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Milligan F, Whittingham C, Granitsitotis V, Simpson H, Woodfield J, Carson A, Stone J, Hoeritzauer I. Chronic idiopathic urinary retention: Comorbidity and outcome in 102 individuals. J Psychosom Res 2024; 181:111663. [PMID: 38643683 DOI: 10.1016/j.jpsychores.2024.111663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 04/04/2024] [Accepted: 04/04/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES Chronic Idiopathic urinary retention is poorly understood. One small study suggests higher than expected rates of functional neurological disorder and pain comorbidity which may have implications for understanding the disorder. We investigated the frequency of functional neurological disorder, chronic pain other medical and psychiatric comorbidity, triggers of urinary retention, results of urodynamic assessment, medication history, management, and outcome in patients with chronic idiopathic urinary retention. METHODS A consecutive retrospective electronic notes analysis was undertaken of patients with chronic idiopathic urinary retention presenting to a secondary care urology clinic between Jan 2018-Jan 2021, with follow-up to their most recent urological appointment. RESULTS 102 patients were identified (mean age of 41.9 years, 98% female). 25% had functional neurological disorder (n = 26), most commonly limb weakness (n = 19, 19%) and functional seizures (n = 16, 16%). Chronic pain (n = 58, 57%) was a common comorbidity. Surgical and medical riggers to urinary retention were found in almost half of patients (n = 49, 48%). 81% of patients underwent urodynamic assessment (n = 83). Most frequently no specific abnormality was reported (n = 30, 29%). Hypertonic urethral sphincter was the most identified urodynamic abnormality (n = 17, 17%). We noted high levels of opioid (n = 50, 49%) and benzodiazepine (n = 27, 26%) use. Urinary retention resolved in only a small number of patients (n = 6, 6%, median follow up 54 months), in three cases spontaneously. CONCLUSION This preliminary data suggests idiopathic urinary retention is commonly comorbid with functional neurological disorder, and chronic pain, suggesting shared mechanisms.
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Affiliation(s)
- Fintan Milligan
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | | | - Voula Granitsitotis
- Centre for Clinical Brain Sciences, University of Edinburgh, UK; Department of Urology, Royal Victoria Hospital Kirkcaldy, UK.
| | - Helen Simpson
- Department of Urology, Western General Hospital, UK.
| | - Julie Woodfield
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, UK.
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Rosier PFWM, Gammie A, Valdevenito JP, Speich J, Smith P, Sinha S. ICS-SUFU standard: Theory, terms, and recommendations for pressure-flow studies performance, analysis, and reporting. Part 2: Analysis of PFS, reporting, and diagnosis. Neurourol Urodyn 2023; 42:1603-1627. [PMID: 37139677 DOI: 10.1002/nau.25187] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/04/2023] [Indexed: 05/05/2023]
Abstract
AIMS The Working Group (WG), initiated by the International Continence Society (ICS) Standardisation Steering Committee and supported by the Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction, has revised the ICS Standard for pressure-flow studies of 1997. METHODS Based on the ICS standard for developing evidence-based standards, the WG developed this new ICS standard in the period from May 2020 to December 2022. A draft was posted on the ICS website in December 2022 to facilitate public discussion and the comments received have been incorporated into this final release. RESULTS The WG has recommended analysis principles for the diagnosis of voiding dysfunction for adult men and women without relevant neurological abnormalities. New standard terms and parameters for objective and continuous grading of urethral resistance (UR), bladder outflow obstruction (BOO) and detrusor voiding contraction (DVC) are introduced in this part 2 of the standard. The WG has summarized the theory and recommendations for the practice of pressure-flow study (PFS) for patients in part 1. A pressure-flow plot is recommended for the diagnosis of every patient, in addition to time-based graphs. Voided percentage and post void residual volume should always be included in PFS analysis and diagnosis. Only parameters that represent the ratio or subtraction of pressure and synchronous flow are recommended to quantify UR and only parameters that combine pressure and flow in a product or sum are recommended to quantify DVC. The ICS BOO index and the ICS detrusor contraction index are introduced in this part 2 as the standard. The WG has suggested clinical PFS dysfunction classes for male and female patients. A pressure-flow scatter graph including every patient's pdet at maximum flow (pdetQmax ) with maximum flow rate (Qmax ) point should be included in all scientific reports considering voiding dysfunction. CONCLUSION PFS is the gold standard used to objectively assess voiding function. Quantifying the dysfunction and grading of abnormalities are standardized for adult males and females.
