A 40- to 50-year Follow-up Study. Urology 2017; 104:52-58. [DOI: 10.1016/j.urology.2017.03.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/22/2017] [Accepted: 03/02/2017] [Indexed: 10/20/2022]
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125
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Truzzi JC, Silvinato A, Bernardo WM. Overactive bladder: pharmacological treatment. Rev Assoc Med Bras (1992) 2017; 63:197-202. [PMID: 28489120 DOI: 10.1590/1806-9282.63.03.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
- José Carlos Truzzi
- Sociedade Brasileira de Urologia. Universidade Federal de São Paulo. Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
| | - Antonio Silvinato
- Sociedade Brasileira de Urologia. Universidade Federal de São Paulo. Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil
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126
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Witte LP, Odekerken VJJ, Boel JA, Schuurman PR, Gerbrandy-Schreuders LC, de Bie RMA. Does deep brain stimulation improve lower urinary tract symptoms in Parkinson's disease? Neurourol Urodyn 2017; 37:354-359. [PMID: 28464331 DOI: 10.1002/nau.23301] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/23/2017] [Indexed: 11/09/2022]
Abstract
AIMS To investigate whether deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) or the subthalamic nucleus (STN) improve lower urinary tract symptoms (LUTS) in advanced Parkinson's disease (PD). METHODS An exploratory post-hoc analysis was performed of specific LUTS items of questionnaires used in a randomized clinical trial with 128 patients (NSTAPS study). First, we compared scores on LUTS items at baseline and 12 months for the GPi DBS and STN DBS group separately. Second, we divided the group by sex, instead of DBS location; to assess a possible gender associated influence of anatomical and pathophysiological differences, again comparing scores at baseline and 12 months. Third, we reported on Foley-catheter use at baseline and after 12 months. RESULTS Urinary incontinence and frequency improved after both GPi DBS and STN DBS at 12 months, postoperatively, but this was only statistically significant for the STN DBS group (P = 0.004). The improvements after DBS were present in both men (P = 0.01) and women (P = 0.05). Nocturia and urinary incontinence did not improve significantly after any type of DBS, irrespective of sex. At 12 months, none of the patients had a Foley-catheter. CONCLUSIONS Urinary incontinence and frequency significantly improved after STN DBS treatment in male and female patients with PD. Nocturia and nighttime incontinence due to parkinsonism did not improve after DBS, irrespective of gender.
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Affiliation(s)
- Lambertus P Witte
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Vincent J J Odekerken
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Judith A Boel
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Rob M A de Bie
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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127
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Ineichen BV, Schneider MP, Hlavica M, Hagenbuch N, Linnebank M, Kessler TM. High EDSS can predict risk for upper urinary tract damage in patients with multiple sclerosis. Mult Scler 2017; 24:529-534. [PMID: 28367674 DOI: 10.1177/1352458517703801] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neurogenic lower urinary tract dysfunction (NLUTD) is very common in patients with multiple sclerosis (MS), and it might jeopardize renal function and thereby increase mortality. Although there are well-known urodynamic risk factors for upper urinary tract damage, no clinical prediction parameters are available. OBJECTIVE We aimed to assess clinical parameters potentially predicting urodynamic risk factors for upper urinary tract damage. METHODS A consecutive series of 141 patients with MS referred from neurologists for primary neuro-urological work-up including urodynamics were prospectively evaluated. Clinical parameters taken into account were age, sex, duration, and clinical course of MS and Expanded Disability Status Scale (EDSS). RESULTS Multivariate modeling revealed EDSS as a clinical parameter significantly associated with urodynamic risk factors for upper urinary tract damage (odds ratio = 1.34, 95% confidence interval (CI) = 1.06-1.71, p = 0.02). Using receiver operator characteristic (ROC) curves, an EDSS of 5.0 as cutoff showed a sensitivity of 86%-87% and a specificity of 52% for at least one urodynamic risk factor for upper urinary tract damage. CONCLUSION High EDSS is significantly associated with urodynamic risk factors for upper urinary tract damage and allows a risk-dependent stratification in daily neurological clinical practice to identify MS patients requiring further neuro-urological assessment and treatment.
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Affiliation(s)
- Benjamin V Ineichen
- Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland/Department of Neurology, University Hospital Zürich, Zürich, Switzerland
| | - Marc P Schneider
- Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland/Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Martin Hlavica
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Michael Linnebank
- Department of Neurology, University Hospital Zürich, Zürich, Switzerland/Department of Neurology, HELIOS-Klinik Hagen-Ambrock, Hagen, Germany
| | - Thomas M Kessler
- Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
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Efficacy and Adverse Events Associated With Use of OnabotulinumtoxinA for Treatment of Neurogenic Detrusor Overactivity: A Meta-Analysis. Int Neurourol J 2017; 21:53-61. [PMID: 28361515 PMCID: PMC5380821 DOI: 10.5213/inj.1732646.323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 08/02/2016] [Indexed: 11/08/2022] Open
Abstract
PURPOSE OnabotulinumtoxinA is used widely for the treatment of neurogenic detrusor overactivity. We conducted a systematic review and meta-analysis to assess its efficacy and safety for neurogenic detrusor overactivity treatment. METHODS A systematic literature review was performed to identify all published randomized double-blind, placebo-controlled trials of onabotulinumtoxinA for neurogenic detrusor overactivity treatment. MEDLINE, Embase, and the CENTRAL were employed. Reference lists of retrieved studies were reviewed carefully. RESULTS Six publications involving 871 patients, which compared onabotulinumtoxinA with a placebo were analyzed. Efficacy of onabotulinumtoxinA treatment was shown as a reduction of the mean number of urinary incontinence episodes per day (mean difference, -1.41; 95% confidence interval [CI], -1.70 to -1.12; P<0.00001), maximum cystometric capacity (135.48; 95% CI, 118.22-152.75; P<0.00001), and maximum detrusor pressure (-32.98; 95% CI, -37.33 to -28.62; P<0.00001). Assessment of adverse events revealed that complications due to onabotulinumtoxinA injection were localized primarily to the urinary tract. CONCLUSIONS This meta-analysis suggests that onabotulinumtoxinA is an effective treatment for neurogenic detrusor overactivity with localized advent events.
