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Furrer MA, Kessler TM, Panicker JN. Detrusor Sphincter Dyssynergia. Urol Clin North Am 2024; 51:221-232. [PMID: 38609194 DOI: 10.1016/j.ucl.2024.01.001] [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
Detrusor sphincter dyssynergia (DSD) is defined as a detrusor contraction concurrent with an involuntary contraction of the urethral and/or periurethral striated muscles typically occurring in a patient with a spinal cord lesion above the sacral cord. Consequently, high urethral closure pressures during the detrusor contraction leads to high intravesical voiding pressure and large postvoid residuals, which can lead to significant complications in up to 50% of patients if DSD is not treated and followed-up regularly. DSD treatment options are centered around symptomatic management rather that addressing the underlying causative mechanisms.
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Affiliation(s)
- Marc A Furrer
- Department of Uro-Neurology, National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, Queen Square, London, UK; Department of Urology Inselspital, University of Bern, Bern 3010, Switzerland; Department of Urology, Solothurner Spitäler AG, Kantonsspital Olten, Olten 4600, Switzerland; Department of Urology, Solothurner Spitäler AG, Bürgerspital Solothurn, Solothurn 4500, Switzerland.
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich 8008, Switzerland
| | - Jalesh N Panicker
- Faculty of Brain Sciences, UCL Queen Square Institute of Neurology, University College London, London, WC1N 3BG, UK
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Wu L, Wang F, Zhang J, Zhang C, Zhang P. Comparison of Air-charged Catheter and Water-filled Catheter in Female Urethral Pressure Profile. Urology 2024; 184:45-50. [PMID: 38070833 DOI: 10.1016/j.urology.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 01/01/2024]
Abstract
OBJECTIVE To compared the maximum urethral pressure (Pura@max) and functional urethral length (FUL) obtained with water-filled catheters and air-charged catheters during female urethral pressure profile (UPP) in a retrospective study. PATIENTS AND METHODS One hundred and five female patients were enrolled in our investigation. At Beijing Chao-Yang Hospital, patients who had lower urinary tract dysfunction underwent UPP using a modified UPP equipment. In one UPP, both a water-filled catheter (WFC) and an air-charged catheter (ACC) were employed simultaneously. The paired t test was used to compare the differences between the two systems. Bias and correlations between the two systems were analyzed according to the American Clinical and Laboratory Standardization Institute (CLSI) EP9-A3 recommendations. RESULTS There were 105 female participants in this study. The patients were 55.5 ± 14.2years old on average. By using the ACC and WFC systems, the mean FUL was determined to be 39.7 ± 16.2 mm and 33.9 ± 13.9 mm, respectively. The FUL findings of two systems differed significantly from one another (P < .01), and a linear fit with R2 = 0.94 indicates a strong linear correlation. The findings of the maximum urethral pressure (Pura@max) measurements made by the ACC and WFC systems, respectively, were 134.3 ± 39.1cmH2O and 99.2 ± 27.6cmH2O, are substantially different (P < .01), and the linear fit R2 = 0.67. The Pura@max of two systems did not linearly correlate with one another. CONCLUSION For UPP, ACCs often provide higher readings than WFCs, and there is a significant difference in the readings between the two systems. The pressure values derived from the two systems do not correlate, although the FUL does have a significant linear correlation. Results from the ACC and WFC cannot be used interchangeably.
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Affiliation(s)
- Liyang Wu
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fei Wang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jianzhong Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chaohua Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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van Geelen H, Sand PK. The female urethra: urethral function throughout a woman's lifetime. Int Urogynecol J 2023; 34:1175-1186. [PMID: 36757487 DOI: 10.1007/s00192-023-05469-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/01/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this narrative review is to describe changes in urethral function that occur during a woman's lifetime. Evaluation of urethral function includes measurements of urethral closure pressure, at rest and during stress, leak point pressure, and the detailed study of anatomical and histological changes of the urethral sphincteric mechanism. METHODS A literature search in MEDLINE, PubMed, and relevant journals from 1960 until 2020 was performed for articles dealing with urethral function and the impact of aging, pregnancy, and childbirth, female hormones, and menopausal transition on the urethral sphincteric mechanism. Longitudinal and cross-sectional epidemiological surveys, studies on histological changes in urethral anatomy during aging, and urodynamic data obtained at different points in a woman's lifetime, during pregnancy, after childbirth, as well as the effects of female hormones on urethral sphincter function are reviewed. Relevant studies presenting objective data are analyzed and briefly summarized. RESULTS AND CONCLUSIONS The findings lead one to conclude that a constitutional or genetic predisposition, aging, and senescence are the most prominent etiological factors in the development of urinary incontinence and other pelvic floor disorders. Vaginal childbirth dilates and may damage the compressed pelvic supportive tissues and is invariably associated with a decline in urethral sphincter function. Pregnancy, hormonal alterations, menopausal transition, weight gain, and obesity are at best of secondary influence on the pathology of lower urinary tract dysfunction. The decline of circulating estrogens during menopausal transition may play a role in the transition of fibroblasts to cellular senescence.
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Perrin A, Corcos J. The Utility of Urodynamic Studies in Neuro-Urological Patients. Biomedicines 2023; 11:biomedicines11041134. [PMID: 37189752 DOI: 10.3390/biomedicines11041134] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/01/2023] [Accepted: 04/03/2023] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION The utility of a clinical tool lies in its clinical performance evaluation and describes the relevance and usefulness of that tool in a medical setting. The utility of urodynamic and video-urodynamic studies in the management of specific urodynamic profiles in the diagnosis, treatment, and prognostic approach in neuro-urological patients is the focus of the current review. METHODS For this narrative review, a PubMed® search was performed by cross-referencing the keywords "urodynamics", "neurogenic bladder", "utility", "clinical utility" and "clinical performance" with various terms related to the management of neurogenic lower urinary tract dysfunction. Clinical practice guidelines and landmark reviews from the most renowned experts in the field were also used. ANALYSIS Assessment of the utility of urodynamic study was performed during the diagnostic, therapeutic and prognostic steps of the neuro-urological patients' management. We focused on its clinical performance in the identification and evaluation of several unfavorable events, such as neurogenic detrusor overactivity, detrusor-sphincter dyssynergia, elevated detrusor leak point pressure and the presence of vesico-ureteral reflux, which may be indicators for a higher risk for the development of urological comorbidities. CONCLUSION Despite the paucity of existing literature assessing the utility of urodynamic study-specifically video-urodynamic study-in neuro-urological patients, it does remain the gold standard to assess lower urinary tract function precisely in this patient category. With regard to its utility, it is associated with high clinical performance at every step of management. The feedback on possible unfavorable events allows for prognostic assessment and may lead us to question current recommendations.
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Affiliation(s)
- Andry Perrin
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
| | - Jacques Corcos
- Department of Urology, Jewish General Hospital, McGill University, Montreal, QC H3T 1E2, Canada
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Kumar SJ, Biswas DA. Anatomical Aspects of Neurogenic Bladder and the Approach in Its Management: A Narrative Review. Cureus 2022; 14:e31165. [DOI: 10.7759/cureus.31165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/06/2022] [Indexed: 11/07/2022] Open
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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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Three-Dimensional Urethral Profilometry-A Global Urethral Pressure Assessment Method. Diagnostics (Basel) 2021; 11:diagnostics11040687. [PMID: 33921357 PMCID: PMC8070236 DOI: 10.3390/diagnostics11040687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background: To present a new method of urethral pressure examination, and to evaluate diagnostic capabilities of three-dimensional profilometry, as an alternative to classical urethral profile (UPP). Using five channel catheters and dedicated software, a global urethral pressure image is obtained. The method eliminates the main limitation of classical urethral profilometry, where the catheter orientation determines the pressure picture limited to only one point in the urethral circumference; we observed up to 50% differences in pressure measures depending on the point of urethral circumference where the measurement was taken. Methods: This is a preliminary study containing a method presentation and analysis of the use in varied clinical cases of either healthy patients or patients with lower urinary tract symptoms (LUTS). The article includes a technique and equipment description and a full evaluation of selected cases, including three-dimensional urethral pressure distribution graphics. Results and Conclusions: Three-dimensional profilometry compared to the classical technique is comparable regarding the time, cost, technical difficulty and patient discomfort. At the same time, we obtained much more data on the urethral pressure and its distribution. The results are easy to interpret due to the 3D movable graphics created automatically by the dedicated software.