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Affiliation(s)
- Peter F W M Rosier
- Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrew Gammie
- Department of Urology Clinical Research, Bristol Urological Institute, Bristol, UK
| | | | - John Speich
- Department of Mechanical and Nuclear Engineering, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Phillip Smith
- Department of Surgery, UConn Health School of Medicine, Farmington, Connecticut, USA
| | - Sanjay Sinha
- Department of Urology, Apollo Hospital, Hyderabad, Telangana, India
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Pintauro M, Jian J, Wang J, Shen B, Scolieri J, Madhavaram A, Chermansky C, Beckel J, de Groat WC, Tai C. Role of opioid and β-adrenergic receptors in bladder underactivity induced by prolonged pudendal nerve stimulation in cats. Neurourol Urodyn 2023; 42:1344-1351. [PMID: 37306331 PMCID: PMC10460192 DOI: 10.1002/nau.25226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/06/2023] [Accepted: 06/01/2023] [Indexed: 06/13/2023]
Abstract
AIMS To determine the role of opioid and β-adrenergic receptors in bladder underactivity induced by prolonged pudendal nerve stimulation (PNS). METHODS In α-chloralose anesthetized cats, 30-min PNS was applied repeatedly for 3-9 times to induce poststimulation or persistent bladder underactivity. Then, naloxone (opioid receptor antagonist, 1 mg/kg, IV) or propranolol (β-adrenergic receptor antagonist, 3 mg/kg, IV) was given to reverse the bladder underactivity. After the drug treatment, an additional 30-min PNS was applied to counteract the drug effect. Repeated cystometrograms were performed by slowly (1-2 mL/min) infusing the bladder with saline via a urethral catheter to determine the bladder underactivity and the treatment effects. RESULTS Prolonged (2-4.5 h) PNS induced bladder underactivity evident as a large bladder capacity (169 ± 49% of control) and a reduced amplitude of bladder contraction (59 ± 17% of control). Naloxone fully reversed the bladder underactivity by reducing bladder capacity to 113 ± 58% and increasing the amplitude of bladder contraction to 104 ± 34%. After administration of naloxone an additional 30-min PNS temporarily increased the bladder capacity to the underactive bladder level (193 ± 74%) without changing the amplitude of the bladder contraction. Propranolol had no effect on bladder underactivity. CONCLUSIONS A tonic enkephalinergic inhibitory mechanism in the CNS plays a critical role in the bladder underactivity induced by prolonged PNS, while the peripheral β-adrenergic receptor mechanism in the detrusor is not involved. This study provides basic science evidence consistent with the clinical observation that comorbid opioid usage may contribute to voiding dysfunction in patients with Fowler's syndrome.
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Affiliation(s)
- Michael Pintauro
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jianan Jian
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jicheng Wang
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Bing Shen
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph Scolieri
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Avanish Madhavaram
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Jonathan Beckel
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William C. de Groat
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Changfeng Tai
- Department of Urology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Powell K. Critical thinking and diagnostic reasoning when assessing problems with the genitourinary system. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:28-32. [PMID: 35019737 DOI: 10.12968/bjon.2022.31.1.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Urological conditions have become increasingly common and early diagnosis is key to achieving better outcomes. This article discusses the importance of having a comprehensive understanding of urological disorders, having the skills to interpret relevant information, and recognising the relationships among given elements to make an appropriate clinical diagnosis.
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Affiliation(s)
- Karen Powell
- Clinical Nurse Manager, Clinisupplies Limited and Visiting Lecturer, Birmingham City University
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Biers SM, Harding C, Belal M, Thiruchelvam N, Hamid R, Sahai A, Parkinson R, Barratt R, Ali A, Reid S. British Association of Urological Surgeons (BAUS) consensus document: Management of female voiding dysfunction. BJU Int 2021; 129:151-159. [PMID: 33772995 DOI: 10.1111/bju.15402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To report the British Association of Urological Surgeon's (BAUS) guidance on the assessment and management of female voiding dysfunction. METHODS A contemporary literature search was conducted to identify the evidence base. The BAUS Section of Female, Neurological and Urodynamic Urology (FNUU) Executive Committee formed a guideline development group to draw up and review the recommendations. Where there was no supporting evidence, expert opinion of the BAUS FNUU executive committee, FNUU Section and BAUS members, including urology consultants working in units throughout the UK, was used. RESULTS Female patients with voiding dysfunction can present with mixed urinary symptoms or urinary retention in both elective and emergency settings. Voiding dysfunction is caused by a wide range of conditions which can be categorized into bladder outlet obstruction (attributable to functional or anatomical causes) or detrusor underactivity. Guidance on the assessment, investigation and treatment of women with voiding dysfunction and urinary retention, in the absence of a known underlying neurological condition, is provided. CONCLUSION Wa have produced a BAUS approved consensus on the management pathway for female voiding dysfunction with the aim to optimize assessment and treatment pathways for patients.
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Affiliation(s)
| | - Chris Harding
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Mo Belal
- Queen Elizabeth Hospital, Birmingham, UK
| | | | - Rizwan Hamid
- London and London Spinal Injuries Unit, University College London Hospitals, Stanmore, UK
| | - Arun Sahai
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | | | - Rachel Barratt
- London and London Spinal Injuries Unit, University College London Hospitals, Stanmore, UK
| | - Ased Ali
- Mid Yorkshire NHS Hospitals Trust, Wakefield, UK
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Bennett K, Diamond C, Hoeritzauer I, Gardiner P, McWhirter L, Carson A, Stone J. A practical review of functional neurological disorder (FND) for the general physician. Clin Med (Lond) 2021; 21:28-36. [PMID: 33479065 PMCID: PMC7850207 DOI: 10.7861/clinmed.2020-0987] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We present a practical overview of functional neurological disorder (FND), its epidemiology, assessment and diagnosis, diagnostic pitfalls, treatment, aetiology and mechanism. We present an update on functional limb weakness, tremor, dystonia and other abnormal movements, dissociative seizures, functional cognitive symptoms and urinary retention, and 'scan-negative' cauda equina syndrome. The diagnosis of FND should rest on clear positive evidence, typically from a combination of physical signs on examination or the nature of seizures. In treatment of FND, clear communication of the diagnosis and the involvement of the multidisciplinary team is beneficial. We recommend that patients with FND are referred to specialists with expertise in neurological diagnosis. FND is a common presentation in emergency and acute medical settings and there are many practical elements to making a positive diagnosis and communication which are useful for all physicians to be familiar with.
