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Werneburg GT, Stoffel JT. Bladder Compliance: How We Define It and Why It Is Important. Urol Clin North Am 2024; 51:209-220. [PMID: 38609193 DOI: 10.1016/j.ucl.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Bladder compliance is the relationship between detrusor pressure and bladder storage volume. We discuss the definition of compliance, how it may be accurately measured, and its clinical relevance. Specifically, we discuss the association between low compliance and upper urinary tract deterioration. We discuss medical and surgical therapies that have been demonstrated to improve compliance and reduce upper tract risk. Finally, we propose a model, which not only considers compliance but also differential pressure between the bladder and ureters, and how this may also be an accurate predictor of upper tract deterioration. We call for further investigation to test this model.
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Affiliation(s)
- Glenn T Werneburg
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - John T Stoffel
- Department of Urology, Neurourology and Pelvic Reconstruction Division, University of Michigan, 3875 Taubman Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
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Chen SF, Kuo HC. Management of spinal cord injury patients with neurogenic lower urinary tract dysfunction using minimally invasive and surgical therapies in Taiwan. Int Urol Nephrol 2024; 56:1205-1216. [PMID: 38036803 DOI: 10.1007/s11255-023-03884-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/06/2023] [Indexed: 12/02/2023]
Abstract
The main problems of neurogenic lower urinary tract dysfunction (NLUTD) in patients with spinal cord injury (SCI) consist of impaired urine storage, impaired bladder emptying, or both. The priorities in the management of SCI-NLUTD should be preservation of renal function, followed by freedom from urinary tract infections and improvement of quality of life. Management of NLUTD in patients with SCI must be based on urodynamic findings rather than clinical evaluations. In the hospital without urodynamic equipment, careful measurement of intravesical pressure and safety functional bladder capacity in conjunction with clinical assessment are also feasible. Identification of high-risk patients is important for preventing urological complications in patients with chronic SCI. The management of NLUTD should start with conservative bladder management and medical treatment. Patients with SCI should be regularly followed up, and any NLUTDs and urological complications should be adequately treated. When surgical intervention is necessary, less invasive and reversible procedures should be considered first, and any unnecessary surgery should be avoided. This article reports the current evidence and expert opinions on the patient-centered bladder management of NLUTD in chronic SCI patients in Taiwan. To avoid renal function deterioration and urological complications, annual active surveillance of bladder and renal function is mandatory, especially for high-risk SCI patients.
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Affiliation(s)
- Sheng-Fu Chen
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University 707, Section 3, Chung-Yang Road, Hualien, Taiwan.
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, and Tzu Chi University 707, Section 3, Chung-Yang Road, Hualien, Taiwan.
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Bladder Management Strategies for Urological Complications in Patients with Chronic Spinal Cord Injury. J Clin Med 2022; 11:jcm11226850. [PMID: 36431327 PMCID: PMC9697498 DOI: 10.3390/jcm11226850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/08/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Neurogenic lower urinary tract dysfunction, common in patients with chronic spinal cord injury, inevitably results in urological complications. To address neurogenic lower urinary tract dysfunction after spinal cord injury, proper and adequate bladder management is important in spinal cord injury rehabilitation, with the goal and priorities of the protection of upper urinary tract function, maintaining continence, preserving lower urinary tract function, improvement of SCI patients' quality of life, achieving compatibility with patients' lifestyles, and decreasing urological complications. This concise review aims to help urologists address neurogenic lower urinary tract dysfunction by focusing on the risks of long-term urological complications and the effects of different bladder management strategies on these complications based on scientifically supported knowledge.
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Zhang HC, Ye X, Yang Y, Liu ZD, Gong YQ, Yang J, Liang GB. Application of urodynamics combined with contrast-enhanced ultrasound in evaluation of the urinary tract in patients with low bladder compliance and vesicoureteric reflux who underwent bladder augmentation alone. Kaohsiung J Med Sci 2022; 38:790-795. [PMID: 35607979 DOI: 10.1002/kjm2.12561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/28/2022] [Accepted: 04/24/2022] [Indexed: 02/05/2023] Open
Abstract
We assessed the use of common urodynamics (CUD) combined with contrast-enhanced ultrasound (CEUS) to investigate the efficacy and durability of sigmoid cystoplasty alone in patients with low bladder compliance associated with vesicoureteric reflux (VUR). In this study, we recruited 25 patients with low bladder compliance and VUR who underwent bladder augmentation without antireflux surgery at our institutions between June 2017 and June 2021. The bladder condition and VUR grade were assessed preoperatively and postoperatively via CUD combined with CEUS. The mean follow-up period was 2.6 years. CUD showed significant improvement in bladder capacity and compliance and a decrease in intravesical pressure after sigmoid cystoplasty. CEUS demonstrated resolution of VUR compared with preoperative assessment. Of the 25 patients who had various degrees of reflux, VUR was eliminated in 18 patients and reduced to a lower grade in the remaining seven patients. CUD combined with CEUS is accurate and safe. They are invaluable and reliable tools for morphological and functional evaluations of the entire urinary tract in patients with low bladder compliance and VUR.
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Affiliation(s)
- Han-Chao Zhang
- Department of Urology, Affiliated Hospital and Clinical Medical College of Chengdu University, Chengdu, Sichuan, China.,Medical College of Soochow University, Suzhou, Jiangsu, China.,Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xin Ye
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Yue Yang
- Department of Urology, Affiliated Hospital and Clinical Medical College of Chengdu University, Chengdu, Sichuan, China.,Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Zheng-Dao Liu
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Ye-Qiong Gong
- Department of Ultrasound, Affiliated Hospital and Clinical Medical College of Chengdu University, Chengdu, Sichuan, China
| | - Jin Yang
- Department of Urology, Affiliated Hospital and Clinical Medical College of Chengdu University, Chengdu, Sichuan, China
| | - Guo-Biao Liang
- Department of Urology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Chen SF, Kuo HC. Interventional management and surgery of neurogenic lower urinary tract dysfunction in patients with chronic spinal cord injury: A urologist's perspective. Low Urin Tract Symptoms 2022; 14:132-139. [PMID: 35233967 DOI: 10.1111/luts.12434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/30/2022]
Abstract
Neurogenic lower urinary tract dysfunction (NLUTD) caused by spinal cord injury (SCI) is challenging for urologists. NLUTD not only affects the quality of life but also endangers the upper urinary tract of patients with chronic SCI. Considering that the bladder and urethral function change with time, regular follow-up of NLUTD is necessary, and any complication should be adequately treated. The first priority of bladder management in patients with chronic SCI manifesting NLUTD should be renal function preservation, followed by the normalization of lower urinary tract function. The quality of life should also be assessed. Patients who have a high risk for impaired renal function should be more frequently identified and investigated. Conservative treatment and pharmacological therapy should be started as early as possible. Intravesical or urethral injections of botulinum toxin A is an alternative treatment for refractory NLUTD. When surgical intervention is necessary, less invasive and reversible procedures should be considered first. Improving patients' quality of life and willingness to undergo bladder management is the most important aspect of treatment.
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Affiliation(s)
- Sheng-Fu Chen
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Banakhar M, Yamani A. In Patients with Neurogenic Detrusor Overactivity and Hinman's Syndrome: Would Intravesical Botox Injections Decrease the Incidence of Symptomatic Urinary Tract Infections. Res Rep Urol 2021; 13:659-663. [PMID: 34513743 PMCID: PMC8421780 DOI: 10.2147/rru.s317361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 08/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To study the effect of intravesical Botox injection on the incidence of recurrent symptomatic UTI in neurogenic bladder patients with detrusor overactivity. Patients and Methods This was a prospective cohort study for patients who received Botox intravesical injection. We included patients with neurogenic bladder with detrusor overactivity and symptomatic recurrent UTI. We compared the number of symptomatic UTIs at six months pre- and post-intravesical Botox injection. Patient files were reviewed for diagnosis, vesico-uretric reflux, hydronephrosis, urodynamic findings pre- and post-injection, and dose of Botox used. Patients were followed for the number of symptomatic UTIs post-Botox injection. Results There were 93 patients diagnosed with neurogenic detrusor overactivity and symptomatic recurrent UTI. Patients were categorized into three categories: Group 1 – adults, Group 2 – pediatrics, Group 3 – non-neurogenic neurogenic bladder (Hinman’s syndrome). Spina bifida was diagnosed in 22 adults (Group 1) and 32 pediatric patients (Group 2). After receiving Botox injection, 75% of all patients (70) had a significant decrease in number of symptomatic UTIs. Urodynamic tests post-injection showed an improvement in bladder capacity, compliance, and detrusor pressure versus baseline in all three groups. Correlation analysis showed significant correlation between decreased symptomatic UTI post-Botox injection and detrusor pressure post-injection as well as bladder compliance; p-value=0.01 and p=0.021, respectively. Conclusion Intravesical Botox injection may decrease incidence of symptomatic UTI in neurogenic detrusor overactivity. This effect seemed to be related to better bladder management.