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Vilos GA, Reyes-MuÑoz E, Riemma G, Kahramanoglu I, Lin LT, Chiofalo B, Lordelo P, Della Corte L, Vitagliano A, Valenti G. Gynecological cancers and urinary dysfunction: a comparison between endometrial cancer and other gynecological malignancies. Minerva Med 2021; 112:96-110. [PMID: 32700863 DOI: 10.23736/s0026-4806.20.06770-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this paper is to provide a narrative overview of the available literature about voiding dysfunction in women with gynecological cancer before and after surgical, chemo- and radiotherapy treatments. Radical surgery, radiotherapy, and chemotherapy may cause lower urinary tract dysfunction such as stress and urge urinary incontinence, and voiding difficulties. However, nerve-sparing radical hysterectomy may be a valid surgical approach in order to reduce bladder innervation impairment and maintain normal urinary function. Also, newer radiotherapy techniques significantly reduce the number of adverse effects, including bladder dysfunction. Pelvic floor muscle physiotherapy and training with biofeedback and urethral bulking agents represent some additional therapies that can be used in oncologically treated patients with urinary symptoms in order to improve a significant aspect of their quality of life. Considering the important impact on the patients' quality of life, a full urogynecological evaluation should be considered as an important part of oncological treatment and follow-up.
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Affiliation(s)
- George A Vilos
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada -
| | - Enrique Reyes-MuÑoz
- Department of Endocrinology, Isidro Espinosa de los Reyes National Institute of Perinatology, Mexico City, Mexico
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, Luigi Vanvitelli University of Campania, Naples, Italy
- Division of Gynecologic Oncology, Department of Women's and Children's Health, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Ilker Kahramanoglu
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cerrahpasa Faculty of Medicine, University of Instanbul, Istanbul, Turkey
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Benito Chiofalo
- Unit of Gynecologic Oncology, Department of Experimental Clinical Oncology, Regina Elena National Cancer Institute, Rome, Italy
| | - Patricia Lordelo
- Centro de Atenção ao Piso Pélvico (CAAP), Division of Physiotherapy, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, Federico II University, Naples, Italy
| | - Amerigo Vitagliano
- Department of Women and Children's Health, University of Padua, Padua, Italy
| | - Gaetano Valenti
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
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The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J 2021; 32:501-552. [PMID: 33416968 PMCID: PMC8053188 DOI: 10.1007/s00192-020-04622-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/16/2020] [Indexed: 01/15/2023]
Abstract
Introduction and hypothesis To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women. Methods For the data sources, a structured search of the peer-reviewed literature (English language; 1960–April 2020) was conducted using predefined key terms in PubMed and Embase. Google Scholar was also searched. Peer-reviewed manuscripts that reported on anatomical, physiological or functional differences between females with signs and/or symptoms consistent with SUI and a concurrently recruited control group of continent females without any substantive urogynecological symptoms. Of 4629 publications screened, 84 met the inclusion criteria and were retained, among which 24 were included in meta-analyses. Results Selection bias was moderate to high; < 25% of studies controlled for major confounding variables for SUI (e.g., age, BMI and parity). There was a lack of standardization of methods among studies, and several measurement issues were identified. Results were synthesized qualitatively, and, where possible, random-effects meta-analyses were conducted. Deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS) and levator ani muscles all appear to be associated with SUI. Meta-analyses showed that observed bladder neck dilation and lower functional urethral length, bladder neck support and maximum urethral closure pressures are strong characteristic signs of SUI. Conclusion The pathology of SUI is multifactorial, with strong evidence pointing to bladder neck and urethral incompetence. While there is also evidence of impaired urethral support and levator ani function, standardized approaches to measurement are needed to generate higher levels of evidence.
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Meng LF, Wang M, Zhang W, Liu XD, Zhang YG. Feasibility of measuring urethral pressure during female midurethral slings: Case report. Medicine (Baltimore) 2020; 99:e21100. [PMID: 32664130 PMCID: PMC7360259 DOI: 10.1097/md.0000000000021100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Stress urinary incontinence (SUI) refers to the involuntary leakage of urine when abdominal pressure increases. Midurethral slings (MUS) have become the main surgical method for treating SUI, but no quantitative standard for the degree of sling tightness during operation exists. We achieved this quantitative measurement using ambulatory urodynamic equipment. PATIENT CONCERNS A 49-year-old woman presented to our hospital with intermittent urine leakage. Five pads were used daily to keep the vulva dry. The preoperative urethral pressure profilometry (UPP) showed that maximum urethral pressure (MUP) was 54 cmH2O and maximum urethral closure pressure (MUCP) was 53 cmH2O. DIAGNOSIS According to the medical history and examination findings, the patient was diagnosed as SUI. INTERVENTIONS The MUS and UPP were performed. OUTCOMES The intraoperative UPP showed that MUP was 29 cmH2O and MUCP was 17 cmH2O. Three months after the operation, the patient was followed up by telephone. The amount of urine pad usage decreased from 5 pads/d to 0 pads/d, reaching the social control standard (0-1 pads/d). The patient's international consultation on incontinence questionnaire short form score decreased from 18 to 5, and their incontinence quality of life score increased from 12.5 to 78.4. The effect of urine control was satisfactory, and no complications occurred.Five months after operation, the patient was reexamined in the outpatient department. The UPP showed that the MUP was 98 cmH2O and the MUCP was 72 cmH2O. The patient still uses 1 pad/day. The international consultation on incontinence questionnaire short form score is 6 and incontinence quality of life score is 79.5. The curative effect is stable. LESSONS MUS has become an effective surgical method for SUI, and the tightness of the sling directly affects the surgical outcome. We have achieved the measurement of urethral pressure during MUS. However, although we found that there is no obvious clinical significance of urethral pressure measurement in MUS operation, future research will benefit from our findings by improving upon our study design to help standardize the clinical diagnosis and treatment of MUS.
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Chen G, Liao L, Wang Y, Ying X. Urodynamic findings during the filling phase in neurogenic bladder patients with or without vesicoureteral reflux who have undergone sacral neuromodulation. Neurourol Urodyn 2020; 39:1410-1416. [DOI: 10.1002/nau.24354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Guoqing Chen
- Department of UrologyChina Rehabilitation Research Center Beijing China
- Department of UrologyCapital Medical University Beijing China
| | - Limin Liao
- Department of UrologyChina Rehabilitation Research Center Beijing China
- Department of UrologyCapital Medical University Beijing China
| | - Yiming Wang
- Department of UrologyChina Rehabilitation Research Center Beijing China
- Department of UrologyCapital Medical University Beijing China
| | - Xiaoqian Ying
- Department of UrologyChina Rehabilitation Research Center Beijing China
- Department of UrologyCapital Medical University Beijing China
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Karmakar D, Dwyer PL, Nikpoor P. Mid‐urethral sling revision for mesh exposure–long‐term outcomes of two surgical techniques from a comparative clinical retrospective cohort study. BJOG 2020; 127:1027-1033. [DOI: 10.1111/1471-0528.16149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Affiliation(s)
- D Karmakar
- Department of Urogynaecology Mercy Hospital for Women Heidelberg Victoria Australia
| | - PL Dwyer
- Department of Urogynaecology Mercy Hospital for Women Heidelberg Victoria Australia
| | - P Nikpoor
- Department of Urogynaecology Mercy Hospital for Women Heidelberg Victoria Australia
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Meng LF, Liu XD, Wang M, Zhang W, Zhang YG. Urethral pressure profilometry in artificial urinary sphincter implantation: A case report. World J Clin Cases 2019; 7:4084-4090. [PMID: 31832412 PMCID: PMC6906567 DOI: 10.12998/wjcc.v7.i23.4084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/30/2019] [Accepted: 11/13/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Artificial urethral sphincter (AUS) implantation is currently the gold standard for treating moderate and severe urinary incontinence. Currently, cuffs are chosen based on the surgeon’s experience, and adjusting cuff tightness is crucial. The T-DOC air-charged catheter has not been proven to be inferior to traditional catheters. We report how intraoperative urethral pressure profilometry is performed using a T-DOC air-charged catheter with ambulatory urodynamic equipment, to guide cuff selection and adjustment.