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129
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Aharony SM, Lam O, Corcos J. Treatment of lower urinary tract symptoms in multiple sclerosis patients: Review of the literature and current guidelines. Can Urol Assoc J 2017; 11:E110-E115. [PMID: 28360957 DOI: 10.5489/cuaj.4059] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Multiple sclerosis (MS) is a unique neurological disease with a broad spectrum of clinical presentations that are time- and disease course-related. Lower urinary tract symptoms (LUTS) are highly prevalent in this patient population, with approximately 90% showing some degree of voiding dysfunction and/or incontinence 6-8 years after the initial MS diagnosis. Major therapeutic goals include quality of life improvement and the avoidance of urological complications Owing to the wide divergence of clinical symptoms and disease course, evaluation and treatment differ between patients. Treatment must be customized for each patient based on disease phase, patient independence, manual dexterity, social support, and other medical- or MS-related issues. Ablative or irreversible therapies are indicated only when the disease course is stable. In most cases of "safe" bladder, behavioural treatment is considered first-line defense. Antimuscarinic drugs, alone or in combination with intermittent self-catheterization, are currently the mainstay of conservative treatment, and several other medications may help in specific disease conditions. Second-line treatment includes botulinum toxin A injection, neuromodulation, indwelling catheters, and surgery in well-selected cases.
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Affiliation(s)
| | - Ornella Lam
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC, Canada
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130
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Sugiyama H, Uemura O, Mori T, Okisio N, Unai K, Liu M. Effect of imidafenacin on the urodynamic parameters of patients with indwelling bladder catheters due to spinal cord injury. Spinal Cord 2017; 55:187-191. [PMID: 27897185 PMCID: PMC5308215 DOI: 10.1038/sc.2016.168] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 09/23/2016] [Accepted: 10/19/2016] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES To investigate the effect of imidafenacin on the urodynamic parameters of patients with indwelling bladder catheters due to spinal cord injury (SCI). SETTING Spinal center (Tokyo, Japan). METHODS Imidafenacin was prescribed to 34 patients with SCI who had a low cystometric volume and/or detrusor compliance according to a urodynamic study. A low cystometric volume and detrusor compliance were defined as <200 ml and <20 ml cm-1 H2O, respectively. The urodynamic study was repeated 4 weeks after imidafenacin was prescribed. When the urodynamic parameters did not improve in the follow-up study, the dose of imidafenacin was increased twofold. Then the urodynamic study was repeated 4 weeks thereafter. We compared the urodynamic parameters before and after imidafenacin treatment. Complications such as vesico-urethral reflux (VUR) and autonomic dysreflexia (AD) were documented. RESULTS Fifteen patients took 0.2 mg of imidafenacin daily, and 19 received 0.4 mg of imidafenacin daily. Imidafenacin increased the cystometric volume from 246.0 to 321.5 ml (median, P=0.002), detrusor compliance from 6.67 ml cm-1 H2O to 8.98 ml cm-1 H2O (median, P=0.012), and decreased the detrusor pressure from 37.0 cm H2O to 30.5 cm H2O (median, P=0.056). All three patients who had VUR fully recovered. Although 3 of 12 patients recovered from AD, 3 patients newly developed symptoms of AD. No patient withdrew from treatment due to adverse effects. CONCLUSION Imidafenacin is a safe drug that may improve the urodynamic parameters of patients with SCI, and it possibly alleviates bladder complications.