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Affiliation(s)
| | | | | | | | | | - Alan Carson
- Centre for Clinical Brain Services, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Services, Edinburgh, UK
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Hoeritzauer I, Carson A, Statham P, Panicker JN, Granitsiotis V, Eugenicos M, Summers D, Demetriades AK, Stone J. Scan-Negative Cauda Equina Syndrome: A Prospective Cohort Study. Neurology 2020; 96:e433-e447. [PMID: 33177221 DOI: 10.1212/wnl.0000000000011154] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/04/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe clinical features relevant to diagnosis, mechanism, and etiology in patients with "scan-negative" cauda equina syndrome (CES). METHODS We carried out a prospective study of consecutive patients presenting with the clinical features of CES to a regional neurosurgery center comprising semi-structured interview and questionnaires investigating presenting symptoms, neurologic examination, psychiatric and functional disorder comorbidity, bladder/bowel/sexual function, distress, and disability. RESULTS A total of 198 patients presented consecutively over 28 months. A total of 47 were diagnosed with scan-positive CES (mean age 48 years, 43% female). A total of 76 mixed category patients had nerve root compression/displacement without CES compression (mean age 46 years, 71% female) and 61 patients had scan-negative CES (mean age 40 years, 77% female). An alternative neurologic cause of CES emerged in 14/198 patients during admission and 4/151 patients with mean duration 25 months follow-up. Patients with scan-negative CES had more positive clinical signs of a functional neurologic disorder (11% scan-positive CES vs 34% mixed and 68% scan-negative, p < 0.0001), were more likely to describe their current back pain as worst ever (41% vs 46% and 70%, p = 0.005), and were more likely to have symptoms of a panic attack at onset (37% vs 57% and 70%, p = 0.001). Patients with scan-positive CES were more likely to have reduced/absent bilateral ankle jerks (78% vs 30% and 12%, p < 0.0001). There was no significant difference between groups in the frequency of reduced anal tone and urinary retention. CONCLUSION The first well-phenotyped, prospective study of scan-negative CES supports a model in which acute pain, medication, and mechanisms overlapping with functional neurologic disorders may be relevant.
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Affiliation(s)
- Ingrid Hoeritzauer
- From the Centre for Clinical Brain Sciences (I.H., A.C., A.K.D., J.S.), University of EdinburghDepartments of Clinical Neurosciences (I.H., A.C., P.S., A.K.D., J.S.), Neurosurgery (P.S., A.K.D.), Urology (V.G.), Gastroenterology (M.E.), and Neuroradiology (D.S.), Western General HospitalDepartment of Rehabilitation Medicine (A.C.), NHS Lothian, EdinburghDepartment of Uro-Neurology (J.N.P.), The National Hospital of Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, LondonEdinburgh Spinal Surgery Outcomes Study Group (I.H., P.S., A.K.D.), UK.
| | - Alan Carson
- From the Centre for Clinical Brain Sciences (I.H., A.C., A.K.D., J.S.), University of EdinburghDepartments of Clinical Neurosciences (I.H., A.C., P.S., A.K.D., J.S.), Neurosurgery (P.S., A.K.D.), Urology (V.G.), Gastroenterology (M.E.), and Neuroradiology (D.S.), Western General HospitalDepartment of Rehabilitation Medicine (A.C.), NHS Lothian, EdinburghDepartment of Uro-Neurology (J.N.P.), The National Hospital of Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, LondonEdinburgh Spinal Surgery Outcomes Study Group (I.H., P.S., A.K.D.), UK
| | - Patrick Statham
- From the Centre for Clinical Brain Sciences (I.H., A.C., A.K.D., J.S.), University of EdinburghDepartments of Clinical Neurosciences (I.H., A.C., P.S., A.K.D., J.S.), Neurosurgery (P.S., A.K.D.), Urology (V.G.), Gastroenterology (M.E.), and Neuroradiology (D.S.), Western General HospitalDepartment of Rehabilitation Medicine (A.C.), NHS Lothian, EdinburghDepartment of Uro-Neurology (J.N.P.), The National Hospital of Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, LondonEdinburgh Spinal Surgery Outcomes Study Group (I.H., P.S., A.K.D.), UK
| | - Jalesh N Panicker
- From the Centre for Clinical Brain Sciences (I.H., A.C., A.K.D., J.S.), University of EdinburghDepartments of Clinical Neurosciences (I.H., A.C., P.S., A.K.D., J.S.), Neurosurgery (P.S., A.K.D.), Urology (V.G.), Gastroenterology (M.E.), and Neuroradiology (D.S.), Western General HospitalDepartment of Rehabilitation Medicine (A.C.), NHS Lothian, EdinburghDepartment of Uro-Neurology (J.N.P.), The National Hospital of Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, LondonEdinburgh Spinal Surgery Outcomes Study Group (I.H., P.S., A.K.D.), UK
| | - Voula Granitsiotis