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Affiliation(s)
- Mai Banakhar
- Urology Department, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed Yamani
- Urology Department, King Abdulaziz University, Jeddah, Saudi Arabia
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D’Ancona CAL, Nunes RLV, Antunes AA, Fraga RD, Mosconi A, Abranches-Monteiro L, Haylen B. Tradução para a língua portuguesa do artigo original em inglês “ The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction”. EINSTEIN-SAO PAULO 2021. [PMCID: PMC8253591 DOI: 10.31744/einstein_journal/2021ae5694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introdução No desenvolvimento da terminologia do trato urinário inferior, devido à sua crescente complexidade, a terminologia para os sintomas e a disfunção do trato urinário inferior masculino e assoalho pélvico precisa ser atualizada, utilizando abordagem específica masculina e por meio de um relatório de consenso clinicamente embasado. Métodos Este relatório combina a contribuição de membros do Standardisation Committee da International Continence Society em um Grupo de Trabalho com especialistas reconhecidos no campo, assistido por muitos julgadores externos. Categorias clínicas centrais apropriadas e uma subclassificação foram desenvolvidas para fornecer uma codificação numérica para cada definição. Um extenso processo de 22 rodadas de revisão interna e externa foi desenvolvido para examinar exaustivamente cada definição, com tomada de decisão por opinião coletiva (consenso). Resultados Um relatório de terminologia para os sintomas e a disfunção do trato urinário inferior e do assoalho pélvico foi desenvolvido, abrangendo cerca de 390 definições/descritores separados. É clinicamente embasado nos diagnósticos mais comuns definidos. A clareza e a facilidade de uso foram os principais objetivos para torná-lo interpretável por profissionais e estagiários em todos os diferentes grupos de especialidades envolvidos na disfunção do trato urinário inferior e do assoalho pélvico masculino. Imagens específicas para homens (ultrassonografia, radiologia, tomografia computadorizada e ressonância magnética) foram um adicional importante, enquanto figuras apropriadas foram incluídas para complementar e ajudar a esclarecer o texto. Conclusões Um relatório de terminologia com base em consenso para sintomas e disfunção do trato urinário inferior e do assoalho pélvico masculino foi produzido visando ser um auxílio significativo para a prática clínica e um estímulo para a pesquisa.
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Herrity AN, Aslan SC, Ugiliweneza B, Mohamed AZ, Hubscher CH, Harkema SJ. Improvements in Bladder Function Following Activity-Based Recovery Training With Epidural Stimulation After Chronic Spinal Cord Injury. Front Syst Neurosci 2021; 14:614691. [PMID: 33469421 PMCID: PMC7813989 DOI: 10.3389/fnsys.2020.614691] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/03/2020] [Indexed: 12/27/2022] Open
Abstract
Spinal cord injury (SCI) results in profound neurologic impairment with widespread deficits in sensorimotor and autonomic systems. Voluntary and autonomic control of bladder function is disrupted resulting in possible detrusor overactivity, low compliance, and uncoordinated bladder and external urethral sphincter contractions impairing storage and/or voiding. Conservative treatments managing neurogenic bladder post-injury, such as oral pharmacotherapy and catheterization, are important components of urological surveillance and clinical care. However, as urinary complications continue to impact long-term morbidity in this population, additional therapeutic and rehabilitative approaches are needed that aim to improve function by targeting the recovery of underlying impairments. Several human and animal studies, including our previously published reports, have documented gains in bladder function due to activity-based recovery strategies, such as locomotor training. Furthermore, epidural stimulation of the spinal cord (scES) combined with intense activity-based recovery training has been shown to produce volitional lower extremity movement, standing, as well as improve the regulation of cardiovascular function. In our center, several participants anecdotally reported improvements in bladder function as a result of training with epidural stimulation configured for motor systems. Thus, in this study, the effects of activity-based recovery training in combination with scES were tested on bladder function, resulting in improvements in overall bladder storage parameters relative to a control cohort (no intervention). However, elevated blood pressure elicited during bladder distention, characteristic of autonomic dysreflexia, was not attenuated with training. We then examined, in a separate, large cross-sectional cohort, the interaction between detrusor pressure and blood pressure at maximum capacity, and found that the functional relationship between urinary bladder distention and blood pressure regulation is disrupted. Regardless of one’s bladder emptying method (indwelling suprapubic catheter vs. intermittent catheterization), autonomic instability can play a critical role in the ability to improve bladder storage, with SCI enhancing the vesico-vascular reflex. These results support the role of intersystem stimulation, integrating scES for both bladder and cardiovascular function to further improve bladder storage.
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Affiliation(s)
- April N Herrity
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Sevda C Aslan
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
| | - Ahmad Z Mohamed
- Department of Urology, University of Louisville, Louisville, KY, United States
| | - Charles H Hubscher
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, United States
| | - Susan J Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States.,Department of Neurological Surgery, University of Louisville, Louisville, KY, United States
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Incidence and predictive factors for developing vesicoureteric reflux in individuals with suprasarcral spinal cord injury: a historical cohort study. Spinal Cord 2020; 59:753-760. [PMID: 33139847 DOI: 10.1038/s41393-020-00573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN A historical cohort study OBJECTIVES: The aim of the study was to examine the incidence of and predictive factors for VUR in individuals with suprasacral spinal cord injury (SCI). SETTING Srinagarind Hospital, Khon Kaen University, Thailand METHODS: Medical records were reviewed for all individuals with SCI and neurogenic bladder admitted for urological check-up between 1996 and 2016. The primary outcome was the cumulative incidence of VUR. The statistical tests used included the Nelson-Aalen Estimator and Cox Proportional Hazard Ratio. Harrell's C concordance statistic was used to evaluate the discrimination ability of the predictive model. RESULTS 293 participants with SCI (102 tetraplegic and 191 paraplegic) were included. Most participants were male (67%), and the median age was 52 years. The overall incidence of VUR was 7.5 cases per 100 person-years (95% CI, 6.15-9.4). In the multivariate analysis, the predictive factors for VUR were: (1) maximum detrusor pressure at first visit ≥ 75 cm of water (HRadj: 2.4 [95% CI: 1.4-4.1]); (2) indwelling urethral catheterization (IUC) (HRadj: 11.1 [95% CI: 3.9-31.7]) and clean intermittent catheterization (CIC) (HRadj: 6.5 [95% CI: 2.2-18.7]); (3) age ≥ 60 years at onset of SCI (HRadj: 1.7 [95% CI: 1.1-2.8]); and, (4) absence of antimuscarinic medication (HRadj: 3.8 [95% CI: 2.4-6.1]). The predictive model had an overall C-index of 0.78. CONCLUSIONS The incidence of VUR was high up to 12 years after SCI. High maximum detrusor pressure, IUC, age ≥ 60 years and absence of antimuscarinic medication were predictive factors for VUR.
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Xu L, Fu C, Zhang Q, Xiong F, Peng L, Liang Z, Chen L, He C, Wei Q. Efficacy of biofeedback, repetitive transcranial magnetic stimulation and pelvic floor muscle training for female neurogenic bladder dysfunction after spinal cord injury: a study protocol for a randomised controlled trial. BMJ Open 2020; 10:e034582. [PMID: 32759239 PMCID: PMC7409967 DOI: 10.1136/bmjopen-2019-034582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 05/14/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Neurogenic bladder dysfunction is prevalent in female patients with spinal cord injury (SCI), and previous guidelines have recommended pelvic floor muscle training (PFMT) for first-line conservative treatment. However, the actual regimen of PFMT varies widely and the single treatment does not satisfy the need of some patients. Therefore, this study aims to provide a detailed rationale and methodology for comparing the effectiveness of PFMT, biofeedback and repetitive transcranial magnetic stimulation (rTMS) as adjunct treatments for neurogenic bladder dysfunction. METHODS AND ANALYSIS This trial is a single-centre randomised controlled trial for female patients with urinary incontinence (UI) in phase of chronic SCI. Eligible participants will be randomised to one of four arms: (1) PFMT, (2) PFMT with biofeedback, (3) PFMT and rTMS and (4) PFMT with biofeedback and rTMS. There will be 44 participants in each arm and all the subjects will undergo 20 treatment sessions, five times a week for 4 weeks. The outcomes will be evaluated at 4 weeks, 3 months and 6 months after randomisation. The primary outcome is the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form, and the secondary outcomes include bladder diary, pelvic floor muscle function and the International Spinal Cord Injury Quality of Life Basic Data Set. ETHICS AND DISSEMINATION The Clinical Research and Biomedical Ethics Committee of the West China Hospital, Sichuan University has approved this trial and the approval number is 2019-885. All participants will be provided written informed consent after verification of the eligibility criteria. The results of this study will be accessible in peer-reviewed publications and be presented at academic conferences. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry (ChiCTR1900026126).