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Affiliation(s)
- H Sugiyama
- National Hospital Organization Murayama Medical Center, Tokyo, Japan
| | - O Uemura
- National Hospital Organization Murayama Medical Center, Tokyo, Japan
| | - T Mori
- National Hospital Organization Murayama Medical Center, Tokyo, Japan
| | - N Okisio
- National Hospital Organization Murayama Medical Center, Tokyo, Japan
| | - K Unai
- National Hospital Organization Murayama Medical Center, Tokyo, Japan
| | - M Liu
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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Rognoni C, Tarricone R. Intermittent catheterisation with hydrophilic and non-hydrophilic urinary catheters: systematic literature review and meta-analyses. BMC Urol 2017; 17:4. [PMID: 28073354 PMCID: PMC5225586 DOI: 10.1186/s12894-016-0191-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Intermittent catheterisation is the method of choice for the management of bladder dysfunctions. Different urinary catheters are available, but there is conflicting evidence on which type of catheter is best. The present study provides an objective evaluation of the clinical effectiveness of different subsets of urinary catheters. Methods A systematic literature review was performed for published RCTs regarding hydrophilic coated and PVC (standard) catheters for intermittent catheterisation. Separate meta-analyses were conducted to combine data on frequencies of urinary tract infections (UTIs) and haematuria. Two separate analyses were performed, including or excluding reused standard catheters. Results Seven studies were eligible for inclusion in the review. The meta-analyses exploring UTI frequencies showed a lower risk ratio associated with hydrophilic catheters in comparison to standard ones (RR = 0.84; 95% CI, 0.75–0.94; p = 0.003). Results for the “reuse” scenario were consistent with the ones related to “single-use” scenario in terms of frequency of UTIs. The meta-analyses exploring haematuria were not able to demonstrate any statistically significant difference between hydrophilic catheters in comparison to standard ones. Conclusions The findings confirm previously reported benefits of hydrophilic catheters but a broader evaluation that takes into account also patient preferences, compliance of therapy, quality of life and costs would be needed to assess the economic sustainability of these advanced devices. Electronic supplementary material The online version of this article (doi:10.1186/s12894-016-0191-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carla Rognoni
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Via Roentgen 1, Milan, 20136, Italy.
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Via Roentgen 1, Milan, 20136, Italy.,Department of Policy Analysis and Public Management, Bocconi University, Via Roentgen 1, Milan, 20136, Italy
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132
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Kim HJ. Management of urinary incontinence in geriatric hospitals. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2017. [DOI: 10.5124/jkma.2017.60.7.542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hyung Jee Kim
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
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133
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Martinez L, Neshatian L, Khavari R. Neurogenic Bowel Dysfunction in Patients with Neurogenic Bladder. CURRENT BLADDER DYSFUNCTION REPORTS 2016; 11:334-340. [PMID: 28717406 PMCID: PMC5510247 DOI: 10.1007/s11884-016-0390-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patients with primary neurologic conditions often experience urinary and bowel dysfunction due to loss of sensory and/or motor control. Neurogenic bowel dysfunction is frequently characterized by both constipation and fecal incontinence. In general, the management of neurogenic bowel dysfunction has been less well studied than bladder dysfunction despite their close association.. It is widely accepted that establishment of a multifaceted bowel regimen is the cornerstone of conservative management. Continuing assessment is necessary to determine need for more invasive interventions. In the clinical setting, the Urologist may be the principle provider addressing bowel concerns in addition to bladder dysfunction, and furthermore, treatment of one often impacts the other. Future directions should include development of follow up and management guidelines that address the comprehensive care of this patient population.
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Affiliation(s)
- Laura Martinez
- Houston Methodist Hospital, Department of Urology, 6560 Fannin, Suite 2100, Houston, Texas 77030, USA
| | - Leila Neshatian
- Houston Methodist Hospital, Division of Gastroenterology and Hepatology, 6550 Fannin St. Suite 1201, Houston, TX, 77030, USA
| | - Rose Khavari
- Houston Methodist Hospital, Department of Urology, 6560 Fannin, Suite 2100, Houston, Texas 77030, USA,
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Elmelund M, Klarskov N, Bagi P, Oturai PS, Biering-Sørensen F. Renal deterioration after spinal cord injury is associated with length of detrusor contractions during cystometry-A study with a median of 41 years follow-up. Neurourol Urodyn 2016; 36:1607-1615. [PMID: 27813141 DOI: 10.1002/nau.23163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 09/22/2016] [Indexed: 11/08/2022]
Abstract
AIMS To investigate which urodynamic parameters are associated with renal deterioration over a median of 41 years follow-up after traumatic spinal cord injury. METHODS Medical records of patients with a traumatic spinal cord injury sustained 1944-1975 were reviewed from time of injury until 2012. Patients who attended regular renography and/or renal clearance examinations and had minimum one cystometry and pressure-flow study were included. Renal deterioration was diagnosed as split renal function ≤30% in one kidney or relative glomerular filtration rate ≤51% of expected according to age and gender. Detrusor function, presence of detrusor sphincter dyssynergia, maximum detrusor pressure, post-void residual volume, and cystometric bladder capacity were obtained. In patients with detrusor overactivity, a detrusor overactivity/cystometry ratio was calculated using duration of detrusor contraction(s) during filling cystometry divided by total duration of filling cystometry. RESULTS A total of 73 patients were included in the study, and the median follow-up time was 41 years after injury (range 24-56). Sixty-four patients (88%) used reflex triggering or bladder expression as bladder emptying method for the longest period after injury. During follow-up 60% changed to clean intermittent catheterization. The majority of the patients (68%) had neurogenic detrusor overactivity. In 35 patients, a detrusor-overactivity/cystometry ratio could be calculated and a detrusor overactivity/cystometry ratio > 0.33 was significantly associated with renal deterioration (P < 0.02). No significant association was found between maximum detrusor pressure or other urodynamic parameters and renal deterioration. CONCLUSIONS Duration of detrusor overactivity longer than one third of the duration of cystometry is associated with renal deterioration after spinal cord injury.