CASE SUMMARY A 67-year-old man presented to our hospital with complete urinary incontinence following transurethral prostatectomy, using five pads/d to maintain local dryness. Preoperatively, the maximum urethral pressure (MUP) and maximum urethral closure pressure (MUCP) were 52 cmH2O and 17 cmH2O, respectively. An AUS was implanted. Intraoperatively, in the inactivated state, the MUP and MUCP were 53 cmH2O and 50 cmH2O, respectively; in the activated state, they were 112 cmH2O and 109 cmH2O, respectively. The pump was activated 6 wk postoperatively. Re-measurement of the urethral pressure on the same day showed that in the inactivated state, MUP and MUCP were 89 cmH2O and 51 cmH2O, respectively, and in the activated state, 120 cmH2O and 92 cmH2O, respectively. One month after device activation, telephonic follow-up revealed that pad use had decreased from five pads/d to one pad/d, which met the standard for social continence (0-1 pad per day). There were no complications.
CONCLUSION The relationship between intraoperative urethral pressure and urinary continence post-surgery can provide data for standardizing AUS implantation and evaluating efficacy.
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Affiliation(s)
- Ling-Feng Meng
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Xiao-Dong Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Miao Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Wei Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
| | - Yao-Guang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
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Determinants and prognostic value of post-operative maximum urethral closure pressure after artificial urinary sphincter in men. World J Urol 2019; 38:1303-1309. [PMID: 31346759 DOI: 10.1007/s00345-019-02884-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To evaluate the determinants and prognostic value of post-operative maximum urethral closure pressure (MUCP) after AUS implantation in male patients. METHODS The charts of all male patients who had an AUS implantation between 2008 and 2018 at a single center were reviewed retrospectively for an exploratory study. A post-operative urethral profilometry was performed systematically as part of routine daily practice over the study period to assess the post-operative MUCP with the AUS consecutively closed (c-MUCP) and opened (o-MUCP). The difference between c-MUCP and the manufacturer's theoretical pressure objective determined by the pressure regulating balloon (PRB) was calculated (diff-th-MUCP). The primary endpoint was social continence at 3 months defined as 0-1 protection/day. RESULTS Ninety patients were included. The median age was 71 years, and the median follow-up was 50 months. The etiology of incontinence was radical prostatectomy in 84% of cases, and endoscopic prostate surgery in 6.6% of patients. There were 74.4% of patients who were socially continent at 3 months. The c-MCUP was significantly higher in the continent group (53 [42.2, 60.2] vs 62 [58, 70] p = 0.02). The diff-th-MUCP did not differ significantly between the two groups (18 [0, 23] vs 1 [- 2, 7.7] p = 0.29). The c-MUCP was not statistically associated with the risk of revision and/or explantation. CONCLUSION The MUCP after AUS implantation in male patients often differs from the manufacturer's pressure objective. The postoperative c-MUCP might be significantly associated with functional outcomes suggesting that it might be a valuable tool for treatment decision-making. This should be confirmed by larger studies.
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Moser DC, D'ancona CAL, Voris BRI, Lahan D, Jani K, Henry GD. Proposal of a new way to evaluate the external sphincter function prior male sling surgey. Int Braz J Urol 2019; 45:354-360. [PMID: 30735337 PMCID: PMC6541136 DOI: 10.1590/s1677-5538.ibju.2018.0146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 11/17/2018] [Indexed: 11/24/2022] Open
Abstract
Objective: To propose a new way to objectively evaluate the external sphincter function prior to male sling surgery. Materials and Methods: We evaluated the pre-operative sphincter function throughout sphincter pressure at rest (SPAR) and sphincter pressure under contraction (SPUC) obtained throughout urethral profilometry profile (UPP) of 10 consecutive patients (age range, 54-79 years) treated with the retrourethral transobturator sling (RTS) for stress urinary incontinence (SUI) because of prostate surgery. The primary endpoint for surgery success rate was post-operative pad weight test. This was correlated to pre-operative pad test, RT, SPAR and SPUC. Post-operatively patients were classified as continent (no pad use) and those who still were incontinent. Results: Mean SPUC in the continent and incontinent group was respectively 188 + 8.8 (median 185.1, range 181 to 201) and 96.9 + 49.4 (median 109.9, range 35.6 to 163.6) (P = 0.008). Mean 24-hour pad test was 151 + 84.2gm (median 140, range 80 to 245) and 973 + 337.1gm (median 1940, range 550 to 1200) in post-operative continent and incontinent groups respectively (P = 0.008). The repositioning test (RT) was positive in all continent patients except one. The RT was also positive in three incontinence patients (false positive). In all post-operative continent patients SPUC was higher than 180cmH2O and pre-operative pad test was less than 245gm. Conclusions: SPUC seems to be a way for optimizing the sphincter evaluation as well to become a useful tool for patient selection prior to RTS surgery.
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Affiliation(s)
- Daniel Carlos Moser
- Departamento de Cirurgia Urológica, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | | | | | - Daniel Lahan
- Departamento de Cirurgia Urológica, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Kavina Jani
- Department of Urology, Ark-La-Tex Urology, Shreveport, Louisiana, USA
| | - Gerard D Henry
- Departamento de Cirurgia Urológica, Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
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Zhao H, Liao L, Deng H, Wang Y. Differences between water-filled and air-charged urodynamic catheters for determining the urethral pressure profile in neurogenic lower urinary tract dysfunction patients. Neurourol Urodyn 2019; 38:1760-1766. [PMID: 31215070 DOI: 10.1002/nau.24071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/26/2019] [Accepted: 05/27/2019] [Indexed: 12/20/2022]
Abstract
AIM The maximum urethral closure pressure (MUCPs) and functional urethral length (FUL) obtained with water-filled and air-charged catheters during urethral pressure profile (UPP) determination was compared in a single, blind, randomized, and prospective trial. METHODS Thirty-three males with spinal cord injuries and neurogenic lower urinary tract dysfunction underwent UPP determinations using water-filled and air-charged catheters in random order; the patients were unaware of the catheter sequence. The variability of the same type of catheter and the agreement between the different types of catheters were compared. The Pearson correlation coefficient was used to check the correlation between the catheters and the Bland-Altman method was used to verify the agreement. RESULT The intraclass correlation coefficients for MUCPs and FULs determined using water-filled and air-charged catheters were 0.89, 0.75, 0.94, and 0.78, respectively. The interclass correlation coefficients for MUCPs and FULs between the two catheters were 0.43 and 0.28, respectively. Bland-Altman plots suggested that the values measured by air-charged catheters were significantly higher than water-filled catheters (mean difference, 26.0 and 2.4 cmH2 O, respectively). There were wide 95% limits of agreement (-54.0 to 106.0 and -0.3 to 5.1 cmH 2 O, respectively) that exceeded the clinical range for differences in MUCP and FUL. CONCLUSION Air-charged catheters usually give higher readings than water-filled catheters for UPP. Agreement between water-filled and air-charged catheters was not good. Nevertheless, the catheter type which is more relevant to the disease requires further study.