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Affiliation(s)
- Lin Xu
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chenying Fu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Qing Zhang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Feng Xiong
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Lihong Peng
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Zejun Liang
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Li Chen
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Chengqi He
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Quan Wei
- Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
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Reliability of the international spinal cord injury urodynamic basic data set version 1.0. Spinal Cord 2020; 59:613-617. [PMID: 32514061 DOI: 10.1038/s41393-020-0496-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/23/2020] [Accepted: 05/27/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN A cross-sectional study. OBJECTIVE To assess interrater and intrarater reliability of the International Spinal Cord Injury (SCI) Urodynamic Basic Data Set (UBS) version 1.0. SETTING Urodynamic clinic at Maharaj Nakorn Chiang Mai Hospital. METHODS Two raters independently analyzed urodynamic tracings from 50 patients and completed the UBS twice, each test 1 month apart. The interrater and intrarater reliability of this data set were analyzed using Kappa, Weighted Kappa, and the Intraclass correlation coefficient (ICC). RESULTS Of the 50 patients, 72% were male. The mean (SD) age was 48.2 (16.6) years. The median time (IQR) since the injury was 27 months (0-101 months). The interrater reliability of the items of UBS were substantial to almost perfect (0.78-0.99). The intrarater reliability of the first rater was fair to almost perfect (0.37-1.00). The intrarater reliability of the second rater was moderate to almost perfect (0.51-1.00). Relatively low interrater and intrarater reliability were observed in bladder compliance and urethral function items. CONCLUSION The first version of UBS has acceptable interrater and intrarater reliability on most items. Although bladder compliance and urethral function have problematic interrater and intrarater reliability, they have been adjusted in the second version. Due to its simplicity and reliability, UBS is clinically useful for urodynamic assessment in people with SCI.
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Abstract
This article summarizes stroke rehabilitation, with a particular focus on rehabilitation from acute diagnosis to chronic impairments of stroke. The emphasis is on both pharmacologic and nonpharmacologic intervention and interdisciplinary collaboration.
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Affiliation(s)
- Leroy R Lindsay
- Department of Rehabilitation Medicine, Weill Cornell Medical College, 525 East 68th Street, Baker 16, New York, NY 10065, USA.
| | - Diane A Thompson
- Department of Rehabilitation Medicine, Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, 180 Fort Washington Avenue, HP1-199, New York, NY 10032, USA
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medical College, 525 East 68th Street, Baker 16, New York, NY 10065, USA
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Braga A, Serati M, Illiano E, Manassero F, Milanesi M, Natale F, Torella M, Pistolesi D, De Nunzio C, Soligo M, Finazzi Agrò E. When should we use urodynamic testing? Recommendations of the Italian Society of Urodynamics (SIUD). Part 2 - Male and neurogical population. MINERVA UROL NEFROL 2019; 72:187-199. [PMID: 31166102 DOI: 10.23736/s0393-2249.19.03447-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Recent studies in literature, have raised some doubts on the routine use of urodynamic testing. Many physicians and articles recommend a selective use of this tool, considering carefully risks and benefits. These recommendations are intended to guide clinicians in the right selection of the male and neurological patients to submit to a urodynamic evaluation. This is the second part of a previous article regarding the urodynamic recommendations in the female population. We reviewed the literature, regarding the use of UDS in male and neurological population with lower urinary tract symptoms (LUTS). Specifically, we analyzed and compared the guidelines and recommendations of the most important urology and urogynecology international scientific societies. These publications were used to create the evidence basis for characterizing the recommendations to perform urodynamic testing. A panel of 10 experts was composed and Delphi process was followed to obtain the panelist consensus. The final recommendations were approved by the unanimous consensus of the panel and compared with the best practice recommendations available in the literature. The recommendations are provided for diagnosis and management of common LUTS in male and neurological population. This review provides a summary of the most effective utilization of urodynamic studies for the global evaluation of patients with LUTS, and how to use them when really needed, avoiding unnecessary costs and patient inconveniences.
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Affiliation(s)
- Andrea Braga
- Department of Obstetrics and Gynecology, EOC - Beata Vergine Hospital, Mendrisio, Switzerland -
| | - Maurizio Serati
- Department of Obstetrics and Gynecology, Del Ponte Hospital, University of Insubria, Varese, Italy
| | - Ester Illiano
- Division of Urology and Andrology Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Francesca Manassero
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Martina Milanesi
- Department of Urology, AOU Careggi Hospital, University of Florence, Florence, Italy
| | - Franca Natale
- Department of Urogynecology, San Carlo of Nancy Hospital, Rome, Italy
| | - Marco Torella
- Department of Woman, Child and General and Specialized Surgery, Second University of Naples, Naples, Italy
| | - Donatella Pistolesi
- Division of Urology, Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marco Soligo
- Department of Women, Mothers and Neonates, Buzzi Children's Hospital, ASST Fatebenefratelli Sacco, University of Milan, Milan, Italy
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Gürbüz C, Drake MJ. Where can urodynamic testing help assess male lower urinary tract symptoms? Turk J Urol 2019; 45:157-163. [PMID: 30817272 DOI: 10.5152/tud.2019.82783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/05/2018] [Indexed: 01/23/2023]
Abstract
Urodynamic studies assess the function of the bladder and bladder outlet. They are often useful in the assessment and diagnosis of patients presenting with lower urinary tract symptoms (LUTS). The evidence regarding the value and risks of invasive urodynamics remains insufficient. However, men with LUTS who are assessed by invasive urodynamics are more likely to have their management changed and less likely to undergo surgery. This review discusses the role of urodynamic diagnosis and application in the diagnosis and treatment of male LUTS.
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Affiliation(s)
- Cenk Gürbüz
- Department of Urology Medistate Hospital, Beykoz University, İstanbul, Turkey
| | - Marcus J Drake
- Bristol Urological Institute and Bristol Medical School, University of Bristol, Southmead Hospital, Bristol, UK
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15
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D'Ancona C, Haylen B, Oelke M, Abranches-Monteiro L, Arnold E, Goldman H, Hamid R, Homma Y, Marcelissen T, Rademakers K, Schizas A, Singla A, Soto I, Tse V, de Wachter S, Herschorn S. The International Continence Society (ICS) report on the terminology for adult male lower urinary tract and pelvic floor symptoms and dysfunction. Neurourol Urodyn 2019; 38:433-477. [PMID: 30681183 DOI: 10.1002/nau.23897] [Citation(s) in RCA: 344] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 11/07/2018] [Indexed: 12/28/2022]
Abstract
INTRODUCTION In the development of terminology of the lower urinary tract, due to its increasing complexity, the terminology for male lower urinary tract and pelvic floor symptoms and dysfunction needs to be updated using a male-specific approach and via a clinically-based consensus report. METHODS This report combines the input of members of the Standardisation Committee of the International Continence Society (ICS) in a Working Group with recognized experts in the field, assisted by many external referees. Appropriate core clinical categories and a subclassification were developed to give a numeric coding to each definition. An extensive process of 22 rounds of internal and external review was developed to exhaustively examine each definition, with decision-making by collective opinion (consensus). RESULTS A Terminology Report for male lower urinary tract and pelvic floor symptoms and dysfunction, encompassing around 390 separate definitions/descriptors, has been developed. It is clinically-based with the most common diagnoses defined. Clarity and user-friendliness have been key aims to make it interpretable by practitioners and trainees in all the different specialty groups involved in male lower urinary tract and pelvic floor dysfunction. Male-specific imaging (ultrasound, radiology, CT, and MRI) has been a major addition whilst appropriate figures have been included to supplement and help clarify the text. CONCLUSIONS A consensus-based Terminology Report for male lower urinary tract and pelvic floor symptoms and dysfunction has been produced aimed at being a significant aid to clinical practice and a stimulus for research.
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Affiliation(s)
| | | | | | | | | | | | - Rizwan Hamid
- University College Hospitals, London, United Kingdom
| | - Yukio Homma
- Japanese Red Cross Medical Centre, Tokyo, Japan
| | | | | | | | - Ajay Singla
- Massachusetts General Hospital, Harvard, Boston
| | - Irela Soto
- Complejo Hospitalario, Panama City, Panama
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16
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Liu Z, Zhou K, Wang Y, Pan Y. Electroacupuncture Improves Voiding Function in Patients with Neurogenic Urinary Retention Secondary to Cauda Equina Injury: Results from a Prospective Observational Study. Acupunct Med 2018; 29:188-92. [PMID: 21984981 DOI: 10.1136/aim.2010.003913] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objective To report the therapeutic effectiveness and feasibility of electroacupuncture (EA) treatment in patients with urinary retention which is caused by cauda equina injury and refractory to conventional conservative treatments. Methods From 9 August 2007 to 10 May 2010 prospective evaluation was carried out in 15 patients with neurogenic urinary retention secondary to cauda equina injury who underwent EA treatment at bilateral points BL32, BL33 and BL35. All patients received five sessions of EA treatment each week for the first 4 weeks, three sessions a week for the following 2 weeks, and then were followed up for 6 months. Voiding abilities, postvoiding residual urine volume (RUV) and maximum urinary flow rate (Qmax) were documented as outcome measures. Results After 6 weeks’ EA treatment, 10/15 enrolled patients regained their self-voiding ability, and the mean postvoiding RUV for all patients decreased by 303.6±148.8 ml. In nine patients with documented data, Qmax increased by 11.0±6.3 ml/s. In nine patients, voiding difficulties changed from severe to mild. At the end of 6 months’ follow-up, 8/10 patients retained their regained self-voiding ability, whereas two patients had lost their voiding ability again. Conclusion The results indicate that the EA treatment may have longlasting therapeutic effectiveness in the management of neurogenic urinary retention secondary to cauda equina injury.