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Affiliation(s)
- Marlene Elmelund
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Hornbaek, Denmark.,Department of Obstetrics and Gynecology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Niels Klarskov
- Department of Obstetrics and Gynecology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Per Bagi
- Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter S Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Hornbaek, Denmark
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135
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136
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Typical Value Ranges and Typical Signal Patterns in the Initial Cough in Patients With Neurogenic Bladder: Quality Control in Urodynamic Studies. Int Neurourol J 2016; 20:214-223. [PMID: 27706014 PMCID: PMC5083832 DOI: 10.5213/inj.1632556.278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/04/2016] [Indexed: 11/10/2022] Open
Abstract
Purpose The goal of this study was to establish typical value ranges (TVRs) and to analyze typical signal patterns (TSPs) of the initial cough (cough before bladder filling) for quality control in urodynamic studies. Methods A total of 539 urodynamic traces from patients with neurogenic bladder obtained over the course of a year were retrospectively reviewed. The TVRs for cough amplitude in measurements of the intravesical pressure (Pves), abdominal pressure (Pabd), and detrusor pressure (Pdet) during the initial cough were established. We used the 95% range as a reference range for all parameters. Cough spikes in Pdet were described and classified, and the reasons for different patterns of cough spikes were established. The quality of all the cystometry traces was checked, and we also present remedial actions for inappropriate cough spikes. Results The cough amplitudes in the measurements of Pves and Pabd were similar, with 95% of measurements falling within the following ranges: 4–62 cm H2O and 3–70 cm H2O, respectively, in supine position and 9–95 cm H2O and 8–98 cm H2O, respectively, in sitting position. For Pdet, the cough amplitude ranged from −38 to 25 cm H2O in supine position and from −44 to 41 cm H2O in sitting position. The cough spikes for Pdet were classified as follows: type I, Pdet pressure exhibited a minimal change (<5 cm H2O) during the cough; type II, a monophasic spike (>5 cm H2O) was observed for Pdet; and type III, biphasic spikes were observed for Pdet. Type I coughs were found to have more high-quality traces (P<0.01). Conclusions TVRs for the initial cough test among neurogenic patients were established in order to provide guidelines for quantitative quality control. The TSPs for the initial cough signal were described, and the presence of a high-quality cough signal may be recommended as a component of quality control in urodynamic measurements.
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137
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Huang YH, Chang HY, Tsai SW, Chou LW, Chen SL, Lin YH. Comparison of Autonomic Reactions during Urodynamic Examination in Patients with Spinal Cord Injuries and Able-Bodied Subjects. PLoS One 2016; 11:e0161976. [PMID: 27575616 PMCID: PMC5004842 DOI: 10.1371/journal.pone.0161976] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 08/15/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND/PURPOSE This study compares heart rate variability (HRV) and systolic blood pressure (SBP) changes of spinal cord injury (SCI) patients during urodynamic study (UDS) with able-bodied controls. METHODS Twenty four complete suprasacral SCI patients (12 tetraplegia and 12 paraplegia) and 12 age-matched able-bodied volunteers received BP and HRV evaluation throughout urodynamic examination. We chose seven time points during the examinations: resting, Foley catheter insertion, start of infusion, and infused volume reaching 1/4, 2/4, 3/4 and 4/4 of maximal capacity. At each time point, electrocardiogram with a duration of 5 min was used for power spectral density analysis of HRV. RESULTS Only control subjects displayed significant elevation of SBP during Foley catheter insertion compared to resting values. Both control and tetraplegic groups experienced significant elevation of SBP at maximal bladder capacity compared to resting values. Tetraplegic values were also significantly greater than the other two groups. Control subjects displayed significant elevation of low frequency/high frequency (LF/HF) ratios during Foley catheter insertion and when approaching maximum bladder capacity. These findings were not seen in the paraplegic and tetraplegic groups. However, subgroup analysis of tetraplegic subjects with SBP elevation >50 mmHg demonstrated a similar LF/HF response to the able-bodied controls. CONCLUSION Tetraplegic patients experienced BP elevation but did not experience significant changes in HRV during bladder distension. This finding may imply that different neurological pathways contribute to AD reaction and HRV changes during bladder distension. However, profound AD during UDS in tetraplegic patients was associated with corresponding changes in HRV. Whether HRV monitoring would be beneficial in SCI patients presenting with significant AD, it needs further studies to elucidate.
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Affiliation(s)
- Yu-Hui Huang
- Department of Physical Medicine & Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsiao-Yun Chang
- School of Physical Therapy, Chung Shan Medical University, Taichung, Taiwan
- Room of Physical Therapy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Sen-Wei Tsai
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan
- Department of Physical Medicine and Rehabilitation, School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Li-Wei Chou
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Sung-Lang Chen
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan
- * E-mail:
| | - Yu-Hao Lin
- Department of Physical Medicine & Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan
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138
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Hu HZ, Granger N, Jeffery ND. Pathophysiology, Clinical Importance, and Management of Neurogenic Lower Urinary Tract Dysfunction Caused by Suprasacral Spinal Cord Injury. J Vet Intern Med 2016; 30:1575-1588. [PMID: 27527382 PMCID: PMC5032886 DOI: 10.1111/jvim.14557] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 06/30/2016] [Accepted: 07/06/2016] [Indexed: 12/24/2022] Open
Abstract
Management of persistent lower urinary tract dysfunction resulting from severe thoracolumbar spinal cord injury can be challenging. Severe suprasacral spinal cord injury releases the spinal cord segmental micturition reflex from supraspinal modulation and increases nerve growth factor concentration in the bladder wall, lumbosacral spinal cord, and dorsal root ganglion, which subsequently activates hypermechanosensitive C-fiber bladder wall afferents. Hyperexcitability of bladder afferents and detrusor overactivity can cause urine leaking during the storage phase. During urine voiding, the loss of supraspinal control that normally coordinates detrusor contraction with sphincter relaxation can lead to spinal cord segmental reflex-mediated simultaneous detrusor and sphincter contractions or detrusor-sphincter dyssynergia, resulting in inefficient urine voiding and high residual volume. These disease-associated changes can impact on the quality of life and life expectancy of spinal-injured animals. Here, we discuss the pathophysiology and management considerations of lower urinary tract dysfunction as the result of severe, acute, suprasacral spinal cord injury. In addition, drawing from experimental, preclinical, and clinical medicine, we introduce some treatment options for neurogenic lower urinary tract dysfunction that are designed to: (1) prevent urine leakage arising because of detrusor overactivity during bladder filling, (2) preserve upper urinary tract integrity and function by reducing intravesical pressure and subsequent vesicoureteral reflux, and (3) prevent urinary tract and systemic complications by treating and preventing urinary tract infections.