- From the Centre for Clinical Brain Sciences (I.H., A.C., A.K.D., J.S.), University of EdinburghDepartments of Clinical Neurosciences (I.H., A.C., P.S., A.K.D., J.S.), Neurosurgery (P.S., A.K.D.), Urology (V.G.), Gastroenterology (M.E.), and Neuroradiology (D.S.), Western General HospitalDepartment of Rehabilitation Medicine (A.C.), NHS Lothian, EdinburghDepartment of Uro-Neurology (J.N.P.), The National Hospital of Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, LondonEdinburgh Spinal Surgery Outcomes Study Group (I.H., P.S., A.K.D.), UK
| | - Maria Eugenicos
- From the Centre for Clinical Brain Sciences (I.H., A.C., A.K.D., J.S.), University of EdinburghDepartments of Clinical Neurosciences (I.H., A.C., P.S., A.K.D., J.S.), Neurosurgery (P.S., A.K.D.), Urology (V.G.), Gastroenterology (M.E.), and Neuroradiology (D.S.), Western General HospitalDepartment of Rehabilitation Medicine (A.C.), NHS Lothian, EdinburghDepartment of Uro-Neurology (J.N.P.), The National Hospital of Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, LondonEdinburgh Spinal Surgery Outcomes Study Group (I.H., P.S., A.K.D.), UK
| | - David Summers
- From the Centre for Clinical Brain Sciences (I.H., A.C., A.K.D., J.S.), University of EdinburghDepartments of Clinical Neurosciences (I.H., A.C., P.S., A.K.D., J.S.), Neurosurgery (P.S., A.K.D.), Urology (V.G.), Gastroenterology (M.E.), and Neuroradiology (D.S.), Western General HospitalDepartment of Rehabilitation Medicine (A.C.), NHS Lothian, EdinburghDepartment of Uro-Neurology (J.N.P.), The National Hospital of Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, LondonEdinburgh Spinal Surgery Outcomes Study Group (I.H., P.S., A.K.D.), UK
| | - Andreas K Demetriades
- From the Centre for Clinical Brain Sciences (I.H., A.C., A.K.D., J.S.), University of EdinburghDepartments of Clinical Neurosciences (I.H., A.C., P.S., A.K.D., J.S.), Neurosurgery (P.S., A.K.D.), Urology (V.G.), Gastroenterology (M.E.), and Neuroradiology (D.S.), Western General HospitalDepartment of Rehabilitation Medicine (A.C.), NHS Lothian, EdinburghDepartment of Uro-Neurology (J.N.P.), The National Hospital of Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, LondonEdinburgh Spinal Surgery Outcomes Study Group (I.H., P.S., A.K.D.), UK
| | - Jon Stone
- From the Centre for Clinical Brain Sciences (I.H., A.C., A.K.D., J.S.), University of EdinburghDepartments of Clinical Neurosciences (I.H., A.C., P.S., A.K.D., J.S.), Neurosurgery (P.S., A.K.D.), Urology (V.G.), Gastroenterology (M.E.), and Neuroradiology (D.S.), Western General HospitalDepartment of Rehabilitation Medicine (A.C.), NHS Lothian, EdinburghDepartment of Uro-Neurology (J.N.P.), The National Hospital of Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, LondonEdinburgh Spinal Surgery Outcomes Study Group (I.H., P.S., A.K.D.), UK
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Tarcan T, Selai C, Herve F, Vrijens D, Smith PP, Apostolidis A, Panicker JN, Kirschner-Hermanns R, Arlandis S, Mosiello G, Dmochowski R, Cardozo L, von Gontard A. Should we routinely assess psychological morbidities in idiopathic lower urinary tract dysfunction: ICI-RS 2019? Neurourol Urodyn 2020; 39 Suppl 3:S70-S79. [PMID: 32662559 DOI: 10.1002/nau.24361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 04/02/2020] [Indexed: 12/20/2022]
Abstract
AIMS Psychological morbidities play a major role in idiopathic lower urinary tract dysfunction (iLUTD). The aim of the Think Tank (TT) was to discuss the relevance of psychological morbidities in idiopathic LUTD over the life span, including overactive bladder (OAB) or dysfunctional voiding (DV) and methods of assessment. METHODS The paper is based on a selective review of the literature and in-depth discussions, leading to research recommendations regarding the assessment of psychological morbidities in iLUTD on children and adults held during the TT of the International Consultation on Incontinence Research Society in 2019. RESULTS Psychological comorbidities affect the health behaviors and treatment outcomes in patients with iLUTD. Both clinically relevant comorbid mental disorders, as well as subclinical psychological symptoms have a major impact and negatively influence incontinence treatment. Research is needed to elucidate mechanisms underlying iLUTD and psychological comorbidities. Clinical studies are needed to determine how perception generation and cognition impacts on the relationship of urinary perceptions, symptoms, and objective urodynamic function. Due to high psychological comorbidity rates, screening with validated, generic questionnaires for emotional and behavioral disorders in children with nocturnal enuresis, daytime urinary incontinence, and fecal incontinence is recommended. Brief screening is recommended for all adults with iLUTD, especially with OAB and DV, who are refractory to treatment. CONCLUSIONS Due to the high rate and relevance in clinical practice, screening for psychological comorbidities is recommended for all age groups. The research recommendations of this TT may be followed to improve the assessment of psychological morbidities in iLUTD.