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Affiliation(s)
- Zhishun Liu
- Department of Acupuncture, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Kehua Zhou
- Department of Acupuncture, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Department of Physical Therapy, Daemen College, Amherst, NewYork, USA
| | - Yang Wang
- Department of Acupuncture, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanxia Pan
- Department of Acupuncture, Guang An Men Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
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17
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Pannek J, Kennelly M, Kessler TM, Linsenmeyer T, Wyndaele JJ, Biering-Sørensen F. International spinal cord injury urodynamic basic data set (version 2.0). Spinal Cord Ser Cases 2018; 4:98. [PMID: 30393569 DOI: 10.1038/s41394-018-0133-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 02/07/2023] Open
Abstract
Study design Revision, review, and presentation of the International Spinal Cord Injury (SCI) Urodynamic Basic Data Set (version 2.0). Objectives Describe the revision and review and present the dataset. Setting International. Methods The first version of the dataset was revised according to new knowledge and suggestions. The review included International SCI Data Sets Committee, American Spinal Injury Association (ASIA) board, International Spinal Cord Society (ISCoS) executive and scientific committees, major organizations, and interested individuals. The dataset was also on ASIA and ISCoS websites. All replies were answered and appropriate adjustments made. Finally, the dataset was endorsed by ASIA board, and ISCoS executive and scientific committees. Results Among revisions are adoptions of new terminology by the International Continence Society. The variable "Detrusor function" has been divided into "Detrusor function during filling cystometry" and "Detrusor function during voiding". The response categories have been adjusted, deleting 'Not applicable' for the variables "Detrusor leak point pressure during filling cystometry", "Cystometric bladder capacity during filling cystometry" and "Urethral function during voiding". The cutoff-value for low bladder compliance has been modified from 10 mL/cm H2O to 20 mL/cm H2O. Conclusions The International SCI Urodynamic Basic Data Set (version 2.0) with its complete syllabus is available from http://www.iscos.org.uk/international-sci-data-sets.
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Affiliation(s)
- Jürgen Pannek
- 1Neuro-Urology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Michael Kennelly
- 2Carolinas Rehabilitation, Carolinas Healthcare System, Charlotte, NC USA
| | - Thomas M Kessler
- 3Neuro-Urology, Spinal Cord Injury Center and Research, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Todd Linsenmeyer
- 4Urology Department, Kessler Institute for Rehabilitation, W. Orange, NJ USA.,5Departments Surgery (Urology) and PM&R, Rutgers New Jersey Medical School, Newark, NJ USA
| | | | - Fin Biering-Sørensen
- 7Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Chapple CR, Osman NI, Birder L, Dmochowski R, Drake MJ, van Koeveringe G, Nitti VW, Oelke M, Smith PP, Yamaguchi O, Wein A, Abrams P. Terminology report from the International Continence Society (ICS) Working Group on Underactive Bladder (UAB). Neurourol Urodyn 2018; 37:2928-2931. [DOI: 10.1002/nau.23701] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 04/05/2018] [Indexed: 11/07/2022]
Affiliation(s)
| | - Nadir I. Osman
- Sheffield Teaching Hospitals NHS Foundation Trust; Sheffield United Kingdom
| | - Lori Birder
- Pittsburgh University; Pittsburgh Pennsylvania
| | | | - Marcus J. Drake
- University of Bristol and Bristol Urological Institute; Bristol United Kingdom
| | | | | | | | | | | | - Alan Wein
- University of Philadelphia; Philadelphia Pennsylvania
| | - Paul Abrams
- Bristol Urological Institute; Bristol United Kingdom
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Fan Q, Cavus O, Xiong L, Xia Y. Spinal Cord Injury: How Could Acupuncture Help? J Acupunct Meridian Stud 2018; 11:124-132. [PMID: 29753705 DOI: 10.1016/j.jams.2018.05.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/25/2018] [Accepted: 05/04/2018] [Indexed: 01/02/2023] Open
Abstract
Spinal cord injury (SCI) is one of the most common causes of death and disability worldwide, and it can result in both permanent disability and serial complications in patients. Research shows that patients with SCI complications are often interested in acupuncture for symptomatic relief. Therefore, the issue of physicians advising their patients regarding the use of acupuncture to alleviate SCI complications becomes pertinent. We review and summarize two types of relevant publications: (1) literature concerning acupuncture for SCI and its complications and (2) underlying mechanisms of acupuncture therapy for SCI. Clinical trials and reviews have suggested that acupuncture effectively manages a range of post-SCI complications, including motor and sensory dysfunction, pain, neurogenic bowel and bladder, pressure ulcers, spasticity, and osteoporosis. The effect of acupuncture on post-SCI orthostatic hypotension and sexual dysfunction remains unclear. Decreased oxidative stress, inhibition of inflammation and neuronal apoptosis, regulation of the expression and activity of endogenous biological mediators, and increased regenerative stem cell production are the possible mechanisms of acupuncture therapy for SCI. Although many limitations have been reported in previous studies, given the evidence for the efficacy of acupuncture, we recommend that physicians should support the use of acupuncture therapy for SCI complications.
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Affiliation(s)
- Qianqian Fan
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Omer Cavus
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Lize Xiong
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, PR China.
| | - Yun Xia
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States
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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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22
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Cardiovascular Monitoring During Video Urodynamic Studies in Persons With Spinal Cord Injury. Am J Phys Med Rehabil 2017; 97:1-6. [PMID: 29252405 DOI: 10.1097/phm.0000000000000839] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aims of the study were to observe cardiovascular responses during video urodynamic studies and to identify correlations between autonomic dysreflexia events and video urodynamic study findings in spinal cord injuries. DESIGN Thirty-four persons with spinal cord injury were enrolled and investigated using continuous cardiovascular monitoring during video urodynamic studies. Associations between cardiovascular responses and video study variables were analyzed. RESULTS Bladder type-specific cardiovascular responses occurred during the study. The incidence of overactive detrusor during urodynamic study and bladder trabeculation on voiding cystourethrogram was significantly higher in autonomic dysreflexia persons with spinal cord injury (P < 0.05). Systolic blood pressure changes showed moderate negative correlation (r = -0.402, P = 0.020) with bladder compliance and high positive correlation (r = 0.810, P = 0.000) with maximum detrusor pressure. However, no significant differences in neurological level of injury, injury completeness, autonomic dysreflexia symptoms, and voiding type were found. Spinal cord injury increase at each section was significantly higher in overactive detrusor group (P < 0.05). Significant bradycardia or tachycardia correlating with autonomic dysreflexia during urodynamic studies was not observed. CONCLUSIONS Unpredictable cardiovascular reactions during urodynamic study should be considered carefully in persons with a spinal cord injury above T6. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Describe limitations of previous cardiovascular monitoring during urodynamic study to observe changes in cardiovascular responses; (2) Identify factors contributing to autonomic dysreflexia during urodynamic testing; and (3) Discuss the effect of morphologic features in voiding cystourethrogram including trabeculation and vesicourethral reflux on autonomic dysreflexia. LEVEL Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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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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Ruzhynsky VA, Bitzos S, Goping I, Radomski SB. Comparing a novel hand held device (Peritron+) to standard urodynamics in measuring intravesical pressure. Neurourol Urodyn 2017; 37:1002-1006. [PMID: 29023939 DOI: 10.1002/nau.23373] [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: 04/20/2017] [Accepted: 06/26/2017] [Indexed: 11/05/2022]
Abstract
AIMS Peritron+ is a new handheld device, which can be attached to a urethral catheter to measure intravesical pressures (Pves). The goal of this study was to assess if Pves recorded by standard urodynamics (UDs) are comparable to those recorded by the Peritron+. METHODS Patients with voiding dysfunction and an indication for UD underwent measurement of Pves with nonvideo UD and Peritron+. Pves were recorded at volumes of 50, 100, and 200 mL for the supine and sitting positions. A failure of the Peritron+ was considered to be a discrepancy of Pves values >3 cmH2 O between Peritron+ and UD recordings. Two-way ANOVA was used to assess for statistical significance. P-values < 0.05 were considered significant. RESULTS Ten female patients, mean age 51 years old, were enrolled in the study. The difference in Pves measurements between Peritron+ and UD were ≤3 cmH2 O at all bladder volumes measured in a supine and sitting positions. There were no adverse events and there were no malfunctions of the Peritron+ device during the study. CONCLUSIONS Peritron+ handheld device accurately assessed Pves at different intravesical volumes when compared to UD measurements. The Peritron+ is a simple and safe device, which can be used in the office by a clinician and at home by a patient to monitor Pves and help to select patients who may require standard UD re-evaluation. This will be a valuable tool in managing patients with neurogenic and nonneurogenic bladders who are at a risk of upper urinary tract deterioration.