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Affiliation(s)
- H Z Hu
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA
| | - N Granger
- School of Veterinary Sciences, University of Bristol, Langford House, Langford, North Somerset, UK
| | - N D Jeffery
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, IA.
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Goranitis I, Barton P, Middleton LJ, Deeks JJ, Daniels JP, Latthe P, Coomarasamy A, Rachaneni S, McCooty S, Verghese TS, Roberts TE. Testing and Treating Women after Unsuccessful Conservative Treatments for Overactive Bladder or Mixed Urinary Incontinence: A Model-Based Economic Evaluation Based on the BUS Study. PLoS One 2016; 11:e0160351. [PMID: 27513926 PMCID: PMC4981306 DOI: 10.1371/journal.pone.0160351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/18/2016] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the cost-effectiveness of bladder ultrasonography, clinical history, and urodynamic testing in guiding treatment decisions in a secondary care setting for women failing first line conservative treatment for overactive bladder or urgency-predominant mixed urinary incontinence. Design Model-based economic evaluation from a UK National Health Service (NHS) perspective using data from the Bladder Ultrasound Study (BUS) and secondary sources. Methods Cost-effectiveness analysis using a decision tree and a 5-year time horizon based on the outcomes of cost per woman successfully treated and cost per Quality-Adjusted Life-Year (QALY). Deterministic and probabilistic sensitivity analyses, and a value of information analysis are also undertaken. Results Bladder ultrasonography is more costly and less effective test-treat strategy than clinical history and urodynamics. Treatment on the basis of clinical history alone has an incremental cost-effectiveness ratio (ICER) of £491,100 per woman successfully treated and an ICER of £60,200 per QALY compared with the treatment of all women on the basis of urodynamics. Restricting the use of urodynamics to women with a clinical history of mixed urinary incontinence only is the optimal test-treat strategy on cost-effectiveness grounds with ICERs of £19,500 per woman successfully treated and £12,700 per QALY compared with the treatment of all women based upon urodynamics. Conclusions remained robust to sensitivity analyses, but subject to large uncertainties. Conclusions Treatment based upon urodynamics can be seen as a cost-effective strategy, and particularly when targeted at women with clinical history of mixed urinary incontinence only. Further research is needed to resolve current decision uncertainty.
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Affiliation(s)
- Ilias Goranitis
- Health Economics Unit, University of Birmingham, Birmingham, United Kingdom
| | - Pelham Barton
- Health Economics Unit, University of Birmingham, Birmingham, United Kingdom
| | - Lee J. Middleton
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Jonathan J. Deeks
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
- Public Health, Epidemiology and Biostatistics, University of Birmingham, Birmingham, United Kingdom
| | - Jane P. Daniels
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom
| | - Pallavi Latthe
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom
- Birmingham Women’s National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom
| | - Arri Coomarasamy
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom
- Birmingham Women’s National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom
| | - Suneetha Rachaneni
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom
| | - Shanteela McCooty
- Birmingham Women’s National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom
| | - Tina S. Verghese
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, United Kingdom
- Birmingham Women’s National Health Service (NHS) Foundation Trust, Birmingham, United Kingdom
| | - Tracy E. Roberts
- Health Economics Unit, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
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Liu L, Zhao S, Li F, Li E, Kang R, Luo L, Luo J, Wan S, Zhao Z. Effect of 5α-Reductase Inhibitors on Sexual Function: A Meta-Analysis and Systematic Review of Randomized Controlled Trials. J Sex Med 2016; 13:1297-1310. [PMID: 27475241 DOI: 10.1016/j.jsxm.2016.07.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION 5α-Reductase inhibitors (5ARIs) are widely used for the treatment of benign prostatic hyperplasia (BPH) and androgenetic alopecia (AGA). AIM To review all the available data on the effect of 5ARIs on sexual function and assess whether 5ARIs increase the risk of sexual dysfunction. METHODS A systematic search of the literature was conducted using the Medline, Embase, and Cochrane databases. The search was limited to articles published in English and up to October 2015. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Data were analyzed using Stata 12.0. A fixed- or a random-effects model was used to calculate the overall combined risk estimates. Publication bias was assessed using Begg and Egger tests. MAIN OUTCOME MEASURES Sexual dysfunction, erectile dysfunction, and decreased libido. RESULTS After screening 493 articles, 17 randomized controlled trials with 17,494 patients were included. Nine studies evaluated the efficacy of 5ARIs in men with BPH. The other eight reported using 5ARIs in the treatment of men with AGA. The mean age of participants was 60.10 years across all studies. We included 10 trials (6,779 patients) on the efficacy and safety of finasteride, 4 trials (6,222 patients) on the safety and tolerability of dutasteride, and 3 trials (4,493 patients) using finasteride and dutasteride for AGA. The pooled relative risks for sexual dysfunction were 2.56 (95% CI = 1.48-4.42) in men with BPH and 1.21 (95% CI = 0.85-1.72) in men with AGA; those for erectile dysfunction were 1.55 (95% CI = 1.14-2.12) in men with BPH and 0.66 (95% CI = 0.20-2.25) in men with AGA; and those for decreased libido were 1.69 (95% CI = 1.03-2.79) in men with BPH and 1.16 (95% CI = 0.50-2.72) in men with AGA. Estimates of the total effects were generally consistent with the sensitivity analysis. No evidence of publication bias was observed. CONCLUSION Evidence from the randomized controlled trials suggested that 5ARIs were associated with increased adverse effects on sexual function in men with BPH compared with placebo. However, the association was not statistically significant in men with AGA. Well-designed randomized controlled trials are indicated to study further the mechanism and effects of 5ARIs on sexual function.