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Affiliation(s)
- Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey.,Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | - Caroline Selai
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - François Herve
- Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Phillip P Smith
- Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Apostolos Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, London, UK
| | - Ruth Kirschner-Hermanns
- Department of Urology, Pediatric Urology, and Neurourology, University Hospital of Bonn, Bonn, Germany
| | - Salvador Arlandis
- Department of Urology, La Fe University and Polytechnic Hospital, Valencia University, Spain
| | - Giovanni Mosiello
- Department of Surgery, Neuro-Urology Unit, Bambino Gesu Pediatric Hospital, Rome, Italy
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
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Malde S, Marcelissen T, Vrijens D, Apostilidis A, Rahnama'I S, Cardozo L, Lovick T. Sacral nerve stimulation for refractory OAB and idiopathic urinary retention: Can phenotyping improve the outcome for patients: ICI-RS 2019? Neurourol Urodyn 2020; 39 Suppl 3:S96-S103. [PMID: 32662561 DOI: 10.1002/nau.24204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/20/2019] [Indexed: 11/09/2022]
Abstract
AIMS Sacral nerve stimulation (SNS) is widely used to treat refractory idiopathic overactive bladder (OAB) and idiopathic urinary retention. However, clinical outcomes are variable and understanding predictive factors for success or side-effects would enable personalization of therapy and optimization of outcomes. At the International Consultation on Incontinence-Research Society meeting 2019, a Think Tank was convened to discuss how advances in the basic science study of SNS may be translatable into clinical practice to improve outcomes of patients undergoing SNS treatment. METHODS We conducted a literature review and expert consensus meeting focusing on current methods of phenotyping patients and specifically, how advances in basic science research of the mechanism of action of SNS can be translated into clinical practice to improve patient selection for therapy. RESULTS The terms "Idiopathic OAB" and "idiopathic urinary retention" encompass several underlying pathophysiological phenotypes. Commonly, phenotyping is based on clinical and urodynamic factors. Animal studies have demonstrated that high-frequency stimulation can produce rapid onset, reversible conduction block in peripheral nerves. Altering stimulation parameters may potentially enable personalization of therapy depending upon the clinical indication in the future. Similarly, advances in conditional and closed-loop stimulation may offer greater efficacy for certain patients. Phenotyping based on psychological comorbidity requires further study to potentially optimize patient selection for therapy. CONCLUSIONS Idiopathic OAB and idiopathic urinary retention are heterogenous conditions with multiple potential underlying phenotypes. Tailoring stimulation parameters to the needs of each individual according to phenotype could optimize outcomes. Assessing psychological comorbidity may improve patient selection. Areas for further research are proposed.
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Affiliation(s)
- Sachin Malde
- Department of Urology, Guy's Hospital, London, UK
| | - Tom Marcelissen
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | | | - Sajjad Rahnama'I
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Thelma Lovick
- School of Physiology, Pharmacology, and Neuroscience, University of Bristol, Bristol, UK
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10
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Gilmour GS, Nielsen G, Teodoro T, Yogarajah M, Coebergh JA, Dilley MD, Martino D, Edwards MJ. Management of functional neurological disorder. J Neurol 2020; 267:2164-2172. [PMID: 32193596 PMCID: PMC7320922 DOI: 10.1007/s00415-020-09772-w] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 01/24/2023]
Abstract
Functional neurological disorder (FND) is a common cause of persistent and disabling neurological symptoms. These symptoms are varied and include abnormal control of movement, episodes of altered awareness resembling epileptic seizures and abnormal sensation and are often comorbid with chronic pain, fatigue and cognitive symptoms. There is increasing evidence for the role of neurologists in both the assessment and management of FND. The aim of this review is to discuss strategies for the management of FND by focusing on the diagnostic discussion and general principles, as well as specific treatment strategies for various FND symptoms, highlighting the role of the neurologist and proposing a structure for an interdisciplinary FND service.
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Affiliation(s)
- Gabriela S Gilmour
- Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Glenn Nielsen
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Tiago Teodoro
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK
- Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Hospital de Santa Maria, Lisbon, Portugal
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Mahinda Yogarajah
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Jan Adriaan Coebergh
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Michael D Dilley
- Atkinson Morley Regional Neuroscience Centre, St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Davide Martino
- Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mark J Edwards
- Neuroscience Research Centre, Institute of Molecular and Clinical Sciences, St. George's University of London, Cranmer Terrace, London, SW17 0RE, UK.
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11
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Panicker JN, Selai C, Herve F, Rademakers K, Dmochowski R, Tarcan T, von Gontard A, Vrijens D. Psychological comorbidities and functional neurological disorders in women with idiopathic urinary retention: International Consultation on Incontinence Research Society (ICI-RS) 2019. Neurourol Urodyn 2019; 39 Suppl 3:S60-S69. [PMID: 31782982 DOI: 10.1002/nau.24233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022]
Abstract
AIMS Chronic urinary retention occurring in young women is poorly understood and a cause may not be found in a majority of cases. Different psychological comorbidities and functional neurological symptom disorders (FNDs) have been reported; however, these have been poorly explored. METHODS At the International Consultation on Incontinence Research Society meeting in 2019, a panel of clinicians generated a proposal to explore the relationship between psychological comorbidities, FNDs, and urinary retention in women with chronic idiopathic urinary retention. RESULTS Psychological comorbidities such as depression and anxiety, and FNDs such as leg weakness and loss of consciousness, have been reported in women with idiopathic urinary retention. Individuals react differently to physical and emotional stressors, and experimental models have demonstrated a relationship between the stress response and developing urinary retention. Trauma, particularly sexual trauma, may be a shared risk factor for developing psychological comorbidities and urinary retention. Children with voiding postponement often suffer from psychological comorbidities and behavioral disturbances; however, there is no evidence to suggest that this progresses to urinary retention in adulthood. "Psychogenic urinary retention" has been described in the urology and psychiatry literature in the past, and anecdotal cases of successful voiding following psychotherapy have been reported, though the true pathophysiology of this entity is uncertain. CONCLUSION Psychological and functional disorder comorbidities are reported in women with chronic urinary retention. The nature of the association between urinary retention and functional neurological disorder comorbidities needs to be further explored in terms of a disorder of bladder-brain interaction.