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Affiliation(s)
| | - Stephanie Bitzos
- Laborie Medical Technologies Canada ULC, Mississauga, Ontario, Canada
| | - Ing Goping
- Laborie Medical Technologies Canada ULC, Mississauga, Ontario, Canada
| | - Sidney B Radomski
- University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
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25
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Toh S, Boswell‐Ruys CL, Lee BSB, Simpson JM, Clezy KR. Probiotics for preventing urinary tract infection in people with neuropathic bladder. Cochrane Database Syst Rev 2017; 9:CD010723. [PMID: 28884476 PMCID: PMC6483743 DOI: 10.1002/14651858.cd010723.pub2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Neuropathic or neurogenic bladder describes a process of dysfunctional voiding as the result of injury in the brain, spinal cord or nerves innervating the bladder. People with neuropathic bladder, such as from spinal cord injury (SCI), are at significant risk of morbidity from urinary tract infections (UTI). Effective methods to prevent UTI in people with SCI have been sought for many years. Probiotics (micro-organisms that exert beneficial health effects in the host) have been recommended for bacterial interference of the urological tract to reduce colonisation by uropathogen and to manage the dual problems of infection and antibiotic resistance. OBJECTIVES This review looked at the benefits and harms of probiotics in preventing symptomatic UTI in people with neuropathic bladder compared with placebo, no therapy, or non-antibiotic prophylaxis (cranberry juice, methenamine hippurate, topical oestrogen). SEARCH METHODS We searched the Cochrane Kidney and Transplant Specialised Register up to 10 March 2017 through contact with the Information Specialist using search terms relevant to this review. Studies in the Specialised Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal, and ClinicalTrials.gov. SELECTION CRITERIA All randomised controlled trials (RCTs), quasi-RCTs and cross-over RCTs looking at the use of probiotics for the prophylaxis of UTI in people with neuropathic bladders was considered for inclusion. Men, women and children of all ages with neuropathic bladders from neurological injury such as suprapontine, supra sacral and sacral aetiologies was included. All bladder management types, including reflex voiding, time voiding, indwelling and intermittent catheterization were eligible for this review.Studies comparing probiotics to placebo, no treatment or other non-antibiotic prophylaxis was included. Studies comparing probiotics with antibiotics or in combination with antibiotics were excluded. DATA COLLECTION AND ANALYSIS Summary estimates of effect were obtained using a random-effects model, and results were expressed as risk ratios (RR) and their 95% confidence intervals (CI) for dichotomous outcomes, and mean difference (MD) or standardised mean difference (SMD) and 95% CI were planned for continuous outcomes. MAIN RESULTS This review includes a total of three studies (one cross-over and two parallel RCTs) which involved 110 participants. All three studies looked at intravesical instillation of a low virulent Escherichia coli (E. coli) strain in reducing the risk of symptomatic UTI in participants with neuropathic bladder, predominantly from SCI. Two studies used the E. coli 83972 strain and one study used the E. coli HU2117 strain.We did not find any RCTs involving other probiotics or other routes of administration for preventing UTI in people with neuropathic bladder.There was consistency in definition of symptomatic UTI in all three studies. Symptoms that all studies considered were relevant to diagnose UTI were adequately defined. All three studies defined microbiological diagnosis of symptomatic UTI.Asymptomatic bacteriuria was not considered an outcome measure in any of the included studies; however it was defined in two studies to establish successful inoculation.It is uncertain if the risk of symptomatic UTI is reduced with bladder inoculation using E. coli because the certainty of the evidence is very low (3 studies, 110 participants: RR 0.32, 95% CI 0.08 to 1.19; I2 = 82%).Two studies reported adverse events. One study reported one episode of autonomic dysreflexia. One study reported three symptomatic UTI occurring in two patients, and two studies mentioned the absence of septicaemia and pyelonephritis. Intravesical instillation was reported as "generally safe". One study reported high attrition rates in participants due to the need to adhere to strict instillation protocols.The overall quality of the studies was poor. All three studies had high risk of attrition bias due to failure of an intention-to-treat analysis which undermines the randomisation process and weakened the results of the studies. All three studies also had high risk of reporting bias. AUTHORS' CONCLUSIONS In this review, there were no studies identified addressing oral probiotics in preventing UTI in people with neuropathic bladder. It is uncertain if the risk of symptomatic UTI is reduced in people with neuropathic bladders via intravesical instillation of non-pathogenic E. coli as data were derived from small studies with high risk of bias.Although very minimal levels of harm was reported with this procedure, due to variable success rates, the need for strict adherence to instillation protocols together with high attrition rates in these studies, it is doubtful bladder instillation will be a widely accepted intervention in its current form.It is recommended that further appropriately powered RCTs with more robust methodological reporting be carried out.
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Affiliation(s)
- Swee‐Ling Toh
- Prince of Wales HospitalSpinal Medicine DepartmentLevel 2, High Street EntranceRandwickNSWAustralia2031
| | | | - Bon San B Lee
- Prince of Wales HospitalSpinal Medicine DepartmentLevel 2, High Street EntranceRandwickNSWAustralia2031
| | - Judy M Simpson
- The University of SydneySydney School of Public HealthEdward Ford Building, A27SydneyNSWAustralia2006
| | - Kate R Clezy
- Prince of Wales HospitalInfectious DiseasesBarker StreetRandwickNSWAustralia2031
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Cheng WM, Huang YH, Chiu AW, Shih CC, Chang YH, Lin AT, Chen KK. Urinary retention after endovascular treatment for aortic aneurysm: A single hospital experience. UROLOGICAL SCIENCE 2017. [DOI: 10.1016/j.urols.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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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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Schurch B, Iacovelli V, Averbeck MA, Carda S, Altaweel W, Finazzi Agrò E. Urodynamics in patients with spinal cord injury: A clinical review and best practice paper by a working group of The International Continence Society Urodynamics Committee. Neurourol Urodyn 2017; 37:581-591. [DOI: 10.1002/nau.23369] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/30/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Brigitte Schurch
- Department of Clinical Neurosciences; Neuropsychology and Neurorehabilitation Service; Vaudois University Hospital of Lausanne; Lausanne Switzerland
| | - Valerio Iacovelli
- Department of Experimental Medicine and Surgery; Unit of Functional Urology; Tor Vergata University Hospital; University of Rome Tor Vergata; Rome Italy
| | | | - Stefano Carda
- Department of Clinical Neurosciences; Neuropsychology and Neurorehabilitation Service; Vaudois University Hospital of Lausanne; Lausanne Switzerland
| | - Waleed Altaweel
- King Faisal Specialist Hospital and Research Centre; Alfaisal University; Riyadh Saudi Arabia
| | - Enrico Finazzi Agrò
- Department of Experimental Medicine and Surgery; Unit of Functional Urology; Tor Vergata University Hospital; University of Rome Tor Vergata; Rome Italy
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Noninvasive Medical Tools for Evaluating Voiding Pattern in Real Life. Int Neurourol J 2017; 21:S10-16. [PMID: 28446014 PMCID: PMC5426433 DOI: 10.5213/inj.1734860.430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 04/10/2017] [Indexed: 11/08/2022] Open
Abstract
Voiding dysfunction is a common disease that contributes to a lower quality of life and has an increased prevalence in the elderly population. Noninvasive and objective methods such as uroflowmetry (UFM) and voiding diaries (VDs) are essential for exact diagnosis and effective treatment of this condition because patients with different causes of voiding dysfunction can complain of the same lower urinary tract symptoms. Further, different treatment options can be determined based on the diagnosis made from these symptoms. In order to improve the quality of UFM and VDs and to provide a convenient testing environment, several advances have been made by previous investigators. In this study, we investigate the history and technological mechanisms of UFM and VDs. We also aim to review UFM from the viewpoint of clinical and at-home uses, including the recently proposed toilet-shaped UFM and electronic VDs.
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Centonze D, Petta F, Versace V, Rossi S, Torelli F, Prosperetti C, Rossi S, Marfia GA, Bernardi G, Koch G, Miano R, Boffa L, Finazzi-Agrò E. Effects of motor cortex rTMS on lower urinary tract dysfunction in multiple sclerosis. Mult Scler 2017; 13:269-71. [PMID: 17439897 DOI: 10.1177/1352458506070729] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We tested the effects of 5-Hz rTMS over the motor cortex in multiple sclerosis (MS) subjects complaining of lower urinary tract symptoms either in the filling or voiding phase. Our data show that motor cortex stimulation for five consecutive days over two weeks ameliorates the voiding phase of the micturition cycle, suggesting that enhancing corticospinal tract excitability might be useful to ameliorate detrusor contraction and/or urethral sphincter relaxation in MS patients with bladder dysfunction. Multiple Sclerosis 2007; 13: 269–271. http://msj.sagepub.com
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Affiliation(s)
- D Centonze
- Dipartimento di Neuroscienze, Clinica Neurologica, Università Tor Vergata, Rome, Italy and Fondazione Santa Lucia IRCCS, Rome, Italy.