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Affiliation(s)
- Luhao Liu
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shankun Zhao
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Futian Li
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ermao Li
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Ran Kang
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lianmin Luo
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jintai Luo
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Shawpong Wan
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhigang Zhao
- Department of Urology and Andrology, Minimally Invasive Surgery Center, Guangdong Provincial Key Laboratory of Urology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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Transcutaneous tibial nerve stimulation in the treatment of lower urinary tract symptoms and its impact on health-related quality of life in patients with Parkinson disease: a randomized controlled trial. J Wound Ostomy Continence Nurs 2016; 42:94-9. [PMID: 25549314 DOI: 10.1097/won.0000000000000078] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE A randomized controlled trial study was performed to evaluate the efficacy of transcutaneous tibial nerve stimulation (TTNS) and sham TTNS, in patients with Parkinson disease (PD) with lower urinary tract symptoms (LUTS). DESIGN Randomized controlled trial. SUBJECTS AND SETTINGS Thirteen patients with a diagnosis of PD and bothersome LUTS were randomly allocated to one of the following groups: Group I: TTNS group (n = 8) and group II: Sham group (n = 5). Both groups attended twice a week during 5 weeks; each session lasted 30 minutes. METHODS Eight patients received TTNS treatment and 5 subjects allocated to group II were managed with sham surface electrodes that delivered no electrical stimulation. Assessments were performed before and after the treatment; they included a 3-day bladder diary, Overactive Bladder Questionnaire (OAB-V8), and the International Consultation on Incontinence Quality of Life Questionnaire Short Form (ICIQ-SF), and urodynamic evaluation. RESULTS Following 5 weeks of treatment, patients allocated to TTNS demonstrated statistically significant reductions in the number of urgency episodes (P = .004) and reductions in nocturia episodes (P < .01). Participants allocated to active treatment also showed better results after treatment in the OAB-V8 and ICIQ-SF scores (P < .01, respectively). Urodynamic testing revealed that patients in the active treatment group showed improvements in intravesical volume at strong desire to void (P < .05) and volume at urgency (P < .01) when compared to subjects in the sham treatment group. CONCLUSION These findings suggest that TTNS is effective in the treatment of LUTS in patients with PD, reducing urgency and nocturia episodes and improving urodynamic parameters as well as symptom scores measured by the OAB-V8 and health-related quality-of-life scores measured by the ICIQ-SF.
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Tudor KI, Sakakibara R, Panicker JN. Neurogenic lower urinary tract dysfunction: evaluation and management. J Neurol 2016; 263:2555-2564. [DOI: 10.1007/s00415-016-8212-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 06/18/2016] [Indexed: 12/20/2022]
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Bardsley A. Intermittent catheterisation: an option for managing bladder dysfunction. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2016; 25:S16-8. [PMID: 27172502 DOI: 10.12968/bjon.2016.25.9.s16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alison Bardsley
- Senior Lecturer, Course Director for Non-Medical Prescribing, Coventry University discusses the role of intermittent catheterisation and considerations for health professionals and the individual concerned
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Chughtai B, Forde JC, Thomas DDM, Laor L, Hossack T, Woo HH, Te AE, Kaplan SA. Benign prostatic hyperplasia. Nat Rev Dis Primers 2016; 2:16031. [PMID: 27147135 DOI: 10.1038/nrdp.2016.31] [Citation(s) in RCA: 193] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Benign prostatic hyperplasia (BPH), which causes lower urinary tract symptoms (LUTS), is a common diagnosis among the ageing male population with increasing prevalence. Many risks factors, both modifiable and non-modifiable, can increase the risk of development and progression of BPH and LUTS. The symptoms can be obstructive (resulting in urinary hesitancy, weak stream, straining or prolonged voiding) or irritative (resulting in increased urinary frequency and urgency, nocturia, urge incontinence and reduced voiding volumes), or can affect the patient after micturition (for example, postvoid dribble or incomplete emptying). BPH occurs when both stromal and epithelial cells of the prostate in the transitional zone proliferate by processes that are thought to be influenced by inflammation and sex hormones, causing prostate enlargement. Patients with LUTS undergo several key diagnostic investigations before being diagnosed with BPH. Treatment options for men with BPH start at watchful waiting and progress through medical to surgical interventions. For the majority of patients, the starting point on the treatment pathway will be dictated by their symptoms and degree of bother.