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Affiliation(s)
- Jalesh N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | - Caroline Selai
- Department of Clinical and Movement Neurosciences and Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Queen Square Institute of Neurology, London, UK
| | - Francois Herve
- Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Kevin Rademakers
- Department of Urology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tufan Tarcan
- Department of Urology, Marmara University School of Medicine and Koç University School of Medicine, Istanbul, Turkey
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
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12
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Tarcan T, Rademakers K, Arlandis S, von Gontard A, van Koeveringe GA, Abrams P. Do the definitions of the underactive bladder and detrusor underactivity help in managing patients: International Consultation on Incontinence Research Society (ICI-RS) Think Tank 2017? Neurourol Urodyn 2019; 37:S60-S68. [PMID: 30133789 DOI: 10.1002/nau.23570] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/26/2018] [Indexed: 01/10/2023]
Abstract
AIMS The Think Tank aimed to discuss the pitfalls and advantages of current definitions in terms of research and management of underactive bladder (UAB). UAB broadly defines a symptom complex of bladder emptying problems and does not indicate a specific pathology. Detrusor underactivity (DU) is a urodynamic diagnosis from pressure-flow studies. The correlation of UAB with DU remains to be precisely determined. METHODS The presentations and subsequent discussion, leading to research recommendations during the Think Tank of the International Consultation on Incontinence Research Society in Bristol, 2017, are summarized. RESULTS To develop more specific individualized management strategies, the Think Tank panel proposed (i) that, since defining a single type of index patient to represent all UAB will not fulfill all clinical research needs, several index patients should be defined by phenotyping of patients with UAB, including, children, young men and women, elderly male and female patients with co-existing DU and detrusor overactivity, and neurological patients with UAB; (ii) prospective longitudinal studies to assess the natural history of UAB, in the different target populations, based on different UAB phenotypes, should be initiated; (iii) DU should be precisely defined by urodynamic parameters; and (iv) work to develop validated specific questionnaires combined with non-invasive tests for screening, diagnosis and follow up, needs to be continued. CONCLUSIONS The precise relationship of UAB to DU remains to be defined. Phenotyping patients with UAB/DU, performing prospective trials of natural history, and developing symptom questionnaires and diagnostic investigations will improve our ability to identify and treat UAB/DU.
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Affiliation(s)
- Tufan Tarcan
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Kevin Rademakers
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Salvador Arlandis
- Department of Urology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | | | - Paul Abrams
- Department of Urology, University of Bristol, Bristol Urological Institute, Bristol, UK
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13
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Malde S, Apostilidis A, Selai C, Rahnama'i MS, Marcelissen T, Cardozo L, Lovick T. Botulinum toxin A for refractory OAB and idiopathic urinary retention: Can phenotyping improve outcome for patients: ICI-RS 2019? Neurourol Urodyn 2019; 39 Suppl 3:S104-S112. [PMID: 31692092 DOI: 10.1002/nau.24207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/20/2019] [Indexed: 12/17/2022]
Abstract
AIMS Botulinum toxin A (BTX-A) is a well-established treatment for refractory idiopathic overactive bladder (OAB). It has also been used with short-term success in treating idiopathic urinary retention. However, efficacy and complication rates are variable and predicting those likely to benefit most from treatment would enable personalization of therapy and optimization of outcomes. At the International Consultation on Incontinence-Research Society (ICI-RS) meeting in 2019 a Think Tank addressed the question of how we can improve the way we phenotype patients undergoing BTX-A treatment. METHODS The Think Tank conducted a literature review and expert consensus meeting focussing on how advances in basic science research of the mechanism of action of BTX-A, as well as assessment of psychological comorbidity, can be translated into clinical practice to improve patient selection for therapy. RESULTS Idiopathic OAB and idiopathic urinary retention are heterogenous conditions encompassing several phenotypes with multiple potential pathophysiological mechanisms. Animal models have demonstrated a central nervous system mechanism of action of intravesically injected BTX-A and this has been confirmed in human functional MRI studies, but whether this tool can be used to predict outcome from treatment remains to be determined. Phenotyping based on psychological comorbidity using validated screening tools should be studied as a way to potentially optimize patient selection for therapy. CONCLUSIONS Advances in basic science research into the mechanism of action of BTX-A have improved our understanding of the pathophysiology of OAB and may lead to novel ways to phenotype patients. Psychological assessment is another way in which phenotyping may be improved. Areas for further research are proposed.