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Affiliation(s)
- Haitao Zhao
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, China
| | - Limin Liao
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, China
| | - Han Deng
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, China
| | - Yue Wang
- Department of Urology, China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing, China
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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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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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19
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Urethral Pressure Measurement as a Tool for the Urodynamic Diagnosis of Detrusor Sphincter Dyssynergia. Int Neurourol J 2019; 22:268-274. [PMID: 30599498 PMCID: PMC6312974 DOI: 10.5213/inj.1836178.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 10/11/2018] [Indexed: 11/08/2022] Open
Abstract
Purpose To describe a technique for urodynamic diagnosis of detrusor sphincter dyssynergia (DSD) using urethral pressure measurements and examine potential associations between urethral pressure and bladder physiology among patients with DSD. Methods Multiple sclerosis (MS) and spinal cord injured (SCI) patients with known DSD diagnosed on videourodynamics (via electromyography or voiding cystourethrography) were retrospectively identified. Data from SCI and MS patients with detrusor overactivity (DO) without DSD were abstracted as control group. Urodynamics tracings were reviewed and urethral pressure DSD was defined based on comparison of DSD and control groups. Results Seventy-two patients with DSD were identified. Sixty-two (86%) had >20 cm H2O urethral pressure amplitude during detrusor contraction. By comparison, 5 of 23 (22%) of control group had amplitude of >20 cm H2O during episode of DO. Mean duration of urethral pressure DSD episode was 66 seconds (range, 10–500 seconds) and mean urethral pressure amplitude was 73 cm H2O (range, 1–256 cm H2O). Longer (>30 seconds) DSD episodes were significantly associated with male sex (81% vs. 50%, P=0.013) and higher bladder capacity (389 mL vs. 219 mL, P=0.0004). Urethral pressure amplitude measurements during DSD were not associated with significant urodynamic variables or neurologic pathology. Conclusions Urethral pressure amplitude of >20 cm H2O during detrusor contraction occurred in 86% of patients with known DSD. Longer DSD episodes were associated with larger bladder capacity. Further studies exploring the relationship between urethral pressure measurements and bladder physiology could phenotype DSD as a measurable variable rather than a categorical observation.
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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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21
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Clausen I, Tvedt LGW, Hellandsvik A, Rognlien DKW, Glott T. An in vivo MEMS sensor system for percutaneous measurement of urinary bladder. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2017:1857-1860. [PMID: 29060252 DOI: 10.1109/embc.2017.8037208] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An in vivo sensor system for direct measurement of pressure in the human urinary bladder is developed. The core component in the system is a small-sized and highly sensitive piezoresistive MEMS pressure sensor element integrated in a sensor catheter. The sensor catheter is wired to an external module for biasing, sampling, conversion and storage of sensor measurements. Our solution provides a target sensor placed directly into the urinary bladder and a reference sensor placed outside the bladder wall through a suprapubic and minimally invasive technique. Physiological recordings through natural filling and emptying cycles of the bladder are achievable. The case report from the first 17-hours investigation in a patient is presented in this paper. It reveals that the procedure was successful and no complications occurred. The patient expressed good experience during the participation. A functionality test shows that the percutaneous pressure sensor system responds immediately to external pressure stimuli.
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22
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Lower Urinary Tract Symptoms in Elderly Population With Multiple Sclerosis. Int Neurourol J 2018; 22:58-64. [PMID: 29609425 PMCID: PMC5885135 DOI: 10.5213/inj.1835054.527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/22/2018] [Indexed: 12/29/2022] Open
Abstract
Purpose The aim of this study is to compare the clinical and urodynamic characteristics of urinary disorders in multiple sclerosis (MS) patients in a geriatric population with a nongeriatric population. Methods This study was conducted retrospectively between 2010 and 2016. Each patient with MS aged 65 and older was matched with 2 patients with MS aged less than 65 in sex, form of MS, and Expended Disability Status Scale (EDSS). Demographic data, urinary symptoms, treatment, quality of life, repercussion of lower urinary tract symptoms on daily life activities and psychological state and urodynamic parameters were collected. Differences between the 2 populations were evaluated using Student test, chi-square, or Fischer tests. Results Twenty-four patients with MS aged 65 and older (mean age, 69.8 years) were matched with 48 patients aged less than 65 years (mean age, 49.4 years). Maximum urethral closure pressure was lower in the elderly population than in the nongeriatric population (mean±standard deviation [SD]: 35.6±18.5 cm H<sub>2</sub>O vs. 78.2±52.3 cm H<sub>2</sub>O, P<0.001). In the male population, there was no statistical difference in any other clinical or urodynamic endpoints. In the female population, voiding symptoms was more described in the nongeriatric population (Urinary Symptom Profile low stream: 3.4±3.5 vs. 1.7±2.4, P=0.04), geriatric population had less urinary treatment (P=0.05). LUTS had less impact on quality of life (Qualiveen: 1.4±1.0 vs. 2.1±0.9, P=0.02) on the geriatric population than in the nongeriatric of female MS patients. Conclusions Geriatric population of MS has few differences of urinary disorders compared to a nongeriatric population with EDSS, sex, and MS form equal. However, the psychological impact of these urinary disorders is less important in female geriatric population.
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23
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Schaefer W. Re: Klünder et al: High definition urethral pressure profilometry: Evaluating a novel microtip catheter and Klünder et al: Assessing the reproducibility of high definition urethral pressure profilometry and its correlation with an air-charged system. Neurourol Urodyn 2017; 36:2184-2187. [DOI: 10.1002/nau.23233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 11/08/2022]
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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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Kirschner-Hermanns R, Anding R, Rosier P, Birder L, Andersson KE, Djurhuus JC. Fundamentals and clinical perspective of urethral sphincter instability as a contributing factor in patients with lower urinary tract dysfunction--ICI-RS 2014. Neurourol Urodyn 2016; 35:318-23. [PMID: 26872575 PMCID: PMC4760427 DOI: 10.1002/nau.22815] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 06/08/2015] [Indexed: 01/02/2023]
Abstract
Aims Urethral pathophysiology is often neglected in discussions of bladder dysfunction. It has been debated whether “urethral sphincter instability,” referred to based on observed “urethral pressure variations,” is an important aspect of overactive bladder syndrome (OAB). The purpose of this report is to summarize current urethral pathophysiology evidence and outline directions for future research based on a literature review and discussions during the ICI‐RS meeting in Bristol in 2014. Methods Urethral pathophysiology with a focus on urethral pressure variation (UPV) was presented and discussed in a multidisciplinary think tank session at the ICI_R meeting in Bristol 2014. This think tank session was based on collaboration between physicians and basic science researchers. Results Experimental animal studies or studies performed in clinical series (predominantly symptomatic women) provided insights into UPV, but the findings were inconsistent and incomplete. However, UPV is certainly associated with lower urinary tract symptoms (likely OAB), and thus, future research on this topic is relevant. Conclusions Future research based on adequately defined clinical (and urodynamic) parameters with precisely defined patient groups might shed better light on the cause of OAB symptoms. Further fundamental investigation of urethral epithelial–neural interactions via the release of mediators should enhance our knowledge and improve the management of patients with OAB. Neurourol. Urodynam. 35:318–323, 2016. © 2016 The Authors. Neurourology and Urodynamics published by Wiley Periodicals, Inc.
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Affiliation(s)
- Ruth Kirschner-Hermanns
- Neuro-Urologie, University Clinic Friedrich-Wilhelms-University Bonn and Neurologic Rehabilitation Center Godeshoehe, Germany
| | - Ralf Anding
- Neuro-Urologie, University Clinic Friedrich-Wilhelms-University Bonn and Neurologic Rehabilitation Center Godeshoehe, Germany
| | - Peter Rosier
- Department of Urology, University Medical Centre Utrecht, the Netherlands
| | - Lori Birder
- Departments of Medicine and Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Karl Erik Andersson
- Faculty of Health Sciences, Institut for Klinisk Medicin, Aarhus Universitet, Denmark.,AIAS, Aarhus Institute of Advanced Studies, Aarhus University, Denmark
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Rosier PF, Schaefer W, Lose G, Goldman HB, Guralnick M, Eustice S, Dickinson T, Hashim H. International Continence Society Good Urodynamic Practices and Terms 2016: Urodynamics, uroflowmetry, cystometry, and pressure-flow study. Neurourol Urodyn 2016; 36:1243-1260. [DOI: 10.1002/nau.23124] [Citation(s) in RCA: 257] [Impact Index Per Article: 32.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/13/2016] [Indexed: 01/11/2023]
Affiliation(s)
- Peter F.W.M Rosier
- Department of Urology; University Medical Center Utrecht; Utrecht The Netherlands
| | - Werner Schaefer
- Department of Medicine (Geriatrics); University of Pittsburgh; Pittsburgh Pennsylvania
| | - Gunnar Lose
- University of Copenhagen Herlev Hospital; Herlev Denmark
| | - Howard B. Goldman
- Glickman Urologic and Kidney Institute Cleveland Clinic; Lerner College of Medicine; Cleveland Ohio
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Comparison of Perineal Sonographically Measured and Functional Urodynamic Urethral Length in Female Urinary Incontinence. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4953091. [PMID: 27819004 PMCID: PMC5081444 DOI: 10.1155/2016/4953091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/29/2016] [Accepted: 09/08/2016] [Indexed: 11/23/2022]
Abstract
Objectives. To detect the anatomical insufficiency of the urethra and to propose perineal ultrasound as a useful, noninvasive tool for the evaluation of incontinence, we compared the anatomical length of the urethra with the urodynamic functional urethral length. We also compared the urethral length between continent and incontinent females. Methods. 149 female patients were enrolled and divided into four groups (stress, urge, or mixed incontinence; control). Sonographically measured urethral length (SUL) and urodynamic functional urethral length (FUL) were analyzed statistically. Standardized and internationally validated incontinence questionnaire ICIQ-SF results were compared between each patient group. Results. Perineal SUL was significantly longer in incontinent compared to continent patients (p < 0.0001). Pairwise comparison of each incontinent type (stress, urge, or mixed incontinence) with the control group showed also a significant difference (p < 0.05). FUL was significantly shorter in incontinent patients than in the control group (p = 0.0112). But pairwise comparison showed only a significant difference for the stress incontinence group compared with the control group (p = 0.0084) and not for the urge or mixed incontinent group. No clear correlation between SUL, FUL, and ICIQ-SF score was found. Conclusions. SUL measured by noninvasive perineal ultrasound is a suitable parameter in the assessment of female incontinence, since incontinent women show a significantly elongated urethra as a sign of tissue insufficiency, independent of the type of incontinence.