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Anding R, Rosier P, Smith P, Gammie A, Giarenis I, Rantell A, Thiruchelvam N, Arlandis S, Cardozo L. When should video be added to conventional urodynamics in adults and is it justified by the evidence? ICI-RS 2014. Neurourol Urodyn 2016; 35:324-9. [PMID: 26872576 DOI: 10.1002/nau.22865] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 08/17/2015] [Indexed: 11/07/2022]
Abstract
AIMS To debate and evaluate the evidence base regarding the added value of video to urodynamics in adults and to define research questions. METHODS In the ICI-RS Meeting 2014 a Think Tank analyzed the current guidelines recommending video urodynamics (VUD) and performed a literature search to determine the level of evidence for the additional value of the imaging with urodynamic assessment of both neurogenic and non-neurogenic lower urinary tract dysfunction. RESULTS Current guidelines do not specify the added value of imaging to urodynamics. Recommendations are based on single center series and expert opinion. Standard imaging protocols are not available and evidence regarding the balance between number and timing of pictures, patient positioning, and exposure time on the one hand and diagnosis on the other hand is lacking. On the basis of expert consensus VUD is relevant in the follow-up of patients with spinal dysraphism. Evidence for the value of VUD in non-neurogenic lower urinary tract dysfunction is sparse. There is some evidence that VUD is not necessary in uncomplicated female SUI, but expert opinion suggests it might improve the evaluation of patients with recurrent SUI. CONCLUSIONS There is only low level evidence for the addition of video to urodynamics. The ICI-RS Think Tank encourages better reporting of results of imaging and systematic reporting of X-ray doses. Specific research hypotheses regarding the added value of imaging are recommended. The panel suggests the development of standards for technically optimal VUD that is practically achievable with machines that are on the market.
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Affiliation(s)
- Ralf Anding
- Department of Neuro-Urology, University Hospital, Bonn, Germany
| | - Peter Rosier
- Department of Urology, University Medical Center Utrecht, Netherlands
| | - Phillip Smith
- Department of Surgery, University Connecticut Health Center, Farmington, Connecticut
| | - Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
| | - Ilias Giarenis
- Department of Urogynaecology, King's College Hospital, London, United Kingdom
| | - Angela Rantell
- Department of Urogynaecology, King's College Hospital, London, United Kingdom
| | - Nikesh Thiruchelvam
- Department of Urology, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Salvador Arlandis
- Urology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, United Kingdom
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Stothers L, Tsang B, Nigro M, Lazare D, Macnab A. An integrative review of standardized clinical evaluation tool utilization in anticholinergic drug trials for neurogenic lower urinary tract dysfunction. Spinal Cord 2016; 54:1114-1120. [PMID: 27241452 PMCID: PMC5308214 DOI: 10.1038/sc.2016.63] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 02/01/2016] [Accepted: 03/21/2016] [Indexed: 02/08/2023]
Abstract
STUDY DESIGN To review prospective and randomized trials studying anticholinergic therapy for neurogenic bladder in SCI to identify whether trials included standardized clinical evaluation tools and reporting measures now recognized to enhance clinical trial data. METHODS A systematic search via EMBASE, MEDLINE, CENTRAL, CINAHL (Cumulative Index to Nursing and Allied Health Literature), HTA (Health Technology Assessment), CMR (Comprehensive Microbial Resource), HAPI (Health and Psychosocial Instruments) and PsycINFO using the key term spinal cord injury crossed with oxybutynin, tolterodine, darifenacin, solifenacin, fesoterodine, trospium chloride, propiverine, propantheline and anticholinergic(s) for 1946-2015 inclusive. We then collated whether standardized clinical tools, measures and descriptors were used within each study identified: American Spine Injury Association (ASIA) impairment scale; symptom scores validated in SCI; technical methodology for urodynamics/video urodynamics; urinary diaries; and standardized urologic terminology. RESULTS A total of 1225 entries with 610 unique articles were identified, 14 randomized and 16 prospective studies. In 6/30 the population comprised SCI patients with neurogenic bladder alone; the remainder included mixed neurogenic etiologies. Classification using the ASIA impairment scale was used in <10% of studies; none used symptom scores validated in SCI; <50% reported urodynamic test methodology fully, incorporated urinary diaries or used International Continence Society Standardization Subcommittee urinary tract terminology. CONCLUSION Integrative review of trials from 1946 to 2015 identified infrequent use of standardized clinical evaluation tools and reporting measures. Data from future trials evaluating therapies for neurogenic bladder would likely be more applicable to specific SCI patients if current standardized classification and descriptors now available were used consistently: for example, the ASIA scale, symptom scores validated in SCI, standardized urodynamic methodology, urinary diaries and urinary tract terminology. Studies recruiting SCI patients exclusively would also provide additional benefit.
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Affiliation(s)
- L Stothers
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Associate Member Department of Obstetrics and Gynaecology and School of Population and Public Health University of British Columbia, Vancouver, BC, Canada
| | - B Tsang
- St Andrews University, Fife, Scotland, UK
| | - M Nigro
- Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - D Lazare
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - A Macnab
- Department of Urologic Sciences and Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Wyndaele JJ. The management of neurogenic lower urinary tract dysfunction after spinal cord injury. Nat Rev Urol 2016; 13:705-714. [PMID: 27779229 DOI: 10.1038/nrurol.2016.206] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The management of patients with neurogenic bladder has changed substantially over the past decades. Obtaining balanced lower urinary tract function has become possible in most patients, although, urological complications remain among the most serious complications these patients are likely to have and, even today, these can have a negative effect on quality of life. To this extent, patients with spinal cord injury (SCI) are likely to develop neurogenic bladder, and data are available on most aspects of neurogenic bladder in these patients. Data on physiology and pathophysiology form the basis of our understanding of patients' symptoms, and also provide a basis for the management of these patients. The use of conservative, and/or more invasive treatment measures, their complications and measures to prevent these complications, are all important clinical aspects that merit discussion. Considerable progress has been made in the urological management of patients with SCI over the past decades, but opportunities remain to make diagnosis more accurate and therapy more successful.
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Affiliation(s)
- Jean-Jacques Wyndaele
- University of Antwerp, Antwerp, SIRATE32 GCV, Bredabaan 32, 2930 Brasschaat, Belgium
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Krebs J, Wöllner J, Grasmücke D, Pannek J. Long-term course of sacral anterior root stimulation in spinal cord injured individuals: The fate of the detrusor. Neurourol Urodyn 2016; 36:1596-1600. [PMID: 27778371 DOI: 10.1002/nau.23161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 09/21/2016] [Indexed: 11/09/2022]
Abstract
AIMS To investigate the long-term course of the detrusor pressure during sacral anterior root stimulation in spinal cord injury (SCI) patients. METHODS Retrospective evaluation of 111 patients who had undergone sacral deafferentation and implantation of an anterior root stimulator at a single SCI rehabilitation center with a minimum follow-up time of 5 years. RESULTS The median follow-up time was 11.7 years (range 5.0-24.9 years). The maximum detrusor pressure (Pdet_max) during stimulation was higher in men compared to women (P = 0.0004) and decreased over time (P = 0.0006). However, there were no significant (P ≥ 0.06) differences in the median Pdet_max during stimulation between the first measurement time point and any follow-up time point. The Pdet_max during stimulation decreased from 62 cmH2 O (95%CI 57-73 cmH2 O) to 53 cmH2 O (95%CI 47-69 cmH2 O) (P = 0.9). The time had also a significant effect on Pdet_max during the storage phase (P < 0.0001) and bladder compliance (P = 0.0007). The Pdet_max during the storage phase decreased, whereas bladder compliance increased during the follow-up period. There were no significant (P ≥ 0.1) changes over time in bladder capacity, the number of daily stimulations and the residual urine volume after voiding. CONCLUSIONS The detrusor pressure during sacral anterior root stimulation decreases over time in SCI individuals. However, the changes do not seem to be clinically relevant during the first decade after surgery.
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Affiliation(s)
- Jörg Krebs
- Clinical Trial Unit, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Jens Wöllner
- Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Dennis Grasmücke
- Spinal Surgery Orthopaedics, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Jürgen Pannek
- Neurourology, Swiss Paraplegic Centre, Nottwil, Switzerland
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Celebi S, Kuzdan Ö, Özaydın S, Başdaş C, Özaydın İ, Yazıcı M, Sander S. The effect of bladder diverticula on bladder function: An experimental study in rabbits. J Pediatr Surg 2016; 51:1538-42. [PMID: 27041230 DOI: 10.1016/j.jpedsurg.2016.02.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/07/2016] [Accepted: 02/24/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aims to evaluate the effect of bladder diverticula (BD) on bladder function using a rabbit model, based on urodynamic findings. METHODS A total of 32 New Zealand white rabbits were randomly assigned to four groups: (1) sham surgery; (2) a single, 1-cm-diameter BD; (3) a single, large, 3-cm-diameter BD; and (4) four (multi) 1-cm-diameter BD. Urodynamic evaluations were performed preoperatively, and 1week and 1month postoperatively, to measure the postmicturition residual (PMR), maximum bladder capacity (MBC), filling and voiding detrusor pressure (Pdet), compliance, and unstable detrusor contractions. At the end of the study, the animals were sacrificed and assessed for pathologic evaluation and stone formation. RESULTS In groups 3 and 4, the rabbits all had PMR. At 30days postsurgery, the MBC was found to be 28% and 31% lower than the reference range in groups 3 and 4 and compliance was decreased (p<0.05). Further, the filling Pdet was significantly higher for large and multiple BD than in the 1-cm diverticula or sham groups (6.33±1.73, 4±1.26, p=0.0001). Groups 3 (62%) and 4 (50%) had unstable detrusor contractions. There was also a muscular/collagen ratio increase in the large and multiple BD groups. Four rabbits in the large group and one rabbit in the multiple BD group exhibited stone formation. CONCLUSIONS Large or multiple BD can alter bladder storage and emptying, and can decrease the capacity of the bladder and reduce its elasticity. Large or multiple bladder diverticula can lead to involuntary contractions, causing dysfunctional voiding.