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Affiliation(s)
- Sachin Malde
- Department of Urology, Guy's Hospital, London, UK
| | - Apostolos Apostilidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Caroline Selai
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Mohammad Sajjad Rahnama'i
- Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany.,Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Tom Marcelissen
- Department of Urology, Uniklinik Aachen RWTH, Aachen, Germany
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Thelma Lovick
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK
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14
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von Gontard A, Vrijens D, Selai C, Mosiello G, Panicker J, van Koeveringe G, Apostolidis A, Anding R. Are psychological comorbidities important in the aetiology of lower urinary tract dysfunction-ICI-RS 2018? Neurourol Urodyn 2019; 38 Suppl 5:S8-S17. [PMID: 31059602 DOI: 10.1002/nau.24016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/10/2019] [Accepted: 04/11/2019] [Indexed: 12/19/2022]
Abstract
AIMS To review studies on the comorbid psychological symptoms and disorders in patients with lower urinary tract disorders (LUTD) over the life-span, to analyse how they contribute toward the aetiology of LUTD and to discuss optimal service implementation. MATERIALS AND METHODS A review of relevant literature was conducted and presented during the ICI-RS meeting in 2018. Open questions and future directions were discussed. RESULTS On the basis of current research, there is overwhelming evidence in all age groups that psychological comorbidities are more common in patients with LUTD. Vice versa, patients with psychiatric disorders have higher rates of LUTD. The types of LUTDs and psychiatric disorders are heterogeneous. Complex aetiological models best explain specific associations of comorbidity. Irrespective of aetiology, it is advisable to address both urological and psychological issues in patients of all age groups with LUTD. CONCLUSIONS Psychological symptoms and disorders play a decisive role in the development of LUTD in all age groups and need to be considered in the assessment and treatment of LUTD.
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Affiliation(s)
- Alexander von Gontard
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, Homburg, Germany
| | - Desiree Vrijens
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Caroline Selai
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Giovanni Mosiello
- Department of Surgery, Urology and Neuro-Urology, Bambino Gesù Pediatric Hospital, Rome, Italy
| | - Jalesh Panicker
- Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Gommert van Koeveringe
- Department of Urology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Apostolos Apostolidis
- 2nd Department of Urology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ralf Anding
- Department of Urology, Pediatric Urology and Neuro-Urology, University Hospital Bonn, Bonn, Germany
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15
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Hoeritzauer I, Pronin S, Carson A, Statham P, Demetriades AK, Stone J. The clinical features and outcome of scan-negative and scan-positive cases in suspected cauda equina syndrome: a retrospective study of 276 patients. J Neurol 2018; 265:2916-2926. [PMID: 30298195 PMCID: PMC6244667 DOI: 10.1007/s00415-018-9078-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/17/2018] [Accepted: 09/30/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND The majority of patients presenting with suspected clinical cauda equina syndrome (CES) have no identifiable structural cause for their symptoms ('scan-negative' CES). Understanding these patients aids clinical differentiation and management in CES. METHODS A retrospective electronic note review was undertaken of patients presenting with suspected CES, defined as ≥ 1 of acute bladder, bowel, sexual dysfunction or saddle numbness, to a regional neurosciences centre. We investigated radiology, clinical features, psychiatric and functional disorder comorbidities and outcome of patients with 'scan-negative' CES and patients with MRI confirmed compression of the cauda equina ('scan-positive' CES). RESULTS 276 patients were seen over 16 months. There were three main radiologically defined patient groups: (1) 'scan-positive' CES (n = 78, mean age 48 years, 56% female), (2) 'scan-negative' CES without central canal stenosis but with lumbosacral nerve root compression not explaining the clinical presentation (n = 87, mean age 43 years, 68% female) and (3) 'scan-negative' CES without neural compromise (n = 104, mean age 42 years, 70% female). In the two 'scan-negative' groups (no neural compromise and nerve root compression), there were higher rates of functional disorders (37% and 29% vs. 9%), functional neurological disorders (12% and 11% vs 0%) and psychiatric comorbidity (53% and 40% vs 20%). On follow-up (mean 13-16 months), only 1 of the 191 patients with 'scan-negative' CES was diagnosed with an explanatory neurological disorder (transverse myelitis). CONCLUSIONS The data support a model in which scan-negative cauda equina syndrome arises as an end pathway of acute pain, sometimes with partly structural findings and vulnerability to functional disorders.