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Klünder M, Amend B, Sawodny O, Stenzl A, Ederer M, Kelp A, Sievert KD, Feuer R. Assessing the reproducibility of high definition urethral pressure profilometry and its correlation with an air-charged system. Neurourol Urodyn 2016; 36:1292-1300. [PMID: 27574912 DOI: 10.1002/nau.23115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 08/18/2016] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Recently, a new urodynamic method for the assessment of stress urinary incontinence called high definition urethral pressure profilometry (HD-UPP) has been introduced. This method combines a novel microtip catheter with advanced signal processing to enable spatial data location and the reconstruction of a pressure image inside the urethra. In order to assess the reproducibility of HD-UPP data, we statistically evaluate HD-UPP datasets and compare them to data from a double balloon air-charged system. MATERIALS AND METHODS Both catheters are used on sedated female minipigs. Data from the microtip catheter are processed through a signal reconstruction algorithm, urodynamic features are extracted, and compared to the air-charged system. Reproducibility of HD-UPP data is assessed by statistically evaluating consecutive, intra-individual datasets. RESULTS HD-UPP delivers results in agreement with previous comparisons of microtip and air-charged systems. The average deviation of two consecutive, intra-individual pressure images is very low at 7 cm H2 O. CONCLUSIONS HD-UPP provides physicians with detailed information on the pressure distribution inside the urethra. Through comparison with an air-charged catheter, it is shown that HD-UPP delivers results in agreement with previous studies on the comparison of microtip and air-charged catheters. It provides excellent reproducibility, as the difference between sequentially measured profiles from the same minipig is significantly lower than the one between profiles from different minipigs.
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Affiliation(s)
- Mario Klünder
- University of Stuttgart, Institute for System Dynamics, Stuttgart, Germany
| | - Bastian Amend
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Oliver Sawodny
- University of Stuttgart, Institute for System Dynamics, Stuttgart, Germany
| | - Arnulf Stenzl
- Department of Urology, University of Tübingen, Tübingen, Germany
| | - Michael Ederer
- University of Stuttgart, Institute for System Dynamics, Stuttgart, Germany
| | - Alexandra Kelp
- Department of Urology, University of Tübingen, Tübingen, Germany
| | | | - Ronny Feuer
- University of Stuttgart, Institute for System Dynamics, Stuttgart, Germany
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Ballouhey Q, Panicker JN, Mazerolles C, Roumiguie M, Zaidi F, Rischmann P, Malavaud B, Game X. Sphingosine Kinase 1 urothelial expression is increased in patients with neurogenic detrusor overactivity. Int Braz J Urol 2016; 41:1141-7. [PMID: 26742972 PMCID: PMC4756940 DOI: 10.1590/s1677-5538.ibju.2014.0676] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 05/04/2015] [Indexed: 01/28/2023] Open
Abstract
Objectives: To evaluate the expression of sphingosine kinase 1 (SPK1) in the bladder wall in patients with neurogenic lower urinary tract dysfunction and its association with clinical, urodynamic and pathological features. Materials and Methods: The expression of SPK1 was studied in bladder wall specimens obtained from cystectomy using immunohistochemistry in ten patients with spinal cord injury (n=8) or multiple sclerosis (n=2) with urodynamically proven neuropathic bladder dysfunction, and in controls (n=5). Inflammation and fibrosis were analysed with histological criteria and SPK1 expression was determined by individual immunohistochemical staining. Results: Significant increased SPK1 urothelial immunoreactivity was shown in patients compared to control group (p=0.03). By contrast, SPK1 immunoreactivity in patients was significantly decreased in the sub-urothelium, muscles and nerves, p=0.02; 0.01 and 0.003, respectively. Patients with neurogenic detrusor overactivity (NDO) had higher SPK1 urothelium expression than those without any DO (p=0.04). Conclusions: SPK1 is expressed in the human bladder wall, specifically the urothelium, in bladder specimens from patients with NDO. The role of SPK1 in the pathophysiology of NDO needs further elucidation.
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Affiliation(s)
| | - Jalesh N Panicker
- Department of Uro-Neurology, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, United Kingdom
| | | | - Mathieu Roumiguie
- INSERM I2MC UMR1048, CHU Rangueil, Toulouse, France 1 Departement d'Urologie, CHU Rangueil, Toulouse, France
| | - Falek Zaidi
- Laboratoire d'Anatomo-pathologie, CHU Rangueil, Toulouse, France
| | - Pascal Rischmann
- Departement d'Urologie, CHU Rangueil, Toulouse, France.,INSERM I2MC UMR1048, CHU Rangueil, Toulouse, France 1 Departement d'Urologie, CHU Rangueil, Toulouse, France
| | - Bernard Malavaud
- Departement d'Urologie, CHU Rangueil, Toulouse, France.,INSERM I2MC UMR1048, CHU Rangueil, Toulouse, France 1 Departement d'Urologie, CHU Rangueil, Toulouse, France
| | - Xavier Game
- Departement d'Urologie, CHU Rangueil, Toulouse, France.,INSERM I2MC UMR1048, CHU Rangueil, Toulouse, France 1 Departement d'Urologie, CHU Rangueil, Toulouse, France
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Lose G, Dwyer PL, Riss P. The standardization of urodynamic reporting in the International Urogynecology Journal. Int Urogynecol J 2016; 27:979-80. [DOI: 10.1007/s00192-016-3044-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
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Sharipova K, Pilsetniece Z, Bekmukhambetov Y, Vjaters E. The Correlation of Urethral Pressure Profilometry Data in Women with Different Types of Urinary Incontinence. Urol Int 2016; 97:218-23. [PMID: 27074045 DOI: 10.1159/000445807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 03/24/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of the study was to analyse the correlation of subjective complaints and urethral pressure profilometry (UPP) data in women with different types of urinary incontinence (UI): stress UI (SUI), urgency UI (UUI), and mixed UI (MixUI). METHODS A study group of 405 women with complaints about UI were surveyed (UDI-6; ICIQ-UI) to determine the subjectively dominant type of UI, and UPP was performed for all these women. The variables analysed by UPP were the maximum urethral closure pressure at rest (MUCPrest), maximum urethral closure pressure at cough stress (MUCPstress), functional urethral length at rest (FULrest), functional urethral length during cough stress (FULstress) test and pressure transmission ratio (PTR). The statistical variation between different groups of UI patients was calculated for all the analysed variables. RESULTS The value of PTR was statistically and significantly higher in the group of patients with isolated UUI, compared to the SUI and MixUI groups. The MUCPrest and MUCPstress values were consistently lower in women with isolated SUI, compared to isolated UUI. The FULrest and FULstress values showed no statistically significant difference between the groups with different types of UI. CONCLUSIONS The PTR value is a result of UPP test that helps in distinguishing objectively between UUI, SUI, and MixUI. The PTR value can be used to characterise the hypermobility of urethra. The MUCPrest and MUCPstress values are consistently lower in women with isolated SUI, compared to those with isolated UUI. MUCP can be used as an objective criterion for differentiation of these 2 groups of patients.