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Affiliation(s)
- Bilal Chughtai
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - James C Forde
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - Dominique Dana Marie Thomas
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - Leanna Laor
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - Tania Hossack
- Department of Urology, Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Henry H Woo
- Department of Urology, Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Alexis E Te
- Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York, USA
| | - Steven A Kaplan
- Department of Urology, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, 625 Madison Avenue, New York, New York 10022, USA
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Biardeau X, Corcos J. Intermittent catheterization in neurologic patients: Update on genitourinary tract infection and urethral trauma. Ann Phys Rehabil Med 2016; 59:125-9. [DOI: 10.1016/j.rehab.2016.02.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/27/2016] [Accepted: 02/28/2016] [Indexed: 12/15/2022]
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146
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Jiménez-Cidre M, Arlandis-Guzmán S. OnabotulinumtoxinA in overactive bladder: Evidence-based consensus recommendations. Actas Urol Esp 2016; 40:139-47. [PMID: 26007622 DOI: 10.1016/j.acuro.2015.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 03/31/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To offer a set of useful recommendations for urologists who are starting to provide treatment of overactive bladders with onabotulinumtoxinA. METHODS A literature search to December 2013 was conducted, as well as a subsequent critical reading of the selected publications. The coordinators prepared a document that was submitted for review by the members of the Spanish Group for the use of Botulinum Toxin in Urology. RESULTS The expert group considered that onabotulinumtoxinA may be used for overactive bladder syndrome with urinary urge incontinence secondary to neurogenic or idiopathic detrusor overactivity for patients for whom conservative treatment and first-line medical treatment has failed, is not tolerated or is contraindicated. Treatment in most cases was performed with local intravesical anesthesia, although it can also be performed under epidural or general anesthesia. Patients must be informed of the possibility of requiring self-catheterization or temporary catheterization. Clinicians should ensure that the patients are capable of performing this catheterization before the treatment is conducted. Patients must also be informed of the need for antibiotic prophylaxis to reduce the risk of urinary tract infections. At least 2 follow-up visits are recommended: the first at days 7-14 after the injection and the second at 2-3 months. Reinjection is indicated when the effect of the treatment decreases. CONCLUSION These guidelines can help clinicians in their daily decisions and limit the potential risks associated with the incorrect use of the drug.
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147
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Cobussen-Boekhorst H, Beekman J, van Wijlick E, Schaafstra J, van Kuppevelt D, Heesakkers J. Which factors make clean intermittent (self) catheterisation successful? J Clin Nurs 2016; 25:1308-18. [DOI: 10.1111/jocn.13187] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Joke Beekman
- Department of Rehabilitation; Sint Maartenskliniek; Ubbergen The Netherlands
| | - Edith van Wijlick
- Department of Urology; Canisius Wilhelmina Hospital; Nijmegen The Netherlands
| | - Judith Schaafstra
- Department of Urology; Canisius Wilhelmina Hospital; Nijmegen The Netherlands
| | - Dirk van Kuppevelt
- Department of Rehabilitation; Sint Maartenskliniek; Ubbergen The Netherlands
| | - John Heesakkers
- Department of Urology; Radboud University Medical Center; Nijmegen The Netherlands
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148
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Çetinel B, Önal B, Can G, Talat Z, Erhan B, Gündüz B. Risk factors predicting upper urinary tract deterioration in patients with spinal cord injury: A retrospective study. Neurourol Urodyn 2016; 36:653-658. [PMID: 26934371 DOI: 10.1002/nau.22984] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 02/05/2016] [Indexed: 11/10/2022]
Abstract
AIMS To determine the risk factors predicting upper urinary tract (UUT) deterioration in patients with spinal cord injury (SCI). METHODS Medical records of 303 SCI patients who referred to the urodynamic unit of a rehabilitation hospital between 1996 and 2003 were retrospectively reviewed. The data included general patient demographics, SCI characteristics, bladder management methods, serum creatinine level, presence of urinary tract infection, indwelling catheter time, radiological findings of upper and lower urinary tract, and video-urodynamic (VUD) findings. Univariate and multivariate analyses were used to determine the risk factors predicting UUT deterioration. ROC analysis was done to determine the cut-off values of detrusor pressure and cystometric bladder capacity volume predicting UUT deterioration. RESULTS Complete data were available on 255 patients. Median patient age was 33 years (18-75). The leading causes of SCI were motor vehicle accidents (40%) and falls (29%). Upper urinary tract deterioration was determined in 63 patients (25%). Abnormal radiological LUT findings, the absence of antimuscarinic drug usage in the history, detrusor pressures greater than 75 cmH2 O and cystometric bladder capacity less than 200 ml were found to be independent risk factors in logistic regression analysis. ROC analysis revealed that values ≥75 cmH2 O for maximum detrusor pressure, <200 ml for bladder capacity, and >6 months for indwelling catheter time were cutoff values for UUT deterioration. CONCLUSION Abnormal radiological LUT findings, the absence of antimuscarinic drug usage, detrusor pressures ≥75 cmH2 O, and cystometric bladder capacity <200 ml were independent risk factors predicting UUT deterioration SCI patients. Neurourol. Urodynam. 36:653-658, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Bülent Çetinel