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Affiliation(s)
- Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU UK
- Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
| | - Savva Pronin
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU UK
- Department of Rehabilitation Medicine, NHS Lothian, Edinburgh, UK
| | - Patrick Statham
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU UK
- Department of Neurosurgery, Western General Hospital, Edinburgh, EH4 2XU UK
- Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
| | - Andreas K. Demetriades
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU UK
- Department of Neurosurgery, Western General Hospital, Edinburgh, EH4 2XU UK
- Edinburgh Spinal Surgery Outcome Studies Group, Edinburgh, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Western General Hospital, Edinburgh, EH4 2XU UK
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16
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Petros P, Abendstein B, Swash M. Retention of urine in women is alleviated by uterosacral ligament repair: implications for Fowler's syndrome. Cent European J Urol 2018; 71:436-443. [PMID: 30680238 PMCID: PMC6338811 DOI: 10.5173/ceju.2018.1785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 09/28/2018] [Accepted: 10/10/2018] [Indexed: 01/04/2023] Open
Abstract
Introduction The aim of this study was to independently evaluate idiopathic urinary retention and other known Fowler's syndrome (FS) descriptions in 24 women treated for posterior fornix syndrome (PFS) by reinforcement of the uterosacral ligaments (USL) using the tissue fixation system (TFS). Material and methods The main inclusion criterion was: idiopathic urinary retention with post-void residual urines (PVR) >100 ml. Results The mean patient age was 63 years (range 32–87). Except for peak urine flow, features typical of FS were statistically improved (p 0.015 to <0.0001), pre-op mean with post-op mean in brackets: PVR 272 ml (34 ml); abnormal emptying symptoms n = 24 (18/24 cured or 80% improved); natural bladder volume 598 ml (301 ml); emptying time 50 seconds (20 seconds): peak flow 42 ml/sec (37 ml/sec); chronic pelvic pain n = 18 (14/18 >80% improved); maximal urethral closure pressure >90 cm (n = 4) 93 cm H2O (75 cm); frequency (14/14 improved); nocturia 110 episodes (33 episodes). Conclusions Functional disorders typical of FS, also present in posterior fornix syndrome, principally idiopathic urinary retention, were cured/improved by USL sling repair. Suggested anatomical pathway: lax USLs weaken the backward muscular forces, unbalancing bladder neck and urethral closure. Compensatory forward-acting closure muscles narrow the distal urethra, causing urinary flow difficulties, and retention. This functional imbalance can be relieved by posterior sling repair. We suggest that, rather than spasm from the (weak) rhabdosphincter (Fowler's syndrome), USL weakness is the most likely cause of idiopathic urinary retention in women.
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Affiliation(s)
- Peter Petros
- University of Western Australia, Perth, Australia
| | - Burghard Abendstein
- FA für Gynäkologie, Geburtshilfe und Chirurgie, Akademisches Lehrkrankenhaus, Feldkirch, Austria
| | - Michael Swash
- Institute of Molecular Medicine, University of Lisbon, Portugal.,Royal London Hospital, Barts and the London School of Medicine, QMUL, United Kingdom
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17
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Panicker JN, Anding R, Arlandis S, Blok B, Dorrepaal C, Harding C, Marcelissen T, Rademakers K, Abrams P, Apostolidis A. Do we understand voiding dysfunction in women? Current understanding and future perspectives: ICI-RS 2017. Neurourol Urodyn 2018; 37:S75-S85. [DOI: 10.1002/nau.23709] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/05/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Jalesh N. Panicker
- Department of Uro-Neurology; The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology; Queen Square London United Kingdom
| | - Ralf Anding
- Neurourology; Department of Urology and Pediatric Urology; University Hospital Bonn; Bonn Germany
| | - Salvador Arlandis
- Department of Urology; Hospital Universitario y Politécnico La Fe; Valencia Spain
| | - Bertil Blok
- Department of Urology; Erasmus Medical Center; Rotterdam The Netherlands
| | | | - Chris Harding
- Department of Urology; Freeman Hospital; Newcastle Upon-Tyne United Kingdom
| | - Tom Marcelissen
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Kevin Rademakers
- Department of Urology; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Paul Abrams
- Department of Urology; University of Bristol; Bristol United Kingdom
- Department of Teaching and Research, Bristol Urological Institute; International Consultation on Urological Diseases; Bristol United Kingdom
| | - Apostolos Apostolidis
- 2nd Department of Urology; Aristotle University of Thessaloniki; Thessaloniki Greece
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18
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Salim G, Agdi M, Al-Zebeidi J, Dawood A, Al-Jaroudi D. Fowler's syndrome post oocyte retrieval for intracytoplasmic sperm injection. Case Rep Womens Health 2017; 14:4-5. [DOI: 10.1016/j.crwh.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 03/10/2017] [Indexed: 11/29/2022] Open
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19
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Hoeritzauer I, Phé V, Panicker JN. Urologic symptoms and functional neurologic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2016; 139:469-481. [PMID: 27719863 DOI: 10.1016/b978-0-12-801772-2.00038-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The term functional urologic disorders covers a wide range of conditions related broadly to altered function rather than structure of the lower urinary tract, mainly of impaired urine voiding or storage. Confusingly, for a neurologic readership, these disorders of function may often be due to a urologic, gynecologic, or neurologic cause. However, there is a subset of functional urologic disorders where the cause remains uncertain and, in this chapter, we describe the clinical features of these disorders in turn: psychogenic urinary retention; Fowler's syndrome; paruresis (shy-bladder syndrome); dysfunctional voiding; idiopathic overactive bladder, and interstitial cystitis/bladder pain syndrome. Some of these overlap in terms of symptoms, but have become historically separated. Psychogenic urinary retention in particular has now largely been abandoned as a concept, in part because of the finding of specific urethral electromyogram findings in patients with this symptom now described as having Fowler's syndrome, and their successful treatment with sacral neurostimulation. In this chapter we review the poorly researched interface between these "idiopathic" functional urologic disorders and other functional disorders (e.g., irritable-bowel syndrome, fibromyalgia) as well as specifically functional neurologic disorders. We conclude that there may be a relationship and overlap between them and that this requires further research, especially in those idiopathic functional urologic disorders which involve disorders of the urethral sphincter (i.e., voluntary muscle).
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Affiliation(s)
- I Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, UK
| | - V Phé
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London, UK and Department of Urology, Pitié-Salpêtrière Academic Hospital, Paris, France
| | - J N Panicker
- Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, Queen Square, London.
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