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Affiliation(s)
- Kuralay Sharipova
- Department of Urology, Marat Ospanov West Kazakhstan State Medical University, Aktobe, Kazakhstan
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Vij M, Dua A, Freeman RM. Should maximal urethral closure pressure be performed before midurethral sling surgery for stress incontinence? A time to revisit. Int Urogynecol J 2016; 27:1491-5. [PMID: 27010558 DOI: 10.1007/s00192-016-3007-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 03/07/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Maximum urethral closure pressure (MUCP) provides an objective assessment of urethral integrity, but its role in predicting outcome after midurethral sling (MUS) placement is debatable and current practice in the UK is variable. The study was carried out to determine if lower preoperative MUCP is associated with poor outcome following MUS. METHOD The study was a retrospective review of the British Society of Urogynaecology (BSUG) database and urodynamics (UDS) data. Patients who reported outcome as "no improvement", "worse" or "much worse" on the Patient Global Impression of Improvement (PGII) scale were identified as having a poor outcome. Patients who reported "a little improvement", "improved" and "very much improved" on the PGII were thought to have a good outcome. The preoperative demographics, UDS findings and quality of life (International Consultation of Incontinence questionnaires [ICIQ-SF]) data of the two groups were compared. RESULT A total of 236 women were identified for the study. Of these, 24 women (10.2 %) had a poor outcome. Of the remaining women reporting a good outcome, 50 cases were randomly selected. All urodynamic parameters, including mean functional urethral length (FUL), bladder capacity, and Qmax, were similar, except for mean MUCP 37.05 cm H2O, which was significantly lower in group 1 (poor outcome 37.05 cm H2O) compared with a mean MUCP of 50.6 cm H2O in group 2 (good outcome; p = 0.005). CONCLUSION We conclude that failure following MUS is associated with preoperatively lower MUCP, which can be used as a predictor of failure.
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Klünder M, Sawodny O, Amend B, Ederer M, Kelp A, Sievert KD, Stenzl A, Feuer R. Signal processing in urodynamics: towards high definition urethral pressure profilometry. Biomed Eng Online 2016; 15:31. [PMID: 27000558 PMCID: PMC4802619 DOI: 10.1186/s12938-016-0145-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urethral pressure profilometry (UPP) is used in the diagnosis of stress urinary incontinence (SUI) which is a significant medical, social, and economic problem. Low spatial pressure resolution, common occurrence of artifacts, and uncertainties in data location limit the diagnostic value of UPP. To overcome these limitations, high definition urethral pressure profilometry (HD-UPP) combining enhanced UPP hardware and signal processing algorithms has been developed. In this work, we present the different signal processing steps in HD-UPP and show experimental results from female minipigs. METHODS We use a special microtip catheter with high angular pressure resolution and an integrated inclination sensor. Signals from the catheter are filtered and time-correlated artifacts removed. A signal reconstruction algorithm processes pressure data into a detailed pressure image on the urethra's inside. Finally, the pressure distribution on the urethra's outside is calculated through deconvolution. A mathematical model of the urethra is contained in a point-spread-function (PSF) which is identified depending on geometric and material properties of the urethra. We additionally investigate the PSF's frequency response to determine the relevant frequency band for pressure information on the urinary sphincter. RESULTS Experimental pressure data are spatially located and processed into high resolution pressure images. Artifacts are successfully removed from data without blurring other details. The pressure distribution on the urethra's outside is reconstructed and compared to the one on the inside. Finally, the pressure images are mapped onto the urethral geometry calculated from inclination and position data to provide an integrated image of pressure distribution, anatomical shape, and location. CONCLUSIONS With its advanced sensing capabilities, the novel microtip catheter collects an unprecedented amount of urethral pressure data. Through sequential signal processing steps, physicians are provided with detailed information on the pressure distribution in and around the urethra. Therefore, HD-UPP overcomes many current limitations of conventional UPP and offers the opportunity to evaluate urethral structures, especially the sphincter, in context of the correct anatomical location. This could enable the development of focal therapy approaches in the treatment of SUI.
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Affiliation(s)
- Mario Klünder
- Institute for System Dynamics, University of Stuttgart, Waldburgstr. 17/19, 70563, Stuttgart, Germany.
| | - Oliver Sawodny
- Institute for System Dynamics, University of Stuttgart, Waldburgstr. 17/19, 70563, Stuttgart, Germany
| | - Bastian Amend
- Department of Urology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Michael Ederer
- Institute for System Dynamics, University of Stuttgart, Waldburgstr. 17/19, 70563, Stuttgart, Germany
| | - Alexandra Kelp
- Department of Urology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Karl-Dietrich Sievert
- Department of Urology, Paracelsus Medical University of Salzburg, Müllner Hauptstr. 48, 5020, Salzburg, Austria
| | - Arnulf Stenzl
- Department of Urology, University of Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Ronny Feuer
- Institute for System Dynamics, University of Stuttgart, Waldburgstr. 17/19, 70563, Stuttgart, Germany
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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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Stoffel JT. Detrusor sphincter dyssynergia: a review of physiology, diagnosis, and treatment strategies. Transl Androl Urol 2016; 5:127-35. [PMID: 26904418 PMCID: PMC4739973 DOI: 10.3978/j.issn.2223-4683.2016.01.08] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Detrusor sphincter dyssynergia (DSD) is the urodynamic description of bladder outlet obstruction from detrusor muscle contraction with concomitant involuntary urethral sphincter activation. DSD is associated with neurologic conditions such as spinal cord injury, multiple sclerosis, and spina bifida and some of these neurogenic bladder patients with DSD may be at risk for autonomic dysreflexia, recurrent urinary tract infections, or upper tract compromise if the condition is not followed and treated appropriately. It is diagnosed most commonly during the voiding phase of urodynamic studies using EMG recordings and voiding cystourethrograms, although urethral pressure monitoring could also potentially be used. DSD can be sub-classified as either continuous or intermittent, although adoption of this terminology is not widespread. There are few validated oral pharmacologic treatment options for this condition but transurethral botulinum toxin injection have shown temporary efficacy in reducing bladder outlet obstruction. Urinary sphincterotomy has also demonstrated reproducible long term benefits in several studies, but the morbidity associated with this procedure can be high.
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Affiliation(s)
- John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
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Khayyami Y, Klarskov N, Lose G. The promise of urethral pressure reflectometry: an update. Int Urogynecol J 2016; 27:1449-58. [PMID: 26872643 DOI: 10.1007/s00192-016-2964-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
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Zubieta M, Carr RL, Drake MJ, Bø K. Influence of voluntary pelvic floor muscle contraction and pelvic floor muscle training on urethral closure pressures: a systematic literature review. Int Urogynecol J 2015; 27:687-96. [DOI: 10.1007/s00192-015-2856-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 08/23/2015] [Indexed: 11/24/2022]
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Groen J, Pannek J, Castro Diaz D, Del Popolo G, Gross T, Hamid R, Karsenty G, Kessler TM, Schneider M, 't Hoen L, Blok B. Summary of European Association of Urology (EAU) Guidelines on Neuro-Urology. Eur Urol 2015; 69:324-33. [PMID: 26304502 DOI: 10.1016/j.eururo.2015.07.071] [Citation(s) in RCA: 305] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 07/31/2015] [Indexed: 11/24/2022]
Abstract
CONTEXT Most patients with neuro-urological disorders require life-long medical care. The European Association of Urology (EAU) regularly updates guidelines for the diagnosis and treatment of these patients. OBJECTIVE To provide a summary of the 2015 updated EAU Guidelines on Neuro-Urology. EVIDENCE ACQUISITION Structured literature searches in several databases were carried out to update the 2014 guidelines. Levels of evidence and grades of recommendation were assigned where possible. EVIDENCE SYNTHESIS Neurological disorders often cause urinary tract, sexual, and bowel dysfunction. Most neuro-urological patients need life-long care for optimal life expectancy and quality of life. Timely diagnosis and treatment are essential to prevent upper and lower urinary tract deterioration. Clinical assessment should be comprehensive and usually includes a urodynamic investigation. The neuro-urological management must be tailored to the needs of the individual patient and may require a multidisciplinary approach. Sexuality and fertility issues should not be ignored. Numerous conservative and noninvasive possibilities of management are available and should be considered before a surgical approach is chosen. Neuro-urological patients require life-long follow-up and particular attention has to be paid to this aspect of management. CONCLUSIONS The current EAU Guidelines on Neuro-Urology provide an up-to-date overview of the available evidence for adequate diagnosis, treatment, and follow-up of neuro-urological patients. PATIENT SUMMARY Patients with a neurological disorder often suffer from urinary tract, sexual, and bowel dysfunction and life-long care is usually necessary. The update of the EAU Guidelines on Neuro-Urology, summarized in this paper, enables caregivers to provide optimal support to neuro-urological patients. Conservative, noninvasive, or minimally invasive approaches are often possible.