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Bülent Önal
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Günay Can
- Department of Public Health, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Zübeyr Talat
- Department of Urology, Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | - Belgin Erhan
- Sirinevler 70nci Yıl Physical Therapy and Rehabilitation Hospital, Istanbul, Turkey
| | - Berrin Gündüz
- Sirinevler 70nci Yıl Physical Therapy and Rehabilitation Hospital, Istanbul, Turkey
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149
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Li X, Liao L. Updates of underactive bladder: a review of the recent literature. Int Urol Nephrol 2016; 48:919-30. [DOI: 10.1007/s11255-016-1251-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 02/16/2016] [Indexed: 12/21/2022]
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150
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Ghezzi A, Mutta E, Bianchi F, Bonavita S, Buttari F, Caramma A, Cavarretta R, Centonze D, Coghe GC, Coniglio G, Del Carro U, Ferrò MT, Marrosu MG, Patti F, Rovaris M, Sparaco M, Simone I, Tortorella C, Bergamaschi R. Diagnostic tools for assessment of urinary dysfunction in MS patients without urinary disturbances. Neurol Sci 2016; 37:437-42. [PMID: 26613723 DOI: 10.1007/s10072-015-2415-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/30/2015] [Indexed: 10/22/2022]
Abstract
Many guidelines are available for the management of lower urinary tract symptoms (LUTSs) in multiple sclerosis (MS) patients, but no agreement exists on the best approach for subjects without LUTSs. The objective of this study was to evaluate whether LUTSs can be detected in MS patients asymptomatic for urinary dysfunction, comparing three different tools [measure of post-void residual volume (PRV), bladder diary (BD), a focused questionnaire (IPSS)], and whether disability, disease duration and signs of pyramidal involvement are linked to their subclinical presence. 178 MS patients (118 women) have been included (mean age 41.2 years, mean disease duration 11.3 years, mean EDSS 2.2), and tested with the above-mentioned tools. PRV was abnormal in 14 subjects (7.8%), associated to abnormal findings at IPSS in 3 cases, at BD in 2 cases, at both in 1. BD was abnormal in 37 subjects (20.8%), with concomitant abnormal PRV in 2, abnormal IPSS in 10 cases, abnormal IPSS and BD in 1. IPSS was ≥ 9 in 43 subjects (24.1%). At least one test was abnormal in 76 patients (42.7%): 1 in 57 patients (32.0%), 2 in 17 (9.5%), and 3 tests in 2 (1.1%). Patients with at least one abnormal urinary variable, compared to patients without urinary abnormalities, had a more frequent pyramidal involvement (69.5 vs. 16.8%, χ(2) = 48.6, p < 0.00001), a more frequent occurrence of EDSS ≥2 (83.1 vs. 23.5%, χ(2) = 56.9, p < 0.00001), and a longer disease duration (15.7 ± 7.3 vs. 9.1 ± 7.1, t = 5.7, p < 0.00001). Asymptomatic LUTS were frequent but none of the tests used permitted to better identify asymptomatic patients.
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Affiliation(s)
- A Ghezzi
- Neurologia 2-Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Via Pastori 4, 21013, Gallarate, Italy.
| | - E Mutta
- Neurologia 2-Centro Studi Sclerosi Multipla, Ospedale di Gallarate, Via Pastori 4, 21013, Gallarate, Italy
| | - F Bianchi
- Divisione di Neurologia, Ospedale S. Raffaele Milano, Milan, Italy
| | - S Bonavita
- Clinica Neurologica, Università Federico II Napoli, Naples, Italy
| | - F Buttari
- Clinica Neurologica, Università Tor Vergata, Rome, Italy
| | - A Caramma
- Clinica Neurologica, Università di Catania, Catania, Italy
| | - R Cavarretta
- Centro Sclerosi Multipla, IRCCS Don Gnocchi, Milan, Italy
| | - D Centonze
- Clinica Neurologica, Università Tor Vergata, Rome, Italy
| | - G C Coghe
- Centro Sclerosi Multipla, Ospedale Binaghi, Cagliari, Italy
| | - G Coniglio
- Divisione di Neurologia, Ospedale S. Carlo, Matera, Italy
| | - U Del Carro
- Divisione di Neurologia, Ospedale S. Raffaele Milano, Milan, Italy
| | - M T Ferrò
- Divisione di Neurologia, Ospedale di Cremona, Cremona, Italy
| | - M G Marrosu
- Centro Sclerosi Multipla, Ospedale Binaghi, Cagliari, Italy
| | - F Patti
- Clinica Neurologica, Università di Catania, Catania, Italy
| | - M Rovaris
- Centro Sclerosi Multipla, IRCCS Don Gnocchi, Milan, Italy
| | - M Sparaco
- Clinica Neurologica, Università Federico II Napoli, Naples, Italy
| | - I Simone
- Clinica Neurologica, Università di Bari, Bari, Italy
| | - C Tortorella
- Clinica Neurologica, Università di Bari, Bari, Italy
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