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Affiliation(s)
- Süleyman Celebi
- Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Surgery, Turkey.
| | - Özgür Kuzdan
- Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Surgery, Turkey
| | - Seyithan Özaydın
- Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Surgery, Turkey
| | - Cemile Başdaş
- Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Surgery, Turkey
| | - İpek Özaydın
- Kanuni Sultan Suleyman Education and Research Hospital, Department of Pathology, Turkey
| | - Mehmet Yazıcı
- Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Surgery, Turkey
| | - Serdar Sander
- Kanuni Sultan Suleyman Education and Research Hospital, Department of Pediatric Urology, Turkey
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Hascoet J, Manunta A, Brochard C, Arnaud A, Damphousse M, Menard H, Kerdraon J, Journel H, Bonan I, Odent S, Fremond B, Siproudhis L, Gamé X, Peyronnet B. Outcomes of intra-detrusor injections of botulinum toxin in patients with spina bifida: A systematic review. Neurourol Urodyn 2016; 36:557-564. [PMID: 27187872 DOI: 10.1002/nau.23025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 03/30/2016] [Indexed: 12/11/2022]
Abstract
CONTEXT Bladder management in spina bifida patients relies on clean intermittent catheterization and oral antimuscarinics with a significant failure rate. The efficacy of intradetrusor injections of botulinum toxin has been confirmed in patients with spinal cord injury or multiple sclerosis but not in patients with myelomeningocele. OBJECTIVE To conduct a systematic review of current evidence regarding the efficacy of intra-detrusor injections of Botulinum Toxin A (BTX-A) in spina bifida patients with neurogenic detrusor overactivity (NDO) refractory to antimuscarinics. METHODS A research has been conducted on Medline and Embase using the keywords: ("spina bifida" OR "myelomeningocele" OR "dysraphism") AND "toxin." The search strategy and studies selection were performed using the PICOS method according to the PRISMA statement. RESULT Twelve published series were included (n = 293 patients). All patients were <18 years old. There was no randomized study comparing BTX-A versus placebo and most studies had no control group. Most studies reported a clinical and urodynamic improvement with resolution of incontinence in 32-100% of patients, a decrease in maximum detrusor pressure from 32 to 54%, an increase of maximum cystometric capacity from 27 to 162%, and an improvement in bladder compliance of 28-176%. Two studies suggested lower efficacy in patients with low compliance bladder compared to those with isolated detrusor overactivity. CONCLUSION Intradetrusor injections of BTX-A could be effective in children with spina bifida but this assumption is not supported by high level of evidence studies. There is no data available in adult patients. Neurourol. Urodynam. 36:557-564, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Andrea Manunta
- Service d'urologie, CHU Rennes, Rennes, France.,Centre de référence spina bifida, CHU Rennes, Rennes, France
| | - Charlène Brochard
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de Gastro-Entérologie, CHU Rennes, Rennes, France.,Equipe thématique INPHY CIC 1414 et INSERM UMR 991, CHU Rennes, Rennes, France
| | - Alexis Arnaud
- Service de chirurgie pédiatrique, CHU Rennes, Rennes, France
| | - Mireille Damphousse
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de médecine physique et réadaptation, CHU Rennes, Rennes, France
| | - Hélène Menard
- Centre de référence spina bifida, CHU Rennes, Rennes, France
| | - Jacques Kerdraon
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Centre de rééducation de Kerpape, Ploemeur, France
| | - Hubert Journel
- Centre de référence spina bifida, CHU Rennes, Rennes, France
| | - Isabelle Bonan
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de médecine physique et réadaptation, CHU Rennes, Rennes, France
| | - Sylvie Odent
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de génétique, CHU Rennes, Rennes, France
| | - Benjamin Fremond
- Service de chirurgie pédiatrique, CHU Rennes, Rennes, France.,Centre de référence spina bifida, CHU Rennes, Rennes, France
| | - Laurent Siproudhis
- Centre de référence spina bifida, CHU Rennes, Rennes, France.,Service de Gastro-Entérologie, CHU Rennes, Rennes, France.,Equipe thématique INPHY CIC 1414 et INSERM UMR 991, CHU Rennes, Rennes, France
| | - Xavier Gamé
- Département d'Urologie, Transplantation Rénale et Andrologie, CHU Rangueil, Toulouse, France
| | - Benoit Peyronnet
- Service d'urologie, CHU Rennes, Rennes, France.,Centre de référence spina bifida, CHU Rennes, Rennes, France.,Equipe thématique INPHY CIC 1414 et INSERM UMR 991, CHU Rennes, Rennes, France
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de Tayrac R, Haylen B, Deffieux X, Hermieu J, Wagner L, Amarenco G, Labat J, Leroi A, Billecocq S, Letouzey V, Fatton B. Traduction française de la terminologie commune International Urogynecological Association (IUGA)/International Continence Society (ICS) sur les troubles de la statique pelvienne chez la femme initialement publiée dans Int Urogynecol J 2010;21(1):5–26. Prog Urol 2016; 26:197-225. [DOI: 10.1016/j.purol.2016.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 01/04/2016] [Indexed: 11/24/2022]
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Samijn B, Van Laecke E, Renson C, Hoebeke P, Plasschaert F, Vande Walle J, Van den Broeck C. Lower urinary tract symptoms and urodynamic findings in children and adults with cerebral palsy: A systematic review. Neurourol Urodyn 2016; 36:541-549. [DOI: 10.1002/nau.22982] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/05/2016] [Indexed: 01/23/2023]
Affiliation(s)
- Bieke Samijn
- Department of Uro-Gynaecology; Ghent University; Ghent Belgium
- Department of Rehabilitation Sciences and Physiotherapy; Ghent University; Ghent Belgium
| | - Erik Van Laecke
- Department of Uro-Gynaecology; Ghent University; Ghent Belgium
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | | | - Piet Hoebeke
- Department of Uro-Gynaecology; Ghent University; Ghent Belgium
- Department of Urology; Ghent University Hospital; Ghent Belgium
| | - Frank Plasschaert
- Department of Orthopaedic Surgery; Ghent University Hospital; Ghent Belgium
| | - Johan Vande Walle
- Department of Pediatric Nephrology and Rheumatology; Ghent University Hospital; Ghent Belgium
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Paes FGDS, Salgado Filho N, Neto da Silva MAC, Lima HCM, Ferreira DAP, Brandão Nascimento MDDS, Costa MDRDSR. Effect of urinary incontinence on the quality of life of asthmatic women. J Asthma 2016; 53:553-8. [PMID: 26786665 DOI: 10.3109/02770903.2015.1108439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Urinary incontinence (UI) has been associated with chronic respiratory symptoms, and it affects quality of life. This study evaluated the quality of life of asthmatic patients from the Assistance Program for Asthmatic Patients (PAPA) with and without UI. METHODS This is an analytical descriptive cross-sectional study using a sample of 358 women with asthma. Data were collected via the International Consultation Incontinence Questionnaire-Simplified Form (ICIQ-SF), Quality of Life in Asthma Questionnaire (QLAQ-ASTHMA) and Short Form 36 Health Survey (SF-36). RESULTS We found a general prevalence of UI of 55.3%. Overall quality of life scores in the SF-36 and QLAQ-ASTHMA were not related to the presence of UI. However, the amount of urine lost was significantly correlated with the subdomains physical aspects, general health, social functioning and mental health of the SF-36 and with socioeconomic and psychosocial domains of the QLAQ-ASTHMA. CONCLUSIONS Urinary incontinence may affect a large proportion of older women with asthma. This study demonstrates the importance of routinely evaluating the occurrence of UI in order to improve the quality of life of asthmatic patients.