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Affiliation(s)
- Jan Groen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Jürgen Pannek
- Department of Neuro-Urology, Swiss Paraplegic Center, Nottwil, Switzerland
| | - David Castro Diaz
- Department of Urology, University Hospital of the Canary Islands, Tenerife, Spain
| | - Giulio Del Popolo
- Department of Neuro-Urology, Careggi University Hospital, Florence, Italy
| | - Tobias Gross
- Department of Urology, University of Bern, Inselspital, Bern, Switzerland
| | - Rizwan Hamid
- Department of Neuro-Urology, London Spinal Injuries Centre, Stanmore, UK
| | - Gilles Karsenty
- Department of Urology, Aix Marseille University, Marseille, France
| | - Thomas M Kessler
- Department of Neuro-Urology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Marc Schneider
- Department of Neuro-Urology, Spinal Cord Injury Center, University of Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Lisette 't Hoen
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Bertil Blok
- Department of Urology, Erasmus Medical Center, Rotterdam, The Netherlands
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Klünder M, Amend B, Vaegler M, Kelp A, Feuer R, Sievert KD, Stenzl A, Sawodny O, Ederer M. High definition urethral pressure profilometry: Evaluating a novel microtip catheter. Neurourol Urodyn 2015. [DOI: 10.1002/nau.22835] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Mario Klünder
- Institute for System Dynamics; University of Stuttgart; Stuttgart Germany
| | - Bastian Amend
- Department of Urology; University of Tübingen; Tübingen Germany
| | - Martin Vaegler
- Department of Urology; University of Tübingen; Tübingen Germany
| | - Alexandra Kelp
- Department of Urology; University of Tübingen; Tübingen Germany
| | - Ronny Feuer
- Institute for System Dynamics; University of Stuttgart; Stuttgart Germany
| | | | - Arnulf Stenzl
- Department of Urology; University of Tübingen; Tübingen Germany
| | - Oliver Sawodny
- Institute for System Dynamics; University of Stuttgart; Stuttgart Germany
| | - Michael Ederer
- Institute for System Dynamics; University of Stuttgart; Stuttgart Germany
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Lee JKS, Rosamilia A, Dwyer PL, Lim YN, Muller R. Randomized trial of a single incision versus an outside-in transobturator midurethral sling in women with stress urinary incontinence: 12 month results. Am J Obstet Gynecol 2015; 213:35.e1-35.e9. [PMID: 25637849 DOI: 10.1016/j.ajog.2015.01.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 01/14/2015] [Accepted: 01/26/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate objective and subjective outcomes of MiniArc and Monarc (American Medical Systems, Minnetonka, MN) midurethral sling (MUS) in women with stress incontinence at 12 months. STUDY DESIGN A total of 225 women were randomized to receive MiniArc or Monarc. Women with intrinsic sphincter deficiency, previous MUS, or untreated detrusor overactivity were excluded. Objective cure was defined as negative cough stress test with a comfortably full bladder. Subjective cure was defined as no report of leakage with coughing or exercise on questionnaire. Validated questionnaires, together with urodynamic and clinical cough stress test, were used to evaluate the objective and subjective outcomes following surgery. Participants and clinicians were not masked to treatment allocation. Outcomes were compared with exact binomial tests (eg, Fisher exact test for dichotomous data) for categorical data and Student t tests or exact versions of Wilcoxon tests for numerical data as appropriate. RESULTS There was no statistically significant difference in the subjective (92.2% vs 94.2%; P = .78; difference, 2.0%; 95% confidence interval, -2.7% to +6.7%) or objective (94.4% vs 96.7%; P = .50; difference, 2.3%; 95% confidence interval, -1.5% to +6.1%) cure rates between MiniArc and Monarc at 12 m, respectively, with a significant improvement in overactive bladder outcomes and incontinence impact from baseline in both arms. CONCLUSION MiniArc outcomes are not inferior to Monarc MUS outcomes at 12 months' follow-up in women without intrinsic sphincter deficiency.
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Affiliation(s)
- Joseph K-S Lee
- Department of Urogynecology, Mercy Hospital for Women, Heidelberg, VIC, Australia; Pelvic Floor Clinic, Monash Medical Center, Moorabbin, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia.
| | - Anna Rosamilia
- Pelvic Floor Clinic, Monash Medical Center, Moorabbin, VIC, Australia; Faculty of Medicine, Monash University, Melbourne, VIC, Australia
| | - Peter L Dwyer
- Department of Urogynecology, Mercy Hospital for Women, Heidelberg, VIC, Australia; Faculty of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Yik N Lim
- Department of Urogynecology, Mercy Hospital for Women, Heidelberg, VIC, Australia
| | - Reinhold Muller
- School of Public Health and Tropical Medicine, James Cook University, Townsville, QLD, Australia
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Raimondo D, Arena A, Zannoni L, Spagnolo E, Ferrini G, Seracchioli R. Reply: To PMID 25544711. J Minim Invasive Gynecol 2015; 22:702-3. [PMID: 25700794 DOI: 10.1016/j.jmig.2015.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 02/13/2015] [Indexed: 11/17/2022]
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Tsai PY, Wang CP, Hsieh CY, Tsai YA, Yeh SC, Chuang TY. Long-Term Sacral Magnetic Stimulation for Refractory Stress Urinary Incontinence. Arch Phys Med Rehabil 2014; 95:2231-8. [DOI: 10.1016/j.apmr.2014.07.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 06/24/2014] [Accepted: 07/10/2014] [Indexed: 11/25/2022]
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Spagnolo E, Zannoni L, Raimondo D, Ferrini G, Mabrouk M, Benfenati A, Villa G, Bertoldo V, Seracchioli R. Urodynamic Evaluation and Anorectal Manometry Pre- and Post-operative Bowel Shaving Surgical Procedure for Posterior Deep Infiltrating Endometriosis: A Pilot Study. J Minim Invasive Gynecol 2014; 21:1080-5. [DOI: 10.1016/j.jmig.2014.05.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 05/24/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
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Bing MH, Gimbel H, Greisen S, Paulsen LB, Soerensen HC, Lose G. Clinical risk factors and urodynamic predictors prior to surgical treatment for stress urinary incontinence: a narrative review. Int Urogynecol J 2014; 26:175-85. [PMID: 25248411 DOI: 10.1007/s00192-014-2489-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 08/06/2014] [Indexed: 12/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Knowledge about clinical risk factors and the value of urodynamic testing is important to optimize treatment strategy and secure true informed consent. METHODS We reviewed the relevant literature to clarify the evidence regarding clinical risk factors and the predictive value of urodynamic testing in patients with urinary incontinence, where surgery is considered. Because of the paucity of evidence based on randomized controlled trials, we conducted a narrative review of the published literature. RESULTS Clinical risk factors in terms of mixed urinary incontinence, previous incontinence surgery, body mass index (BMI) ≥ 35, age ≥ 75, and presence of diabetes mellitus were significantly related to decreased outcome of incontinence surgery. Furthermore, noninvasive and invasive urodynamic parameters indicating detrusor overactivity, voiding difficulties, low urethral pressure, and bladder-neck immobility were related to poorer outcome of surgery. CONCLUSIONS This study summarized the available evidence regarding preoperative clinical risk factors and urodynamic parameters indicating decreased or adverse outcome of surgery, and this report also provides clinical recommendations.
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Affiliation(s)
- Mette Hornum Bing
- Department Gynecology/Obstetrics, Herlev University Hospital, Herlev, Denmark,
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Awada HK, Fletter PC, Zaszczurynski PJ, Cooper MA, Damaser MS. Conversion of urodynamic pressures measured simultaneously by air-charged and water-filled catheter systems. Neurourol Urodyn 2014; 34:507-12. [DOI: 10.1002/nau.22633] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 04/17/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Hassan K. Awada
- Department of Biomedical Engineering; The Cleveland Clinic; Cleveland Ohio
- Advanced Platform Technology Center; Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Cleveland Ohio
| | - Paul C. Fletter
- Advanced Platform Technology Center; Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Cleveland Ohio
| | - Paul J. Zaszczurynski
- Advanced Platform Technology Center; Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Cleveland Ohio
| | - Mitchell A. Cooper
- Department of Biomedical Engineering; The Cleveland Clinic; Cleveland Ohio
- Advanced Platform Technology Center; Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Cleveland Ohio
| | - Margot S. Damaser
- Department of Biomedical Engineering; The Cleveland Clinic; Cleveland Ohio
- Advanced Platform Technology Center; Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Cleveland Ohio
- Glickman Urological & Kidney Institute; The Cleveland Clinic; Cleveland Ohio
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Transurethral injection of polyacrylamide hydrogel (Bulkamid®) for the treatment of female stress or mixed urinary incontinence. Eur J Obstet Gynecol Reprod Biol 2014; 178:199-202. [DOI: 10.1016/j.ejogrb.2014.03.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 03/20/2014] [Accepted: 03/31/2014] [Indexed: 11/22/2022]
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Gammie A, Bosch R, Djurhuus JC, Goping I, Kirschner-Hermanns R. Do we need better methods of assessing urethral function: ICI-RS 2013? Neurourol Urodyn 2014; 33:587-90. [PMID: 24838441 DOI: 10.1002/nau.22606] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/14/2014] [Indexed: 11/07/2022]
Abstract
AIMS To assess whether current methods of urethral function assessment are sufficient for clinical requirement. METHODS A summary of the debate held at the 2013 meeting of the International Consultation on Incontinence Research Society, with subsequent analysis by the authors. RESULTS All reported methods of assessment were reviewed and a summary of reported efficacy and clinical application for each is given. Every method of assessment has limitations as to its use, and in some cases the methods have yet to be proved reliable. CONCLUSIONS A gap exists between clinical requirements and the capacity of current urethral function assessments to assist diagnosis. Recommendations are therefore made for future research topics.
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Affiliation(s)
- Andrew Gammie
- Bristol Urological Institute, Southmead Hospital, Bristol, United Kingdom
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YONO M, OTANI M, ITO K, INOUE Y, FURUKAWA K, HORI M, TSUJI S, TANAKA T, SAKATA Y, IRIE S. Effect of Duloxetine on Urethral Resting Pressure and on Sphincter Contractility in Response to Coughing and Magnetic Stimulation in Healthy Women. Low Urin Tract Symptoms 2014; 7:93-8. [DOI: 10.1111/luts.12057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 01/15/2014] [Accepted: 02/02/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Makoto YONO
- Department of Clinical Pharmacology; Nishi-Kumamoto Hospital, Medical Co. LTA; Kumamoto Japan
- Department of Urology; Nishi-Kumamoto Hospital, Medical Co. LTA; Kumamoto Japan
| | - Masayuki OTANI
- Department of Urology; Nishi-Kumamoto Hospital, Medical Co. LTA; Kumamoto Japan
| | - Kazuya ITO
- Department of Clinical Pharmacology; Sumida Hospital, Medical Co. LTA; Tokyo Japan
| | - Yumi INOUE
- Department of Clinical Pharmacology; Nishi-Kumamoto Hospital, Medical Co. LTA; Kumamoto Japan
| | - Kohichiro FURUKAWA
- Department of Clinical Pharmacology; Nishi-Kumamoto Hospital, Medical Co. LTA; Kumamoto Japan
| | - Masaharu HORI
- Department of Clinical Pharmacology; Nishi-Kumamoto Hospital, Medical Co. LTA; Kumamoto Japan
| | - Shigeki TSUJI
- Department of Clinical Pharmacology; Nishi-Kumamoto Hospital, Medical Co. LTA; Kumamoto Japan
| | - Takanori TANAKA
- Department of Clinical Pharmacology; Nishi-Kumamoto Hospital, Medical Co. LTA; Kumamoto Japan
| | - Yukikuni SAKATA
- Department of Clinical Pharmacology; Nishi-Kumamoto Hospital, Medical Co. LTA; Kumamoto Japan
| | - Shin IRIE
- Department of Clinical Pharmacology; Nishi-Kumamoto Hospital, Medical Co. LTA; Kumamoto Japan
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Liao L, Schaefer W. Quantitative quality control during urodynamic studies with TVRs for cystometry in men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Int Urol Nephrol 2014; 46:1301-8. [PMID: 24557685 DOI: 10.1007/s11255-014-0668-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 02/07/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To establish typical value ranges (TVRs) and to outline their role in urodynamic quality control. METHODS Five hundred and eighty-two data sets of free flow, filling cystometry, and voiding from 181 males in a strictly quality-controlled study were analyzed for intravesical pressure (Pves), abdominal pressure (Pabd), and detrusor pressure (Pdet) before, at the beginning and end of filling, and after voiding. Cystometric capacity, maximum flow rate (Qmax), voided volume (Vvoid), and compliance were determined. Mean value, standard deviation, median, and various TVRs were calculated. Technical errors related to the TVRs are classified and examples given. RESULTS TVRs for initial resting Pves, Pabd, and Pdet were 31-42, 28-39, and 0-4 cmH₂O, respectively. Various technical errors are classified as type I: normal initial Pdet, both Pves and Pabd are incorrect; type II: negative initial Pdet; and type III: initial Pdet too high. The incidences of I, II, and III errors were 9.8, 4.5, and 1.4%, respectively. The TVRs for maximum cystometric capacity and compliance were 157-345 mL and 26.7-70.8 mL/cmH₂O; Qmax, Pdet, and Vvoid were 5.5-9 mL/s, 57-92 cmH₂O, and 167-315 mL, respectively; Qmax and Vvoid in free flow were 8-9.2 mL/s and 167-301 mL, respectively. After voiding, two errors were found: type V (Pves and Pdet after voiding still high) and type VI (Pves and Pdet negative). CONCLUSIONS TVRs in urodynamics are indispensable and effective tools for quantitative plausibility checks and quality control. They are sensitive and reliable indicators for correct measurement and a relevant contribution to a collection of normal values.
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Affiliation(s)
- Limin Liao
- Department of Urology, China Rehabilitation Research Center, Rehabilitation School of Capital Medical University, 10 Jiaomen Beilu, Fengtai District, Beijing, 100068, China,
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50
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McCoin JL, Bhadra N, Brose SW, Gustafson KJ. Does patterned afferent stimulation of sacral dermatomes suppress urethral sphincter reflexes in individuals with spinal cord injury? Neurourol Urodyn 2014; 34:219-23. [DOI: 10.1002/nau.22545] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 11/15/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Jaime L. McCoin
- Neural Engineering Center; Department of Biomedical Engineering; Case Western Reserve University; Wickenden Building, Room 114, 10900 Euclid Avenue Cleveland Ohio 44106
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Cleveland Ohio
| | - Narendra Bhadra
- Neural Engineering Center; Department of Biomedical Engineering; Case Western Reserve University; Wickenden Building, Room 114, 10900 Euclid Avenue Cleveland Ohio 44106
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Cleveland Ohio
| | - Steven W. Brose
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Cleveland Ohio
- Case Western Reserve University, Department of PM+R; Cleveland Ohio
- Ohio University Heritage College of Osteopathic Medicine; Athens Ohio
| | - Kenneth J. Gustafson
- Neural Engineering Center; Department of Biomedical Engineering; Case Western Reserve University; Wickenden Building, Room 114, 10900 Euclid Avenue Cleveland Ohio 44106
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center; Cleveland Ohio
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