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Intradetrusorial Botulinum Toxin in Patients with Multiple Sclerosis: A Neurophysiological Study. Toxins (Basel) 2015; 7:3424-35. [PMID: 26343721 PMCID: PMC4591651 DOI: 10.3390/toxins7093424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/18/2015] [Accepted: 08/19/2015] [Indexed: 11/17/2022] Open
Abstract
Patients with multiple sclerosis (MS) often complain of urinary disturbances characterized by overactive bladder syndrome and difficulties in bladder emptying. The aim of the study was to investigate the pathophysiology of bladder dysfunction and the neurophysiological effects of intradetrusorial incobotulinum toxin A (BoNT/A) in patients with MS having both brain and spinal MS-related lesions. Twenty-five MS patients with neurogenic detrusor overactivity (NDO) underwent clinical evaluation and soleus Hoffmann reflex (H reflex) study during urodynamics. Of the 25 patients, 14 underwent a further session one month after intradetrusorial BoNT/A injection. Eighteen healthy subjects acted as the control. In healthy subjects, the H reflex size significantly decreased at maximum cystometric capacity (MCC), whereas in MS patients with NDO, the H reflex remained unchanged. In the patients who received intradetrusorial BoNT/A, clinical and urodynamic investigations showed that NDO improved significantly. Volumes at the first, normal and strong desire to void and MCC increased significantly. Despite its efficacy in improving bladder symptoms and in increasing volumes for first desire, normal and strong desire to void, BoNT/A left the H reflex modulation during bladder filling unchanged. In the MS patients we studied having both brain and spinal MS-related lesions, the H reflex size remained unchanged at maximum bladder filling. Since this neurophysiological pattern has been previously found in patients with spinal cord injury, we suggest that bladder dysfunction arises from the MS-related spinal lesions. BoNT/A improves bladder dysfunction by changing bladder afferent input, as shown by urodynamic findings on bladder filling sensations, but its effects on H reflex modulation remain undetectable.
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Liao L. Evaluation and Management of Neurogenic Bladder: What Is New in China? Int J Mol Sci 2015; 16:18580-600. [PMID: 26266405 PMCID: PMC4581261 DOI: 10.3390/ijms160818580] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Revised: 07/23/2015] [Accepted: 07/23/2015] [Indexed: 11/16/2022] Open
Abstract
Neurogenic bladder (NB) or neurogenic lower urinary tract dysfunction (NLUTD), a dysfunction of the urinary bladder and urethra due to disease of the central nervous system or peripheral nerves, is a major global medical and social problem. Numerous nervous system abnormalities, such as: stroke, Alzheimer's and Parkinson's diseases, traumatic spinal cord injury, spinal cord tumors, congenital spina bifida, and diabetes, can cause NB/NLUTD. There are two major types of bladder control problems associated with NB/NLUTD: the bladder becomes either overactive or underactive depending on the nature, level, and extent of nerve damage. This review specifically focuses on the diagnosis and management of NB/NLUTD in China as well as on recent efforts to treat this disease.
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Affiliation(s)
- Limin Liao
- Department of Urology, China Rehabilitation Research Center, Beijing 100068, China.
- Department of Urology, Capital Medical University, Beijing 100069, China.
- Center of Neural Injury and Repair, Beijing Institute for Brain Disorders, Beijing 100068, China.
- Beijing Key Laboratory of Neural Injury and Rehabilitation, Beijing 100068, China .
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Juho YC, Wu ST, Meng E, Tsao CW, Cha TL, Yu DS, Sun GH, Ma CP, Chang SY, Tang SH. Self-catheterization of urinary bladder complicated with extraperitoneal abscess that mimics an infected bladder diverticulum. UROLOGICAL SCIENCE 2014. [DOI: 10.1016/j.urols.2014.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Sacral neuromodulation for neurogenic bladder and bowel dysfunction with multiple symptoms secondary to spinal cord disease. Spinal Cord 2014; 53:204-208. [PMID: 25224602 DOI: 10.1038/sc.2014.157] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Revised: 07/24/2014] [Accepted: 08/05/2014] [Indexed: 01/10/2023]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVES The primary aim was to assess the clinical effects of sacral neuromodulation (SNM) for neurogenic bladder and/or bowel dysfunction with multiple symptoms secondary to spinal cord disease or injury. SETTING Beijing, China. METHODS Between 2011 and 2013, 23 patients with multiple bladder and/or bowel problems secondary to spinal cord disease or injury were treated with a preliminary test SNM. If at least 50% clinical improvement occurred, then the patient underwent a permanent SNM procedure. We evaluated the patients using a bladder diary, post-void residual volume measurement and the Wexner questionnaire score for constipation before the test phase, during the test phase and after the permanent SNM. RESULTS In the test phase, the rate of improvement in dysuria (29.4%) was significantly lower than urgency frequency (64.7%), urinary incontinence (69.2%) and constipation (75.0%). An implant was performed in 13 (56.5%) patients, including 4 patients who still used intermittent catheterization to exclude urine after permanent SNM because the symptom of dysuria could not be improved significantly and 1 patient who achieved ⩾50% improvement in lower urinary tract dysfunction but not in constipation. During follow-up (17.5±2.0 months), 1 patient (7.7%) failed and 1 patient had bilateral vesicoureteral reflux. CONCLUSION Chronic SNM cannot always resolve all the bladder and bowel symptoms secondary to spinal cord disease or injury, but combined with other treatments may help improve multiple symptoms.
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Abstract
INTRODUCTION Neurogenic bladder is one of the most common complications following spinal cord injury (SCI). In China, acupuncture therapy is a common treatment for neurogenic bladder due to SCI, but its effects and safety remain uncertain. A protocol is described for a systematic review to investigate the beneficial effects and safety of acupuncture for neurogenic bladder due to SCI. METHODS AND ANALYSIS Eight databases will be searched from their inception: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, the China National Knowledge Infrastructure (CNKI), the VIP database, the Wanfang database, the China Doctoral Dissertations Full-text Database (CDFD) and the China Master's Theses Full-text Database (CMFD). Any clinical randomised controlled trials (RCTs) and the first period of randomised cross-over studies related to acupuncture for neurogenic bladder due to SCI will be included. Outcomes will include change in urinary symptoms, urodynamic tests, clinical assessment and quality of life (QoL). The incidence of adverse events will be assessed as the safety outcome. Study selection, data extraction and quality assessment will be performed independently by two reviewers. Assessment of risk of bias, data synthesis and subgroup analysis will be carried out using Review Manager software. ETHICS AND DISSEMINATION Ethics approval is not required as this is a protocol for a systematic review. The findings of this systematic review will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER PROSPERO (CRD42014010448).
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Affiliation(s)
- Tao Zhang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Huilin Liu
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Linpeng Wang
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine affiliated to Capital Medical University, Beijing, China
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45
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Clinical guidelines for the diagnosis and management of neurogenic lower urinary tract dysfunction. Tzu Chi Med J 2014. [DOI: 10.1016/j.tcmj.2014.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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46
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Taiwanese Continence Society clinical guidelines for diagnosis and management of neurogenic lower urinary tract dysfunction. UROLOGICAL SCIENCE 2014. [DOI: 10.1016/j.urols.2014.03.003] [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] Open
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47
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Urodynamics for Spinal Cord Injury – How, When, Why. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0225-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Vírseda-Chamorro M, Salinas-Casado J, de la Marta-García M, Esteban-Fuertes M, Méndez S. Comparison of ambulatory versus video urodynamics in patients with spinal cord injury. Spinal Cord 2014; 52:551-5. [DOI: 10.1038/sc.2014.9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 12/24/2013] [Accepted: 01/14/2014] [Indexed: 11/09/2022]
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Bladder management and urological complications in patients with chronic spinal cord injuries in Taiwan. Tzu Chi Med J 2014. [DOI: 10.1016/j.tcmj.2013.09.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Di Filippo M, Proietti S, Gaetani L, Gubbiotti M, Di Gregorio M, Eusebi P, Calabresi P, Sarchielli P, Giannantoni A. Lower urinary tract symptoms and urodynamic dysfunction in clinically isolated syndromes suggestive of multiple sclerosis. Eur J Neurol 2014; 21:648-53. [PMID: 24471827 DOI: 10.1111/ene.12370] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 12/17/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Urinary symptoms associated with multiple sclerosis (MS) are common and negatively impact on quality of life, representing a considerable psychosocial and economic burden, often requiring care and hospitalization. Although the importance of identifying and adequately treating urinary symptoms in MS is now well recognized, there is no information, to date, about the real prevalence and impact of bladder symptoms in patients with clinically isolated syndromes (CISs) suggestive of MS. METHODS The aim of the present study was to investigate, in a cohort of patients with a diagnosis of CIS suggestive of MS, the prevalence of urinary tract symptoms, their impact on quality of life measures and their association with functional urodynamic dysfunctions. Patients underwent a complete neurological and urological visit, urodynamic investigation and the MSQoL-54 questionnaire. RESULTS Twenty-eight consecutive patients presenting with CISs were enrolled in the study; 53.6% of CIS patients reported urinary symptoms, 46.7% reporting irritative symptoms, 33.3% both irritative and obstructive symptoms and 20% obstructive symptoms alone. Urodynamic abnormalities were observed in 57.1% of the CIS patients. In 17.9% of the CIS patients urodynamic dysfunctions were asymptomatic. The presence of urinary symptoms was associated with lower scores on specific quality of life domains, particularly in women with obstructive symptoms. CONCLUSIONS A high prevalence of urinary symptoms and urodynamic dysfunctions in patients with CISs and an association of urinary symptoms with quality of life measures were found. These results highlight the importance of identifying and optimally treating urinary symptoms also at the very early stages of MS.
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Affiliation(s)
- M Di Filippo
- Clinica Neurologica, Università di Perugia, Perugia, Italy
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